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The medical profession and the state in Zimbabwe: a sociological study of professional autonomy

By Dorothy Mutizwa-Mangiza

Abstract

This thesis explores the nature and extent of medical autonomy and dominance of government-employed doctors in Zimbabwe, specifically focusing on the profession's control over the technical aspects of medical work (clinical autonomy); determination of the terms and conditions of work (economic autonomy); and regulation of medical education, licensing and discipline (collective regulation). Data was collected through in-depth interviews with different grades of doctors employed on a full-time basis at the Parirenyatwa Group of Hospitals, key informants and other respondents from the Ministry of Health and Child Welfare and other health-related organisations. Additional information was obtained through extensive document analysis and non-participant observation.\ud \ud The findings of the thesis show that all grades of government-employed doctors in Zimbabwe exercise considerable clinical autonomy. There is minimal administrative regulation of their work, although their clinical autonomy is constrained by severe breakdowns of essential equipment and shortages of all types of resources. They also enjoy a high degree of economic autonomy, largely by default. The findings further indicate that medical education and discipline are inadequately regulated by the various regulatory structures, most of which are dominated by the medical profession, leaving doctors with more autonomy in their work than is desirable for good patient care.\ud \ud The thesis reveals that the factors which erode or maintain medical autonomy in Western developed countries and post-colonial states are very distinct and that current theoretical conceptualisations of medical autonomy, comprising medical dominance theory, deprofessionalisation as well as proletarianisation hypotheses, which are largely based on analyses of medical practice in the United States and Britain, are inadequate for analysing medical autonomy in Zimbabwe and other post-colonial states. In this respect, Johnson (1973) is alone in realising the uniqueness of professions in post-colonial states arising from their different historical, cultural, social, political and economic circumstances, although his analysis is somewhat out of date

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OAI identifier: oai:wrap.warwick.ac.uk:2703

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