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Civil servant and professional – understanding the challenges of being a public service doctor in a plural health care setting in rural South Africa
Thesis (PhD)--University of Pretoria, 2014.
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| Format: | Thesis |
| Language: | English |
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University of Pretoria
2015
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| _version_ | 1867613440404619264 |
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| access_status_str | Open Access |
| author2 | Marcus, Tessa S. |
| author_browse | Marcus, Tessa S. |
| author_facet | Marcus, Tessa S. |
| collection | Thesis |
| dc_rights_str_mv | © 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. |
| description | Thesis (PhD)--University of Pretoria, 2014. |
| format | Thesis |
| id | oai:repository.up.ac.za:2263/45907 |
| institution | University of Pretoria (South Africa) |
| language | English |
| last_indexed | 2026-06-10T12:36:11.018Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UPSpace — University of Pretoria Institutional Repository |
| publishDate | 2015 |
| publishDateRange | 2015 |
| publishDateSort | 2015 |
| publisher | University of Pretoria |
| publisherStr | University of Pretoria |
| record_format | dspace |
| source_str | UPSpace — University of Pretoria Institutional Repository |
| spelling | oai:repository.up.ac.za:2263/45907 Civil servant and professional – understanding the challenges of being a public service doctor in a plural health care setting in rural South Africa Marcus, Tessa S. Health Sciences theses SDG11 Gaede, Bernhard Martin UCTD Health sciences theses SDG-11 Health sciences theses SDG-17 Thesis (PhD)--University of Pretoria, 2014. 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. tm2015 Family Medicine PhD Unrestricted 2015-07-02T11:05:55Z 2015-07-02T11:05:55Z 2015/04/24 2014 Thesis Gaede, BM 2014, Civil servant and professional – understanding the challenges of being a public service doctor in a plural health care setting in rural South Africa, PhD Thesis, University of Pretoria, Pretoria, viewed yymmdd <http://hdl.handle.net/2263/45907> A2015 http://hdl.handle.net/2263/45907 en © 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. application/pdf University of Pretoria |
| spellingShingle | UCTD Health sciences theses SDG-11 Health sciences theses SDG-17 Civil servant and professional – understanding the challenges of being a public service doctor in a plural health care setting in rural South Africa |
| title | Civil servant and professional – understanding the challenges of being a public service doctor in a plural health care setting in rural South Africa |
| title_full | Civil servant and professional – understanding the challenges of being a public service doctor in a plural health care setting in rural South Africa |
| title_fullStr | Civil servant and professional – understanding the challenges of being a public service doctor in a plural health care setting in rural South Africa |
| title_full_unstemmed | Civil servant and professional – understanding the challenges of being a public service doctor in a plural health care setting in rural South Africa |
| title_short | Civil servant and professional – understanding the challenges of being a public service doctor in a plural health care setting in rural South Africa |
| title_sort | civil servant and professional understanding the challenges of being a public service doctor in a plural health care setting in rural south africa |
| topic | UCTD Health sciences theses SDG-11 Health sciences theses SDG-17 |
| url | http://hdl.handle.net/2263/45907 |