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Injections and self-help: risk and trust in Ugandan health care

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  • Birungi, Harriet

Abstract

The paper draws upon research material collected during a one year long ethnographic study on injection use and a WHO funded Injection Practices Research Project, which were both carried out during 1992/1993. The paper examines the changing trends in injection use and practices in the context of the Ugandan health system and in relation to popular views about risk and trust. Generally, people mistrust injections provided at government health institutions and prefer to gain access to injections as symbolic tokens of healing through personal contacts and private ownership of injecting equipment. It now appears that the use of this Western biomedical technology is widespread at all levels of the health care system; needles, syringes and injectables are readily available in homes for use by families and untrained providers. In other words, the injection technology has been domesticated and personalized. The Giddens (1990) framework [Giddens, A. (1990) Consequences of Modernity. Stanford University Press, California.] concerning modernity, trust and risk is applied to understand the motivations behind these processes. The basic argument is that the weakening of state institutions of health care has been accompanied by a loss of trust in the treatment offered there. In addition, the massive anti-AIDS education campaigns which have warned people against the dangers of sharing unsterilized needles, have reinforced existing mistrust in public health facilities and induced families to seek care from people they know and using injecting equipment over which they have personal control. The paper concludes that changing the current injection practices in Uganda will necessitate a change in the organization of public health institutions.

Suggested Citation

  • Birungi, Harriet, 1998. "Injections and self-help: risk and trust in Ugandan health care," Social Science & Medicine, Elsevier, vol. 47(10), pages 1455-1462, November.
    • Handle: RePEc:eee:socmed:v:47:y:1998:i:10:p:1455-1462
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    Cited by:

    1. Badru Bukenya, 2013. "Are service-delivery NGOs building state capacity in the global South? Experiences from HIV/AIDS programmes in rural Uganda," Global Development Institute Working Paper Series esid-022-13, GDI, The University of Manchester.
    2. Gilson, Lucy & Palmer, Natasha & Schneider, Helen, 2005. "Trust and health worker performance: exploring a conceptual framework using South African evidence," Social Science & Medicine, Elsevier, vol. 61(7), pages 1418-1429, October.
    3. Grace Akello & Ulrike Beisel, 2019. "Challenges, Distrust, and Understanding: Employing Communicative Action in Improving Trust in a Public Medical Sector in Uganda," SAGE Open, , vol. 9(4), pages 21582440198, December.
    4. Streefland, Pieter, 2005. "Public health care under pressure in sub-Saharan Africa," Health Policy, Elsevier, vol. 71(3), pages 375-382, March.
    5. Jitta, Jessica & Whyte, Susan Reynolds & Nshakira, Nathan, 2003. "The availability of drugs: what does it mean in Ugandan primary care," Health Policy, Elsevier, vol. 65(2), pages 167-179, August.
    6. Kotwal, Atul, 2005. "Innovation, diffusion and safety of a medical technology: a review of the literature on injection practices," Social Science & Medicine, Elsevier, vol. 60(5), pages 1133-1147, March.
    7. Mohseni, Mohabbat & Lindstrom, Martin, 2007. "Social capital, trust in the health-care system and self-rated health: The role of access to health care in a population-based study," Social Science & Medicine, Elsevier, vol. 64(7), pages 1373-1383, April.
    8. Goudge, Jane & Gilson, Lucy, 2005. "How can trust be investigated? Drawing lessons from past experience," Social Science & Medicine, Elsevier, vol. 61(7), pages 1439-1451, October.
    9. Russell, Steven, 2005. "Treatment-seeking behaviour in urban Sri Lanka: Trusting the state, trusting private providers," Social Science & Medicine, Elsevier, vol. 61(7), pages 1396-1407, October.
    10. Hampshire, Kate & Hamill, Heather & Mariwah, Simon & Mwanga, Joseph & Amoako-Sakyi, Daniel, 2017. "The application of Signalling Theory to health-related trust problems: The example of herbal clinics in Ghana and Tanzania," Social Science & Medicine, Elsevier, vol. 188(C), pages 109-118.
    11. Molyneux, C.S. & Peshu, N. & Marsh, K., 2005. "Trust and informed consent: insights from community members on the Kenyan coast," Social Science & Medicine, Elsevier, vol. 61(7), pages 1463-1473, October.
    12. Rodrigues, Carla F., 2021. "Communicative trust in therapeutic encounters: users’ experiences in public healthcare facilities and community pharmacies in Maputo, Mozambique," Social Science & Medicine, Elsevier, vol. 291(C).
    13. Ridde, Valery & Haddad, Slim & Yacoubou, Moussa & Yacoubou, Ismaelou, 2010. "Exploratory study of the impacts of Mutual Health Organizations on social dynamics in Benin," Social Science & Medicine, Elsevier, vol. 71(3), pages 467-474, August.
    14. Megan M McLaughlin & Louis Simonson & Xia Zou & Li Ling & Joseph D Tucker, 2015. "African Migrant Patients’ Trust in Chinese Physicians: A Social Ecological Approach to Understanding Patient-Physician Trust," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-13, May.
    15. Hamill, Heather & Hampshire, Kate & Mariwah, Simon & Amoako-Sakyi, Daniel & Kyei, Abigail & Castelli, Michele, 2019. "Managing uncertainty in medicine quality in Ghana: The cognitive and affective basis of trust in a high-risk, low-regulation context," Social Science & Medicine, Elsevier, vol. 234(C), pages 1-1.

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