EQUINET Discussion Paper 69: How power relations affect the implementation of policy on equity in access to anti-retroviral therapy: The case of rural health centres in Malawi,
LK Simwaka
Cite as: Simwaka LK (2008) 'How power relations affect the implementation of policy on equity in access to anti-retroviral therapy: The case of rural health centres in Malawi,' EQUINET Discussion Paper 69. Malawi Interfaith AIDS Association EQUINET: Harare.
Available online at:
http://www.equinetafrica.org/bibl/docs/DIS69POLsimwaka.pdf
The national ART scale-up plan contains several measures to promote equity, considering also that there are insufficient resources to cover everyone who is eligible. Thus study focused on four of these covering ART enrolment on an open 'first-come, first-served' basis; targeted gender-sensitive health promotion of ART, measures to overcome specific geographical barriers to access for remote populations and prioritisation of people already on ART, pregnant women and young children. Using a case study approach the study analysed the power relations that influenced outcomes on these policy measures on four health facilities in Malawi. The findings indicate that health workers commonly exercise power in relation to patients, and that patient acquiesce with health worker behaviours. In poorly performing facilities, implementation of policy measures is negatively affected by managerial practices that discourage teamwork and de-motivate health workers, while in the two better performing facilities, management practices had a more positive role in supporting positive health worker practices. The study findings highlight that implementing equity policies needs to include measures to orient and involve staff, and address power and resource imbalances that can undermine access.
December 2008
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Rene Loewenson
mailto:rene@tarsc.org