Abstract:
INTRODUCTION:In the perspectives of implementation of policy, the top-down and bottom-up perspectives of policy-making dominate the discourse. However, service delivery and therefore the experience of the policy by the citizen ultimately depend on the civil servant at the front line to implement the policy. Lipsky named this street-level bureaucracy, which has been used to understand professionals working in the public sector throughout the world. The public sector in South Africa has undergone a number of changes in the transition to a democratic state, post 1994. This needs to be understood in public administration developments throughout the world. At the time of the study, the public sector was characterized by considerable inefficiencies and system failures as well as inequitable distribution of resources. The context of the study was a rural hospital serving a population of approximately 150 000. RESULTS:An insider-ethnography over a period of 13 months explored the challenges of being a professional within the public sector in a rural hospital in South Africa. Data collection included participant observation, field notes of events and meetings, and documentation review supplemented with in-depth interviews of doctors working at a rural hospital. Street-level bureaucracy was used as a framework to understand the challenges of being a professional and civil servant in the public sector. RESULTS:The context of a resource-constrained setting was seen as a major limitation to delivering a quality service. Yet considerable evidence pointed to doctors (both individually and collectively) being active in managing the services in the context and aiming to achieve optimal health service coverage for the population. In the daily routine of the work, doctors often advocated for patients and went beyond the narrow definitions of the guidelines. They compensated for failing systems, beyond a local interpretation of policy. However, doctors also at times used their discretion negatively, to avoid work or to contribute to the inefficiencies of healthcare delivery. CONCLUSIONS:While appearing to be in conflict, the merging of the roles of the health professional and the bureaucrat is required to be able to function effectively within the healthcare system. Being a doctor and being a civil servant are synergistic in daily work, and as a result it is difficult to neatly differentiate professional and civil servant roles in decision-making. It is in the discretion of both roles that considerable flexibility within the roles is possible. Such freedom to act is critical for being able to find local solutions and thereby improve healthcare services. The findings resonate strongly with studies from other parts of the world and offer a window into making sense of the local decision making of doctors. Street-level bureaucracy remains an important lens to view the work of healthcare professionals in the public sector. In the tension between the top-down policy-making and the bottom-up pressure, street-level bureaucracy acts as an important terrain for improving the implementation of services and therefore advocacy and health system improvement.
journal_name
Rural Remote Healthjournal_title
Rural and remote healthauthors
Gaede BMsubject
Has Abstractpub_date
2016-01-01 00:00:00pages
3461issue
1issn
1445-6354pii
3461journal_volume
16pub_type
杂志文章abstract:INTRODUCTION:Behavioral determinants can enable or hinder motivation towards registration and donorship and, subsequently, action or inertia towards organ donation. Nevertheless, there is limited information about the role of self-efficacy in relation to organ donation awareness and presumed consent among individuals a...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:10.22605/RRH5241
更新日期:2019-10-01 00:00:00
abstract:INTRODUCTION:Farm health and safety has historically focussed on strategies such as injury prevention, safety audits and fulfilling legislative responsibilities. However, farmer injuries mask deeper health issues including higher rates of cancer, suicides, cardiovascular disease and stress. The relationship between occ...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2009-01-01 00:00:00
abstract:INTRODUCTION:Reacting to demand and supply pressures, European healthcare systems are undergoing significant structural changes to the organisation and delivery of out of hours care. Such pressures are of particular concern to rural practice. Although patient satisfaction with out of hours care has been extensively stu...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2004-07-01 00:00:00
abstract:INTRODUCTION:St Mary's Hospital in Rehoboth, Namibia, attends to all individuals who have health problems that are considered serious by the community. The aim of this study was to describe the existing suicide management approach in Rehoboth. METHOD:Clinical charts of all patients who attended St Mary's Hospital Reho...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2006-10-01 00:00:00
abstract:INTRODUCTION:There is evidence in the literature that rural background significantly encourages eventual rural practice. Given the shortage of healthcare providers in rural areas, we need to explore ways of ensuring throughput and success of rural-origin students in health sciences. It is therefore important to underst...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2012-01-01 00:00:00
