School of People Environment and Planning

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    “Broken” pathways : understanding the licensing experiences of overseas-trained medical doctors in Aotearoa New Zealand : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Development Studies at Massey University, Palmerston North, Aotearoa New Zealand
    (Massey University, 2024) Thomas-Maude, Johanna
    More than 40% of registered medical doctors in Aotearoa New Zealand received their primary medical qualifications overseas. Within this landscape, the pathways that international medical graduates (IMGs) must follow to achieve professional licensing depend on their background. This research explores IMG experiences of these processes using a capabilities approach to mobility justice, finding that although pathways to registration exist on paper, many are broken, unpredictable, and often unattainable in practice. General registration is available to doctors who completed their primary qualifications, or have worked for a minimum time period, in 24 high-income, Global North countries known as Comparable Health Systems (CHS). Other IMGs must apply for registration by taking a medical knowledge examination from the United Kingdom (U.K.), Australia, Canada, or the United States of America (U.S.A.), demonstrating English language competency, and taking the New Zealand Registration Examination (NZREX), which evaluates context-specific clinical skills. While completing these steps is time-consuming and costly, IMGs on the NZREX pathway are also required to complete two years of supervised work in local hospitals. First year positions, known as Postgraduate Year One (PGY1), are limited and prioritised for New Zealand medical graduates (NZMGs). As a result, a bottleneck has delayed or prevented many of these IMGs, typically originating from Global South countries, from finding PGY1 employment. This research addresses a knowledge gap by exploring the relationship between IMG experiences, professional outcomes, and their designated pathway to registration. An exploratory sequential mixed methods research design was employed, consisting of semi-structured interviews of IMGs (n = 24) and local experts (n = 9), an online questionnaire of IMGs (N = 80), and a document analysis of historical policies, grey literature, and media reports (N = 370), across three phases. The project was framed by a capabilities approach to mobility justice that evolved alongside the research design, data collection, and analysis. This theoretical approach considers what IMGs in Aotearoa New Zealand are able to “be” and “do” as migrant professionals, through four key components known as the 4Ps. The 4Ps comprise professional mobilities and capabilities, (inter)personal mobilities and capabilities, mobilities and capabilities in practice, and mobilities and capabilities power regimes. Combining empirical data with this theoretical lens highlights how medical registration pathways and policies contribute to uneven mobilities and capabilities among IMGs in Aotearoa New Zealand. Injustices are produced through misrecognition and the arbitrary exclusion of individuals who did not train in CHS countries. Such arbitrary exclusions, in turn, produce brain waste, whereby some IMGs already residing in Aotearoa New Zealand were unable to work as doctors, or experienced significant delays in registration, even during the COVID-19 pandemic. This situation is detrimental not only to these IMGs, but also to the chronically under-resourced local medical workforce and, consequently, the broader population in need of healthcare. Furthermore, colonial vestiges can be seen to have contributed to a recurring cycle of policy changes, which have culminated in contemporary licensing policies strongly resembling those from 1905. To create more just pathways for registration for IMGs in Aotearoa New Zealand, this (post)colonial cycle needs to be examined, evaluated, and broken, paving the way for more equitable medical regulation.
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    Fostering a new approach : how alternative care models in Greece are meeting unaccompanied minors' rights : a thesis presented in partial fulfillment of the requirements for the degree of Master of International Development at Massey University, Palmerston North, New Zealand
    (Massey University, 2019) Finlay, Liselle
    Unaccompanied minors seeking refuge in Greece are met with woefully inadequate care structures for meeting their needs. Despite the United Nation’s Convention on the Rights of the Child [CRC] stipulating children’s entitlement to appropriate care arrangements, there is a gap between this rhetoric and the reality of alternative care provision for minor refugees. Significantly, institutions are prioritised over familybased solutions. There is also a lack of research addressing the processes of power and exclusion in refugee hosting countries, and how these structural conditions influence unaccompanied minors’ situations and their wellbeing. To address these issues, this study adopts a socio-political construction of children’s rights to understand both how different care models are meeting unaccompanied minors rights, and why these models were selected. In conceiving rights as a socio-political process, this thesis addresses issues of power and agency in the navigation of rights. Tensions between restrictive migration policy and commitment to the CRC will be shown to compromise care provision for unaccompanied minors through conscription to control over care. Despite the overarching structural limitations, young people in this study find avenues for exercising their agency, albeit often risky ones. What emerges is a need to understand both young people’s vulnerabilities and strength, and how they are both these things in different parts of their lives. This thesis presents results of fieldwork largely undertaken in Athens over a six-week period in 2018. A cross-section of care providers engaged in the welfare of unaccompanied minors participated in the study. Also interviewed were the foremost experts in Greece’s child protection system: young people who themselves have experienced these care models. Findings reveal the impact migration policy has had in undermining care provision for unaccompanied minors, and the corresponding tensions that emerge for NGOs looking to address urgent needs and find sustainable solutions. This study recorded that rights violations and risks are occurring. It also explored the barriers and opportunities to expand the spectrum of care options and strengthen optimal care, which were identified as family and community-based alternative care initiatives.
