Culturally Competent Health policy: Developing Country Context Shahaduz Zaman Ph.D.

1. Culturally Competent Health policy: Developing Country Context Shahaduz Zaman Ph.D. Institute of Health and Society

2. Topics to cover • Concept of culture • Relation between culture and health • Historical and cultural context of health policies in developing country • Culturally competent health policy

5. Baby turns blue and red with high fever The baby was born without skilled attendant Pregnant mother did not get the TT Health Services Disease: Tetanus Baby dies on the way…… Mother decides for Health Centre Infra- structure Power relationship Slow transport Grandfather stops them Poverty Health Seeking Behavior Cultural belief Baby gets further worse- decision to take to clinic- short of money Grandfather recites Holy Quran and prays Baby gets worse - taken to a Traditional healer

6. Health Services Disease The baby was born without skilled attendant Pregnant mother did not get the TT Baby turns blue and red with high fever Slow transport Infra- structure Mother decides for health centre Power relationship Grandfather stops them Baby gets further worse- decision to take to clinic- short of money Poverty Grandfather recites Holy Quran and prays Baby gets worse - taken to a Traditional healer Health Seeking behavior Cultural belief

7. Why it is important to have a culturally competent health policy ? Is cultural perception a barrier to global health interventions?

8. Concept of ‘Culture’

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12. Culture is the customs, ideas, symbols, artifacts, and languages that human beings in groups share with and learn with one another.

13. Culture • That Complex whole which includes knowledge, belief, art, morals, law, custom, and other capabilities and habits acquired by man as a member of society.(Edward Tylor 1871)

14. Culture

15. Iceberg Model of Culture (Edward Hall:1976)

16. Two basic bodily functions of human being • Eating • Defecating

19. Slum in Mexico

20. How to deal with the beliefs and behaviors that are different from my own?Ethnocentrism

21. Ethnocentrism The tendency to view the world through the narrow lens of ones own culture or social position.

22. Cultural relativism • The idea that each culture must be understood in terms of the values and beliefs of that culture and should not be judged by the standard of another culture.

23. Critical cultural relativism • Offers an alternative view that poses questions about cultural practices and ideas in terms of who accepts them and why and who they might be harming or helping.

24. It is important not to take things for granted

25. A different point of view is simply the view from a place where you are not

26. Victory

27. Defeat

28. Is it possible to see the world through the eyes of others?

29. Two crucial terms • Emic view • Etic view

30. Emic View • Refers to what insiders do and perceive about their culture. It included their perceptions of reality and their explanations for why they do what they do.

31. Etic view • Refer to the analytical framework and tools used by outsiders in searching for patterns of the insiders culture.

35. How Emic/Etic works in global health context?

36. Illness (Emic view) Disease (Etic) • Subjective • Contextual • Lay knowledge • Objective • Universal • Science Patients come to a doctor’s chamber with an illness and leaves with a disease

37. As public health professional our focus is on the population.

38. How population developed cultural perception?

39. It is therefore important to consider the following question while thinking of policies in health intervention.

41. Health Policies in Developing Countries: Historical Perspective

43. Phases: 1900-1940’s Colonial Medical services: Protection of native labour force Protection of the expatriate community Missionary medical service

44. The peaceful and civilizing influence of the work done in the dispensaries and by regimental surgeons on the frontiers of India has been in political importance equivalent to the presence of some thousands bayonets. It is because of such unexpected philanthropy that, as conquerors, we hold a position in the minds of the people which would not otherwise be possible. (Crawford : Medical Gadget of India 1914)

45. Phases: 1940’s-1960’s National Medical Service: Independence movement Hospital centred services Medical and nursing training Vertical disease programme: - single purpose - specific worker: Small pox worker, TB worker, malaria worker….

46. Phases: 1960’s to 1980’s Basic Health Services: Radical changes – Policy driven by WHO, UNICEF District Hospitals to: - Rural health centres - Community health centres Integration of vertical programmes Multitasking workers: multipurpose health care worker

47. Phases: 1980’s to Present Primary Health Care: • 1978 - Declaration of Alma Ata • 1980 - WHO Policy – Health For All 2000 Primary Health Care: 1 Essential health care 2 Socially acceptable 3 Accessible 4 Affordable 5 Community Participation 6 Scientific

48. Millennium Development Goals (MDGs): Formulated in 2000 at the United Nations Millennium Summit Goal 1: Eradicate Extreme Hunger and Poverty Goal 2: Achieve Universal Primary Education Goal 3: Promote Gender Equality and Empower Women Goal 4: Reduce Child Mortality Goal 5: Improve Maternal Health Goal 6: Combat HIV/AIDS, Malaria and other Diseases Goal 7: Ensure Environmental Sustainability Goal 8: Develop an Global Partnership for Development

49. Current Challenges of Health Policy Making in Developing countries Diversity Complexity Priority setting Change

50. Diversity • Great diversity within developing countries in terms of geographical, ecological, economical, cultural dimensions. But common: • Fragile health systems • Insufficient resources