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

Document Type : Original Article


1 School of Health and Health Related Research, University of Sheffield, Sheffield, UK

2 Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK

3 The Department of Community Medicine, University of Jos, Jos, Nigeria


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.

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.

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.

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.



Commentaries Published on this Paper


  • Medical Dominance in Global Health Institutions as an Obstacle to Equity and Effectiveness; Comment on “Power Dynamics Among Health Professionals in Nigeria: A Case Study of the Global Fund Policy Process”

        Abstract | PDF


  • Coloniality, Elite Networks and Intersectionality: Key Concepts in Understanding Biomedical Power and Equity in Health Policy Processes; Comment on “Power Dynamics Among Health Professionals in Nigeria: A Case Study of the Global Fund Policy Process”

        Abstract | PDF


  • The Dynamics of Power Flow From the Global Health Financing; Comment on “Power Dynamics Among Health Professionals in Nigeria: A Case Study of the Global Fund Policy Process”

        Abstract | PDF



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Volume 11, Issue 12
December 2022
Pages 2876-2885
  • Receive Date: 05 March 2021
  • Revise Date: 16 March 2022
  • Accept Date: 28 March 2022
  • First Publish Date: 29 March 2022