Health workers in interaction with clients. The role of personal and professional identities and culture in behaviour of health workers

Principal researcher

Aagje Papineau Salm

Type of research

PhD research

Supervisor

Professor Inge Hutter

Summary of the project

Health indicators, like infant mortality and life expectancy, show a negative trend in most African countries since the last 10 years. A greater part of the countries are off-track for reaching the Millennium Development Goals. Many factors contribute to this: slow economic growth, longstanding conflicts, HIV/Aids and low quality of health services. The functioning of health services is determined by three M's: Management, Money and Manpower.

Only recently the last M got more attention, while human resources are the glue of the health systems as stated in the report of the Joint Learning Initiative 'Overcoming the Crisis' (2004). Health policy makers and experts approach the issue of human resources in health mostly from a macro-level and policy-making perspective, concentrating on numbers and external factors like salaries and career structure. More personal factors like motivation, attitude and socio-cultural circumstances are not addressed, while they are determining the behaviour of health workers during the interaction with clients.

Formal health systems in Sub-Sahara Africa are based on a western bio-medical paradigm, both concerning the concepts about causes of illness, disease and treatment, as well as concerning the organisational structure of the system. It is a modernistic way of approaching health and disease based on the explanatory models and principles of bio-medical sciences. These systems however function in societies with a different cultural background, with their own concepts about health and disease and cultural meaning giving systems.

Health workers belong to two worlds, the professional world of the hospital or clinic and the personal world of the society they belong to.

Through this study we hope to get more insight in the personal factors that influence the behaviour of health workers. Based on literature study so far four research questions are formulated: 1) What is the behaviour of health workers during the interaction with clients, 2) What is the influence of professional and personal characteristics, 3) How is the behaviour embedded in the 'community of practice' and 4) What is the influence of bio-medical explanatory models and cultural schemas on the behaviour.

Hopefully the field-work will be conducted in Kenya, if the political circumstances allow it, in the form of case-studies. Proposed methods will be participatory observation, interviews and focus-group discussions. Participatory observation by me as outsider might be difficult, so other methods like the use of mystery clients could be useful.

Due to the political situation in Kenya it might be necessary to do the research somewhere else.

In the PRC newsletter of January 2008, Aagje explains why she started this research project.

Presentations

• "Health workers in interaction with clients: The role of personal and professional identities and culture in behaviour of health workers". PhD proposal presented at the CERES summer school, within the panel 'Health, Disease and Livelihood', 25-27 June 2007, Utrecht.
• "The role of health workers in the quality of care". Research  proposal presented in a seminar on the quality of care at the Great Lakes University Kisumu (GLUK), Kenya, 18 February, 2007.

Other related activities

• Chaired a seminar about integration of HIV/Aids programmes in basic health services, organized by Stop Aids Now and the Aids Fonds, 23 October 2007.
• Chaired a workshop on the World Aids Day conference, on Aids and tuberculosis in prisons in the former Soviet Union, 30 November 2007.
• Attended the 5th African Population Conference in Arusha, Tanzania, 10-14 December, 2007.
• Represented PRC in several meetings on reproductive health and safe motherhood of Share-net, the Aids Fonds, and the Ministry of Foreign Affairs.
• Participated in February and March 2007 as guest lecturer in the course 'Christian response to HIV/AIDS' at St. Paul's University in Limuru, Kenya.
• Participated in the IS Academy Expert Meeting on HIV/AIDS 'Rethinking HIV/AIDS preventive counselling' organized by KIT, ASSSR and DGIS, 13-14 November 2006.
• Participated in a seminar on 'Ethical issues in reproductive health' organized by the IUSSP committee on reproductive health in cooperation with NIDI and PRC, Wassenaar, 20-24 September, 2006.
• Attended the presentation of the World Population Report 2006 at the Ministry of Foreign Affairs in The Hague, 6 September, 2006.
• Participated in a working conference on 'Integration of HIV/AIDS and sexual and reproductive health in health systems' organized by Sharenet, 23 May 2006.
• Attended the symposium 'Health, cure and care from a cultural and religious perspective' organized by the University Medical Centre Groningen and the Theological Faculty of the University of Groningen, 6 March, 2006.