International Journal of Health Policy and Management

International Journal of Health Policy and Management

The Practice of Power by Regional Managers in the Implementation of an Indigenous Peoples Health Policy in the Philippines

Document Type : Original Article

Authors
Ryan C. Guinaran 1
Erlinda B. Alupias 1
Lucy Gilson 2, 3
1 Department of Extension Education, College of Agriculture, Benguet State University, Benguet, Philippines
2 HPS Division, University of Cape Town, Cape Town, South Africa
3 London School of Tropical Medicine and Hygiene, London, UK
10.34172/ijhpm.2020.246
Abstract
Background
Indigenous peoples are among the most marginalized groups in society. In the Philippines, a new policy aimed at ensuring equity and culture-sensitivity of health services for this population was introduced. The study aimed to determine how subnational health managers exercised power and with what consequences for how implementation unfolded. Power is manifested in the perception, decision and action of health system actors. The study also delved into the sources of power that health managers drew on and their reasons for exercising power.
 
Methods
The study was a qualitative case study employing in-depth semi-structured interviews with 26 health managers from the case region and analysis of 15 relevant documents. Data from both sources were thematically analyzed following the framework method. In the analysis and interpretation of data on power, VeneKlasen and Miller’s categorization of the sources and expressions of power and Gilson, Schneider and Orgill’s categorization of the sources and reasons for exercising power were utilized.
 
Results
Key managers in the case region perceived the implementation of the new Indigenous health policy as limited and weakly integrated into health operations. The forms of power exercised by actors in key administrative interfaces were greatly influenced by organizational context and perceived weak leadership and their practices of power hindered policy implementation. However, some positive experiences showed that personal commitment and motivation rooted in one’s indigeneity enabled program managers to mobilize their discretionary power to support policy implementation.
 
Conclusion
The way power is exercised by policy actors at key interfaces influences the implementation and uptake of the Indigenous policy by the health system. Middle managers are strategic actors in translating central directions to operational action down to frontlines. Indigenous program managers are most likely to support an Indigenous health policy but personal and organizational factors can also override this inclination.
Keywords
Health Policy Implementation
Practice of Power
Indigenous Peoples
Philippines

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International Journal of Health Policy and Management
Volume 10, Special Issue on Analysing the Politics of Health Policy Change in LMICs
The HPA Fellowship Programme 2017-2019
July 2021
Pages 402-413

  • Received Date 10 March 2020
  • Revised Date 24 November 2020
  • Accepted Date 28 November 2020
  • First Published Date 14 December 2020
  • Published Date 01 July 2021