Life in the buffer zone: Social relations and surplus health workers in Uganda's medicines retail sector.
Life in the buffer zone: Social relations and surplus health workers in Uganda's medicines retail sector.
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DOI：
10.1016/j.socscimed.2021.113941
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发表时间：
2022-05
影响因子：
5.4
通讯作者：
Clarke, Sian E.
中科院分区：
文献类型：
--
作者：
Hutchinson, Eleanor;Mundua, Sunday;Ochero, Lydia;Mbonye, Anthony;Clarke, Sian E.
在许多国家，当自下而上地检查卫生系统时，药品销售商成为提供护理和获得商品的关键行为者。尽管如此，这些行为者在很大程度上被排除在卫生系统和政策研究之外。在这篇论文中，我们问‘当药品销售商和他们的实践在研究中被突出时，卫生系统的概念化会发生什么？’我们的回应是，这些卖家不舒服地处于机械逻辑中，在这种逻辑中，医疗体系被想象成有界限的机构，紧密整合，由相互交织和相互联系的空间组成，政策、想法、资本和大宗商品通过这些空间流动。他们挑战贯穿复杂适应系统(CAS)方法的功能主义整体论。我们建议将卫生系统更好地理解为处于不平等地位的社会主体(卫生工作者、管理者、患者、护理人员、公民、政客)为争夺同样有限的资源而竞争和合作的社会领域。我们利用乌干达的人种学研究(2018-2019年)来分析不同行为者对一项旨在使药品零售部门合理化并将药店排除在城市中心之外的新政策的反应。我们研究了新的游说团体的出现，这些团体对这项政策提出异议，并确保了“药店小贩”的贸易权利，因为这些商店越来越多地居住着训练有素的护士和临床医生，他们超出了正规医疗系统的能力，因此依靠市场谋生。这篇论文补充了日益增长的关于卫生系统的人类学文献，这些文献允许关注社会变化和一种形式的整体论，使现象能够与其产生的背景的不同元素相联系。训练有素的护士和助产士越来越多地在乌干达的医药市场工作。这些人是多余的工人，无法在正规的医疗体系中找到工作。医药市场挑战医疗系统的模式，认为它们是紧密联系在一起的整体。卫生系统是社会领域，既有综合的部分，也有独立的部分。
In many countries, when health systems are examined from the bottom up medicine sellers emerge as critical actors providing care and access to commodities. Despite this, these actors are for the most part excluded from health systems and policy research. In this paper, we ask ‘what happens to the conceptualisations of a health system when medicine sellers and their practices are foregrounded in research?’ We respond by arguing that these sellers sit uncomfortably in the mechanical logic in which health systems are imagined as bounded institutions, tightly integrated and made up of intertwined and interconnected spaces, through which policies, ideas, capital and commodities flow. They challenge the functionalist holism that runs through the complex adaptive systems (CAS) approach. We propose that health systems are better understood as social fields in which unequally positioned social agents (the health worker, managers, patients, carers, citizens, politicians) compete and cooperate over the same limited resources. We draw on ethnographic research from Uganda (2018–2019) to analyse the responses of different actors to a new policy that sought to rationalise the medicines retail sector and exclude drug shops from urban centres. We examine the emergence of new lobby groups who contested the policy and secured the rights of ‘drug shop vendors’ to trade on the basis that these shops are increasingly populated by trained nurses and clinical officers, who are surplus to the capacity of the formal health system and so look to markets to make a living. The paper adds to the growing anthropological literature on health systems that allows for a focus on social change and a form of holism that enables phenomena to be connected to diverse elements of the context in which they emerge. Trained nurses and midwives increasingly work in Uganda's medicine markets. These are surplus workers, unable to find work in the formal health system. Medicine markets challenge models of health systems as tightly bound totalities. Health systems are social fields with both integrated and independent parts.
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影响因子：
2.8
作者：
Mayora C;Kitutu FE;Kandala NB;Ekirapa-Kiracho E;Peterson SS;Wamani H
通讯作者：
Wamani H
影响因子：
2.3
作者：
Mogensen, Hanne O
通讯作者：
Mogensen, Hanne O
影响因子：
5.4
作者：
Bloom, Gerald;Standing, Hilary;Lloyd, Robert
通讯作者：
Lloyd, Robert
影响因子：
4.6
作者：
Donath, S
通讯作者：
Donath, S
影响因子：
2.5
作者：
GLUCKMAN, M
通讯作者：
GLUCKMAN, M