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.
| Identifer | oai:union.ndltd.org:VTETD/oai:vtechworks.lib.vt.edu:10919/38768 |
| Date | 11 July 2007 |
| Creators | Timberlake, Janis K. |
| Contributors | Environmental Design and Planning, Scarpaci, Joseph L. Jr., Good, Charles M. Jr., Bohland, James, Stephenson, Max O. Jr., Appleby, Michael D. |
| Publisher | Virginia Tech |
| Source Sets | Virginia Tech Theses and Dissertation |
| Language | English |
| Detected Language | English |
| Type | Dissertation, Text |
| Format | xv, 337 leaves, BTD, application/pdf, application/pdf |
| Rights | In Copyright, http://rightsstatements.org/vocab/InC/1.0/ |
| Relation | OCLC# 36762762, LD5655.V856_1996.T563.pdf |
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