Table 5.
Type of power practices and contributing actor lifeworlds
| Types of power practices observed at actor interfaces | Underpinning lifeworld elements |
||
|---|---|---|---|
| Positional power relations | Personal concerns/characteristics | Social, cultural, ideological standpoints | |
| Centre actors’ domination on policy and programmatic agenda | Organizational power and budgetary control of politicians and central actors | ||
| Resistance, contestations and negotiation by private service providers, | Influential social positions and cumulative power of private lobbies | Personal interests of local politicians, managers and doctors in kickbacks | |
| Resistance to follow top down instructions on JSSK documentation and reporting | Social positions of being junior and senior in profession | Unwillingness and non-cooperating attitude of some managers; need for recognition and credit for managers | |
| Domination of doctors and nurses on service delivery decisions (sending a client away) | Professional autonomy on clinical decisions of doctors | ||
| Domination of doctors on patient’s choice for medicines or treatment and consent from patients | Professional position, social positions of influence of doctor; Low knowledge of patients | ||
| Negotiations and contestations of beneficiary and managers for better quality | More informed clients and exercising knowledge, use of social influence by patients | Beneficiary belief in patient rights and entitlements | |
| Doctor and facility control over availability of USG services and client negotiations | Organizational and professional (medical) power of doctors | Absence of choice and personal need of patients to avail services from private; financial interest of doctors | Accepted norm for not being accountable to patient needs; Belief in incentivization to doctors as a systems responsibility |
| Collaboration, facilitation for local problem solving and implantation needs for policy | Commitment, energy, problem solving attitude of one manager | Faith in participatory and collaborative management of a manager | |
| Doctors facilitation for service delivery (all services to a client) | Doctor’s professional ethics and moral sense of duty towards society and poor | ||