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COPYRIGHT 2005 The Institute Inc.
Transnational groups and organizations have had an increasing influence on the lives of Filipino people. Some of these global institutions have financially supported, and in some cases directed, local non-government organizations (NGOs) that seek to improve the conditions of everyday life in Philippine communities. International aid networks and international development organizations have been important elements of globalization processes. As many scholars have discussed and critiqued, international and local development processes have had significant and varying impacts on the lives, positions, and experiences of Filipinos and citizens of other countries of the South (Hilhorst 2003, 2001; Lewis and Wallace 2000; Fisher 1997; St. Hilaire 1992).
Local or "popular" NGOs have rapidly proliferated globally during the last few decades (Fisher 1997:440). This also has occurred in the Philippines, beginning in the early 1970s and expanding particularly since 1986, when Corazon Aquino became president (Hilhorst 2003; Clarke 1993). NGOs in the Philippines, which are multiple and diverse social and cultural institutions, can be viewed as dynamic forces that are influencing change in political, economic, and social relations (Hilhorst 2001; Eder and Youngblood 1994; Clarke 1993). Especially pertinent to this analysis, some NGOs have promoted both global and local sets of discourses and practices that have influenced indigenous cultural and gendered conceptions, processes and identities, sometimes in unintended directions.
In this article, I discuss some of the cultural issues, political contestations, and contradictions that can arise for progressive NGOs working in "cultural communities," or among indigenous cultural groups, as the NGOs operate within a broader context of national and international political and economic processes. I point to complexities that can arise for NGO staff in their attempts to achieve goals that they establish. While addressing NGO processes broadly, I also draw upon ethnographic research I conducted with a progressive community-based health NGO located in Ifugao Province.
A critical-interpretive theoretical approach in medical anthropology can be useful in assessing these issues. This approach addresses the role of power in social and cultural life, including the role of power in medical systems (Lock and Scheper-Hughes 1990: 65-68). The health systems engaged in by members of this NGO were forms of knowledge and practice that comprise cultural systems. Citing Clifford Geertz, Lorna Amarasingham-Rhodes discussed how medical systems, as cultural systems, both "express the nature of the world and ... shape that world to their dimensions" (Geertz 1973, in Amarasingham-Rhodes 1990: 160). Medical systems can exert forms of power that may play a role in figuring the cultural identities, world view, beliefs and practices of groups engaged with them.
The critical-interpretive and post-structuralist political economic approaches to the study of health and international development draw upon discourse theory in analyzing ways in which the body politic can exert control over individuals and collectivities (Ebrahim 2003; Fox 1998; Escobar 1995; Ferguson 1994; St. Hilaire 1992; Scheper-Hughes 1992; Lock and Scheper-Hughes 1990). For Ebrahim:
... a discourse is a specific and historically produced way of looking at the world and is embedded within wider relations of power--power that is manifest, for example, in the scientific 'expertise' of development economists, professionals, and expatriates that serve as advisers, funders and consultants to Southern governments and NGOs (Ebrahim 2003: 13-14).
Scheper-Hughes discussed the body as being "subject to regulation, discipline, and control by larger political and economic processes" (1992: 135). International development discourses, as a form of power-knowledge, can exert some degree of control over individual and collective bodies. Scholars have stressed the power of dominant development discourses to potentially generate certain worldviews and new identities that conform to the perspectives of the development institutions. These include modernization perspectives, which are still prominent in contemporary development paradigms.
As Lynn Morgan (1993: 3-4) has argued, "health and development initiatives must be analyzed dialectically, as consequences of the relations among international, domestic, and local groups who act in response to changing economic and political priorities." Through her research in Costa Rica, she demonstrated that "[w]e must consider ... the crucial role of the state in setting the direction of social policy and the dynamic participation of subordinated peoples in resisting domination and constructing social forms," as these groups respond to and intersect with international economic relations influencing health care (1993: 3). Morgan and other scholars have pointed to alternative development, or "anti-development," discourses that challenge dominant development discourses (Ebrahim 2003; Morgan 1993; Escobar and Alvarez 1992). In the Philippines, local progressive NGOs may be viewed as an alternative to the dominant development paradigm, which stems in part from structural adjustment programs (SAPs) initiated in the Philippines in 1980. SAPs in the Philippines have emphasized neoliberal policies of liberalization, deregulation, and privatization (Bello et al. 2004). Still, some local progressive NGO discourses are derived from international development discourses, such as biomedical and biomedically oriented international health discourses used by members of some progressive health NGOs, despite the alternative approaches to development advocated by these organizations. Discourses that are expressed through progressive health NGOs can influence relations of power within a community, and between a particular community and others.
