{"id":{"repo_id":"vt","oai_identifier":"oai:vtechworks.lib.vt.edu:10919/38768"},"canonical_url":"https://search.dev.ndltd.org/etd/vt/oai:vtechworks.lib.vt.edu:10919/38768","repository":{"repo_id":"vt","name":"Virginia Tech","base_url":"https://vtechworks.lib.vt.edu/oai/request"},"display":{"title":"Reality check on \"Health for All\": decision-makers, democratization and ethnic conflict in Burundi's primary care institutional culture","abstract":"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.","abstract_html":"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.","abstract_has_math":false,"creators":["Timberlake, Janis K."],"institution":"Virginia Tech","degree_name":"Ph. 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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."]},{"key":"dc:description.degree","label":"Dc Description Degree","values":["Ph. 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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."],"dc:description.degree":["Ph. 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