Public reasoning in MSF MDR-TB programme in Khayelitsha

Abstract

The purpose of this thesis is to better understand how Amartya Sen’s (2009) model of public reasoning can be identified in the decentralised Multi-Drug Resistant Tuberculosis (MDR-TB) piloted by Médicins Sans Frontier (MSF). Drug Resistant TB has been seen as a major problem in South Africa; for example, there has been a growing epidemic in Khayelitsha, Cape Town. The first phase of the research involved integrating literature around Sen’s theory of public reasoning and capability approach to better understand its strengths in advocating development. The second phase involved conducting semi-structured interviews with MSF staff role-players to better understand the background, management and reasoning of the study. Public reasoning encompasses looking at both implementation and operational mechanisms that allow for development to occur. The study highlights the connection between public reasoning and its ability to exist within decentralised local clinics particularly evident in MSF programme. Using semi-structured interviews with MSF key role-players in Khayelitsha enabled interpretation of procedures through Sen’s dimensions of public reasoning evoked that it all three domains around were evident. It also sought to see that the nurses within the programme identified the value with the programme itself and how it provided a knowledge base for them to better equip themselves with skills to effectively rollout the programme by improving their capabilities and those of the patients. The research argues that there is a need to have good reasoning vehicles within the TB response that considers various viewpoints of relevant stakeholders. The research further goes to recommend the processes taken by the study should be looked at closely to unlock other public reasoning avenues that could engage with development techniques aiding democratic process. Public reasoning has the ability to sit in the core of development mechanisms that could better provide government with solutions that engage with the ‘freedoms’ of individuals. This case study has found that certain traits of public reasoning, as outlined by Sen, were evident in the process leading up to adopting a decentralised approach that is still pertinent in the management of the process. It is further argued that these elements of public reasoning improved treatment practices thereby contributing to improved health outcomes. iii The research hopes to evoke questions around the public health policy space to strengthen legislation that allow for decentralised and interactive processes to occur in the delivery of health services to patients. Constraints around budget and the Health Authority need to replicate the desires for government to without compromising ethical issues which are even more difficult to address.