Table 4.

Examples of actor interfaces and practices of power in JSSK implementation

Example of interfaces observed	Practices of power and related implementation issue
Political interfaces (centre-state/politician-managers/managers-private owners)	Centre domination on policy and programmatic agenda over the decision of JSSK rollout in HP
	Resistance and contestations by private service providers against free medicines and tests in public hospitals Negotiations by managers with private providers
Interfaces among middle managers across levels (facility/district/state)	Resistance by facility managers to follow top down instructions on JSSK documentation and reporting Contestation for getting credit about delivering free services among state and district managers State domination over reporting needs
	Collaboration for local problem solving and implementation needs for policy among some managers
	Top down push by state to control implementation steps and guidelines, Resistance and avoidance by facility managers
Interfaces among doctors and managers in health facilities	Resistance of doctors towards a restrictive medicine list; Resistance of doctors for using generic drugs Negotiations and contestations from doctors about need of higher end and more modern medicines citing quality issues
	Resistance related to prescription of ultrasonography to pregnant women
	Resistance from doctors for involvement in national programmes
Interfaces among nurses and managers health facilities	Control of administrators on resources Negotiations by nurses for availability of medicines
	Contestation and negotiation by nurses with doctors on choice of free medicines and tests for patients
Interfaces among beneficiaries and service providers (doctors/nurses/managers)	Doctors facilitation for service delivery to clients
	Domination of doctors and nurses on service delivery decisions (sending a client away)
	Domination of doctors on patient’s choice for medicines or treatment and consent from patients
	Negotiations and contestations of beneficiary and managers for better quality or more advanced services or services bypassing the guidelines
	Doctor and service provider control over providing USG service and client negotiations for USG service access