Constructing Success: The World Bank, Onchocerciasis Control, and What Lies Beneath Triumphalist Global Health Narratives

Summary

Using a historical case study of the World Bank and World Health Organization (WHO)’s Onchocerciasis Control Programme (OCP, 1972–2002), I explore how success is conceptualised in global health and why it matters for policy and priority-setting. First, I summarise the ‘dominant’ OCP success narrative that has emerged since the 1980s, which is based on public health, socio-economic and humanitarian justifications for the programme’s effectiveness. Next, I analyse how socio-economic metrics linking the programme’s disease control to increased labour productivity and agricultural land availability evolved in the 1980–90s. This alternative analysis of the OCP demonstrates how metrics, particularly when divorced from their assumptions and political context, are pliable and constructible. I argue that the OCP’s success was actively constructed by the World Bank and that moving beyond triumphalist, programme-level ‘lessons-learned’ approaches within global health requires disruption of the epistemic, institutional and discursive power that ‘lies beneath’ success narratives.