Building social currency with foreskin cuts: a coping mechanism of Papua New Guinea health workers and the implications for new programmes

Tynan, Anna, Vallely, Andrew, Kelly, Angela, Kupul, Martha, Naketrumb, Richard, Aeno, Herick, Siba, Peter, Kaldor, John M. and Hill, Peter S. (2013) Building social currency with foreskin cuts: a coping mechanism of Papua New Guinea health workers and the implications for new programmes. Health Policy and Planning, Advance Access 1-10. doi:10.1093/heapol/czt072

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Author Tynan, Anna
Vallely, Andrew
Kelly, Angela
Kupul, Martha
Naketrumb, Richard
Aeno, Herick
Siba, Peter
Kaldor, John M.
Hill, Peter S.
Title Building social currency with foreskin cuts: a coping mechanism of Papua New Guinea health workers and the implications for new programmes
Journal name Health Policy and Planning   Check publisher's open access policy
ISSN 0268-1080
Publication date 2013-01-01
Sub-type Article (original research)
DOI 10.1093/heapol/czt072
Open Access Status
Volume Advance Access
Start page 1
End page 10
Total pages 10
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Language eng
Formatted abstract
Background Recent research as part of a multi-disciplinary investigation on the acceptability and impact of male circumcision for HIV prevention in Papua New Guinea (PNG) has shown that health workers (HWs) undertake unauthorized forms of penile cutting practices in public health facilities or in community settings, at times within a traditional context. Participation in these activities shares common features with coping mechanisms, strategies used by HWs to alleviate the burden of unsatisfactory living and working conditions. Coping mechanisms, however, are typically described as motivated by economic advantage, but in PNG evidence exists that the behaviours of HWs are also influenced by opportunities for social capital.

Methods Twenty-five in-depth interviews (IDIs) were completed with a variety of HWs from 2009 until 2011 and were triangulated with findings from 45 focus group discussions and 82 IDIs completed with community members as part of a wider qualitative study. Thematic analysis examined HW participation in unauthorized penile cutting services.

Results The emergence of unauthorized practices as a coping mechanism in PNG is compelled by mutual obligations and social capital arising from community recognition and satisfaction of moral, professional and cultural obligations. Using the example of unauthorized penile cutting practices amongst HWs in PNG, the research shows that although economic gains are not explicitly derived, evidence exists that they meet other community and socio cultural responsibilities forming a social currency within local traditional economies.

Conclusions Coping mechanisms create an opportunity to extend the boundaries of a health system at the discretion of the HW. Fragile health systems create opportunities for coping mechanisms to become institutionalized, pre-empting appropriate policy development or regulation in the introduction of new programmes. In order to ensure the success of new programmes, the existence of such practices and their potential implications must be addressed within programme design, and in implementation and regulation.
Keyword Coping mechanisms
Unauthorized practices
Penile foreskin cutting
Social capital
Papua New Guinea
Health system
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes First published online: October 8, 2013

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Public Health Publications
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Created: Tue, 12 Nov 2013, 19:39:41 EST by Associate Professor Peter Hill on behalf of School of Public Health