University of Oulu

Harju, K. (2020). Between Donor Interest, Global Models and Local Conditions: Treatment and Decision-Making in the Somalia-Finland Tuberculosis Control Project, 1981–3. Medical History, 64(1), 94-115. doi:10.1017/mdh.2019.78

Between donor interest, global models and local conditions : treatment and decision-making in the Somalia-Finland Tuberculosis Control Project, 1981–3

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Author: Harju, Kaisa1
Organizations: 1History of Sciences and Ideas, PO Box 8000, FI-90014, University of Oulu, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
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Language: English
Published: Cambridge University Press, 2020
Publish Date: 2020-01-14


Despite numerous global health initiatives after World War II, tuberculosis still poses a major threat in sub-Saharan Africa. This article examines one attempt to tackle this problem: the Somalia-Finland Tuberculosis Control Project. Conducted in the 1980s as a bilateral development aid project between the two countries, it became the most extensive — and expensive — tuberculosis initiative in Somalia in that decade. An interesting feature of the project is that, despite a lack of previous experience in tuberculosis work in developing countries, the Finnish partner decided not to follow the WHO global guidelines designed to standardise tuberculosis activities across the developing world. Instead, Finns established their own treatment programme based on X-ray and short-course chemotherapy — otherwise rarely used in clinical practice in Africa. Through a close reading and comparison of the correspondence, project plans, memos and minutes, the article analyses the formation of this strategy. Focusing on ground-level decision-making, it argues that the decisions were based not only on a belief in the superior clinical effectiveness of these methods, but also on the fact that they better suited Finnish ambitions and project logic. Thus, the article supports the notion that donor perspectives on resources and project objectives determined what was seen as feasible treatment in a developing country. By shedding light on the debate between the supporters of short-course chemotherapy and the WHO standard treatment strategy, it also contributes to the early history of DOTS (directly observed treatment, short course).

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Series: Medical history
ISSN: 0025-7273
ISSN-E: 2048-8343
ISSN-L: 0025-7273
Volume: 64
Issue: 1
Pages: 94 - 115
DOI: 10.1017/mdh.2019.78
Type of Publication: A1 Journal article – refereed
Field of Science: 615 History and archaeology
Funding: This research forms a part of my doctoral thesis project, ‘Exporting Expertise: Somalia-Finland Tuberculosis Control Support and Training Project, 1980–90’ and was supported by Alfred Kordelin Foundation and Oskar Öflunds Stiftelse sr.
Copyright information: © The Author 2019. Published by Cambridge University Press. This article has been published in a revised form in Medical History, This version is free to view and download for private research and study only. Not for re-distribution, re-sale or use in derivative works.