"Now There is No Treatment for Anyone": Health Care Seeking in Neoliberal Nicaragua

Persistent Link:
http://hdl.handle.net/10150/194945
Title:
"Now There is No Treatment for Anyone": Health Care Seeking in Neoliberal Nicaragua
Author:
Tesler, Laura Eve
Issue Date:
2006
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
Over the course of the twentieth century, the quality, quantity and accessibility of health care services in Nicaragua were remarkably altered in accordance with the agendas of stakeholders in the national government and providers of "development aid", many of whose objectives were as much or more political as they were humanitarian. Much of the international health literature has focused on sociocultural factors that impact health care seeking, yet little research has been conducted on the political economic dimensions. This dissertation examines how sociocultural factors, political economy and social relations interacted in health care seeking decision-making among 50 poor and lower-middle-income households in Nicaragua, a country with high rates of poverty, child morbidity and child mortality. Attending to the ways that global and national policies were experienced in a local setting, the study provides an in-depth analysis of health care services in a country that has undergone three major regime changes within the last 25 years. How did the ideology of each regime influence health care, and how did the state influence both health staff and the lay population, especially with regards to people's expectations and understandings of the allocation of responsibility for health?The data indicate that health care services have significantly worsened during the recent years of neoliberal-oriented governance, concordant with an increase in economic insecurity. In conjunction with these macro-level processes, conditions of poverty have undermined people's ability to maintain longstanding reciprocal exchange relations and health care responsibilities. In ideology and praxis, the struggle between an ethos of solidarity and cooperation, versus one of individual competition and self-preservation, was engaged on a daily basis within and across extended households of kin, as well as between and among health care seekers and practitioners. Local level efforts to make up for the gap in government responsibility were limited precisely because the policies implemented by the government and international bodies undermined them. Neither the state nor civil society currently possesses the capacity to meet the basic health needs of the majority of Nicaraguans. For communities to thrive, the state must restore its safety net of health and other basic services.
Type:
text; Electronic Dissertation
Keywords:
Health Care Seeking; Nicaragua; Neoliberalism; Development; Health Policy; Political Economy of Health
Degree Name:
PhD
Degree Level:
doctoral
Degree Program:
Anthropology; Graduate College
Degree Grantor:
University of Arizona
Advisor:
Nichter, Mark A.
Committee Chair:
Nichter, Mark A.

Full metadata record

DC FieldValue Language
dc.language.isoENen_US
dc.title"Now There is No Treatment for Anyone": Health Care Seeking in Neoliberal Nicaraguaen_US
dc.creatorTesler, Laura Eveen_US
dc.contributor.authorTesler, Laura Eveen_US
dc.date.issued2006en_US
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractOver the course of the twentieth century, the quality, quantity and accessibility of health care services in Nicaragua were remarkably altered in accordance with the agendas of stakeholders in the national government and providers of "development aid", many of whose objectives were as much or more political as they were humanitarian. Much of the international health literature has focused on sociocultural factors that impact health care seeking, yet little research has been conducted on the political economic dimensions. This dissertation examines how sociocultural factors, political economy and social relations interacted in health care seeking decision-making among 50 poor and lower-middle-income households in Nicaragua, a country with high rates of poverty, child morbidity and child mortality. Attending to the ways that global and national policies were experienced in a local setting, the study provides an in-depth analysis of health care services in a country that has undergone three major regime changes within the last 25 years. How did the ideology of each regime influence health care, and how did the state influence both health staff and the lay population, especially with regards to people's expectations and understandings of the allocation of responsibility for health?The data indicate that health care services have significantly worsened during the recent years of neoliberal-oriented governance, concordant with an increase in economic insecurity. In conjunction with these macro-level processes, conditions of poverty have undermined people's ability to maintain longstanding reciprocal exchange relations and health care responsibilities. In ideology and praxis, the struggle between an ethos of solidarity and cooperation, versus one of individual competition and self-preservation, was engaged on a daily basis within and across extended households of kin, as well as between and among health care seekers and practitioners. Local level efforts to make up for the gap in government responsibility were limited precisely because the policies implemented by the government and international bodies undermined them. Neither the state nor civil society currently possesses the capacity to meet the basic health needs of the majority of Nicaraguans. For communities to thrive, the state must restore its safety net of health and other basic services.en_US
dc.typetexten_US
dc.typeElectronic Dissertationen_US
dc.subjectHealth Care Seekingen_US
dc.subjectNicaraguaen_US
dc.subjectNeoliberalismen_US
dc.subjectDevelopmenten_US
dc.subjectHealth Policyen_US
dc.subjectPolitical Economy of Healthen_US
thesis.degree.namePhDen_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplineAnthropologyen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.advisorNichter, Mark A.en_US
dc.contributor.chairNichter, Mark A.en_US
dc.contributor.committeememberGreen, Linda B.en_US
dc.contributor.committeememberLansing, J. Stephenen_US
dc.contributor.committeememberNichter, Mimien_US
dc.identifier.proquest1467en_US
dc.identifier.oclc659746255en_US
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