Power Dynamics Among Health Professionals in Nigeria: A Case Study of the Global Fund Policy Process
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نوع سند: مقاله ژورنالی
زبان: English
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شناسه ملی سند علمی:
JR_HPM-11-12_010
تاریخ نمایه سازی: 17 مرداد 1403
Abstract:
Background Health workers are central to health policy-making. Given health systems’ complex, dynamic and political nature, various forms of ‘hidden power’ are at play as health workers navigate health systems. This study aims to explore the dynamics of power and its sources, and how this shapes policy-making and implementation within the Nigerian health systems context.Methods The case study was the Global Fund grant in Nigeria, and results are based on an in-depth qualitative study involving ۳۴ semi-structured key informant interviews (KIIs), board-meeting observations, and documentary analysis conducted in ۲۰۱۴ and ۲۰۱۶. Participants held mid to senior-level positions (eg, Director, Programme Manager) within organisations involved with Global Fund activities, particularly proposal development and implementation. Data were analysed using thematic analysis in order to gain insight into the power dynamics of health professionals in policy processes.Results Medical professionals maintained dominance and professional monopoly, thereby controlling policy spaces. The structural and productive power of the biomedical discourse in policy-making encourages global actors and the local government’s preference for rapid biomedical models that focus on medications, test kits, and the supply of health services, while neglecting aspects that would help us better understand the poor uptake of these services by those in need. The voices of the repressed groups (eg, non-clinical experts, patients and community based organisations) that better understand barriers to uptake of services are relegated.Conclusion Professional monopoly theories help illustrate how medical professionals occupy and maintain an elite position in the health system of Nigeria. Structural and agential factors specific to the contexts are key in maintaining this professional monopoly while limiting the opportunities for other health occupations’ rise up the social status ladder.
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Authors
Samuel Lassa
School of Health and Health Related Research, University of Sheffield, Sheffield, UK
Muhammed Saddiq
School of Health and Health Related Research, University of Sheffield, Sheffield, UK
Jenny Owen
School of Health and Health Related Research, University of Sheffield, Sheffield, UK
Christopher Burton
Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK
Julie Balen
School of Health and Health Related Research, University of Sheffield, Sheffield, UK