Doctors as the governing body of the Kurdish health system: exploring upward and downward accountability among physicians and its influence on the adoption of coping behaviours

Human Resources for Health

Chris Willott²  Goshan Karadaghi¹ 

[1] Department of Family and Community Medicine, University of Sulaimaniyah, Sulaimaniyah, Kurdistan Region, Iraq;Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK

关键词: Coping strategies;    Discontent;    Street-level bureaucracy;    Discretion;    Kurdistan;    Health system;   

Others  :  1213773
DOI  :  10.1186/s12960-015-0039-x

 received in 2014-09-19, accepted in 2015-05-25,  发布年份 2015

【 摘 要 】

Background

The health system of Iraqi Kurdistan is severely understudied, particularly with regard to patient-physician interactions and their effects. We examine patterns of behaviour among physicians in Kurdistan, the justifications given and possible enabling factors, with a view to understanding accountability both from above and below.

Methods

An ethnographic study was conducted in the Sulaimaniyah Teaching Hospital in the Kurdistan Region of Iraq. Data was collected through negotiated interactive observation, and interviews were conducted with 10 participants, 5 physicians and 5 patients. Data collected was analysed using thematic analysis.

Results

Common patterns of practice among physicians in Kurdistan include displays of discontent, reluctance to negotiate decisions with patients and unfavourable behaviours including dual practice and predatory behaviours towards patients. These behaviours are justified as a mechanism of dealing with negative aspects of their work, including overcrowding, low salaries and social pressure to live up to socially conceived ideas of a physician’s identity.

Conclusions

Michael Lipsky’s theory of street-level bureaucrats and their coping behaviours is a useful way to analyse the Kurdish health system. Physician behaviours are enabled by a number of factors that work to enhance physician discretion through lowering of upward and downward accountability. Physicians are under very little pressure to change their behaviour, and as a result, they effectively become the street-level governing body of the Kurdish health system.

【 授权许可】

   
2015 Karadaghi and Willott.

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