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Reality check on "Health for All": decision-makers, democratization and ethnic conflict in Burundi's primary care institutional culture

This research examines the relationships among Ministry of Health - (MOH) decision-makers, the MOH, and structural forces shaping the evolution of Burundi’s primary health care delivery. While WHO's goal of Health for All has shaped health strategies in Sub-Saharan Africa, how primary health care (PHC) is formulated and implemented over time is relatively unknown. Using a realist perspective that allows human agency to come through, multiple methods -- including in-depth interviews with senior MOH decision-makers (>90,000 word data base), content analysis, participant observation and policy document reviews -- were employed to assess the interaction between decision-makers’ PHC beliefs, the Ministry’s PHC approach and the structural factors in a Sub-Saharan African nation, Burundi. Field work was undertaken during a two and a half year period. Findings indicate that Burundi’s history of authoritarian rule and ethnic strife molded the country’s PHC approach over time. The 1988-1993 period characterized by government democratic transition, also witnessed a major in the Ministry’s approach shift towards decentralization and community participation. Decision-makers' PHC beliefs were strongly influenced by public health education, suggesting that long- and short-term education and training are prudent strategies for promoting primary health care in the Ministry of Health’s organizational culture. Collectively, these beliefs changed the top-down institutional approach to decision-making, moving the MOH to a consensus building model in its approach to PHC issues. Despite these changes, authoritarian organizational culture and ethnic conflict conditioned decision-makers to implement their PHC beliefs cautiously and indirectly. Advances in participatory approaches to health care planning have been placed on hold given the surge in ethnic violence in 1996. / Ph. D.

Identiferoai:union.ndltd.org:VTETD/oai:vtechworks.lib.vt.edu:10919/38768
Date11 July 2007
CreatorsTimberlake, Janis K.
ContributorsEnvironmental Design and Planning, Scarpaci, Joseph L. Jr., Good, Charles M. Jr., Bohland, James, Stephenson, Max O. Jr., Appleby, Michael D.
PublisherVirginia Tech
Source SetsVirginia Tech Theses and Dissertation
LanguageEnglish
Detected LanguageEnglish
TypeDissertation, Text
Formatxv, 337 leaves, BTD, application/pdf, application/pdf
RightsIn Copyright, http://rightsstatements.org/vocab/InC/1.0/
RelationOCLC# 36762762, LD5655.V856_1996.T563.pdf

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