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

By Dorothy Mutizwa-Mangiza


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their different historical, cultural, social, political and economic circumstances, although his analysis is somewhat out of date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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  1. (1995). A Central African Odysý.
  2. (1992). A Death in Zimbabwe".
  3. (1990). A Decade of Implementing Health For All Strategies: A Zimbabwean Experience
  4. (1990). A Matter of Record.
  5. (1989). A Patient Voice at the GMC: A Lay Members View of the General Medical Council. Health Rights.
  6. (1979). A reappraisal of the 'brain drain' with special reference to the medical profession. "
  7. (1972). A Review of the Development of the Health Services of Rhodesia from 1923 to the Present Day",
  8. (1976). A Service to the Sick. Gwelo:
  9. (1977). Agricultural and Plantation Workers in Rhodesia.
  10. (1984). An Agenda for Zimbabwe.
  11. (1988). An Evaluation of the Effectiveness of Workers' Participation in Decision-making in a Zimbabwean Parastatal EnteWrise: A Case SLudy of the Harare Dgjj3L:. Unpublished MSc Dissertation. Harare:
  12. (1979). An Introduction to Public Administration,
  13. (1984). An Introduction to the Politics of Tropical Africa.
  14. (1990). An Overview of Health Manpower Issues in Relation to Equity in Health Services in Zimbabwe".
  15. (1994). Association President's letter to Hospital Doctors Association's President dated 25
  16. (1994). Association President's letter to state President dated 26
  17. (1993). Better Incentives Needed for Medical Personnel".
  18. (1994). Breakthrough Reached with Striking Doctors".
  19. (1988). Canadian Medicine: Dominance or Proletarianisation".
  20. (1994). Changing Medicine? Gender and the Politics of Health Care". In
  21. (1989). Clinical Autonomy in the United Kingdom and the United States: Contrasts and Convergence".
  22. (1991). Conflicting Characterisations of Professional Dominance".
  23. (1988). Corporatisation and the Social Transformation of Doctoring".
  24. (1993). Countervailing Power: The Changing Character of the Medical Profession in the United States". In
  25. (1995). Countervailing Powers: A Framework for Professions in Transition". In
  26. (1993). Critical shortage of Physiotherapists "-
  27. (1990). Critics of Doctors Stamped on by Stamps".
  28. (1987). DealinR with Medical Malpractice: The British and Swedish Experience.
  29. (1973). Deprofessionalisation: An Alternate Hypothesis for the Future".
  30. (1988). Destabilisation and the Battle to Reduce Dependence".
  31. Doctor Migration and World Health.
  32. Doctors and their Careers: A New Generation.
  33. (1988). Doctors can't hold Nation to Ransom".
  34. (1988). Doctors feel like going on Strike".
  35. (1988). Doctors Return to Work after 3 day Strike".
  36. (1989). Doctors say No to sweeping powers for Minister".
  37. (1994). Doctors Should not Blackmail State".
  38. (1988). Doctors urged to abandon Strike".
  39. (1995). Doctors, Peer Review and Quality Assurance". In
  40. (1994). Document presented to the Minister of Health and Child Welfare by Hospital Doctors
  41. (1983). Documents of Life.
  42. (1993). Doing Research on Sensitive Topics.
  43. (1993). Doing Your Research Projec .
  44. (1987). Druizs and Allied Substances Control Amendment Act.
  45. (1978). Economy and Sociejy: An Outline of Inteipretive Sociology.
  46. (1993). Elites and SoLiety, Second edition.
  47. (1990). Equity in Health: Zimbabwe Nine Years On".
  48. (1983). Ethnography: Principles in Practice.
  49. (1993). Ethnography". In
  50. (1960). Federal Goverment of Rhodesia and Nyasaland.
  51. (1973). Field Research: Strategries for a Natural SociolM. Englewood Cliffs,
  52. (1990). Free Enterprise, Professional Ideology, and Self-Interest: An Evaluation of Resistance by Canadian Physicians to Universal Health Insurance".
