Power Dynamics Among Health Professionals in Nigeria: A Case Study of the Global Fund Policy Process

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.

Ion-acoustic envelope solitons in electron-positron-ion plasmas

Ion-acoustic envelope solitons in a collisionless unmagnetized electron-positron-ion plasma are studied. The Krylov-Bogoliubov-Mitropolsky perturbative technique is used to obtain the nonlinear Schrödinger equation. The critical wave number for the modulational instability depends upon the concentration of different species and the temperature ratios of electrons and positrons. In the limiting case of zero positron concentration we recover the previous results of electron-ion plasma. It is found that a small concentration of ions in the electron-positron plasmas can change the dynamics of the system significantly. The ions can introduce slow time and long spatial scales in the plasmas. Thus the electron-positron plasmas become richer in linear and nonlinear wave dynamics.