The role of the traditional leader in implementing maternal, newborn and child health policy in Malawi.
Health Policy Plan
; 33(8): 879-887, 2018 Oct 01.
Article
em En
| MEDLINE
| ID: mdl-30084938
ABSTRACT
Traditional leaders play a prominent role at the community level in Malawi, yet limited research has been undertaken on their role in relation to policy implementation. This article seeks to analyse the role of traditional leaders in implementing national maternal, newborn and child health (MNCH) policy and programmes at the community level. We consider whether the role of the chief embodies a top-down (utilitarian) or bottom-up (empowerment) approach to MNCH policy implementation. Primary data were collected in 2014/15, through 85 in-depth interviews and 20 focus group discussions in two districts in Malawi. We discovered that traditional leaders play a pivotal role in supporting MNCH service utilization, through mobilization for MNCH campaigns, and encouraging women to give birth at the health facility rather than at home or in the community setting. Women and their families responded to bylaws to deliver in the facility out of respect for the traditional leader, which is ingrained in Malawian culture. Fines were imposed on women for delivering at home, in the form of goats, chickens and money. Fear and coercion were often used by traditional leaders to ensure that women delivered at the health facility. Chiefs who failed to enforce these bylaws were also fined. Although the role of the traditional leader was often positive and encouraging in relation to MNCH service utilization, this was sometimes carried out in a coercive manner. Results show evidence of a utilitarian top-down model of policy implementation, where the goal of health service utilization justified the means, through encouragement, fear, punishment or coercion. Although the bottom-up approach would be associated with a more empowerment approach, it is unlikely that this would have been successful in Malawi, given the hierarchical nature of society. Further research on policy implementation in the context of community participation is needed.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Serviços de Saúde Materno-Infantil
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Implementação de Plano de Saúde
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Política de Saúde
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Liderança
Tipo de estudo:
Prognostic_studies
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Qualitative_research
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Sysrev_observational_studies
Limite:
Adult
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Child, preschool
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Female
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Humans
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Infant
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Newborn
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Pregnancy
País como assunto:
Africa
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article