Exploring the interactions between medical professionals and Global Health Initiatives in the Nigerian health system: A case study of the Global Fund grant in Nigeria

Recently, increasing attention has been given to behavioural and relational aspects of
health systems, placing actors at the core. Indeed, health systems comprise of numerous
actors, and one of the most important and influential is the medical doctor, playing a
vital role in policy transfer at the national level (Benson 2013). The influence of
medical professionals stems beyond shaping the implementation of health policies, to
also potentially altering the policy content and process (Koon & Mayhew 2013). In lowand middle-income countries (LMICs) the health system is a dynamic mix of multiple
stakeholders, including supra-national organizations, Global Health Initiatives and NonGovernmental Organizations (Samb et al. 2009), resulting in an environment where
contesting interests and values are competing for relevance and authority. This study
examined the power dynamics of medical professionals in the Nigerian health system
through an in-depth case study of the interactions between the Global Fund grant and
Nigerian medical professionals.
Results are based on an in-depth qualitative study involving 34 semi-structured key
informant interviews with policy makers, board-meeting observations, and documentary
analysis. Data was analysed iteratively in order to gain insight into the power dynamics
of medical professionals in policy processes and to analytically identify structural and
agential factors within the health system that encourage or discourage professional
dominance.
Medical professionals maintained dominance and professional monopoly, thereby
controlling policy spaces. Global actors and the local government were challenging
interest groups, with a preference for rapid biomedical models that focus on medications
and test kits, and the supply of health services, while neglecting social science
narratives and demand creation. This work explores such issues in detail and presents
contextual factors of relevance to the Nigerian setting, thereby adding to existing
literature on health systems and the sociology of medical professionals