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Truth, humane treatment, and identity: perspectives on the legitimacy of the public and private health sectors during Covid in Zambia

Author

Listed:
  • Dell D. Saulnier

    (Lund University
    University of Zambia
    University of Geneva)

  • Christabel Saidi
  • Theresa Hambokoma
  • Joseph M. Zulu

    (University of Zambia)

  • Juliet Zulu
  • Felix Masiye

    (University of Zambia)

Abstract

Legitimacy is necessary for resilience and trust helps to legitimize health systems. Providing services during Covid has relied on both the private and public sectors but there is little information on differences in trust between these sectors during shocks like Covid and how it may impact the health system’s legitimacy. The purpose of this study was to explore community trust in the public and private sectors of the Zambian health system during Covid, to generate understanding on how trust in the different sectors may influence the system’s legitimacy. Twelve focus groups discussions and 22 key informant interviews were conducted in 2022 with community members who used public, private, and faith-based services during Covid and service providers, and thematic analysis identified perceptions of trust between the different sectors. The themes ‘Humane, patient-centred treatment’ and ‘Communicating the truth’ describe the desire for humane interactions and truthfulness during Covid, compromised by fear, uncertainty, and suspicions of the motives of the sectors, and alleviated by support, security, and shared identity. The legitimacy of the public sector was influenced by shared spaces, values, and identities with communities. The private sector maintained its legitimacy through service quality and its identity as a non-governmental business. Interpersonal trust was important, but identity played a larger role than high-quality interactions for legitimacy in Zambia during the pandemic. To enhance legitimacy and resilience during shocks, potential strategies include strengthening the quality of public sector interactions to meet private sector standards, emphasizing the public sector as a public good, and clarifying the public sector’s role vis-à-vis the government during crises.

Suggested Citation

  • Dell D. Saulnier & Christabel Saidi & Theresa Hambokoma & Joseph M. Zulu & Juliet Zulu & Felix Masiye, 2024. "Truth, humane treatment, and identity: perspectives on the legitimacy of the public and private health sectors during Covid in Zambia," Palgrave Communications, Palgrave Macmillan, vol. 11(1), pages 1-11, December.
    • Handle: RePEc:pal:palcom:v:11:y:2024:i:1:d:10.1057_s41599-024-02913-w
    DOI: 10.1057/s41599-024-02913-w
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    References listed on IDEAS

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    1. Gilson, Lucy, 2005. "Editorial: building trust and value in health systems in low- and middle-income countries," Social Science & Medicine, Elsevier, vol. 61(7), pages 1381-1384, October.
    2. Felix Masiye & Oliver Kaonga & Joses M Kirigia, 2016. "Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from Zambia," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-15, January.
    3. Gilson, Lucy, 2003. "Trust and the development of health care as a social institution," Social Science & Medicine, Elsevier, vol. 56(7), pages 1453-1468, April.
    4. Ezumah, Nkoli & Manzano, Ana & Ezenwaka, Uchenna & Obi, Uche & Ensor, Tim & Etiaba, Enyi & Onwujekwe, Obinna & Ebenso, Bassey & Uzochukwu, Benjamin & Huss, Reinhard & Mirzoev, Tolib, 2022. "Role of trust in sustaining provision and uptake of maternal and child healthcare: Evidence from a national programme in Nigeria," Social Science & Medicine, Elsevier, vol. 293(C).
    5. Bloom, Gerald & Standing, Hilary & Lloyd, Robert, 2008. "Markets, information asymmetry and health care: Towards new social contracts," Social Science & Medicine, Elsevier, vol. 66(10), pages 2076-2087, May.
    6. Owain David Williams, 2020. "COVID-19 and Private Health: Market and Governance Failure," Development, Palgrave Macmillan;Society for International Deveopment, vol. 63(2), pages 181-190, December.
    7. Straten, G. F. M. & Friele, R. D. & Groenewegen, P. P., 2002. "Public trust in Dutch health care," Social Science & Medicine, Elsevier, vol. 55(2), pages 227-234, July.
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