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A System in Crisis: Ethical Concerns about Zimbabwean Healthcare in the 21st Century.

Moyana, Farayi (2017-12)

Thesis (MPhil)--Stellenbosch University, 2017.

Thesis

ENGLISH SUMMARY: Health care services in post-independent Zimbabwe have undergone turbulence with periods of seemingly significant improvements and other periods of definite decline. This thesis looks at health-care systems in general and in particular, the way in which they are reflected through the health-care system of Zimbabwean. Ethical issues and challenges in health care can take many forms ranging from debates and discussions on the fairness or the lack thereof in the health-care reform process, the ethics of inter-professional relationships, the ethical problems with doctorpatient relationships, the state of advocacy in health matters, and patient rights, ethical perspectives influencing discourses on health systems, the ethics of health-care funding, and debates on access to health care. This thesis reflects on the complexities of the challenges, needs and reform requirements of the Zimbabwean situation. A critical analysis of the ethical principles, their impact on the Zimbabwe health care system, using largely the principlist approach as enunciated by Beauchamp and Childress (2013), is conducted. Other moral theories such as the social contract theory is also discussed in some detail because of its important application to issues related to health care. A whole chapter is dedicated to the principle of distributive justice and its relevance and implications for the health care systems in general, but also with particular relevance to the situation in Zimbabwe. Lack of or inadequate insurance is the biggest economic hurdle in accessing health care in many low income countries. There are two main arguments, which appear to support some sort of moral right to a health care funded by the government – “the collective social protection” and the “fair opportunity arguments” (Beauchamp & Childress, 2013). Both of these arguments are discussed in detail. Right to health and right health care are two concepts which confuse a lot of readers because they are close but refer to different dimensions of the concept of health. They are discussed with a particular emphasis on the ethical issues involving allocation of health resources, rationing and setting of priorities. This thesis winds up by looking at the possible solutions to the health crisis in Zimbabwe. The much-flaunted National Health Insurance, amongst other possible remedies, is analyzed. A list of recommendations is outlined, in the last chapter.

AFRIKAANS OPSOMMING: Gesondheidsorgdienste in post-onafhanklike Zimbabwe het turbulensie ondergaan met periodes van oënskynlik beduidende verbeteringe en ander tydperke van definitiewe afname. Hierdie tesis ontleed gesondheidsorgstelsels in die algemee, met spesiale verwysing na die gesondheidsorgstelsel van Zimbabwiese. Etiese kwessies en uitdagings in gesondheidsorg kan baie vorme van debatte aanneem, byvoordeeld besprekings oor die regverdigheid of die gebrek daaraan in die hervormingsproses vir gesondheidsorg, die etiek van interprofessionele verhoudings, die etiese probleme met doktor-pasiëntverhoudinge, die staat van voorspraak in gesondheidsake, pasiënt-regte, etiese perspektiewe wat diskoerse op gesondheidstelsels beïnvloed, die etiek van gesondheidsorgbefondsing en debatte oor toegang tot gesondheidsorg. Hierdie tesis bespreek die kompleksiteit van die uitdagings, behoeftes en hervormingsvereistes van die Zimbabwiese situasie. ‘n Kritiese analise van die etiese beginsels en die impak daarvan op die Zimbabwiese gesondheidsorgstelsel, word hoofsaaklik gebruik deur die beginsel-benadering van Beauchamp en Childress (2013). Ander morele teorieë soos die sosiale kontrakteorie word ook bespreek as gevolg van die belangrike toepassing daarvan op probleme wat verband hou met gesondheidsorg. 'n Hele hoofstuk word gewy aan die beginsel van distributiewe geregtigheid en die relevansie en implikasies daarvan vir die gesondheidsorgstelsels in die algemeen, maar ook met betrekking tot die situasie in Zimbabwe. Gebrek aan of onvoldoende versekering is die grootste ekonomiese struikelblok in die verkryging van gesondheidsorg in baie lae-inkomste lande. Daar is twee hoofargumente wat blykbaar 'n morele reg op 'n gesondheidsorg wat deur die regering befonds word - "die kollektiewe sosiale beskerming" en die "billike geleentheidargumente" (Beauchamp & Childress, 2013) - ondersteun. Albei hierdie argumente word breedvoerig bespreek. Reg op gesondheid en regte gesondheidsorg is twee konsepte wat baie lesers verwar omdat hulle betekenisse verwant is, maar hulle tog onderskeidelik verwys na verskillende dimensies van die konsep van gesondheid. Hulle word bespreek met spesifieke klem op die etiese kwessies wat die toekenning van gesondheidsbronne, rantsoenering en die opstel van prioriteite insluit. Hierdie tesis druk ook deur na moontlike oplossings vir die gesondheidskrisis in Zimbabwe. Die veelbelowende Nasionale Gesondheidsversekering, word onder andere ontleed. 'n Lys aanbevelings word in die laaste hoofstuk uiteengesit.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/102987
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