Table 1. Both Cambodia and Pakistan have faced challenges in recent decades which have weakened or slowed development, and there are signs that domestic policymakers are trying to improve the situation.
In the early s, Cambodia emerged from two decades of civil conflict, embarking in a process of democratic transition and state reconstruction. In the process, international actors and institutions played a central role in setting the policy agenda, defining priorities and approaches through the politics of funding.
In recent years, however, further changes have occurred. While the government is still dependent on foreign aid in many sectors Ear , economic growth and the strengthening of institutional structures, such as the Department of Planning and Health Information, have increased local ownership and management of decision-making processes.
Steps are being taken to improve governance and institutional capacity. For example, the devolution of health as part of the 18th Constitutional Amendment in was implemented to increase accountability and policymaker capacity at the provincial level Government of Pakistan Building on the principles outlined in the National Health Vision—bringing together provincial and national level policy makers as well as academics and private sector representatives—a major reform of the health sector was launched in , after a year gap without any significant policy change Government of Pakistan We focused on domestic policy actors, including those working at the national and provincial levels.
Consultants, in-country donor representatives or non-governmental organization actors that liaise closely with policymakers were also included to collect multiple perspectives on the domestic policymaking environment. Initially, five policy actors in each country were identified purposively based on professional connections of the research team through ongoing or previous public health research in the countries.
During the initial interviews, the other participants were identified through snowball searching in which each policy actor introduced researchers to one or two potential informants in their network. In total, we conducted 24 in-depth, semi-structured interviews 14 in Pakistan and 10 in Cambodia. To ensure broad representation, we interviewed high-level policy actors involved in planning or implementation in a range of health areas and contexts, including maternal and child health, infectious diseases, and in primary and tertiary healthcare delivery, to explore common and contrasting experiences.
If consent was obtained, interviews were audio-recorded. Recorded interviews were transcribed verbatim in full. Interviews that were conducted in languages other than English were translated into English and the interviewer reviewed the translated transcripts to verify accuracy of translation. No contacts refused to participate, although three participants preferred not to be recorded.
We conducted a thematic analysis starting with deductive coding and grouping of transcripts in relation to three means of influence: financial resources, technical expertise and indirect financial and political incentives. We decided to focus on these routes of influence based on former studies that documented their relevance to policymaking Dalglish et al.
Specifically, we focused on financial resources , technical expertise and intersectoral leverage. Finally, intersectoral leverage refer to means of influence operating outside of the health sector, such as effects on the international image or standing of countries which can impact on areas including trade and tourism Lin and Gibson ; Harris and Siplon Deductive coding was followed by an inductive coding phase to identify emerging sub-themes within the three routes of influence, applying techniques from the constant comparative method Boeije , including line by line analysis of initial interviews performed independently by two researchers , the use of subsequent interviews to test preliminary assumptions, and the comparison of codes across countries and health areas Strauss ; Parsons Our interviews with health policy actors in both countries indicated that, as expected, donors were perceived to exert strong influence across the four stages of the policy process.
The three routes of influence studied, and specific mechanisms that were important in establishing donor influence, varied at each stage, as described in the following sections and summarized in Table 2. Table 2. Means of power exercised across the different stages of the policy process in Pakistan and Cambodia, as perceived by domestic policy actors. Impact on international reputation and tourism from failure to address donor priorities Cambodia.
Donors select which health areas are provided funding for, thereby setting agenda. Donors prioritize which research or surveys they fund to provide the evidence base to inform agenda setting Cambodia and Pakistan. Donors have better coordination to collaborate on policy formulation Cambodia and Pakistan. Financial resources from donors shape the areas of work of non-governmental organizations Cambodia and Pakistan.
Control timing of availability of resources for programme implementation; sudden stops and starts Pakistan. Overall, policy actors in Pakistan and Cambodia felt that the level and availability of external funding often dictated which issues were placed high on national health agendas as well as the types of interventions that were selected to address the health issues.
Financial resources were identified as the main mechanism through which donors either directly shaped national health priorities or indirectly exerted influence by determining which research or surveys they fund to provide the evidence base to inform agenda setting and advocacy.