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    Neonatal nursing in Fiji : exploring workforce strategies to help Fiji achieve Sustainable Development Goal 3, Target 3.2 : a thesis presented in partial fulfilment of the requirements for the degree of Master in International Development at Massey University, Palmerston North, New Zealand
    (Massey University, 2019) Manuel, Ireen
    In Fiji 124 neonates lost their lives in 2017. While rates have improved in the Pacific, Fiji’s neonatal mortality rate has remained stagnant. The neonatal workforce struggles to meet the demands of this vulnerable population. Neonatal mortality is a global health challenge which is reflected in Sustainable Development Goal 3, target 3.2. This target aims to end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births by 2030. My research set out to explore and provide some understanding of the development needs of neonatal care globally and review the workforce challenges for nurses in this speciality area in Fiji. Improving the continuum of care for neonates will be critical if Fiji is to achieve Sustainable Development Goal 3, target 3.2. To answer these research questions, I adopted a qualitative methodology. I conducted four semi-structured interviews in Fiji and interpreted qualitative primary and secondary data. In doing so, I came across challenges that were present within programmes, service designs and national policies. Some of these challenges were easily fixed and did not need policy interventions, but rather individual willingness to change. Others required state interventions and long-term commitment and willingness. When applying the rights-based approach to health framework, my findings showed that the hardworking workforce in Fiji is still trying to change an organisational culture to a point where the workforce can feel fully inclusive and able to make evidence-based decisions as a team. The profound effects of not being able to do this is detrimental to the positive outcome for the neonates in their care. It was evident that health has many determinants and the problem relating to neonatal mortality is complex. My research showed that the neonatal nursing workforce were committed to reform and an effective health care service with adequate capacity and consumables is needed to run a well-functioning neonatal service. The key conclusions of my research are that there needs to be better collaboration between all sectors, evidence-based research practice and empowerment of the neonatal nursing workforce in Fiji. This is necessary if the government of Fiji is to achieve a neonatal workforce that can support it to achieve the critical Sustainable Development Goals target of reducing neonatal mortality.
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    Impacts of power sector reforms on rural electrification in the Philippines : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Development Studies at Massey University, Palmerston North, New Zealand
    (Massey University, 2004) Corpus, Ronaldo F
    Inspired by neo-liberal principles, waves of electricity industry reforms have swept the world over the last two decades. To a great extent, the traditional government-extended electrification service was transferred to the hands of private actors and market forces. While these reforms are expected to bring about efficiency gains as a result of market liberalization and private competition, the provision of electrification service to relatively poorer rural areas is less certain. In this light, it is of great interest in development studies to therefore understand the impacts of these reforms on the delivery of public service goals in cash-strapped developing countries like the Philippines. Through assessments of relevant Philippine government data and case study findings, this thesis outlines how the restructured Philippine electricity industry has impacted on the accessibility, service quality and affordability of electrification, especially in rural areas. In a nutshell, electricity industry restructuring in the Philippines resulted in better delivery of public service goals to the rural beneficiaries, but not necessarily resulting from privatization, competition and deregulation that is fostered by a free market regime.
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    The role of government in setting an appropriate environment for public infrastructure development : a case study of hydropower development in Lao PDR : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Development Studies at Massey University, Palmerston North, New Zealand
    (Massey University, 2011) MacGeorge, Richard B.
