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The Making and Circulation of Health Reform Policy in Bolivia


Health policies are typically designed and debated in bureaucratic offices, where participation is limited to physicians, technocrats, and politicians who get called “policymakers.” The ideas they come up with are inscripted into documents, and are often complex, unapproachable, and difficult to understand. My goal in this dissertation is to begin to disrupt this standard story of policy. By focusing on what I will call the origins and mutations of a single health policy in Bolivia called Salud Familiar Comunitaria Intercultural (Family Community Intercultural Health Policy, or SAFCI), I tell what we may call, to use Igor Kopytoff's (1986) phrase from his writing about things, not just a cultural biography of a policy but of "policy" itself. This health policy in Bolivia was designed through what was considered to be a collaborative process, and aimed to shift the focus of healthcare from a previous approach that centered around curing disease in the individual to an approach that involved preventing illness and promoting health amongst the family and the community. The policy also emphasized cultural conceptions of health and healing in a country that is over sixty percent indigenous. Because of the unique process that led to its design, and the forms and ideas that emerged and were bounded as policy, a study of this policy in particular is useful for making visible problems that emerge much more generally, both in policy and in ways that anthropologists attempt to study policy. Through my work I complicate the idea that there is such a thing as policy, with preset boundaries and pre-given sites of enactment, as well as its reification and circulation in policy documents. I argue that we need to suspend the belief that we know what policy is, where it is located, how it circulates, the languages used to describe it, and the very stakes of this type of inquiry itself in order to expand the scope of policy and its study.

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