Working in scarcity: Effects on social interactions and biomedical care in a Tanzanian hospital

Strong, Adrienne E.

doi:10.1016/j.socscimed.2017.02.010

Cited by 15 publications

(15 citation statements)

References 7 publications

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“…Even in the best of circumstances, in communities with resource-poor health facilities there is often a deep mistrust and suspicion of health care providers (Strong 2017); throughout many resourcepoor communities, people speculate that there are no medications or even gloves, because the nurses were selling these supplies in their own shops. In those instances, people became reluctant to seek care in the frontline health facilities, preferring to go further afield or stay at home with local birth attendants for economic, logistic, or social reasons.…”

Section: Stigmatization Of Health Facilities and Health Care Workers:mentioning

confidence: 99%

Effects of the West African Ebola Epidemic on Health Care of Pregnant Women: Stigmatization With and Without Infection

Strong

Schwartz

2019

Global Maternal and Child Health

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Most scholarship on stigma begins with an explanation of Erving Goffman's Stigma: Notes on the Management of Spoiled Identity (Goffman 1963). However, since Goffman's now-classic work on the subject, there have been many linguistic shifts, conceptual slippages, and new contributions to the theorization and understanding of stigma. More recent interpretations of stigma emphasize the psychological and social aspects of stigma, as well as highlight the critical role of power and systemic inequalities which can work to produce or reinforce existing stigmas (Castro and Farmer 2005; Parker and Aggleton 2003). Link and Phelan (2001) stipulate that, in order for stigma to develop, there must be an element of power involved; they do not specifically state who it is that is exercising the power they mention, but surely the differential exists in favor of those doing the stigmatizing. Similarly, Castro and Farmer (2005) argue that for a more nuanced understanding of stigma and its effects in an infectious disease and treatment context, the power structures and inequities that produce poor access to care and treatment should be an integral component of the analysis of stigma production. Parker and Aggleton (2003:13) also argue that stigma "feeds upon, strengthens and reproduces existing inequalities of class, race, gender, and sexuality." There are a number of possible definitions of stigma. Parker and Aggleton (2003) suggest that many times, stemming from Goffman (though, they say, perhaps mistakenly so), authors treat stigma as an individual process and as a static, fixed item that exists. However, they argue that stigma also "plays a key role in producing and reproducing power relations and control…To properly understand issues of stigmatization and discrimination…requires us to think more broadly about how some individuals and groups come to be socially excluded, and about the forces that create and reinforce exclusion in different settings," advocating for analysis of stigma that takes into account its fluid and generative capabilities (Parker and Aggleton 2003:16). Parker and Aggleton (2003) further argue that conceptualizing

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Section: Stigmatization Of Health Facilities and Health Care Workers:mentioning

confidence: 99%

Effects of the West African Ebola Epidemic on Health Care of Pregnant Women: Stigmatization With and Without Infection

Strong

Schwartz

2019

Global Maternal and Child Health

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“…During the economic crisis, hospitals focused on cost reduction and related structural reforms and neglected quality-related issues [ 30 ]. For example, the shortage of resources has led to a decline in evidence-based practice in hospitals [ 38 , 75 ]. In addition, understaffing has led to poor quality and safety of care, patient dissatisfaction [ 38 , 43 , 48 , 52 ], and a higher mortality rate [ 90 ], which is related to increasing staff workload and decreasing adequate skilled staff [ 23 , 73 ].…”

Section: Resultsmentioning

confidence: 99%

Hospitals during economic crisis: a systematic review based on resilience system capacities framework