  53. (1992). Freidson Then and Now: An 'Internalist' Critique of Freidson's Past and Present Views of the Medical Profession".
  54. (1994). From Tribalism to Corporatism". In
  55. (1993). Gaining Access". In
  56. (1990). Ghana".
  57. (1988). Godly Medicine in Zimbabwe.
  58. (1984). Government and Politics in Africa.
  59. (1995). Governmentality and the institutionalisation of expertise". In
  60. (1989). Harare team geared for open Heart Ops as Machines Arrive".
  61. (1991). Health and health care in post-independence rural Zimbabwe".
  62. (1975). Health Care Politics.
  63. (1995). Health Ministry fails to discipline doctors".
  64. (1989). Health Professions and the State in Eu 86-102. London: Routledge -Il '7
  65. (1993). Health Professions Council Functions and a Guide to Ethics.
  66. (1995). Health Sector Reform in Zimbabwe. Concept Paper on Decentralisation in the ministry of health and Child Welfare.
  67. (1986). Historical Changes in Doctoring: A Reply to Milton Roemer",
  68. (1994). Hospitals a National Disaster".
  69. (1994). How Dominant are the Professions? ".
  70. (1964). Huggins of Rhodesia. London: George Allen and Unwin Ltd.
  71. (1992). I A '7 Govemment of Zimbabwe.
  72. (1993). I Health Professions Council, Health Profe--,. qinn,, Council Functions and A Guide to Ethics Harare,
  73. (1946). IAA Government of Southern Rhodesia, Commission of Enquiry into the National Health Services Report,
  74. (1973). Imperialism and the Professions". The Sociological Review Monograp .
  75. (1987). Improve Pay for Doctors".
  76. (1983). Indiscipline may wreck hospitals".
  77. (1982). Interviewing in Field Research". In
  78. (1994). Irregularities in the preparation for the trial of Dr Richard Gladwell McGowan".
  79. (1989). Junior Doctors oppose Bill".
  80. (1971). Knowledge From What? Chicago: Randy McNally and Company.
  81. (1989). Law and Medicine in Zimbabwe. Harare: Baobab Books in Association with the Legal Resources Foundation.
  82. (1994). Letter from Provincial Medical Director of Health Care Services, Ministry of Health and Child Welfare, to the Hospital Doctors Association, dated 29
  83. (1994). Letter from the Hospital Doctors' Association to the
  84. Limits to Medicine.
  85. Macro-economic Management, Adjustment and Stabilisation".
  86. (1993). McGowan allowed to Practise".
  87. (1994). McGowan trial - relevant witnesses not called by AG".
  88. (1994). McGowan wins Court Case".
  89. (1977). Medical Autonomy: Challenge and Response". In
  90. (1993). Medical Dental and Allied Professions (Information) Reizulations,
  91. (1988). Medical discipline in cross-cultural perspective: The United States, Britain and Sweden". In
  92. (1988). Medical Dominance in Britain: Image and Historical Reality".
  93. (1975). Medical Training in Rhodesia".
  94. (1987). Medicine and Labour: The Politics of a Profession. London: Lawrence and Wishort.
  95. (1972). Medicine as an Institution of Social Control".
  96. (1982). Methodological Issues in the Study of Bureaucratic Elites: A Case Study of West Point". In
  97. (1981). Minister Attacks Parasite Doctors".
  98. (1989). Ministry replies to ZIMA".
  99. (1982). Multiple Strategies in Field Research". In
  100. (1993). Nation faces shortage of Speech therapists".
  101. (1982). Observational Research on the National Front". In
  102. (1983). Occupational Monopoly and Modem Medicine.
  103. (1973). On the Professional Regulation of Change".
  104. (1990). Out dated Medical equipment Common".
  105. (1992). Parliament of Zimbabwe. Parliame ttary Debates,
  106. (1925). Parliamentary Publications and Reports Government of Zimbabwe.
  107. (1989). Physicians' Professional Autonomy in the Welfare States: Endangered or Preserved? ". In
  108. (1984). Planning for Equi! y in Health: A Sectoral Review Statement.
