Development Studies

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    Health justice for all : the development of alternative health system capabilities in the conflict-affected context of Shan State, Myanmar : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Development Studies at Massey University, Manawatū, New Zealand
    (Massey University, 2018) Bell, Sharon Margaret
    As the 2030 Agenda for Sustainable Development advances, it is vital to determine how conflict impacts on the achievement of the Sustainable Development Goals (SDGs) in conflict-affected contexts. The United Nations (UN) regards conflict as the leading risk to development progress as these contexts have high rates of poverty and limited access to crucial healthcare services. Shan State, Myanmar is one such context, facing a critical shortage in its health workforce, considered one of the building blocks of an effective health system. Approaches to building health workforce capabilities can meaningfully contribute towards meeting SDG 3 – ‘to ensure healthy lives and promote well-being for all at all ages’, and consequently, health justice for conflict-affected communities. This research aims to understand how the approaches taken by an international nongovernmental organisation (INGO) support the development of alternative health system capabilities in a conflict-affected context. A global development agenda of state- and peace-building has meant that INGOs have been criticised for undermining state legitimacy. Meanwhile, non-state armed groups (NSAGs) in areas like Shan State, Myanmar, have established alternative regimes which seek self-determination as well as attempting to provide for the social and economic wellbeing of their people. However, little is known about how a partnership between an INGO and a NSAG contributes toward enabling alternative health system development in these contexts. This research contributes to new ways of understanding this through the development of a capabilities framework for health system development in conflict-affected contexts. This was used to analyse findings from the qualitative case study of an INGO’s health workforce training programme on the Myanmar-Thailand border. The research found that a positive partnership between the INGO and the NSAG has played a crucial role in enabling the workforce capabilities of the alternative health system, leading to promising improvements in health outcomes in communities. However, the effectiveness of the programme is restricted by the INGO’s reliance on volunteerism for staffing, where expatriate medical volunteers are selected based on their availability, rather than the appropriate skills and experience for this context. The international aid community has also reduced its funding for cross-border development programmes in Myanmar which has constrained the activities of the INGO and the NSAG. For Myanmar to achieve health justice and SDG 3, supporting health system development that focuses on improving health outcomes needs to be a priority for the international community.
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    An examination of the influences on health development post conflict : Angola-- in the transition : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Development Studies at Massey University, Palmerston North, Aotearoa, New Zealand
    (Massey University, 2005) Patterson, Laura
    This thesis examines the issues that influence health development post conflict. Its aim is to increase understanding of the current issues within the transitional post conflict phase through presenting the experiences of three communities in rural Angola. Having emerged from nearly 30 years of civil war, Angola remains in a challenging transitional period. This phase of rehabilitation, flanked by efforts of relief and development, is shown to be problematic. This thesis considers the process from conflict to peace and subsequent repatriation of population. It identifies the transitional phase between relief and development projects and the ambiguous linking of theory and practice within literature Discussion of appropriate health strategies for implementation shows the limitations of the primary health care (PHC) model. Concepts of community participation and empowerment are identified as difficult due to resettlement factors of time and planning. The methods of research include household surveys (181 completed), interviews, group discussions, and observations of three communities. Comparisons of the two groups of previously identified Internally Displaced People (IDPs) and Returned Refugees (RRs) are made throughout the thesis. A focus on the needs, wants, reality and use of health services reveals community participation and responsibility. The influences of identity (tribe, gender, IDP / RR) and past experiences of refuge, settlement, and education are recognised as impacting to varying degrees, knowledge, attitude and practice towards health services. The research concludes that the post conflict phase is impacted most strongly by community (identity), time and communication.
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    Health and development in Vietnam : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Development Studies at Massey University
    (Massey University, 1996) Altmann, Maria
    This research investigates the current situation of Vietnamese people's health and development, with a particular focus on the wellbeing of Vietnamese women. Its central question is the impact of the political and economic reforms in Vietnam from 1986 onward, which reinstated the "family economy" and a number of free market principles within the country's socialist framework. It is based on a combination of field observations from an investigative visit to Vietnam in April 1994 and literature reviews covering concepts of development, Vietnamese culture, history, politics and economics. Wherever possible, Vietnamese sources (in English translation) have been incorporated. The first substantive chapter explores the connection between health, development and the environment, estabishing the interrelationship between the wellbeing of marginalised groups within a society and the meaning behind sustainable human development. The concept of wellbeing is argued as encompassing values of self-determination, while the concept of provision for sustainable livelihood is highlighted as a means to intercept the cycles of poverty and disease. A brief insight into aspects of Vietnamese cultural and social history up to the end of the colonial period is then offered, focusing on the organisation of the traditional village, so as to sign-post key aspects of culture and social organisation which have continued to influence the development of Vietnamese society. The following chapter gives the background to the process of political and economic reform in Vietnam from reunification in 1976 following the end of the Vietnam War identifying the ideological changes involved and outlining the macroeconomic impact of the reforms. The goals of current Vietnamese social policy are also considered. The final two chapters present data and analysis on the current state of Vietnamese people's wellbeing, identifying where possible the effects of recent policy changes. Topics covered are population, gender discrimination and the status of women, household poverty, education, employment, water supply and sanitation, women's health, child wellbeing, and the structure and operation of the Vietnamese health care system. The main findings are that the reforms have increased resource disparities between different groups in Vietnam and that the less advantaged, including a large proportion of Vietnamese women, face a serious decline in wellbeing unless changes occur in priorities for development.