Power analysis in health policy and systems research: a guide to research conceptualisation

Abstract

Power is a growing area of study for researchers and practitioners working in the field of health policy and systems research (HPSR). Theoretical development and empirical research on power are crucial for providing deeper, more nuanced understandings of the mechanisms and structures leading to social inequities and health disparities; placing contemporary policy concerns in a wider historical, political and social context; and for contributing to the (re)design or reform of health systems to drive progress towards improved health outcomes. Nonetheless, explicit analyses of power in HPSR remain relatively infrequent, and there are no comprehensive resources that serve as theoretical and methodological starting points. This paper aims to fill this gap by providing a consolidated guide to researchers wishing to consider, design and conduct power analyses of health policies or systems. This practice article presents a synthesis of theoretical and conceptual understandings of power; describes methodologies and approaches for conducting power analyses; discusses how they might be appropriately combined; and throughout reflects on the importance of engaging with positionality through reflexive praxis. Expanding research on power in health policy and systems will generate key insights needed to address underlying drivers of health disparities and strengthen health systems for all.

See Change: Overcoming Anti-Black Racism in Health Systems

“…In the past decade, many have considered adopting internal racial and gender-related Key Performance Indicators (KPIs) as a positive strategy for increasing diversity through new hiring processes ( 24 ). However, without proper representation and advocacy to actively support marginalized or politicized groups, not as a group member but in solidarity with their struggle, through tangible mechanisms for power redistribution, these efforts focus on the same body of proven players, overlooking emerging scholars of color while simultaneously obstructing opportunities to effect change ( 25 , 26 ). The subjective process of talent searches within educational institutions “typically mirror the networks of those leading the search,” demonstrating a “self-referential decision-making process[es]” contributing to the large number of racial minorities that are left out of these procedures ( 27 ).…”

Powers, engagements and resultant influences over the design and implementation of medicine pricing policies in Ghana

“…Our understanding of stakeholder engagements, powers and resultant influences over policy processes (figure 1) drew on the available conceptualisations of stakeholder powers, engagements and influences over health policy processes. [23][24][25][26][27] Each stakeholder that is, actor with interest in a policy issue, has own sources of power which they can exercise to influence policy decisions as they engage in policy design and/or implementation.…”

Conceptual framework for systemic capacity strengthening for health policy and systems research

“…For example, values of equity and inclusiveness combined with principles of equitable ownership and collaboration can usefully frame capacity strengthening around the available in-house assets and thus ensure longer-term sustainability of capacity gains. Such values and principles also flag the importance of critical reflexivity in any capacity strengthening endeavour, including acknowledgement of the way power (eg, along epistemic or material dimensions) is distributed among and between collaborators, and consideration of what capacity strengthening strategies mitigate rather than exacerbate any power differentials 51 60. Some of these values and principles may naturally reflect the organisational or network-level missions, but there may also be implicit or explicit capacity-specific values and principles.…”