Department of Public Health, Institute of Tropical Medicine, Antwerp, Antwerpen, Belgium
HIV and Viral Hepatitis, World Health Organization Country Office for Nigeria, Abuja, Nigeria.
BMJ Glob Health. 2020 Sep;5(9). doi: 10.1136/bmjgh-2020-003349.
Interprofessional interaction is intrinsic to health service delivery and forms the basis of task-shifting and task-sharing policies to address human resources for health challenges. But while interprofessional interaction can be collaborative, professional hierarchies and discipline-specific patterns of socialisation can result in unhealthy rivalry and conflicts which disrupt health system functioning. A better understanding of interprofessional dynamics is necessary to avoid such negative consequences. We, therefore, conducted a historical analysis of interprofessional interactions and role-boundary negotiations between health professions in Nigeria.
We conducted a review of both published and grey literature to provide historical accounts and enable policy tracing of reforms related to interprofessional interactions. We used Nancarrow and Borthwick's typology for thematic analysis and used medical dominance and negotiated order theories to offer explanations of the conditions that facilitated or constrained interprofessional collaboration.
Despite an overall context of medical dominance, we found evidence of professional power changes (dynamics) and role-boundary shifts between health professions. These shifts occurred in different directions, but shifts between professions that are at different power gradients were more likely to be non-negotiable or conflictual. Conditions that facilitated consensual role-boundary shifts included the feasibility of simultaneous upward expansion of roles for all professions and the extent to which the delegating profession was in charge of role delegation. While the introduction of new medical diagnostic technology opened up occupational vacancies which facilitated consensual role-boundary change in some cases, it constrained professional collaboration in others.
Health workforce governance can contribute to better functioning of health systems and voiding dysfunctional interprofessional relations if the human resource for health interventions are informed by contextual understanding (informed by comparative institutional and health systems research) of conditions that facilitate or constrain effective interprofessional collaboration.
专业间的互动是卫生服务提供的固有组成部分，也是转移和分担任务政策的基础，以应对卫生人力资源挑战。但是，虽然专业间的互动可以是协作性的，但专业等级制度和特定学科的社会化模式可能会导致不健康的竞争和冲突，从而破坏卫生系统的运作。为了避免这种负面影响，我们有必要更好地了解专业间的动态。因此，我们对尼日利亚卫生专业人员之间的专业间互动和界限协商进行了历史分析。
我们对已发表和灰色文献进行了审查，以提供历史叙述，并追溯与专业间互动相关的改革政策。我们使用 Nancarrow 和 Borthwick 的专题分析类型学，并使用医学主导和协商秩序理论来解释促进或限制专业间合作的条件。
尽管存在总体的医学主导地位，但我们发现了卫生专业之间存在权力变化（动态）和界限协商的证据。这些转变方向不同，但在不同权力梯度的专业之间发生的转变更有可能是不可协商或冲突性的。促进协商一致的界限转变的条件包括所有专业角色同时向上扩展的可行性，以及委托专业负责角色委托的程度。虽然新的医学诊断技术的引入为所有专业的角色扩张提供了可行性，从而在某些情况下促进了协商一致的界限变化，但在其他情况下，它也限制了专业合作。
如果卫生人力资源干预措施以对促进或限制有效专业间合作的条件的背景理解（通过比较制度和卫生系统研究提供信息）为指导，卫生劳动力治理可以促进卫生系统更好地运作，并避免功能失调的专业间关系。