In relation to donors directly shaping which health areas are prioritized for action through funding availability or lack thereof , one international NGO representative and policy advisor C1 used mental health in Cambodia as an example to illustrate how much dependence on donor funding impacts the health policy agenda.
She explained that even though domestic stakeholders were aware of the urgent need to address mental health issues—owing to the genocide perpetuated in the country—this was not a priority health area until when the first strategic plan was initiated because of a lack of donor funding, on which the government is reliant.
In addition to directly influencing policy setting through funding availability, some interviews P3, C1, C9 indicated a form of indirect influence donors could have by shaping the areas for which health information or evidence is available to policymakers during the agenda setting process.
One interviewee in Cambodia explained: Many times, however, research is driven by funding, not demand. And this type of research is less relevant to the country. Related to this, an international NGO country director and another international NGO manager who had previously worked in the public sector P3, C1 expressed frustration at the lack of funding made available by their governments for research, which they identified as a reason for the limited power of policy actors in influencing what evidence is available, and through this, overall health priority setting.
Policy actors P3, P12, C1 were clear in acknowledging that the imbalance in power was related to the relatively small amount of funding from national sources.
Firstly, as described above, specific health issues or approaches become prominent in countries—even if they do not fit with the overall national strategy—because these were better resourced by donors. The second negative consequence of the perceived lack of influence of domestic policy actors on priority setting or research was that important areas considered can be neglected, especially when donors focus on narrow, pre-determined policy goals.
In particular, for both research and health programs, there was a common feeling among interviewees that aspects related to health system strengthening, such as prevention and primary care, received less attention because donor funding targeted disease specific programs. Two policy actors in Cambodia C4, C9 explained that the way that donors and UN agencies portray Cambodia globally matters because it has a direct impact on international reputation and tourism; therefore, high-level national policymakers feel the need to particularly pay attention to priorities of donors and international agencies such as the World Health Organization.
Similarly, two interviewees from Pakistan P2, P3 who had held managerial roles in both public and private organizations believed that the threat of travel and trade restrictions being introduced by international organizations if polio was not controlled was important in placing polio high on the national agenda.
In contrast to agenda and priority setting, in which control of financial resources played a major role in mediating donor influence, we found that technical expertise of donors appeared to be a key route of influence at the policy formulation stage. Donors were perceived to have greater proficiency in using data from surveys and research studies to develop strong policies and strategic plans.
Policy actors also felt that donors were better at filling gaps in evidence whether by commissioning specific research or relying on their data and knowledge base to extrapolate findings to inform policies.
We just decide. Two advisers to national policymakers P12, C2 specifically identified the language through which technical information and policy-relevant research was presented as working to disadvantage policy actors or reinforce the influence of donors.
Technical reports used to inform policy formulation were described as lengthy, written in English and utilizing complex terms that served as barriers to the accessibility of the information serving to inform policy choices. As one interviewee explained: Start first of all with the English language, it has already created a barrier for those at the grassroots level to really connect with the technical expertise.
They just want to spend the money. Their aim is not to make Pakistan independent. They also do not take exactly evidence based decisions. We also found that the level of coordination and collaboration among donors was perceived by some interviewees to give them collective power in forming health policies.
These platforms are set up specifically with the aim of enhancing coordination between donors and, in the opinion of interviewees that described them Ca8, Ca6, P12 , allow donors to present a coherent and powerful position to influence policy development. For example, a policy advisor in Cambodia C6 shared details about the Health Partners Meeting, which involves the participation of bilateral and multilateral donors, and international agencies, such as the World Health Organization.
He believed that external donor and technical support agencies holding a closed meeting one week before the monthly Technical Working Group for Health meeting in which health policies are discussed with the Cambodian government helps them to prepare a unified and well composed plan to present to high level policymakers.
