References Overview of selected papers

Few sociological studies have examined care organisation in primary health settings in lowand middle-income countries. This paper explores the organisation of health care work in primary care clinics in CapeTown, South Africa, by analysing two elements of clinic organisation as rituals. The first is a formal,policy-driven element of care: directly observed therapy for tuberculosis patients. The second is aninformal ritual, seemingly separate from the clinical work of the team: morning prayers in the clinic. Wedraw on data from an ethnography in which seven clinics providing care to people with tuberculosiswere theoretically sampled for study. These data include participant observation of clinic sessions, andinterviews and group discussions with providers and patients, which were analysed using approachesdrawn from grounded theory. Our findings suggest that rather than seeing the ritualised aspects of clinicactivities as merely traditional elements of care that potentially interfere with the application of goodpractice, it is essential to understand their symbolic values if their contribution to health care organi-sation is to be recognised. While both staff and patients participate in these rituals, these performancesdo not demonstrate or facilitate cohesion across these groups but rather embody the conflicting values ofpatients and staff in these clinics. As such, rituals act to reinforce asymmetrical relations of powerbetween different constituencies, and to strengthen conventional modes of provider–patient interaction.Ó 2009 Elsevier Ltd. All rights reserved.