TY - JOUR
T1 - A framework for medical power in two case studies of health policymaking in India and Niger
AU - Dalglish, Sarah L.
AU - Sriram, Veena
AU - Scott, Kerry
AU - Rodríguez, Daniela C.
N1 - Funding Information:
The Niger case study was funded by UNICEF (#43114640) and the USAID TRAction project (FY11-G06-6990). Both UNICEF and USAID staff advised the study team, but did not substantively affect the study design, instruments or interpretation of data. Fieldwork for the India case study was supported by the American Institute of Indian Studies and the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. V. S. is currently supported by the Agency for Healthcare Research and Quality [grant number T32 HS000087] (PI: Jane Holl, MD, MPH). The authors sincerely thank Drs Kabir Sheikh and Sara Bennett for reviewing an early version of our manuscript and providing helpful comments and guidance. Additional thanks are due to Reviewer #1, whose engagement with our manuscript improved its final form, and to editors at GPH for their thoroughness and attention to detail. The contents are solely the responsibility of the authors and do not necessarily represent the official views of any funders.
Funding Information:
The Niger case study was funded by UNICEF (#43114640) and the USAID TRAction project (FY11-G06-6990). Both UNICEF and USAID staff advised the study team, but did not substantively affect the study design, instruments or interpretation of data. Fieldwork for the India case study was supported by the American Institute of Indian Studies and the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. V. S. is currently supported by the Agency for Healthcare Research and Quality [grant number T32 HS000087] (PI: Jane Holl, MD, MPH).
Publisher Copyright:
© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2019/4/3
Y1 - 2019/4/3
N2 - 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.
AB - 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.
KW - LMICs
KW - Power
KW - equity
KW - health policy
KW - medicalisation
UR - http://www.scopus.com/inward/record.url?scp=85044973306&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85044973306&partnerID=8YFLogxK
U2 - 10.1080/17441692.2018.1457705
DO - 10.1080/17441692.2018.1457705
M3 - Article
C2 - 29616876
AN - SCOPUS:85044973306
VL - 14
SP - 542
EP - 554
JO - Global Public Health
JF - Global Public Health
SN - 1744-1692
IS - 4
ER -