Refer rather than treat
Coping with uncertainty in municipal primary care clinics in India
Datos Bibliográficos
| ID | 11194993 |
|---|---|
| Autores | Radhika Gore (0000-0001-7564-6808, New York University, autor de correspondencia) |
| Año | 2024 |
| Volumen | 44 |
| Número | 3/4 |
| Páginas | 325-340 |
| Fecha de publicación | 2024-04-04 |
| Peer Reviewed | Sí |
| Open Access | Sí |
| Tipo | ARTICLE |
| Revista | International Journal of Sociology and Social Policy (JOURNAL) |
| Identificadores de la revista | ISSN: 0144-333X • E-ISSN: 1758-6720 |
| Editorial | Emerald (PUBLISHER) |
| DOI | 10.1108/ijssp-04-2023-0090 |
| OpenAlex | W4391563117 |
| Idioma | EN |
| Citas recibidas | 2 |
| Referencias citadas | 52 |
Purpose The institutional conditions of primary care provision remain understudied in low- and middle-income countries. This study analyzes how primary care doctors cope with medical uncertainty in municipal clinics in urban India. As street-level bureaucrats, the municipal doctors occupy two roles simultaneously: medical professional and state agent. They operate under conditions that characterize health systems in low-resource contexts globally: inadequate state investment, weak regulation and low societal trust. The study investigates how, in these conditions, the doctors respond to clinical risk, specifically related to noncommunicable diseases (NCDs). Design/methodology/approach The analysis draws on year-long ethnographic fieldwork in Pune (2013–14), a city of three million, including 30 semi-structured interviews with municipal doctors. Findings Interpreting their municipal mandate to exclude NCDs and reasoning their medical expertise as insufficient to treat NCDs, the doctors routinely referred NCD cases. They expressed concerns about violence from patients, negative media attention and unsupportive municipal authorities should anything go wrong clinically. Originality/value The study contextualizes street-level service-delivery in weak institutional conditions. Whereas street-level workers may commonly standardize practices to reduce workload, here the doctors routinized NCD care to avoid the sociopolitical consequences of clinical uncertainty. Modalities of the welfare state and medical care in India – manifest in weak municipal capacity and healthcare regulation – appear to compel restraint in service-delivery. The analysis highlights how norms and social relations may shape primary care provision and quality
Coping (psychology · Economic growth · Economics · Family medicine · Health care · Political science · Primary care · Primary health care · Psychiatry · Global Maternal and Child Health · Global Public Health Policies and Epidemiology · Healthcare Systems and Reforms · Medicine · Nursing · Psychology
How to prove, how to interpret and what to do? Uncertainty experiences of street-level tax officials
A Public Service Gap
The political origins of health inequity
What is the private sector? Understanding private provision in the health systems of low-income and middle-income countries
Building the Field of Health Policy and Systems Research
High-quality health systems in the Sustainable Development Goals era
Talk, Work and Institutional Order
Reforming the regulation of medical education, professionals and practice in India
Strengthening medical specialisation policy in low-income and middle-income countries
Policy improvisation
Recontextualizing street‐level bureaucracy in the developing world
The State, Legal Rigor, and the Poor
Politics and practices of global health
The power of popular opinion in everyday primary care provision in urban India
Designing a comprehensive Non-Communicable Diseases (NCD) programme for hypertension and diabetes at primary health care level
Practice and power
Street-level bureaucracy in weak state institutions
Coping During Public Service Delivery
Decentred regulation
What explains regulatory failure? Analysing the architecture of health care regulation in two Indian states
Team-based primary health care for non-communicable diseases
Redesigning Primary Care to Tackle the Global Epidemic of Noncommunicable Disease
Law, Medicine, and Trust
Hybrid Regimes for Local Public Goods Provision
Paying for performance and the social relations of health care provision
Ensuring the ordinary
From Farming to Development
On the enchantment of the state
Quality of clinical care and bypassing of primary health centers in India
Tolerance of uncertainty
Talk Is Cheap
| Obras citantes distintas | 2 |
|---|---|
| Citas por año | 2 |
| Intervalo de citas | 2025 - 2026 (2) |
| Velocidad de citación | current |
| Altamente citado | No |
| Tipos de cita | Neutras: 2 |