Much of the literature focusing on NGO discourses, and on conflicts and contradictions found among people involved in NGOs, has addressed these issues as they pertain to relations between donors, particularly Northern donors, and local Southern NGO recipients who manage the organization and control the donors' funds (e.g., Ebrahim 2003; Lister 2003). Other studies have focused primarily on Northern NGOs (Fox 1998). Fewer studies have addressed these issues among members of Southern NGOs, assessing the relations of power within the NGOs (Hilhorst 2001; Mehta 1996; St. Hilaire 1992). A limited number of analyses have addressed the ways in which development discourses and practices within one development institution may include competing development perspectives. These competing perspectives may be unrecognized as such by the NGO members themselves. An effect of these competing discourses may be the accomplishment of ambiguous results for the NGO program, including both intended and unintended outcomes of the program. In the case presented here, some of the unintended results of the health NGO staff's discourses and practices contradicted stated objectives of the program. Another effect may be the generation of tension and conflict among NGO members. These are problems that few scholars during the late 1980s and 1990s would address, although some did, since international and local NGOs were generally viewed as being more advantageous in their effectiveness in bringing about development compared to government approaches to development (Lister 2003: 175; Fisher 1997: 441, 444).
This article stems from my rethinking of NGO activities. William Fisher (1997: 441-442) recommended that ethnographically grounded studies of NGOs analyze "the impact of NGO practices on relations of power among individuals, communities, and the state ... in specific locales at specific times." He further proposed that they attend "to the discourse within which NGOs are presented as the solution to problems of welfare service delivery, development, and democratization" (Fisher 1997:441). This article is an attempt to assess the role of cultural factors, including gender, in progressive NGO work among indigenous cultural groups, issues that have received less attention in the scholarship on NGOs and popular social movements (Hilhorst 2001; Brown 1994; Findji 1992; Escobar and Alvarez 1992). I argue that an NGO staff's transnationally influenced discourses, such as those that promote gender equality and the expression of emerging indigenous beliefs and practices, can be undermined by other NGO discourses and practices that introduce or reinforce new cultural elements and exclude selected indigenous beliefs and practices. These processes can inadvertently transform indigenous cultural practices and ideologies, result in a plurality of effects on women as health workers, and subvert some of the NGO's political goals.
To illustrate these processes, I focus in this article on a progressive community-based health NGO that was operating in one barangay, (1) Kayu, (2) in Ifugao Province during the early 1990s. Initially, the NGO staff intended the Ifugao health committee formed by the NGO to comprise one solid health committee of a broader local people's organization in Kayu, which ultimately did not occur. While a people's organization had been active in the barangay during previous years, one NGO staff member said:
The people's organization was not really functioning. The health committee was very much independent of the people's organization. That's one weakness. In a functional organization, we would have a health committee, an education committee, and a project committee. But the health committee was the only group that was organized.
People's organizations are commonly conceived of by scholars as being community-based or grass-roots organizations that are locally autonomous, and whose political orientation contests state power, oppressive social structures, and other forms of power (Fisher 1997). Fisher noted that, for a certain set of development critics: "Grass-roots organizations, in particular, are seen as engaged in a struggle for ideological autonomy from the state, political parties, and the development apparatus" (1997: 445). I present examples of how, despite the democratic and progressive political orientation of the health NGO, and its sincerely intended goals of politically empowering and aiding members of an indigenous group and of advocating for gender equality in Ifugao, its staff's discourses and practices at times inadvertently contradicted some of their political and practical objectives. More specifically, I look at how this NGO sometimes unintentionally introduced or reinforced Western ideologies and practices that denigrated indigenous ones, especially in the arena of health care.