Foroughi

Ebrahimi

Aryankhesal

et al. 2022

BMC Health Serv Res

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Background Hospitals are the biggest users of the health system budgets. Policymakers are interested in improving hospital efficiency while maintaining their performance during the economic crisis. This study aims at analysing the hospitals’ policy solutions during the economic crisis using the resilience system capacities framework. Method This study is a systematic review. The search strategy was implemented on the Web of Science, PubMed, Embase, Scopus databases, and Econbiz search portal. Data were extracted and analysed through the comparative table of resilience system capacities framework and the World Health Organization (WHO) health system’s six building blocks (i.e., leadership and governance, service delivery, health workforce, health systems financing, health information systems, and medicines and equipment). Findings After the screening, 78 studies across 36 countries were reviewed. The economic crisis and adopted policies had a destructive effect on hospital contribution in achieving Universal Health Coverage (UHC). The short-term absorptive capacity policies were the most frequent policies against the economic crisis. Moreover, the least frequent and most effective policies were adaptive policies. Transformative policies mainly focused on moving from hospital-based to integrated and community-based services. The strength of primary care and community-based services, types and combination of hospital financing systems, hospital performance before the crisis, hospital managers’ competencies, and regional, specialties, and ownership differences between hospitals can affect the nature and success of adopted policies. Conclusion The focus of countries on short-term policies and undermining necessary contextual factors, prioritizing efficiency over quality, and ignoring the interrelation of policies compromised hospital contribution in UHC.

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“…Through Tanzania's national PPP policy, partnerships are encouraged between public, private, NGO or individual actors of any sort, in order to support public institutions and services in the absence of adequate government funding. Homegrown PPPs allow health-sector staff an opportunity (albeit a tenuous one) to circumvent limitations imposed by transnational agreements such as the Sustainable Development Goals, 4 inadequate government funding for the health sector (Strong 2017), and narrowly conceptualized global health partnerships that often eschew the critical capacity and infrastructural needs of the very health institutions on which those partnerships depend (see Herrick and Brooks 2018; Wendland 2016). Homegrown PPPs are thus a means by which health-sector staff actively pursue uncertain becoming (Biehl and Locke 2017) beyond the restrictive frames of national budgets, donor-sponsored initiatives (Pfeiffer et al .…”

Section: Introductionmentioning

confidence: 99%

“…Kamugumya and Olivier (2016) highlight several similar forms of homegrown or ‘informal’ partnerships in health services in Bagamoyo District. Adrienne Strong discusses a case of an administrator losing a prospective donor for infrastructure at a different Tanzanian hospital, but, as noted above, given the considerable ambiguity surrounding the term for ‘donor’ in Swahili, it is possible that this relationship was part of a homegrown PPP that ultimately failed (2017: 220). Outside Tanzania, Alice Street highlights how politicians and administrators also looked to partnership as a means of building infrastructure in Papua New Guinea (2014).…”

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confidence: 99%

‘Like a real hospital’: imagining hospital futures through homegrown public–private partnerships in Tanzania

Sullivan¹

2020

Africa

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This article traces a shift in how hospital workers at a Tanzanian public hospital thought about their workplace. In 2010, for the first time, staff began collectively imagining what they called ‘a real hospital’. This collective dreaming of institutional possibilities emerged due to two transformations: a shift in Tanzanian government policies enabling government institutions to initiate their own ‘public–private partnerships’ (PPPs) with non-state ‘partners’ such as NGOs, private businesses, investors, missionary organizations and others; and the hospital's early successes in attracting (a few) partners. Unlike familiar global PPPs such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, Tanzania's PPP policy allowed health facilities to initiate their own partnerships in order to improve public services. Drawing on longitudinal ethnographic research in one government hospital, this article traces successful, failed and fraught partnership initiatives through which public-sector health workers tried to improve hospital infrastructure and capacity. In tracing institutional aspirations and local workers’ efforts to achieve them through homegrown PPPs, this article highlights the contingency and malleability of public and private spheres operating within public health service provision in Tanzania, as well as the opportunities available to health workers and the constraints involved in attempting to improve hospital care.

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Working in scarcity: Effects on social interactions and biomedical care in a Tanzanian hospital

Cited by 15 publications

References 7 publications

Effects of the West African Ebola Epidemic on Health Care of Pregnant Women: Stigmatization With and Without Infection

Effects of the West African Ebola Epidemic on Health Care of Pregnant Women: Stigmatization With and Without Infection

Hospitals during economic crisis: a systematic review based on resilience system capacities framework

‘Like a real hospital’: imagining hospital futures through homegrown public–private partnerships in Tanzania

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