Civil servant and professional – understanding the challenges of being a public service doctor in a plural health care setting in rural South Africa

English: Using insider-ethnography the study is an exploration of the experiences of public sector doctors in a rural hospital in KwaZulu-Natal. In the context of a complex policy environment as well as a stressed public sector struggling to meet its constitutional obligations, the daily work of public sector doctors is at the civil service professional intersection. Engagement at this intersection is strongly influenced by the local context of the individuals and communities served. Interactions are also shaped by the local plural health care system where public sector doctors, private general practitioners and traditional healers form complex networks that are largely informal and dependent on personal relationships. The study uses Lipsky’s street-level bureaucracy as a theoretical framework to understand and explore the challenges of being a professional, a bureaucrat and a public official in the public health care sector. In interpreting the rules of their various roles they make many complex decisions that require considerable discretion. In this, their daily work as civil servant doctors remains largely regulated and managed locally by the doctors themselves. The convergence of the roles of professional and civil servant provides public sector doctors leverage to synergistically use discretion individually and collectively within their daily work. While discretion is abused at times, in the setting of a larger system struggling to deliver services, many of public sector doctors voluntarily align their activities and practices with the ideals of providing a high quality care to the population served. In this discretionary practice is vital for the service to function. While bureaucratic and professional standards of practices create distance and detachment from the people they serve, in their interaction with colleagues and the public care and caring is evident. Critically, caring is contingent on the space that discretion provides doctors to engage. These findings have considerable implications for how the work of public sector doctors is conceptualized, planned and managed. Sepedi: Dinyakišišo tše di sekaseka maitemogelo a dingaka tša lekala la mmušo tšeo di šomago sepetlele sa dinagamagaeng ka KwaZulu-Natal, di šomiša taodišaserafe ya ka gare. Tikologo ye e raraganego ya pholisi gammogo le lekala la mmušo leo le nago le mathata le katanago le go phethagatša mešomo ya lona ya molaotheo, dingaka tša lekala la mmušo di dira mošomo wa letšatši ka letšatši magahlanong a bohlokwa a tirelo ya setšhaba le mošomo wa seprofešenale. Kamano magahlanong a e hlohleletšwa kudu ke maemo a selegae a batho le ditšhaba tšeo di direlwago. Ditirišano tša selegae di hlohleletšwa ke tshepedišo ya tlhokomelo ya maphelo ya bontši ya selegae moo yeo go yona dingaka tša setšhaba, dingaka tša kakaretšo tša praebete le dingaka tša setšo di bopago dinetweke tše di raraganego, tšeo bontši bja tšona e sego bja semmušo, tšeo di ithekgilego ka dikamano tša motho ka noši. Dinyakišišo di šomiša kgopolo ya Lipsky ya bolaoditatelano ya maemo a mmileng ya bjalo ka tlhako ya teori go kwešiša le go sekaseka ditlhohlo tša go ba profešenale, molaoditatelano le mohlankedi wa setšhaba ka lekaleng la tlhokomelo ya maphelo a setšhaba. Ge ba hlatholla melao ya dikarolo tša bona tše di fapanego ba tšea diphetho tše ntši tše di raraganego tšeo di hlokago gore ba akanye dilo gabotse. Tabeng ye, mošomo wa bona wa letšatši ka letšatši bjalo ka dingaka tša bašomi ba mmušo o dula o laolwa kudu le go sepetšwa tikologong ya bona ke dingaka ka botšona. Ge dingaka di šoma bjalo ka ditsebi le bahlankedi ba mmušo, ba ka kgona go šomiša karolo ya bona ya go tšea diphetho mmogo mošomong wa bona wa letšatši ka letšatši. Le ge temogo ka dinako tše dingwe e dirišwa gampe, ka gare ga tshepedišo ye kgolo yeo e katanago le go aba ditirelo, bontši bja dingaka tša lekala la mmušo ka go boithaopo di dumelelana le melawana ya go abela bao ba direlwago tlhokomelo ya maemo a godimo. Go dira dilo ka mokgwa wo go bohlokwa kudu gore tirelo ye e kgone go šoma. Le ge maemo a pušotatelano le a seprofešenale a dira gore batho bao ba ba direlago ba be kgole le bona le gore ba se be le kamano efe goba efe le bona, tirišano ya bona le bašomimmogo le tlhokomelo ya setšhaba le tlhokomelo di bonagala gabotse. Se bohlokwa kudu ke gore, tlhokomelo e laolwa kudu ke maatla a go tsea diphetho ao dingaka di a fiwago gore di kgone go kgathatema. Diphihlelelo tše di na le ditlamorago tše kgolo ka moo mošomo wa dingaka tša lekala la mmušo o hlomilwego, o beakantšwego le go laolwa ka gona. Afrikaans: Hierdie studie maak gebruik van insider-etnografie en is 'n verkenning van die ervarings van dokters in die openbare sektor in 'n landelike hospitaal in KwaZulu-Natal. Binne die konteks van 'n komplekse beleidsomgewing, sowel