I also assess gender dynamics operating among participants within the health NGO and in the Ifugao community. It is significant to address gendered power relations when studying NGOs, since many scholars have discussed the negative impacts of "women in development" and "gender and development" programs, and/or non-gender specific international development programs on women's lives (Foley 2001; Hilhorst 2001; Smyth 1999; Kwiatkowski 1998; Lindio-McGovern 1997; Escobar 1995; St. Hilaire 1992; Boserup 1970). This critique has been particularly extended to development programs sponsored by Northern development agencies, such as the World Bank or the U.S. Agency for International Development (USAID).
Ines Smyth attributed much of the ineffectiveness of "women and development" and "gender and development" programs to the failure of development specialists to take a feminist approach to their work. A feminist approach would emphasize the ideas that feminism is "rooted in the recognition of women's oppression at all levels" (Moore 1988, cited in Smyth 1999: 18) and is "a multi-layered, transformational, political practice and ethics" (Wieringa 1995, cited in Smyth 1999: 18). She wrote that rather than drawing upon feminist ideology and terminology, the term "gender" has been taken up by Northern development organizations to improve women's lives, and, for some organizations, to also address problems and issues faced by men. She argued, along with others, that the use of the term gender depoliticizes the problem of gender inequality, leading to a reluctance to challenge established norms and practices that subordinate women, and to transform existing relations of inequality. A problem arises when challenging gender inequality is viewed by Northern NGOs as challenging traditions or cultures, which they view as taboo in this case (despite the changes that they introduce in other areas of social and cultural life) (Smyth 1999: 17, 22, 23, 26). Smyth (1999: 28) asserted that local women's organizations, or NGOs, in the countries of the South "by definition, develop and verbalize (to varying degrees) powerful critiques of local culture." She argued that Southern NGOs using feminist terminology and ideology, and those trying to define the terms of their own feminism, are better suited than Northern NGOs to transform gender inequality. Northern NGOs could support, empower, and work together with these Southern NGOs, which "would offer a way out of the 'gender and culture' dilemma in which so many development organizations seem to be stuck" (Smyth 1999:28).
I suggest, however, that local feminist-oriented Southern NGOs, as they are linked to and embedded within global networks of power and resources, are also susceptible to un-intentionally engaging in practices that may replicate existing inequalities or practices, or that may lead women to feel disempowered in particular social arenas. At the same time, the same NGOs may effect changes, intended or unintended, that may positively transform women's positions within their communities or provide them with opportunities to feel a sense of empowerment in relation to other members of their communities, men in particular. This more complex view of feminist-oriented NGOs attends to the actual practices and impacts of NGOs, rather than simply their ideologies and critiques of local culture.
Addressing the processes by which transnational discourses and practices exert influence on Southern NGOs, and how these can lead to both unintended results and internal conflicts, is important particularly since there has been increased attention given to NGOs among the international aid community since the end of the Cold War. Ebrahim suggests that this increased attention is attributable to the failure of states to provide services; state retrenchment in the face of a neoliberal economic climate; and a belief that NGOs are more efficient service providers, more democratic, and more effective in reaching the poor. He also asserted that the latter belief has taken hold "despite a dearth of supportive empirical evidence" (2003:1). I hope that this article will contribute to the emerging literature that provides ethnographic documentation of the intersection of transnational and local level NGO processes. In this regard, it is important to emphasize that we need to look beyond the explicit intentions, ideologies, and goals of globally influenced local NGOs, to analyze their actual practices and effects on individuals and groups at the local level. This would offer a richer and more complex view of how NGOs influence the lives of community members involved in NGO programs, which often is in a multiplicity of ways.
Context, History, and Orientation of the Health NGO
Located in the Cordillera Mountains, Ifugao is predominantly based on a subsistence agricultural economy. While most Ifugao people have some access to land, including terraced land or swidden fields, approximately 75% of Ifugao people were considered to be poor in the early 1990s, when I conducted research there. (3) Ifugao men and women engaged in a variety of occupations and types of labor, including farming, animal husbandry, craft production, government employment (in areas such as political office holding, health care, education, and agriculture), wage labor, transportation, business, tourism, service labor, and migrant labor. However, the majority of the residents of Kayu barangay, which...
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