Distributed Decisions: The Example of Child Access to Primary Health Care

Abstract

Confronted with uncertainty, who within social networks makes decisions and how? This article suggests a framework for answering these questions. It suggests that decision-making is distributed over time within and among network members. These ‘distributed decisions’ originate in, and develop from, initial decisions, termed ‘proto-decisions’. The process of development of distributed decisions is not merely a social activity. It involves the development over time of mental events by one or more persons through interaction. This framework is illustrated through specific reference to the example of who decides about child access to primary health care, and how. At the same time, it elaborates existing models of health service use. It questions the focus of the Social Organisation Strategy framework on one agent deciding about service utilization (albeit within limits set by the structure and content of social network ties) and on social relationships as the dominant influence on decision-making in social life.