this role as compared to the older men in a household because of the shifts in the nature of production, which have increased younger people’s relative earning power, spurred by a change from a farming based economy to more urban type employment in the mainly services sector. As younger people’s earning power increases, so does their influence in deciding the course of action taken over health issues. Women as index sufferers or mothers of index sufferers also tend to bear the cost of care when the men are unable or unwilling to pay. How the health systems work in Tudun Jukun Drawing on the CMO analysis (see table 5-x below), there were at least four (4) different contextual features that are driving decisions and actions to address health issues in the Tudun Jukun. These are the plural health systems landscape, the different manifestations of state fragility (absence of an accountable authority) (both explained in chapter 4), the social structure of the Tudun Jukun society, the economic realities of the people (high levels of poverty), and the nature of the problems that people are dealing with. Table 51 Details of specific incidents and how different circumstances are resulting in different outcome Incident Context Mechanisms Outcomes Early marriage Social norms - Male dominant Disagrees and avoids the Relocated to the city for girls gender norms social norm and married at a later age Preterm Nature of the problem – Confidence in hospitals’ Went to the house of drainage of “difficult” pregnancy abilities to address difficult a female doctor that birth water Governance – abusive and pregnancies lives in the disrespectful midwives at Avoids embarrassment neighbourhood who hospitals from hospital staff attended to her Neglect - lack of maternity Has no confidence in local informally services at the local PHC PHC Economic realities – cannot Avoids unaffordable cost afford hospital delivery
this role as compared to the older men in a household because of the shifts in the nature of production, which have increased younger people’s relative earning power, spurred by a change from a farming based economy to more urban type employment in the mainly services sector. As younger people’s earning power increases, so does their influence in deciding the course of action taken over health issues. Women as index sufferers or mothers of index sufferers also tend to bear the cost of care when the men are unable or unwilling to pay. How the health systems work in Tudun Jukun Drawing on the CMO analysis (see table 5-x below), there were at least four (4) different contextual features that are driving decisions and actions to address health issues in the Tudun Jukun. These are the plural health systems landscape, the different manifestations of state fragility (absence of an accountable authority) (both explained in chapter 4), the social structure of the Tudun Jukun society, the economic realities of the people (high levels of poverty), and the nature of the problems that people are dealing with. Table 51 Details of specific incidents and how different circumstances are resulting in different outcome Incident Context Mechanisms Outcomes Early marriage for girls Social norms - Male dominant gender norms Disagrees and avoids the social norm Relocated to the city and married at a later age Preterm drainage of birth water Nature of the problem – “difficult” pregnancy Governance – abusive and disrespectful midwives at hospitals Neglect - lack of maternity services at the local PHC Economic realities – cannot afford hospital delivery Confidence in hospitals’ abilities to address difficult pregnancies Avoids embarrassment from hospital staff Has no confidence in local PHC Avoids unaffordable cost Went to the house of a female doctor that lives in the neighbourhood who attended to her informally