situating responsibility for the control of infectious disease: the work of lay hiv counsellors in...
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Situating responsibility for the control of infectious disease: the work of lay HIV counsellors in South Africa. Hayley MacGregor. The ESRC STEPS Centre. S ocial T echnological and E nvironmental P athways to S ustainability. STEPS Challenges. - PowerPoint PPT PresentationTRANSCRIPT
Dr Hayley MacGregor, 13 Dec 2011
Situating responsibility for the control of infectious disease:
the work of lay HIV counsellors in South Africa
Hayley MacGregor
The ESRC STEPS CentreSocialTechnological andEnvironmentalPathways toSustainability
Dr Hayley MacGregor, 13 Dec 2011
STEPS Challenges• Understanding development-science interfaces in
a highly dynamic world• Linking environmental sustainability with poverty
reduction and social justice• Making science and technology work for the poor• Across 3 domains: Health, Agriculture and Water• Challenging conventional approaches of separate
sectors and disciplinary silos
www.steps-centre.org
Dr Hayley MacGregor, 13 Dec 2011
Key features of STEPS Approach
• Different FRAMINGS of systems: different ways of representing a system or problem
• A politicised view of ‘systems’ and their dynamic environments
• Acknowledging the politics of knowledge• Addressing governance: power, politics and institutions
www.steps-centre.org
Dr Hayley MacGregor, 13 Dec 2011
‘system’
environment
System:Social, institutional, ecological and technological elements interactingIn dynamic ways
A systems perspective
Dr Hayley MacGregor, 13 Dec 2011
Framings: Different ways of understanding or representing a system and its relevant environment
Integrating knowledge and values: Framing
Dimensions of framing
- Scale- Boundaries
- Key elements and relationships
- Dynamics in play- Outputs
- - Perspectives- - Interests- - Goals- Values- - Notions of relevant
experience
Dr Hayley MacGregor, 13 Dec 2011
Pathways Approach
• In a given situation we might ask:– Who are the actors?– How is the system and goals for change FRAMED?– How is the ‘public’ constructed?
• Identify PATHWAYS of response• Pay attention to alternative and marginalised
perspectives• Constructing pathways to sustainability requires
recognition and deliberation amongst multiple perspectives and possible pathways
Dr Hayley MacGregor, 13 Dec 2011
Epidemics and policy
• Epidemics: Science, Governance and Social Justice
• Avian Influenza: Science, Policy and Politics
Dr Hayley MacGregor, 13 Dec 2011
HIV: a chronic illness
• Different framings of the problem of disease control
• Different understandings of the role of lay HIV counsellors
• Shifting meanings of ‘counselling’• A case study in Khayelitsha, Cape Town
Dr Hayley MacGregor, 13 Dec 2011
Dr Hayley MacGregor, 13 Dec 2011
Dr Hayley MacGregor, 13 Dec 2011
Qualitative Methodology
• In depth interviews with 20 facility-based lay counsellors
• Interviews with their supervisors in the contracting NGO
• Participant observation of their training• Key informant interviews • Background of a new policy framework• Previous fieldwork in Khayelitsha
Dr Hayley MacGregor, 13 Dec 2011
The perspective of lay counsellors:
• Hybrid notions of ‘counselling’• The importance of formal and informal
care practices• Perception of themselves as brokers
between the clinic and the community• Complex understandings of ‘responsibility’
for illness
Dr Hayley MacGregor, 13 Dec 2011
Their working conditions
• Anxiety about task shifting and increasing responsibility
• Anxiety about associated risks• The politics of professionalisation• Concerns about targets: ‘the stats’• Concerns about reduced time with clients:
shifts in their practice and the effect on the nature of care
Dr Hayley MacGregor, 13 Dec 2011
Conclusions
• The importance of relationships with clients
• The dangers of managerialism• Building on the idea of ‘brokers’: helping
others negotiate the health system• Adequate supervision• A critical perspective on discourses of
responsibility
Dr Hayley MacGregor, 13 Dec 2011
A new policy framework
• Re-engineering Primary Health Care in SA: the role of community careworkers?
• UNAIDS/Cordaid cross-country study: case studies and identifying advocacy points with the help of an advisory board
• The value of different kinds of evidence• Anthropology and interdisciplinarity• The politics of policy processes
The STEPS Centre’s Approach
Working papers and briefings free to download on www.steps-centre.org