abstract::Iodine deficiency disorder (IDD) is an important health problem in Thailand. Due to the geographical limitation of marine salt distribution, the Northern and Northeastern regions of Thailand are endemic areas of this disorder. In this study, a cross-sectional survey on the domestic use of iodine-enriched salt by the p...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2007-04-01 00:00:00
abstract::Traditionally dental plaque, calculus and stains have been removed by scaling and polishing manually with hand instruments such as curettes, chisels, hoes and scalers. However, ultrasonic scaling is becoming the preferred method of initial periodontal treatment and maintenance, due to improved patient and operator com...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2012-10-01 00:00:00
abstract:INTRODUCTION:Health care and research in rural populations are often limited due to poor infrastructure and small sample sizes. However, such populations have a need for medical care and can be of great value when studying the health effects of lifestyle and genetic factors. The Northern Sweden Population Health Study ...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2010-04-01 00:00:00
abstract:INTRODUCTION:Mondana Clinic is a small rural clinic located in the Napo river region of the Amazon basin in Ecuador. Since its opening in 1997 the clinic has grown to be the primary health care facility for approximately 3000 individuals. METHODS:A retrospective study was performed tabulating the ambulatory diagnosis,...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2001-01-01 00:00:00
abstract:INTRODUCTION:Occupational noise injury and hearing loss are common features of agricultural workforces internationally. Farmsafe Australia has identified hearing health as one of its 4 key priority goals and targets. Currently, approximately 60-70% of Australian farmers have measurable hearing loss, compared with 27% o...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2010-01-01 00:00:00
abstract:INTRODUCTION:Skin infections including scabies and impetigo have a high burden and cause significant morbidity in remote Aboriginal communities in Australia. Nevertheless, there is limited knowledge about community, healthcare practitioner and service provider perspectives on skin infections and treatment preferences. ...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:10.22605/RRH5227
更新日期:2019-09-01 00:00:00
abstract:INTRODUCTION:Locally and internationally, there have been renewed calls for equitable access to healthcare services. Simultaneously, caseloads have become more challenging and contexts more complex, which may be overwhelming to new graduates. The South African context offers a particularly interesting example of these ...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2013-01-01 00:00:00
abstract:CONTEXT:Entry to practice medical programs (graduate- and undergraduate-entry) in Australia are under considerable pressure to provide clinical training as a result of increased student numbers. At the same time modern medical curricula require the development of active placements in expanded settings to achieve gradua...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2011-01-01 00:00:00
abstract:INTRODUCTION:Suicide remains an important public health issue in Australia, responsible for around 2500 deaths each year. Although suicide only accounts for around 1.7% of total mortality in Australia per year, 75% of suicide deaths are in males. This article reviews the factors contributing to suicide in older rural m...
journal_title:Rural and remote health
pub_type: 杂志文章,评审
doi:10.22605/RRH4020
更新日期:2017-10-01 00:00:00
abstract:INTRODUCTION:A person's capability to access services and achieve good eye health is influenced by their behaviours, perceptions, beliefs and experiences. As evidence from Papua New Guinea (PNG) about people's lived experience with vision impairment is limited, the purpose of the present study was to better understand ...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2016-10-01 00:00:00
abstract:INTRODUCTION:Rural health workforce issues are a priority area for the Australian Government and substantial funding has been provided for rural education programs to address health workforce disparities across Australia's rural and remote communities. The Australian Government established a Rural Health Strategy in 20...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2011-01-01 00:00:00
abstract:INTRODUCTION:The WHO has estimated that 1% of the world's population need a wheelchair, but few have access. Access to wheelchairs for most of the South African poor population is through accessing rehabilitation services at public health facilities. This study explored access to wheelchair services from the perspectiv...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:10.22605/RRH5855
更新日期:2021-01-01 00:00:00
