
































Post-Foucauldian Governmentality and African Healthcare 

Review by Mary-Anne Decatur

Para-States and Medical Science: Making African Global Health 

by Paul Wenzel Geissler

Duke University Press, 2015

The thought-provoking book Para-States and Medical Science draws on anthropology and history to

fruitfully  engage  with  the  concept  of  the  ‘para-state’ in  its  analyses  of  transfigurations  in  the

production, management and social relations of scientific research and public health in various sub-

Saharan African countries. The para-statal organizations discussed in the book adopt some of the work

of  the  nation-state  and  form  when  portions  of  it  have  been  parceled  out  and  segmented  off.

Justifications for and the perceived validity of para-statal organizations are based on and affirmed by

their  connection  to  the  nation-state,  which  persists  as  their  point  of  reference  even  where  these

organizations challenge the institutions of the nation-state. The para-state, shaped by market forces,

evolves next to and around the nation-state rather than being part  of or equivalent to it  (pp.9-10).

African statehood is not discussed in the book as weak or disappearing, but rather as present in the

state’s workforce, its buildings, infrastructure, and bureaucracy. The state is palpable in foreign donors’

emphasis on working through state “partners” as well as in people’s claims for care, memories of past

government services, and imaginings of future improvements. The para prefix helps reveal, the book’s

editor P. Wenzel Geissler explains, conflations between original and copy while highlighting the sense

of  things  changing but  not  losing  their  form (p.1,4).  The book’s  focus  on  the  para-state  provides

fascinating and productive insights into ways of thinking about governmentality.

The para prefix in para-state is further used in the book to allude to the relationship between the

state  and  new  biopolitical  forms,  where  “the  state’s  place  in  biopolitical  order  has  changed,  not

diminished” (p.9). This emergence of new biopolitical forms through para-statal organizations arises in



a variety of ways and contexts analyzed by the book’s contributors. Guillaume Lachenal, for example,

discusses the 1994 discovery of the HIV-1 O strain in Cameroon, which led to the privatization but also

revitalization of Cameroonian medical research when the University of Yaoundé and the underfunded

governmental  Centre  Pasteur  du  Cameroun  agreed  to  give  patient  blood  samples  to  commercial

German and French laboratories in exchange for HIV testing kits. Rene Gerrets explores a malaria

research  and  control  partnership  formed  between  the  Tanzanian  Ifkara  Health  Research  and

Development Centre and US Centers for Disease Control that shifts in perception from clearly distinct

to  barely  distinguishable  from  the  state.  Another  contributor,  Branwyn  Poleykett,  examines  a

Senegalese state clinic that registers female sex workers, placing them into a pool of potential HIV

research subjects in a collaborative project between the Université Cheikh Anta Diop in Dakar, Harvard

University, and the Universities of Tours and Limoges in France. Each of the book’s chapters unearths

compelling insights into African healthcare and/or medical research.

The chapter structure of  Para-States and Medical Science emphasizes points of rupture, pasts

and possible futures, the persistence and struggles of the nation-state, and the ways in which para-states

impact and are impacted by relations between people as members of the public. The book begins with a

chapter by Vinh-Kim Nguyen considering how para-states produce a kind of “experimental society”

with the clinical trial as a technology of rule. The following chapter by John Manton questions the

newness of para-statal configurations by drawing on early post-colonial leprosy research in Nigeria.

Guillaume Lachenal and P. Wenzel Geissler’s chapters explore the relationships between para-states,

neoliberalization and biopolitics. Rene Gerrets and Reynolds Whyte’s chapters reveal the persistent

experienced presence of the state in people’s lives. Branwyn Poleykett and Lotte Meinert engage with

the role of emotion and personal connection in HIV research conducted by para-statal organizations.

Finally, Ulrike Beisel, Ann H. Kelly and Didier Fassin deal with issues of territory between nation-

states,  para-statal  organizations and scientific research,  with Fassin’s chapter highlighting points of

disjuncture between scientific knowledge and policy positions of the South African government. All but

one of the book’s eleven chapters handle para-statal organizations heavily centered in some way on

HIV/AIDS or malaria. This reflects a strong focus on these diseases within African medical science and

healthcare. Other diverse health and health-related issues, however, such as cancer, diabetes, disability,

female  genital  cutting,  maternal  mortality,  or  mental  health  may be  associated  with  very different

biopolitical regimes.

Geissler et al. steer away from simplified discussions of neoliberalism and 1980s style medical

anthropology critiques that position biomedicine as a tool of domination or discipline, the state as the

agent of biomedical technologies in opposition to the public, or biomedicine as one form of knowledge



among  many.  The  book’s  contributors  instead  consider  the  possibilities  and  responsibilities  of

biomedical science and the state to public health,  while paying close attention to space,  place and

historical  trajectories  as  well  as  the  unequal  scientific  partnerships  that  emerge  in  para-statal

organizations. As Geissler notes, this shift stems from a theoretical move to post-Foucauldian and post-

Marxist  analyses  and  the  contributors  problematize  the  idea  of  biopower  as  an  increasing  and

expanding disciplinary mechanism (p.24,35). The book points to ways in which national citizens can be

understood as assemblages of illnesses and bodies with rights and claims, holding mercurial identities

that position them in roles such as peer group member or community representative in relation to the

para-state. Out of this, temporary multiple publics are formed and governed under often short-term

projects, mirroring the fetishization of randomized controlled trials in public health research. Through

this, the book points to innovative ways of thinking about African biological citizenship.

Several  chapters  critically  engage  with  African  scientists’ work-lives  and  visions  of  public

health, but it would be interesting to read more specifically about African scientists’ perspectives on the

logic, value and outcomes of research they participate in. Nguyen notes that randomized controlled

trials can only reliably measure relatively simple interventions across brief periods of time and do not

measure what might happen outside of trial conditions. Interventions such as the social and economic

empowerment of women do not fit easily into this randomized controlled trial framework and would

require  researchers  to  engage  with  complex  issues  of  human  behavior,  gender  identity  and  social

constraint  (p.52,57).  What  discourses  do  African  scientists  use  to  frame,  highlight  or  obscure  the

shortcomings of randomized controlled trials and the social consequences of the interventions these

trials? It would be valuable to also hear more about how discourses produced by local and national

media  interact  with  broader  international  discourses  that  include  transnational  scientists  and

organizations, as Fassin does in his chapter on Nevirapine.

Para-States and Medical Science is an exceptional and engaging book that will be of interest to

anthropologists, Africanists and historians as well as those interested in science and technology, post-

colonial and development studies.

Mary-Anne Decatur is a PhD candidate in anthropology at SOAS, University of London. Her research

examines Maasai and Chagga people’s conceptualizations of female genital cutting on social, cultural,

historical and medical grounds in the Kilimanjaro region of Tanzania. She explores how these differing

understandings  of  the  practice  shape  predominantly  Chagga  NGO  and  healthcare  employees’

strategies  and  messages  for  ending  female  genital  cutting  in  comparatively  less  affluent  Maasai

communities, and in turn influence Maasai interpretations of these strategies and messages. Mary-



Anne is also the FGM country of origin expert for Tanzania for the Rights in Exile Programme and the

editor of Popular Anthropology Magazine.

© 2015 Mary-Anne Decatur


