PERCEPTIONS AND CONTRIBUTIONS OF HEALTH POLICYMAKERS ON THE MANAGEMENT OF INTERPROFESSIONAL GROUP CONFLICTS IN THE NIGERIAN HEALTH SYSTEM

Conflict in healthcare is ubiquitous and unavoidable due to the complexity of interactions, relationships and processes required for care delivery. Health policymakers confronted with this reality often perceive conflict as a threat and thereby seek to eliminate it. However, there is a growing awareness of functional or constructive conflict as a management approach that helps convert conflicts into benefits. The Nigerian health system has consistently faced dysfunctional Interprofessional Group Conflicts (IGCs) that have become synonymous with industrial action. Inequities in salary, career advancement, and leadership of hospitals are widely reported as causes of IPGCs between the often-conflicting parties, the Nigerian Medical Association (NMA) and the Joint Health Sector Union (JOHESU). Evidence to date has focused on the perspectives of frontline health workers, leaving a knowledge gap relating to the perceptions and contributions of policymakers who formulate key decisions that shape the entire health system. Hence, this thesis seeks to understand the perceptions and contributions of health policymakers on the management of IPGCs in the Nigerian health system.
This study is grounded in qualitative health policy and systems research methodology. Data collection includes 20 key informant interviews and 18 official documents which were analysed using reflexive thematic analysis and content/documentary analysis, respectively. Policymakers’ analysis was also conducted to identify policymakers’ roles, interests, and contributions to the management of IPGCs.
The causes of IPGCs were disputed and found to be complex and multifactorial including unregulated professionalisation, organisational, economic, historical, political, and human factors underpinning interprofessional relationships in the health system. Although social dialogue is reportedly used to resolve conflicts by policymakers, current management approaches tend to be reactionary without a comprehensive policy. Policymakers recommend management strategies to functionalise IPGCs including regulating professionalisation, interprofessional education/training, transparent job evaluation/salary review, complete reform of the health system, and establishing a conflict management system within the framework of interprofessional teamworking.
The findings discussed in this thesis can significantly contribute to policies and management efforts for the effective and sustainable management of IPGCs in the health system. This thesis reveals a need for future research in the sociology of profession in Nigeria and its relations to interprofessional teamworking.