Based on the above defined themes and categories, the research is reorganised and classified using an analytical framework by which it demonstrates how best to cultivate a standard policy across the traditional systems of medicine. For its underlying organising idea, the study relies on W. Richard Scott’s discussion of three aspects of social institutions; regulative, normative, and cognitive.265
The regulative element of institutions addresses rule-making, monitoring, and sanctioning activities. Individuals may acknowledge the existence of institutionalised rule systems without having to believe the rules are fair, right, or appropriate. For example, as China implements the ‘Temporary Regulation for the Examination on Apprenticeship in Traditional Medicine and Proof of Suitability to Be a Doctor’ to assess traditional practitioners who have undergone informal training, some apprentices are willing to risk losing their eligibility for practising. On the other hand, some find it expedient to comply with the rules and hence institutionalisation occurs.
The second element of institutions, the normative, emphasises the preferred or the desirable standard, then makes a comparison and decides how to modify behaviour and ultimately achieve the appropriate objectives. Normative rules are emphasised because obeying rules is considered to be morally appropriate and legally correct. Particularly, as certain ISM institutes in India believe that traditional medical students can benefit from integrated medical education, and biomedical curriculum is introduced into ISM curriculum. Thus, institutionalisation occurs while an informal obligation is being honoured socially.
Finally, the cultural-cognitive element of institutions has considered the development of common scripts and common beliefs as indicators. The common culture, experience, and view are shared within the community. Institutionalisation
265
occurs as individuals adopt the similar belief and take it for granted that a particular method in carrying out the task is the best approach. For example, knowledge of modern medicine is incorporated into local traditions in India and certain African countries, and subsequently the communities are educated to manage the HIV/AIDS epidemics. The communities respect the culture, beliefs and reliance on their traditions.
Application of sociological theory on Scott’s formulation can be noted in other earlier studies. Colbeck illustrates how Scott’s idea is used to assess institutionalisation of reforms at seven engineering schools in the Pennsylvania State when attention and funding shifted to new projects.266 Interview data shows that none of the schools is certain on the continuation of the curricular reforms after funding ends. Moreover, they have yet to determine which indicators are the strongest predictors of institutionalisation. Next, Livingston and his colleagues analyse their research on four Australian cases studies of urban water management projects and acknowledge that there is a recurring discourse that shaped the project outcome.267 The discourse depends on the institutional base, namely organisational structure, knowledge and value, within the proponent organisation. This project is an institutional change. Therefore, in attempting to introduce decentralised urban water management, looking into the regulatory context and organisational design within which a project is to operate is recommended. The last and not the least, Dolnicar et al. examine the impact of competitive grant funding on public sector non-profit organisations.268 They use institutional theory to explain that public non-profits face coercive, normative, and mimetic pressures, and subsequently lead to changes in organisational culture,
266 Colbeck, C.L., “Assessing Institutionalisation: Indicators of Lasting Reform” (paper presented at the 29th ASEE/IEEE Frontiers in Education Conference, San Juan, Puerto Rico, November 10-13, 1999).
267 Livingston, D., Ashbolt, N., and Colebatch, H., “Querying Institutional Support for Decentralised
Urban Water: Four Australian Cases,”
http://www.cwwt.unsw.edu.au/ywp2006/papers/YWP%203.14.pdf (accessed August 20, 2011). 268 Dolnicar, S., Irvine, H.J., and Lazarevski, K., “Mission or Money? Competitive Challenges Facing Public Sector Nonprofit Organisations in an Institutionalised Environment,” International
structures and routines, resulting in the possibility that their mission is compromised.
Several scholars’ organising ideas were taken into consideration prior to the decision to apply Scott’s principles. Elster’s arguing (justice, efficiency, and a principle of representation) and the bargaining principle for both equality and proportionality is mainly applied in organising speech acts and formal institutional arrangements.269 Wang’s typology of the organisation of a nation is through exclusion, namely who you are, what you have, where you are, and what you do.270 Institutional exclusion is most suitable to be used in studying human grouping, poverty, and discrimination. Moreover, this organising approach is composed of elements of bias and unfairness. Smith’s work on institutional ethnography investigates the relationship between the work of mothers at home and their children’s schooling, and how this relationship of ruling shapes their daily activities.271 It could be applied in examining the healthcare organisation since it explores the providers’ experiences; however, it allows exposure to only a particular corner within the society. Ansell’s network institutionalism describes recurrent positive and exchangeable relationships between individual, groups, or organisations.272 The network analytic frameworks of centrality and sub-groups are used to identify prominent individuals and small groups of people within their complicated relationships. These frameworks are mainly descriptive rather than explanatory in nature. Chan’s design of economic, political, and cultural approaches on globalisation is a better option as compared to the others.273
269 Elster, J., “Equal or Proportional? Arguing and Bargaining over the Senate at the Federal Convention,” ,” in Explaining Social Institutions, ed. J. Knight, and I. Sened (University of Michigan Press, 2001), 145-160, 146-148.
270
Wang, F.L., Organising Through Division and Exclusion: China’s Hukou System (Stanford University Press, 2005), 9-13.
271
Smith, D.E., The Everyday World as Problematic: A Feminist Sociology (Open University Press, 1988), 151-179.
272 Ansell, C., “Network Institutionalism,” in Oxford Handbook of Political Institutions, ed. R.A.W. Rhodes, S.A. Binder, and B.A. Rockman (OUP, 2006), 75-89.
273 Chan, K.B., “Globalisation, Localisation, and Hybridisation: Their Impact on Our Lives,” in East-
West Identities: Globalisation, Localisation, and Hybridisation, ed. K.B. Chan, J.W. Walls, and D.
However, this approach covers a rather bigger picture on global activities and lacks specificity with regard to the changes in the development of TM.
For this comparative study, Scott’s idea is adopted since it analyses the process by which a practice, TM, is incorporated into a system of existing practice – modern medicine – in national healthcare system of China and India. It allows comparisons of various aspects to be drawn in a more systematic and organised manner because of its orderly and predictable elements. The common structure of meanings and common purposes could explain and justify human behaviour. This facilitates answering a specific policy-related question and providing recommendations. There is an organisational relationship of TM practice within the state and the nation. For example, how do national policy and regulations regulate the traditional practice? What impact do practitioners have on the nation with regard to the development of TM? How do stakeholders affect the success of the implementation of policies and regulations? It ensures that an action is taken logically according to proper prescriptive rules.
Scott’s analysis focuses on causes and outcomes of social organisational process, an approach congruent with the objectives of this study.
A systematic approach enables me to trace the origin of the results from the collected data as it demonstrates clear stages throughout the process of analysis. It also allows me to address certain issues based on the concerns of the stakeholders. The study looks at issues such as regulations, providing support from the stakeholders and the outcome, interests of medical professionals, and professional bodies. Then, the similarities and differences between China and India around these specific issues are outlined and discussed. This will provide part of a frame of reference for discussion of relevant models for Malaysia based on the experience of India and China.