Cross-Cultural Health Management

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· Cross-cultural Management

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Cross-cultural Management of Health Sector Projects: HIV/AIDS and TB

Cross-cultural Management of Health Sector Projects

Introduction to the Project

We have developed a collaborative, multidisciplinary, research project¹. Our premise is that in an area where billions of dollars are being spent, the international and cross-cultural management of programmes and projects has been neglected. This is possibly to the detriment of effective and appropriate health service delivery.

The project seeks to identify and tackle the reasons for any obstacles within a general international governance structure, between resources and achievements in combating HIV/AIDS and TB. We are doing this by focusing on intercultural management issues of programme and project delivery at international, national and local levels, and the connections among these levels.

We are conceptualizing individual organizations and projects within this international governance structure as operating at the interface of both cultural and institutional relationships, within a power dynamic. We are therefore taking account of relations among policy makers (often at international level), policy interpreters (often at national level) and policy implementers (at local level, often with very weak feedback loops to the higher hierarchical levels). The power dynamics are being conceived institutionally in terms of Dependency Theory, and culturally through Postcolonial Theory (which again looks at dependencies, but through the image that the West projects of the non-West, and how this is internalized by local level players, making it difficult to adopt indigenous approaches and solutions).

We investigated this empirically through a focus on specific cases through teams of ‘network researchers’. Each researcher is studied a project, programme or organization, such as a local clinic, NGO, pharmaceutical company, health department, or international organization, at various positions in the international governance structure. Each team and individual researcher was guided by a set of research questions agreed across the research project. Specific research methods were formulated by the team together with the individual researcher. Hence some used extended participant observation, others used interviews or a combination of methods.

Future Research

1. Expanding geographically in Africa. The project has focused on South Africa and Botswana. This in itself is giving us useful areas for comparison (e.g. in government policy and its implications; the nature of international cooperation such as the extensive current interests of American funders in Botswana, and implications). We plan to extend the project to other Africa countries

2. Deepening empirically within South Africa and Botswana and in the international governance structure. The original project is modestly funded for one year, with an emphasis on building the partnership. There is still scope to extend our studies to include more and different types of organization, and at different levels, and multiple perceptions of these organizations through their interactions with other organizations and stakeholders within the governance structure. This would not just extend our coverage, but would provide a greater understanding of interaction of organizations and projects, and where the blockages may exist between resources inputted, and achievements, and possibly how to fix them – providing more complete policy and practice guideline to ensure effectiveness and appropriateness of HIV/AIDS and TB health service delivery.

3. Developing theoretically, and across disciplines. One of the strengths of the project was seen as its interdisciplinary nature. The collaboration between management, development and health studies has been invaluable in considering interactions between the macro and micro levels, and with sociology/social anthropology in clarifying and integrating issues such as culture and ethnicity as well as wider factors, as they relate to health project delivery. There might be an opportunity, for example to also include other disciplines such as legal studies. There is interest in both corruption and how this might contribute to blockages within the governance structure, and how this might be analysed both legally and cross-culturally. Areas for future project developments may include the following:

¨ Working with multiple cultural identities, and policy and practice in clinical interventions. There are some interesting aspects of this when power and dependencies are considered in a global context, and how this reflects on cultural identities and clinical interventions. The prevalence of HIV/AIDS in Africa reinforces (postcolonial) perceptions in the West of Africans as dependent. This not only may influence the way interventions are managed, but also reflect back on the identities of local communities and individuals. The question therefore becomes, not just how do we manage cultural difference between, say manager or clinician and community, but how do we manage the power relationships, and the consequences in terms of cultural identities and cross-cultural interactions, and the effectiveness and appropriateness of interventions. This research could be undertaken at a (societal) micro level, and its outcomes having more relevance to managers and practitioners. Closely related to this, and aimed more at policy levels is the following.

¨ International governance structure and the effectiveness/appropriateness of interventions. Seckinelgin² contends that people with the disease are constructed in a way that is independent of their everyday lives. This allows them to be governed within the domain of international HIV/AIDS policy, which is produced by certain languages, technologies, and logics and culture. The international (western) systems and concepts for addressing HIV/AIDS are largely complied with by organizations working on the ground, or they do not get funding. They cannot survive within the international framework of how the HIV/AIDS pandemic is conceived and managed, if they do not conform. Again, the way these structures and relationships are managed may be crucial to the nature and outcomes of health interventions. They need to be considered alongside purely the clinical aspects of interventions.

The way interventions into combating HIV/AIDS and TB are, or could be, managed international (in terms of an international governance structure) and cross-culturally (in terms of cultural identities and interactions) has been neglected, possibly to the detriment of the effectiveness and appropriateness of interventions. These are areas that need collaboration among discipline areas.

Of course, to do this, we need funding, and collaborators

Do email us with your ideas: [t.jackson (at) AfricaManagement.org]

NOTES

1. Middlesex University Business School; Nelson Mandela Metropolitan University – Department of Development Studies; Stellenbosch University – Faculty of Health Sciences; Rhodes University – Department of Management; University of Botswana – Department of Management

2. Seckinelgin, Hakan (2005) A global desease and its governance: HIV/AIDS in sub-Saharan Africa and the agency of NGOs, Global Governance, 11, 351-68

¨ All Research Projects