Valuing Care Community Workers and Bureaucratic Violence in Global Health

Abstract

In this article, I explore the contradictory demands of ‘participation’ and ‘bureaucratisation’ in Pakistan’s HIV sector. Local models of relatedness, personhood and informal net-works, and the particular social and emotional skills of development workers were co-opted under the rubric of ‘participation’ while rolling-out projects for community care, yet the affect, relations of trust and confidence built by community workers during their work were not translated into templates for reporting-up project impact. Technologically less equipped workers were either forced to extend their roles into report-writing, template-filling and indicator-measuring or driven out of the HIV sector altogether during the process of scaling-up. This, I ague, is a form of bureaucratic violence that undermines community care. It draws attention to moving beyond the metrics-driven data determinism of global health.