Power Dynamics Among Health Professionals in Nigeria: A Case Study of the Global Fund Policy Process.
Power Dynamics Among Health Professionals in Nigeria: A Case Study of the Global Fund Policy Process.
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DOI：
10.34172/ijhpm.2022.6097
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发表时间：
2022-12-19
影响因子：
3.5
通讯作者：
Balen J
中科院分区：
文献类型：
--
作者：
Lassa S;Saddiq M;Owen J;Burton C;Balen J
背景：卫生工作者是卫生政策制定的核心。鉴于卫生系统的复杂性、动态性和政治性，在卫生工作者驾驭卫生系统时，各种形式的“隐性权力”正在发挥作用。本研究旨在探讨权力的动态及其来源，以及如何在尼日利亚卫生系统的背景下形成政策制定和实施。 研究方法：该案例研究是全球基金在尼日利亚的赠款，结果基于一项深入的定性研究，涉及2014年和2016年进行的34次半结构化关键知情人访谈（KII），董事会会议观察和文件分析。参加者在参与全球基金活动的组织中担任中高级职位（如主任、方案管理员），特别是参与提案的制定和执行。使用专题分析对数据进行了分析，以便深入了解卫生专业人员在政策进程中的权力动态。 结果：医疗专业人员保持了主导地位和专业垄断，从而控制了政策空间。生物医学话语在政策制定中的结构性和生产力鼓励全球行为者和地方政府偏爱快速生物医学模式，这些模式侧重于药物、检测试剂盒和医疗服务的供应，而忽视了有助于我们更好地了解的方面。有需要的人对这些服务的接受程度很差。被压制的群体（如非临床专家、患者和社区组织）更好地理解接受服务的障碍，他们的声音被压制。 结论：专业垄断理论有助于说明医疗专业人员如何在尼日利亚的卫生系统中占据并保持精英地位。特定环境的结构和代理因素是维持这种专业垄断的关键，同时限制了其他卫生职业在社会地位阶梯上上升的机会。
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 34 semi-structured key informant interviews (KIIs), board-meeting observations, and documentary analysis conducted in 2014 and 2016. 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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