Delivering Health Services in a Rural Ethiopian Hospital: Employing practice theory to understand the role of health system bureaucracy, electricity, electric equipment and electric light

Abstract

As the global health community seeks to, “ensure healthy lives and promote wellbeing for all”, as outlined in the Sustainable Development Agenda, unreliable electricity in health facilities is one challenge that needs attention. However, in a public health field dominated by quantitative research methods, a comprehensive understanding of how health workers and their daily tasks are affected by this condition is lacking. Using qualitative methods, including interviews and participant observation, this study seeks to remedy this information-gap by first answering: How does the health system bureaucracy and the availability of electricity, electric equipment and electric light influence the way workers at a rural Ethiopian hospital perform their jobs and deliver health services? Practice theory is then used to expand this analysis and consider: How are the health care practices of hospital workers, particularly electricity-dependent ones, shaped by social norms and cultural values, the material resources at workers’ disposal, as well as workers’ knowledge, skills and motivation levels? The findings show that a number of routine health care practices were imbedded in the daily work life of hospital staff and were performed more or less habitually. These routines continued in spite of resource gaps, while others had developed as a response to gaps that staff had come to anticipate. However, the unpredictability of the situation hospital staff worked in and the unreliable availability of certain highly consequential resources meant that other routines were constantly changing or that in certain situations routines could not be formed at all. To understand these findings the study considers how hospital workers’ past experiences and consequent knowledge have shaped their workplace actions. The analysis shows that a strong cultural preference in Ethiopia for urban settings resulted in poor recruitment and retention of staff at the hospital, meaning skills levels were generally low. The study also reflects on the apathy among staff resulting from unreliable availability of electricity, electric equipment and other essential resources, as well as staffs’ general dislike of generators due to the heavier work burden they created. The study demonstrates that the inclusion of qualitative research methods will be essential as the global health community seeks to understand the realities health workers in LMICs face and identify ways for them to find job satisfaction and deliver quality health services.