'Conceiving' maternal child healthscapes in rural Uganda

Abstract

This thesis examines the complexities of delivering high quality pro-poor maternal child healthcare. The research recognises that good maternal child health (MCH) is a fundamental development imperative in which initiatives are not achieving targets. There is a chronic deficit of well trained healthcare workers and increasing reports of abuse being suffered by poor patients. The research suggests that current mechanistic results orientated approaches to healthcare should be foregone in favour of an appreciation of the fundamentally fluid and social nature of health and healthcare delivery. It is also suggested that whilst current literature focus on either a patient or a healthcare provider perspective, a complete picture of the healthcare transaction is generated by examining the relationship between the two. This research aims to unpack the realities of delivering high quality, pro-poor MCH in the chronically poor district of Kibaale, mid-western rural Uganda.Standing at a disjuncture between policy, conceptual theory and empirical research, this thesis presents the conceptual tool of 'healthscapes'. It is suggested that healthscapes are an effective approach to read the hegemonic social values of power, gender and care operating in place. Taking a relational view of space and place, it is suggested that individuals plot routes to achieve health aims through a 'terrain' constructed by their health knowledge embedded in place. This constructs a knowledge base for individuals which can become authoritative, potentially enabling them to construct informal spaces of health within the formal setting. In the informal spaces, individuals can adapt their behaviour to overcome barriers to the healthcare transaction and ultimately achieve their health goals. By contemplating the healthcare transaction from both the health-seekers' and the healthcare providers' perspectives, the post-structural approach challenges conventional understandings of power in health. This nuanced social insight into health-systems could thus be used to inform policy. Based on 18 months of ethnographic fieldwork, the healthscape concept was used to unpack MCH transactions within Bunyoro as a whole, the Antenatal Clinic and the Maternity Ward. The research discovered that despite the prevailing negative perceptions of the government institution, over 60 women attended antenatal a week whilst only five delivered within the maternity ward. The research suggests that within the antenatal clinic, women were able to use their extensive place-based authoritative knowledge to construct informal spaces in which they could influence the healthcare transaction to achieve their antenatal aim. Due to cultural constructions of childbirth, if women presented at the maternity clinic it was ordinarily for emergency reasons. Their lack of experience and need for care meant they had little place-based authoritative knowledge to influence the healthcare transaction and were subjected to the biomedical gaze.

Date of Award	1 Aug 2011
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Neil Coe (Supervisor) & Christopher Perkins (Supervisor)