as 'n openbare sektor onder druk wat sukkel om sy grondwetlike verpligtinge na te kom, is die daaglikse werk van dokters in die openbare sektor op die kruispunt van die staatsdiens se professionele vlakke. Betrokkenheid by hierdie kruispunt word sterk beïnvloed deur die plaaslike konteks van die individue en gemeenskappe wat bedien word. Interaksies word ook gevorm deur die plaaslike meervoudige gesondheidsorgstelsel waar dokters in die openbare sektor, privaat algemene praktisyns en tradisionele genesers komplekse netwerke vorm wat grootliks informeel en afhanklik is van persoonlike verhoudings. Die studie gebruik Lipsky se straatvlak-burokrasie as 'n teoretiese raamwerk om die uitdagings van om 'n professionele persoon, burokraat en openbare amptenaarskap te wees in die openbare gesondheidsorgsektor te verstaan ​​en te ondersoek. In die interpretasie van die reëls van hul verskillende rolle neem hulle baie komplekse besluite wat aansienlike diskresie vereis. Hierin bly hul daaglikse werk as staatsamptenaardokters grootliks gereguleer en plaaslik bestuur deur die dokters self. Die samevloeiing van die rolle van professionele persone en staatsamptenare bied dokters in die openbare sektor die hefboom om diskresie sinergisties individueel en gesamentlik binne hul daaglikse werk te gebruik. Terwyl diskresie soms misbruik word in die konteks van 'n groter stelsel wat sukkel om dienste te lewer, belyn baie dokters in die openbare sektor vrywillig hul aktiwiteite en praktyke met die ideale om hoëgehaltesorg aan die bevolking te bied. In hierdie diskresionêre praktyk is dit noodsaaklik vir die diens om te funksioneer. Terwyl burokratiese en professionele praktykstandaarde afstand en afsydigheid skep van die mense wat hulle dien, is sorg en omgee in hul interaksie met kollegas en die publiek duidelik. Wat krities is, is dat sorg afhanklik is van die ruimte wat diskresie dokters bied om betrokke te raak. Hierdie bevindinge het aansienlike implikasies vir hoe die werk van dokters in die openbare sektor gekonseptualiseer, beplan en bestuur word. IsiZulu: Kusetshenziswe umuntu wangaphakathi ukuchaza izizwe zomhlaba, lolu cwaningo luwukuhlola okuhlangenwe nakho kodokotela bomkhakha kahulumeni esibhedlela sasemakhaya KwaZulu-Natali. Emongweni wesimo senqubomgomo esiyindida kanye nomkhakha womphakathi ocindezelekile olwela ukuhlangabezana nezibopho zawo zomthethosisekelo, umsebenzi wansuku zonke wodokotela bomkhakha womphakathi usemngceleni wochwepheshe bezinsizakalo zomphakathi. Ukuzibandakanya endaweni okuphanjanwana kuyo kuthonywa kakhulu isimo sabantu kanye nemiphakathi esetshenzelwayo. Ukuxhumana nakho kubunjwa uhlelo lokunakekelwa kwempilo lwasendaweni lapho odokotela bomkhakha kahulumeni, odokotela abazimele kanye nabelaphi bendabuko bakha amanethiwekhi ayindida angahlelekile futhi ancike kakhulu ebudlelwaneni bomuntu siqu. Lolu cwaningo lusebenzisa umbuso ophethwe izisebenzi zikahulumeni elibizwa ngeLipsky's street-level njengohlaka lwethiyori lokuqonda nokuhlola izinselele zokuba uchwepheshe, isikhulu sezokuphatha izisebenzi zikahulumeni emkhakheni wezempilo yomphakathi. Ekuchazeni imithetho yezindima zabo ezahlukene benza izinqumo eziningi eziyindida nezidinga ukwahlulela okukhulu. Kulokhu, umsebenzi wabo wansuku zonke njengodokotela abasebenza kuhulumeni usalawulwa kakhulu uphathwa kodokotela bendawo uqobo. Ukuhlangana kwezindima zezisebenzi zobungcweti kanye nezezisebenzi zikahulumeni kunikeza odokotela bomkhakha kahulumeni ithuba lokusebenzisa ukuhlakanipha ngokubambisana ngabanye kanye nabo bonke emsebenzini wabo wansuku zonke. Nakuba ukuhlakanipha kusetshenziswa kabi ngezinye izikhathi, esimweni sesimiso esikhulu esilwela ukuletha izinsizakalo, odokotela abaningi basemkhakheni kahulumeni bavumelanisa ngokuzithandela imisebenzi yabo kanye nemikhuba yabo nemigomo yokuhlinzeka ngokunakekelwa kwekhwalithi ephezulu kubantu abasetshenzelwayo. Kulo mkhakha wokuzikhethela kubalulekile ukwenza okubalulekile ukuze isevisi isebenze. Nakuba izindinganiso zemikhuba ezisekelwe kuhulumeni kanye nobungcweti zidala ukuqhelelana nokuhlukaniswa nabantu abahlinzekwayo, ukuxhumana kwabo nozakwabo kanye nokunakekelwa komphakathi kuyabonakala. Okubaluleke kakhulu, ukunakekela okuncike endaweni enikezwa odokotela ukuze bacobelelane noma babonisane. Okutholakele ocwaningweni kunemiphumela ebalulekile kumsebenzi wodokotela bomkhakha kahulumeni ocatshangwa ngayo, uhlelwe kanye nendllela ophathwa ngayo.

Grantor dc:publisher

University of Pretoria

Year dc:date.issued

2014

Advisors dc:contributor.advisor

• Marcus, Tessa S.
• Health Sciences theses SDG11

• UCTD

Statement dc:rights

• © 2015 University of Pretoria. All rights reserved. The copyright in this work vests in the University of Pretoria. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of the University of Pretoria.

Language dc:language.iso

en

Dc Identifier Other

A2015

OAI identifier oai:identifier

oai:repository.up.ac.za:2263/45907