In Developing to Scale, Heidi Morefield offers a compelling and comprehensive history of global health through the lens of technology, arguing that “appropriate technology” has been central to how global health has imagined, structured, and justified its interventions since the 1970s. Morefield defines appropriate technology as small-scale, locally sourced, labor-intensive, and inexpensive technology. These include not only tools such as vaccines, drugs, and water filters, but also an idea: a political, economic, and moral framework that shaped how development experts, donors, and governments conceived of aid to the Global South. Morefield demonstrates that appropriate technology was assembled, disseminated, transformed, discarded, and reinvented by a wide range of actors, revealing its remarkable elasticity and its deep entanglement with the political and economic crises of the postcolonial era. The book also challenges the chronology of global health that locates the failure of broad-based primary health-care initiatives to neoliberal influence. In contrast, Morefield demonstrates that appropriate technology was central to the visions that undercut calls for well-resourced health-care systems.

The book unfolds across eight chapters that trace the genealogy of appropriate technology from its intellectual origins in the work of economist Ernst Friedrich Schumacher to its contemporary afterlives in the COVID-19 pandemic response. Morefield begins with Schumacher’s synthesis of Buddhist ethics and Hindu economic thought into what he called “intermediate technology,” a model that promised to help the poor by scaling development down to the village level (12–38).Footnote ¹ She then follows how these ideas gained traction among development experts, anticolonial leaders, and activists who saw in small-scale technologies a humane alternative to large-scale modernization projects (39–112). Subsequent chapters examine the networks, organizations, and catalogues—such as the Village Technology Handbook—that circulated appropriate technology globally, and those who turned it into a tool of community empowerment and a site of activism. Morefield’s analysis of how Silicon Valley entrepreneurs drew inspiration from appropriate technology, albeit toward patriarchal and market-driven ends, is particularly striking. Equally insightful is her discussion of how Western feminists adapted the concept for projects of self-sufficiency and communal labor.

The middle chapters (3–6) situate appropriate technology within the political economy of US development policy. During the budget crises of the United States Agency for International Development in the late 1970s and early 1980s, appropriate technology emerged as a cost-saving solution that aligned with selective primary health care. Morefield shows how this shift helped usher in what scholars would later identify as neoliberal tendencies in global health: an emphasis on cost-effectiveness, privatization, and the outsourcing of development work to NGOs.

Morefield also demonstrates that actors in the Global South did not simply accept Western definitions of what counted as “appropriate.” Delegates from Asia and Africa rejected technologies that positioned them as helpless or technologically backward, insisting instead on models that aligned with their political aspirations and liberation struggles (76). Initiatives such as the Kumasi (Ghana) Technology Group, the Conference of Ministers of African States responsible for the Application of Science and Technology to Development (CASTAFRICA), and nonaligned collaborations exemplified these efforts to articulate autonomous technological pathway and Global South solidarity. Women in Zimbabwe also redefined appropriate technology as part of broader projects of decolonization through Bantu technology by South Africa’s National Progressive Primary Health Care (113–49). Many Africans repurposed appropriate technologies as tools for reducing dependence on colonial powers, asserting autonomy from oppressive regimes and advancing community self-help initiatives even as international donors abandoned appropriate technology programs (115). This insight shows Africans as active participants in modern and technological projects of the postcolonial world, challenging narratives that obscure their role in development and global histories.

The final chapter turns to the Bill and Melinda Gates Foundation, whose embrace of scalable, small–scale technologies marks a new phase in the history of appropriate technology. An epilogue brings the story into the COVID-19 pandemic, showing the persistence of small-scale technological thinking in contemporary global health.

Morefield’s research draws on an impressive array of archives, personal papers, interviews, and personal experience that allow her to track the circulation and reinvention of appropriate technology across multiple geographies and the broader circuits of international development. This is in line with recent scholarship, which, since the COVID-19 pandemic, has begun to use medical technologies and infrastructures to complicate the binary of “local” and “global” in global health, and Morefield’s work reinforces this move.Footnote ²

Yet, the analysis that Morefield offers in this book leans heavily toward US institutional and experts histories, and readers interested in the on-the-ground dynamics of technology, primary health care, and its relationship to social medicine, may wish for deeper engagement with African and Asian health personnel, ideologies, and infrastructures. Nevertheless, her in-depth scrutiny and insightful argument invite historians to move beyond narratives of scarcity, failure, and the lacunae created by neoliberalism and structural adjustment programs in postcolonial Africa to examine how African experts adapted, repurposed, and reimagined technologies and infrastructures on the continent and across transnational networks to respond to public health crises in the postcolonial period. This is particularly crucial at a moment when we are witnessing major divestment from the World Health Organization, USAID cuts and a broader United States shift toward a “post-global health,” marked by reliance on bilateral agreements with individual African states and a new global economic order.

Overall, the book is a major contribution to the history of global health, development studies, and African history. It will be essential reading for historians of medicine, scholars of technology and development, and anyone interested in how ideas about technology have shaped global health practice.