BOOK REVIEWS 
Doctors and the State: The Straggle for Professional 
Control in Zimbabwe. Dorothy Mutizwa-Mangiza, Ashgate 
Publishing Limited, Aldershot, 1999. 270pp. 
ISBN 1 84000149120. 
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Kingdom. The aim of this book is to determine the nature and extent 
of professional autonomy enjoyed by doctors employed by the 
government in post-colonial Zimbabwe. In determining autonomy the 
book focuses on the following areas: 
• clinical autonomy 
• economic autonomy 
• regulation of medical education, licensing and medical discipline 
and 
• medical dominance. 
The specific objectives of the book are given in the introductory 
chapter which provides in addition background information and gives 
an overview of the different aspects of professional autonomy. The 
chapter successfully sets the stage for the in-depth discussion of the 
substantive issues surrounding the notion of professional autonomy 
for government-employed doctors. 
In Chapter 2 the author discusses the research process, including 
the process of gaining access to respondents, sampling respondents, 
data collection methods and data analysis. The chapter also discusses 
the problems and ethical dilemmas which the author encountered in 
the research process. The study was qualitative and was based on a 
sampling frame of 60 doctors employed full-time at the Parirenyatwa 
Group of Hospitals. The methodology was well thought-out and 
enabled the author to capture the relevant data. 
Chapter 3 of the book gives an analysis of the historical 
development of health services and the medical profession during 
the colonial period, Of particular importance is the observation that 
health services were fragmented along racial lines with the white 
settler community benefiting disproportionately at the expense of 
the indigenous population. The author also observes that during the 
JOURNAL OF SOCIAL DEVELOPMENT IN AFRICA VOL 15 NO. 2 JULY 2000 171
colonial period, the medical profession emerged as a powerful 
profession which was well placed to influence health policy. 
Consequently, over the years the medical profession has developed 
entrenched interests which it continues to protect. 
Chapter 4 focuses on post-colonial health policies during the period 
1980-1994. The chapter systematically reviews post-colonial health 
polices and assesses their impact on medical autonomy. The author 
observes that some of the post-colonial health policies "had the 
potential of reducing some dimension of medical autonomy". Some 
of these policies included the introduction of free health care for 
those earning Z$ 150 or less per month, the introduction of a bonding 
contract, and the introduction of an essential drugs list as well as 
restricting private health care. Understandably, this was done in order 
to bring about equity in the provision of health care. This was in line 
with the government's socialist ideology which placed special 
emphasis on issues of equity, social justice and egalitarianism. It was 
therefore only natural that aspects of medical autonomy would be 
reduced in line with the demands of the new order. 
In Chapter 5 the author begins to discuss the study findings. 
Chapter 5 specifically explores the extent to which clinical autonomy 
of doctors employed at the Parirenyatwa Group of Hospitals has been 
affected by the shift in health policies and by the general socioeconomic 
and political changes that have occurred since 
independence. The author observes that doctors enjoy "considerable 
clinical autonomy". However, she is quick to point out that this clinical 
autonomy is compromised by lack of resources at hospital level and 
by the general state of poverty among patients. 
The author also discusses the issue of economic autonomy which 
is the focus of chapter 6. In exploring the issue of economic autonomy, 
the chapter focuses on the extent to which state-employed doctors 
at the different levels are able to determine their remuneration and 
hours of work. The author concludes that in general government 
doctors in Zimbabwe enjoy a "higher degree of economic autonomy", 
a factor she attributes to the presence of a large private medical 
sector, shortage of doctors and the existence of employment 
opportunities in neighbouring countries among other issues. 
172 JOURNAL OF SOCIAL DEVELOPMENT IN AFRICA VOL 15 No. 2 JULY 2000
BOOK REVIEWS 
In Chapter 7 the author analyses the notion of autonomy with respect 
to the regulation of medical education, registration and discipline. 
The author observes that there is inadequate regulation of medical 
education and ineffective monitoring and discipline of governmentemployed 
doctors. The author cites a number of cases which serve 
to highlight the fact that there is ineffective monitoring and discipline 
of government-employed doctors. The author argues that this 
emanates from the doctors' reluctance to report on each other.The 
last chapter gives the summary and conclusions. Of particular interest 
in this chapter is the proposal for a model of medical autonomy which 
reflects the realities of post-colonial states in Africa. The author 
observes that medical autonomy in Africa is shaped by factors such 
as pre-industrial cultural values, national economic crises and the 
influence of bilateral and multilateral donor agencies. The discussion 
is very pertinent and underscores the vulnerability of African states 
in the globalization process and how this impacts not only on the 
medical profession but other professions as well. 
This is an incisive and refreshing publication that makes immense 
contributions to the sociology of the professions. The book is essential 
reading not only for those interested in the sociology of the 
professions but also for those in the health professions and policymakers 
as well. 
REVIEWED BY EDWIN KASEKE, SCHOOL OF SOCIAL WORK. HARARE. 
JOURNAL OF SOCIAL DEVELOPMENT IN AFRICA VOL 15 NO. 2 JULY2000 173