Valuing knowledge, valuing lives: Who counts in global health

Background: In the global economy of health, knowledge is often produced in the global north and distributed to the global south, while resources necessary for health are transferred from the south to the north. Hesperian Health Guides, publisher of Where There Is No Doctor, seeks to reconfigure the global pattern of knowledge production and distribution by working with medical professionals and lay people to produce books that allow individuals and communities to take action for health. This study explores how Hesperian’s participatory development process challenges and confirms traditional patterns of knowledge production to create empowering health materials. Methods: This project utilizes in-depth interviews and a grounded theory approach. Six interviews were conducted with key Hesperian partners who live and work in developing countries; these individuals are involved in Hesperian’s editorial process, and use and adapt Hesperian materials in the field. Interviews were systematically coded and analyzed for emergent themes. Results: Participants focused on strategic negotiation between community-based knowledge and medical expertise to create materials that are technically accurate and can be used by lay people to address individual and community health needs. Ownership of the knowledge production process primarily came through local translations and adaptations, in which participants updated illustrations, case studies, and adjusted content to fit the conditions of the people they work with. Conclusions: A global, participatory materials development process facilitates the flow of information between medical professionals and grassroots communities to produce uniquely accurate and empowering materials that reflect community needs and experiences of health and illness.