A framework for medical power in two case studies of health policymaking in India and Niger
A framework for medical power in two case studies of health policymaking in India and Niger
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DOI：
10.1080/17441692.2018.1457705
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发表时间：
2019-04-03
影响因子：
3.3
通讯作者：
Rodriguez, Daniela C.
中科院分区：
文献类型：
--
作者：
Dalglish, Sarah L.;Sriram, Veena;Rodriguez, Daniela C.
医疗专业人员影响卫生决策，但他们行使的权力在低收入和中等收入国家并没有得到很好的理解。我们探索了在尼日尔(1990年代末-2012年)和印度(1990年代初-2015年)为儿童生存制定国家卫生政策的医疗力量。这两个案例研究都使用了文献回顾、深度访谈和非参与者观察；结合分析追溯了政策过程，并建立了围绕权力的理论类别，以构建医疗权力在卫生政策制定中的概念框架。医生，主要是专家，在每个案例中使用他们的权力来制定不同的政策。在尼日尔，一小群有联系的儿科医生在一位强大的非医疗参与者--该国总统--通过制定广泛的卫生系统改进措施改变了辩论之后，推行了转移任务的政策。在印度，一个更加分散的专家群体优先考虑三级医疗政策，这些政策可能只会让一小部分人受益。与高收入环境相比，这些案例中的医疗权力被引导和表达，职业组织和影响政策制定的能力具有更大的变异性。总而言之，这两个案例都提供了证据，表明医疗权力集中在卫生决策中可能导致公共卫生问题的医学化。
Medical professionals influence health policymaking but the power they exercise is not well understood in low- and middle-income countries. We explore medical power in national health policymaking for child survival in Niger (late 1990s-2012) and emergency medicine specialisation in India (early 1990s-2015). Both case studies used document review, in-depth interviews and non-participant observation; combined analysis traced policy processes and established theoretical categories around power to build a conceptual framework of medical power in health policymaking. Medical doctors, mainly specialists, utilised their power to shape policy differently in each case. In Niger, a small, connected group of paediatricians pursued a policy of task-shifting after a powerful non-medical actor, the country's president, shifted the debate by enacting broad health systems improvements. In India, a more fragmented group of specialists prioritised tertiary-level healthcare policies likely to benefit only a small subset of the population. Compared to high-income settings, medical power in these cases was channelled and expressed with greater variability in the profession's ability to organise and influence policymaking. Taken together, both cases provide evidence that a concentration of medical power in health policymaking can result in the medicalisation of public health issues.