Majumdar Piyusha, Gupta S D, Mangal D K, Sharma Neeraj, Kalbarczyk Anna
SD Gupta School of Public Health, IIHMR University, Jaipur, Rajasthan, India.
Indian Institute of Health Management Research, Jaipur, Rajasthan, India.
Front Health Serv. 2022 Sep 6;2:896508. doi: 10.3389/frhs.2022.896508. eCollection 2022.
Power is exercised everywhere in global health, although its presence may be more apparent in some instances than others. Studying power is thus a core concern of researchers and practitioners working in health policy and systems research (HPSR), an interdisciplinary, problem-driven field focused on understanding and strengthening multilevel systems and policies. This paper aims to conduct a power analysis as mobilized by the actors involved in implementation of the polio program. It will also reflect how different power categories are exerted by actors and embedded in strategies to combat program implementation challenges while planning and executing the Global Polio Eradication Initiative.
We collected quantitative and qualitative data from stakeholders who were part of the Polio universe as a part of Synthesis and Translation of Research and Innovations from the Polio Eradication Project. Key informants were main actors of the polio eradication program, both at the national and sub-national levels. Research tools were designed to explore the challenges, strategies and unintended consequences in implementing the polio eradication program in India. We utilized Moon's expanded typology of power in global governance to analyze the implementation of the polio eradication programme in India.
We collected 517 survey responses and conducted 25 key informant interviews. Understanding power is increasingly recognized as an essential parameter to understand global governance and health. Stakeholders involved during polio program implementation have exerted different kinds of power from structural to discursive, moral power wielded by religious leaders to institutional power, expert power used by professional doctors to commoners like female vaccinators, and network power exercised by community influencers. Hidden power was also demonstrated by powerless actors like children bringing mothers to polio booths.
Power is not a finite resource, and it can be used, shared, or created by stakeholders and networks in multiple ways. Those people who seem to be powerless possess invisible power that can influence decision making. Moreover, these power categories are not mutually exclusive and may be deeply interconnected with each other; one type of power can be transformed into another. Power and relations play an important role in influencing the decision-making of the community and individuals. Mid-range theories of core implementation science like PARIHAS and CFIR can also add an important variable of power in their construct necessary for implementation success of any health program.
权力在全球卫生领域无处不在，尽管其存在在某些情况下可能比其他情况更明显。因此，研究权力是从事卫生政策与系统研究（HPSR）的研究人员和从业者的核心关注点，这是一个跨学科、以问题为导向的领域，专注于理解和加强多层次系统及政策。本文旨在对参与脊髓灰质炎项目实施的行为者所运用的权力进行分析。它还将反映不同权力类别是如何由行为者施加并嵌入到应对项目实施挑战的策略中，同时规划和执行全球根除脊髓灰质炎行动。
作为脊髓灰质炎根除项目研究与创新的综合与转化的一部分，我们从脊髓灰质炎领域的利益相关者那里收集了定量和定性数据。关键信息提供者是脊髓灰质炎根除项目在国家和次国家层面的主要行为者。研究工具旨在探索在印度实施脊髓灰质炎根除项目中的挑战、策略和意外后果。我们利用穆恩在全球治理中扩展的权力类型学来分析印度脊髓灰质炎根除项目的实施情况。
我们收集了517份调查回复，并进行了25次关键信息提供者访谈。理解权力越来越被视为理解全球治理和卫生的一个基本参数。脊髓灰质炎项目实施过程中的利益相关者施加了从结构权力到话语权力等不同类型的权力，宗教领袖行使的道德权力、专业医生使用的专家权力、女性疫苗接种员等平民的权力，以及社区有影响力者行使的网络权力。像孩子带着母亲到脊髓灰质炎疫苗接种点这样看似无权的行为者也展示了隐性权力。
权力不是一种有限的资源，利益相关者和网络可以通过多种方式使用、分享或创造权力。那些看似无权的人拥有可以影响决策的无形权力。此外，这些权力类别并非相互排斥，可能彼此深度相互关联；一种权力类型可以转化为另一种。权力和关系在影响社区和个人的决策方面发挥着重要作用。像PARIHAS和CFIR这样的核心实施科学的中程理论在其构建中也可以添加权力这一重要变量，这对于任何卫生项目的实施成功都是必要的。
