The medical profession and the universalisation of South African Health Care: analysing the response of Eastern Cape general practitioners to the National Health Insurance proposals
- Authors: Hannah, Bridget
- Date: 2017
- Subjects: Health insurance -- South Africa , Health insurance -- Government policy -- South Africa , Medical care, Cost of -- South Africa , National health insurance -- South Africa , Medical policy -- South Africa , Physicians -- South Africa -- Attitudes
- Language: English
- Type: Thesis , Masters , MA
- Identifier: http://hdl.handle.net/10962/6075 , vital:21029
- Description: In 2011, the Green Paper on National Health Insurance (NHI) in South Africa was released, committing the South African government to a 14-year plan to radically transform the currently inequitable health system towards providing comprehensive quality health care free at point of access to all citizens. The pursuit of universal health coverage (UHC) in South Africa forms part of a global aspiration to achieve more equitable healthcare delivery. One of the critical issues emerging from the Green Paper was how the NHI would be staffed. The NHI is unlikely to be adequately staffed without GPs but evidence suggests that private sector doctors have always been resistant to nationalisation or socialisation as a threat to their occupational power and professional status. The core work of this thesis is a study undertaken of 78 doctors in the Eastern Cape, focusing on private sector general practitioners (GPs), as the largest constituency of medical professionals in the country. The interview schedule was designed to gauge doctors' responses to the NHI, encourage discussion on their reactions to the reforms, and its implications in their view for private medical practice. The responses of the doctors are analysed through application of two theoretical themes, namely: (i) actor-centred policy creation, discussed through application of Walt and Gilson's (1994) shared focus on content, context, process and actors in the policy process, and (ii) the debate on medical professionalism, espoused by Freidson (1973, 1994) and argued against by Haug and Sussman (1969), and McKinlay (1972, 1993). Thus, if the process of policy making must take into account key actors in order to deliver a successful policy transition, what are the implications if these actors are actively excluded, or do not willingly cooperate? Does this indicate anything telling about the private sector's role to play in the pursuit of universal healthcare?
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- Date Issued: 2017
Healing at the margins: discourses of culture and illness in psychiatrists', psychologists' and indigenous healers' talk about collaboration
- Authors: Yen, Jeffery
- Date: 2000
- Subjects: Traditional medicine -- South Africa , Medical policy -- South Africa , Mental health -- South Africa , Healers -- South Africa
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3090 , http://hdl.handle.net/10962/d1002600 , Traditional medicine -- South Africa , Medical policy -- South Africa , Mental health -- South Africa , Healers -- South Africa
- Description: This dissertation explores discourses about culture and illness in the talk of mental health professionals and indigenous healers. It represents an attempt to situate the issue of indigenous healing in South Africa within a particular strand of critical discourse analytic research. In the context of current deliberations on the value, or otherwise, of indigenous healing in a changing health and specifically mental health system, the talk of both mental health practitioners and indigenous healers as they conceptualise “disorder”, and discuss possibilities for collaboration, is chosen as a specific focus for this study. Disputes over what constitutes “disorder” both within mental health, and between mental health and indigenous healing are an important site in which the negotiation of power relations between mental health professionals and indigenous healers is played out. The results of this study suggest that despite the construction of cogent commendations for the inclusion of indigenous healing in mental health, it remains largely marginalised within talk about mental health practice. While this study reproduces to some extent the marginalisation of indigenous healing discourse, it also examines some of the discursive practices and methodological difficulties implicated in its marginalisation. However, in the context of “cultural pride strategies” associated with talk about an African Renaissance, indigenous healing may also function as a site of assertion of African power and resistance in its construction as an essentially African enterprise. At the same time, it may achieve disciplinary effects consonant with cultural pride strategies, in constructing afflictions in terms of neglect of, or disloyalty to cultural tradition. These results are discussed in terms of the methodological difficulties associated with interviewing and discourse analysis of translated texts, which contributes to difficulties with articulating indigenous healing discourse in a way that challenges the dominant psychiatric discourses implicated in its marginalisation within mental health. It concludes with recommendations for future research which addresses indigenous healing discourse in its own terms, and examines its operation as a disciplinary apparatus in South African society.
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- Date Issued: 2000