abstract:INTRODUCTION:Internationally, musculoskeletal conditions are a major morbidity issue for Indigenous populations and the social and economic burden imposed by musculoskeletal complaints is significant. However, little is known about the prevalence and associated pain and impairment of musculoskeletal conditions among ru...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2004-07-01 00:00:00
abstract::Since the first case of the current pandemic (H1N1) 2009 virus reported to WHO on 24 April 2009 on the American continent, the virus has spread in 160 countries and territories. By mid-2009, there were 135,000 cases and 816 deaths recorded. Pandemic preparedness is not advanced in most developing countries. Effective ...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2009-07-01 00:00:00
abstract:CONTEXT:In India 60-70% of the population live in rural villages. The rural population suffers from a burden of disease and disorders due to the non-availability of appropriate healthcare personnel and facilities. Since 1950, the Indian Government has responded with a series of five-year plans but has been unable to ad...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2005-04-01 00:00:00
abstract:INTRODUCTION:In Scotland, approximately 5% of out-of-hospital cardiac arrest patients survive to hospital discharge. Improving bystander cardiopulmonary resuscitation (CPR), especially in rural areas, could have a significant effect on the numbers of lives saved. The objective of this study was to systematically review...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:10.22605/RRH4772
更新日期:2019-09-01 00:00:00
abstract:INTRODUCTION:This paper reports on research to ascertain the views of general practitioners (GPs) practising in rural and remote areas of South Australia, on evidence-based medicine (EBM). It follows our previous paper that identified, through a literature search, the key issues in moving towards EBM in general practic...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2002-01-01 00:00:00
abstract:INTRODUCTION:Smoke-free laws and the addition of graphic warning labels to cigarette packages represent public health policies that can potentially reduce smoking and smoking-related disease. The attitudes and beliefs relating to these policies were examined among residents of Ohio Appalachia, a mostly rural region wit...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2012-01-01 00:00:00
abstract:INTRODUCTION:Portions of Montgomery County, Virginia, are designated a Medically Underserved Area with a large portion of this population experiencing limited access to healthcare services. In September 2008, the Federal Bureau of Primary Care awarded the authors a planning grant to assess community need in Montgomery ...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2012-01-01 00:00:00
abstract:INTRODUCTION:This study aimed to assess the impact of live interactive telenephrology on diagnosis and disease management, patients' quality of life, and time- and cost savings. METHODS:A pre-test-post-test one-group design was used to evaluate the process and outcomes of the teleconsultations among all consecutive pa...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2016-01-01 00:00:00
abstract:INTRODUCTION:For many women, and particularly rural women, birthing locally and within their own community is important for personal, social and/or cultural reasons. If concerns about the woman or her baby mean transfer to a secondary or tertiary facility is necessary, this can be disruptive and stressful, especially i...
journal_title:Rural and remote health
pub_type: 杂志文章,多中心研究
doi:
更新日期:2011-01-01 00:00:00
abstract:CONTEXT:This article describes the development and evaluation of a tool to prioritize physiotherapy referrals in a remote, under-serviced region in Canada's eastern Arctic. The Baffin Region of Nunavut is home to approximately 16 000 people dispersed across 12 communities accessible only by air. Physiotherapists are ba...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2010-04-01 00:00:00
abstract:INTRODUCTION:Breastfeeding provides health benefits to infants and mothers, yet many women decide against breastfeeding. This study examined differences in the prevalence of breastfeeding among national, urban, rural, and Appalachian regions of the USA. METHODS:Secondary data analysis of the US 2007 National Survey of...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:
更新日期:2011-01-01 00:00:00
abstract:INTRODUCTION:The traditional view of paramedic practice is one of provision of emergency care and transport within community or industrial settings. With greater integration of emergency services with the overall health system, this role is changing. Paramedics, especially in rural areas, are now working more closely w...
journal_title:Rural and remote health
pub_type: 杂志文章,评审
doi:
更新日期:2014-01-01 00:00:00
abstract:INTRODUCTION:With the ability to diagnose malaria with rapid diagnostic tests (mRDT), interest in improving diagnostics for non-malarial fevers has increased. Understanding how health providers diagnose and treat fevers is important for identifying additional tools to improve outcomes and reduce unnecessary antibiotic ...
journal_title:Rural and remote health
pub_type: 杂志文章
doi:10.22605/RRH4818
更新日期:2019-06-01 00:00:00