  109. (1994). Policy and Management Options for Parirenyatwa Group of Hospitals: Report of the Technical Committee. Unpublished report.
  110. (1989). Politicizing Medicine and Medicalising Politics: Physician Power in the United States". In
  111. (1995). Positive and negative factors in defensive medicine: A questionnaire study of General Practitioners".
  112. (1994). Poverty and Structural Adjustment in Zimbabwe.
  113. (1991). Power in Caring Professions.
  114. (1995). Private Eye, Heart and Hip.
  115. (1989). Problems of Organisational Rationality in Health Systems: Political Controls and Policy Options". In
  116. (1988). Profession of Medicine, Second edition.
  117. (1988). Professional Dominance or Proletarianisation?: Neither".
  118. (1995). Professional Dynamics and the Changing Nature of Medical Work".
  119. (1979). Professional Ideology and the Health Care System in Chile".
  120. (1972). Professions and Power.
  121. (1986). Progress and Problems in the Health Care Delivery system".
  122. (1986). Proletarianisation of Physicians or Organization of Health Services",
  123. (1973). Proletarianisation of the Professional".
  124. (1987). Qualitative Analysis for Social Scientists. Cambridge:
  125. Qualitative Data Analysis. London: Routledge Doyal, L and Pennell,
  126. (1994). Qualitative Data Analysis. Second edition.
  127. (1993). Qualitative Interviewing". In
  128. (1985). Qualitative Methodology and Sociology.
  129. (1988). Quantijy and Quality
  130. (1988). Re-examination of the Hypothesis of Physician Deprofessionalisation",
  131. (1992). Recent developments in medical quality assurance and audit: an international comparative study. " In
  132. (1992). Regulating British Medicine.
  133. (1989). Report of the Public Service Review Commission of Zimbabwe under the chairmanship of Professor
  134. (1958). Report of Visit to Central African
  135. (1980). Report on The Commission of InquiEy into Incomes, Prices and Conditions of Service. Harare: Government Printers. Riska, E. "The Professional Status of Physicians in the Nordic Countries"
  136. (1995). Restructuring health and welfare professions in the United Kingdom: the impact of internal markets on the medical, nursing and social work professions". In
  137. (1994). Return to Work or You are Fired".
  138. (1982). Sampling in Ethnographic Fieldwork",
  139. (1984). Second edition. Analysing Social SettjLi&s.
  140. (1938). SecretaKy's Report on the Public Health for the year 1937. Harare: Goverment Printers.
  141. (1963). Secretary's Report on the Public Health for the Year 1962. Goverment Printers.
  142. (1994). Self-help groups and their relationship to medicine". In
  143. (1996). Shot in the arm for Ministry".
  144. (1991). Should Zimbabwe Go Where Others Are Coming From? ".
  145. (1984). Socioloizical Research Methods: An Introduction. Second edition.
  146. (1991). Staff Retention in the Ministjy of Health. Unpublished report. Harare: Government of Zimbabwe.
  147. (1990). Stamps appeals for end to laxity at hospital".
  148. (1995). State control and the health professions in the United Kingdom: historical perspectives". In
  149. (1988). State of Crisis: International Constraints, Contradictions and Capitalism? " In
  150. (1987). State, Capital and Labour". In I. Mandaza (ed), Zimbabwe: The Political Economy of Transition 1980-1987,243-274.
  151. (1994). State's Position on Sacked Doctors".
  152. (1993). Structural Adjustment in Zambia and Zimbabwe.
  153. (1988). The African Colonial State and its Political Legacy".
  154. (1994). The alternatives to medicine". In
  155. (1994). The challenge of nursing". In
  156. (1988). The Changing Character of the Medical Profession: A Theoretical Overview",
  157. (1988). The Changing Character of the Medical Profession",
  158. (1995). The changing response of the medical profession to alternative medicine in Britain: a case of altruism or self-interest? ". In
  159. (1981). The Clinical Experience: The Construction and Reconstruction of Medical Realfty.