    The role of government in setting an appropriate environment for public infrastructure development is explored to understand whether there are strong links between infrastructure, development and government. In examining this subject, a number of related issues are also considered, including why infrastructure is important to development, how managing resources well leads to better infrastructure outcomes and why is it essential that infrastructure is managed more effectively. Each of these leads to a better understanding of the roles government should play in infrastructure management. The methodology is designed to develop a definition for infrastructure and understand what the literature says about the links between government, development and infrastructure. The manner in which infrastructure has been provided historically is also considered and this research supports a system of infrastructure management. The system is then investigated through a hydropower project in Laos that is examined as a qualitative case study. The links between government, development and infrastructure are found to be strong in this thesis, but governments have had mixed involvement in infrastructure provision through the ages. At the end of the last century government is seen to have increasingly engaged with the private sector in a structured way. The core roles of government that cannot be left to others are found to include planning, procurement and regulation of infrastructure outcomes. These roles should be delivered within an overarching national infrastructure plan that is carried out by a centralised Infrastructure Management Unit. The case study project highlights some enhancements that can be made to the system proposed in the thesis and helps explain why there are sometimes exceptions to application of the whole system, although exceptions should be limited because caseby- case project development is suboptimal to initiatives that are formed as part of a national infrastructure planning process.
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    Poverty in three villages in Papua : a thesis presented in fulfilment of the requirement for the degree of Doctor of Philosophy in Development Studies at Massey University
    (Massey University, 2006) Rumbewas, Spener
    The principal objective of this thesis is to explore the issue of poverty in selected research sites in Papua. This objective is broken down to four questions: how is poverty understood, how is it measured, what are its causes and how is it alleviated? Two approaches were utilised to investigate the above questions. Macro level investigation was based on exploring data available in the official publications while the micro approach was based on fieldwork carried out in the selected sites. The results of the first approach are examined in chapters two, three and four, and the second approach are discussed in chapter five, six, seven and eight. In relation to the first question, the macro exploration found that poverty is understood mainly in terms of a lack of basic components of life such as income, consumption or basic needs. Understanding poverty from this approach normally uses the poverty line, which is set up based on these items, to separate the poor from the non-poor. According to this line, poverty refers to those people whose consumption falls below the line while the rest are non-poor. This view looks at poverty from one dimension that is an economic dimension. Hence, it does not provide a complete picture of human poverty, which covers not only the economic dimension but also others such as vulnerability, powerlessness, isolation, and a lack of choice. The micro investigation adopts a poverty understanding stemming from the experience of the poor. This investigation found that the poor understand poverty from what they feel to be lacking in their environment. In this approach, poverty is a lack of assets, in particular natural, physical, human, social and financial assets. Nonetheless, those affected by poverty argue that their poverty is not related to nature, but to physical, human, social and financial assets. This view seems to offer a broader picture of human poverty and hence, it is useful for formulation of or as a basis for a poverty reduction policy. With regard to the second question, the macro approach found that poverty measurement employs a quantitative measurement of both items and methods. The quantitative items can include income, consumption or basic needs (food and non-food), which are valued in monetary terms. The quantitative methods apply statistical techniques such as headcount index, poverty gap index, poverty severity index and others to measure poverty. This measurement only considers the quantitative aspect and, therefore, it does not pay attention to the qualitative aspect of human poverty. The micro approach on the other hand, attempts to amalgamate both aspects into a poverty measurement. One of the approaches that attempts an amalgamation of the two is the participatory approach, which is utilised in this study. Although it is a qualitative-based approach, it still opens the window to the use of quantitative approaches. The micro approach seems to offer some benefits such as giving more depth of information regarding human poverty, directly touching the lives of the poor, and facilitating a bottom-up policy to alleviate poverty in the local context. In the third question, the macro exploration demonstrates that structural forces such as agents, class and institutions bring about poverty through their policies, programmes and rules. The micro investigation on the other hand, shows that individual characteristics and a lack of assets contribute to poverty. This investigation sees that poverty at the micro level is a result of the mutual operation of structural forces, individual characteristics and a lack of assets. With regard to the last question, both approaches demonstrate a variety of polices to eliminate poverty as discussed in chapters three, six, seven, eight and ten. One framework for a poverty reduction strategy is the Asian Development Bank (ABD) three pillars strategy: social development, pro-poor growth and good governance. However the emphasis is for government commitment and the political will to alleviate poverty. Some experts underline this as a prerequisite to implement a poverty reduction policy because, as they argue, without this the policy will either not exist or will develop only very slowly. The selected sites experienced poor environments in terms of infrastructure, poor education and skills, poor health and nutrition. This is indeed a manifestation of poor government policies as identified by the poor. From the poor's point of view, it was found that all participants in the fieldwork identified poor policy as a contributing factor of poverty they experienced. This was also justified by looking at the ranking of institutions they gave. In these rankings, government institutions were generally given a rank of less importance by the poor. Participants stated that these institutions were not trusted and were not effective in providing support to the poor.