Abstract
We assessed how the everyday work challenges that frontline health workers (FRHWs) face in the government health sector in northern Uganda influence their trust in the Ministry of Health (MOH). We employed qualitative research techniques, including interviews and participant observation, over a 9-month period to examine FRHWs’ viewpoints about how the MOH should address these challenges in service delivery. One hundred and sixty-five FRHWs, of whom 48 were recruited for extensive follow-up, participated in our study. Key findings include distrust in the MOH is prevalent among FRHWs, there is a lack of trust in the organization’s coordination role in service delivery and this affects health care delivery to patients, interrelations, and provider cooperation. Therefore, restoring trust in government hospitals will require a truthful non-violent response by the MOH in its contractual agreement with FRHWs. In our analysis, we employ Habermas’s Theory of Communicative Action.
Highlights
There is an ongoing debate about the role of trust and distrust in organizational performance, in particular, how trust influences access, retention, and performance within health care systems, as well as epidemic response and preparedness
That is, when we analyze how to restore trust, we deliberately present the viewpoints of the weaker side (FRHWs), which are directed to the stronger side, to align our arguments with Habermas’s (1984) analysis that a change—or a transformation— in asymmetric relationships happens only when it is publicly identified in the subjective language of the weaker side
One clinical officer2 in a government hospital, upon being asked why he always prescribed an expensive antimalarial to resource-poor patients, expressed his dismay at policy guidelines drafted in 2005 (MOH, 2005) recommending that Coartem be prescribed as the first-line drug for uncomplicated malaria, which the Ministry of Health (MOH) distributed to hospitals in early 2006, in the following terms:
Summary
There is an ongoing debate about the role of trust and distrust in organizational performance, in particular, how trust influences access, retention, and performance within health care systems, as well as epidemic response and preparedness. The lack thereof, influenced the preparedness for and response to the West African Ebola virus epidemic of 2015– 2016. Distrust was reinforced by resentment toward governments and manifested itself in a denial [by the people at high risk] of the epidemic and resistance to disease control programs (Spencer, 2015). Further studies show how trust facilitates collective action and the cooperation of people to achieve goals. When a patient trusts a provider, there can be a direct therapeutic effect, because trust facilitates disclosure and the patient may have greater autonomy and decision-making power (Mechanic, 1998)
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