  160. The Combined and Contradictory Inheritance of the Struggle against Colonialism".
  161. (1967). The Discovejy of Grounded Theojy: Stratggýies for Qualitative Research,
  162. (1988). The Economy: Recognising the Reality".
  163. (1979). The Ethnographic Interview,
  164. (1959). The Fleminiz Letters (1894-1914). Salisbury: The Central African
  165. (1975). The Future Doctors of Rhodesia".
  166. (1995). The Incompetent Doctor: Behind Closed Doors.
  167. (1982). The Key Informant Technique: A Non-Ethnographic Application". In
  168. (1980). The Limits of Professional Power.
  169. (1982). The Making of a Female Researcher: Role Problems in Fieldwork". In
  170. (1993). The Medical Profession and the State' . In
  171. (1989). The Medical Profession in Transition".
  172. (1989). The NicaraRuan Experience.
  173. The One Party State and Democracy in Southern Africa: Towards a Conceptual Framework".
  174. (1988). The Organisation of Traditional Medicine in Zimbabwe".
  175. (1982). The Participant Observer as a Human Being: Observations on the Personal Aspects of Fieldwork". In
  176. (1988). The Political Economy of Health and Nutrition".
  177. (1988). The Political Situation".
  178. (1986). The Politics and Ethics of Field Work.
  179. (1991). The Politics of Professional Power: Medicine in the changing health service". In
  180. (1993). The Problems of Researching Sensitive Topics" In
  181. (1993). The Problems of Researching Sensitive Topics". In
  182. (1988). The Professional Dominance Perspective Revisited"
  183. (1993). The Professional Dominance, Deprofessionalisation, Proletarianisation, and Corporatisation Perspectives: An Overview and Synthesis" In
  184. (1989). The Reorganisation of the Medical Profession".
  185. (1979). The Report of the Committee formed to Investigate the Future of Medicine Under African Majority Rule. Harare (unpublished).
  186. (1987). The Shona Peoples. Third edition.
  187. (1982). The Social Transfonnation of American Medicine.
  188. The Sociological Review Monograph,
  189. (1988). The Sociology of Health and Healing. London: Unwin and Unwin.
  190. (1990). The State and Policy Making in Zimbabwe. Harare:
  191. The State and Politics in the Post-White Settler Colonial Situation".
  192. (1988). The State and the Development of Capitalism in Africa: IllIq Theoretical, Historical and Comparative Reflections". In
  193. (1989). The State and the Medical Profession: A
  194. (1993). The State and the Post-independence Economy of Zimbabwe.
  195. (1979). The Struggle for Health. Gwelo:
  196. (1992). The Tort System and Information: Some comparisons between
  197. (1988). The Transformation of Zimbabwe's Health Care: A Review of the White Paper on Health",
  198. (1988). The Transition To Socialism in Zimbabwe: Some Areas of Debate".
  199. (1961). The Way to Remedy the Present Shortage of Doctors".
  200. (1985). Third World Politics.
  201. (1988). Threat to Strike: Doctors Warned of Heavy Penalty".
  202. (1985). Towards the Proletarianisation of Physicians".
  203. (1978). Traditional Healers and the Shona Patient.
  204. (1988). Turf Battles and the Theory of Professional Dominance".
  205. (1985). Two Models for Change in the health services in Zimbabwe".
  206. (1994). Understanding medical dominance in the modern world".
  207. (1993). UZ students fast over McGowan". In Herald,
  208. (1982). Warning to State Doctors".
  209. (1973). Whither Medicine in Rhodesia? "
  210. (1972). Whither Medicine in the Next Five Years".
  211. (1979). Who Should Know What?
  212. (1990). Zambia".
  213. (1988). ZCTU backs Doctors Strike but ......
  214. (1990). Zimbabwe: Public Service (Maintenance of Services) Regulations,
  215. Zimbabwe: The Political Economy of Transition,
  216. (1993). ZMA Announces System to monitor Doctors Conduct".

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