SOAS Research Online

Abstract

This paper explores the extent and reach of ‘audit culture’ in a rural government hospital in KwaZulu-Natal, South Africa. I describe the institution’s efforts at instilling a new public sector ethos that involves intensifying mechanisms of audit and self-assessment in the workplace. In a context in which ‘accountability’ has become a key trope of institutional bureaucracy, I explore how employees attempt to conform to the normative moral yardstick imposed by ideas of accountability, whilst also expressing a sense of moral uncertainty and discomfort with these. Drawing on anthropological arguments about the role of documents in mediating social relations, I show that the knowledge collated in document form, rather than corresponding to clinical work carried out in the wards, increasingly is viewed as an end in itself. Global features of audit culture combine with existing workplace hierarchies and nursing practices to produce a locally mediated and meaningful version of accountability.