Thesis structure

This thesis is structured thematically, based on the objectives of the thesis: ‘purpose’ (of pharmacy education) as the first theme; and ‘capacity’ (for pharmacy education) as the second. Each theme consists of two to three chapters: one literature chapter plus one or two data chapters. So, Chapters 3 and 4 focus on the theme ‘purpose’; whereas Chapters 5, 6 and 7 are about ‘capacity’. This thematic grouping requires the methodology chapter to be placed ahead of other chapters. Also, the background information about Malawi has to be split thematically into two sections. Literature about Malawi’s health system and pharmacy sector is written in section 3.2; whereas literature about Malawi’s higher education sector and University of Malawi is written in section 5.2. Finally, the concluding chapter (i.e., Chapter 8) brings both themes together.

It must be noted that the literature chapters seek to cover the breadth, rather than the depth, of the literature. In the literature review about capacity building, for instance, it seeks to bring in perspectives from four disciplinary areas, rather than dwelling in-depth with just one perspective. The data chapters put together data collected from fieldwork (e.g., interview quotes), data published in public domains (e.g., country reports) and also literature (that may or may not be raised in the literature chapters) to form arguments. In a way, this thesis is a cross- disciplinary one not only in its content, but also in its writing style. In the

following paragraphs, I shall describe in more details what each chapter is about.

Chapter 2 explains the research methodologies. It is an account of how this research evolved methodologically and why the decision to employ an ethnographic approach was actually a product of fieldwork analysis. It also discusses in detail what methods were used to collect and analyse data; and how research rigour is reached.

Chapter 3 is the literature chapter for the theme of ‘purpose’. The purpose for having pharmacists in the health system is examined by looking at what roles pharmacists (should) play; and this is discussed from five different perspectives:

the structural functionalist perspective, the notion of ‘competence’, the notion of ‘skills’, the notion of ‘needs’ and the sociology of professional boundary. The purpose of providing multiple perspectives is to contextualise the issue of roles; and subsequently the notion of ‘needs’, which is often discussed in a context- free manner otherwise. In the second section of the chapter, the health system and pharmacy sector in Malawi is described.

Chapter 4 is the data chapter for the theme ‘purpose’. It reports the roles of pharmacists from the needs-based perspective. It also examines whether ‘task- shifting’ (i.e., replacing pharmacists with pharmacy technicians) is feasible in present-day public pharmacy sector. Based on the data, this chapter comments on why ‘needs-based’ notion may not be adequate to decide what roles

pharmacists should play in the country.

Chapter 5 is the literature chapter for the theme of ‘capacity’. It seeks to pull together discipline-specific definitions of capacity from four areas: African higher education, pharmacy, health workforce and development. Like Chapter 3, the purpose of doing so is to demonstrate that this issue can be examined from a number of theoretical lenses. However, each theoretical lens offers only partial explanation to the empirical data, which becomes evident in Chapters 6 and 7. In the second part of the chapter, the higher education system in Malawi is

described; and capacity problems faced by the University of Malawi are reported.

Chapter 6 is the first data chapter in response to issues raised in Chapter 5. It starts off by engaging the notion of stakeholder, through analysing the strengths, weaknesses, opportunities and threats (SWOTs) of six categories of stakeholders. The reason for doing SWOT analysis is to identify stakeholders who have the best potential to mobilise resources for institutional capacity building. At the same time, these analyses also point out the problems of doing ‘stakeholder

engagement’ in a postcolonial, aid-dependent setting, because of the lack of readiness in the institution to engage its stakeholders. Capacity building in pharmacy education, as argued by this chapter, is not necessarily discipline-

specific, but involves issues that are commonly found in literature about African higher education and development.

Chapter 7 is the second data chapter, which writes about foreign aid in Malawi. It is also a continuation of the development-related themes from Chapter 6. It starts off by describing six different types of foreign aid and how each one impacted on the domestic structure. A large part of this chapter is devoted to explain the causes and habit of aid dependency, from the perspectives of both the aid givers and receivers. Based on the empirical data, it explores the issues of aid modality (e.g., money vs. knowledge), mentorship, ownership, partnership, etc. Through these discussions, it is argued that not all forms of foreign aid are helpful to domestic capacity building; hence there should be screening for only helpful aid to come through.

Chapter 8 is the concluding chapter. This brings together all themes and issues raised in the previous chapters. By doing so, this chapter generates fresh insights into the issues of ‘purpose’ and ‘capacity’. It seeks to break down disciplinary restrictions to the interpretation of these two issues and argues for an inter- disciplinary approach in future HRH research. At the final sections of the chapter, collective limitations and implications of the research will be summarised.