In contrast, it appeared from account of several interviewees P9, P12, C5, C6, C8 that domestic policy actors had no similar mechanisms to organize themselves in the same way to be able to effectively influence policy design. The main mechanism identified through which donors could influence policies being implemented on the ground was by using financial resources to shape the areas of work of non-governmental organizations NGOs in the country. An advisor to policymakers in Cambodia C2 explained that he had seen sudden growths in NGOs focusing on specific topics, often unlinked to national priorities or even the NGOs own mandate, as they were dependent on winning grants to continue their operations.
Since financial flows to this NGO dwarf independent budgets of the national and provincial tuberculosis control programme, a major shift in decision-making authority of the government policy actors was felt by those interviewees involved in tuberculosis control in Pakistan. Interviews further revealed that there was also a strong donor influence on the timing of implementation of various health initiatives.
Finally, in the evaluation stage of the policy process, several policy actors interviewed P2, P3, P5, P7, P9, P10, C1, C2 felt that donors dictated targets that needed to be achieved for certain national health programs. Targets included numbers of patients to be diagnosed or started on treatment, proportions of patients receiving a selected intervention and numbers of diagnostic devices introduced into health facilities.
For example, an interviewee in Cambodia C1 explained that targets based on the global 90—90—90 HIV strategy have been powerful in influencing programme implementation in the country because of international support for this strategy UNAIDS Similarly, in Pakistan an interviewee P12 felt that the National AIDS program mobilized quickly because HIV was high on the global agenda even though domestic policy actors did not see it as an urgent priority in the Pakistan context owing to very low HIV prevalence.
For example, three public sector programme managers involved in tuberculosis control in Pakistan P6, P10, P11 independently explained that the global strategy calling for a rapid scale-up multidrug resistant MDR tuberculosis treatment is not what they would recommend based on their knowledge of health systems constraints in monitoring adherence to treatment and managing serious side-effects.
One interviewee argued that donors should evaluate success of a policy based on strengthening of broader capabilities rather than on narrow targets: If you want to achieve MDR cases, then we should train our people on them, we should have our expert machines in places, in proper places, we should have the right linkages, right communications, right capacity, those processes should be strengthened instead of looking at the target —target chasing only. It should be the process that should be strengthened all the time.
And, my discussion with the [donor name] that I keep on saying is that the target should not be the patients, the target should be systems instead. Just as donors were found to have influence in putting certain disease specific, vertical programs high on the national health agenda by making resources available for them, we also found that they were able to influence the strength of monitoring and evaluation of selected health areas in both countries.
We identified two main mechanisms by which this occurred. Firstly, donors influenced which health areas information systems were enhanced for by channelling financial resources towards infrastructure development. This included investments in standardized record keeping, moving from paper-based to electronic information storage and capacity building of healthcare providers to use the information systems effectively.
Secondly, donors could be instrumental in ensuring the targets for monitoring were clearly defined, and made resources available for regular monitoring by independent organizations. Finally, this study indicated that the perceived lack of influence of policy actors when negotiating health targets may have been exacerbated by limitations in their power to decide which health areas are covered by strong health monitoring and information systems.
For example, one Cambodian policy adviser explained that without credible independent data, national policy actors were unable to resist unrealistic targets set forth by donors or advocate for alternative health priorities, even if they disagreed with the evidence presented C2. Donors are known to exert influence over policy and practice in low resource settings, but to date only limited work has explored the implications of power imbalances at different stages of the policy process in aid-recipient nations.
We recognize that the four stages we analyse separately—priority setting, policy formulation, policy implementation and monitoring and evaluation—do in fact overlap in reality and are not discrete or linear Walt et al. Nonetheless, by considering them one-by-one we were able to draw useful insights and organize the research material in a logical manner.
Another key contribution of this study is its direct focus on perceptions and experiences of domestic health policy actors, many of whom appeared to be struggling to gain or maintain power in one way or another, and the variety of mechanisms through which donors may shape policy making and interventions. Given the qualitative nature of the study, and the focus on two particular countries, our findings may not be generalizable or relevant beyond them.
With this limitation in mind, however, we must note that a striking point emerging from the comparative analysis of the interviews is the essential agreement of participants in Cambodia and Pakistan on fundamental issues concerning their relations with international donors. Despite significant differences in health systems, history and engagement with the international community, policy actors in both countries raised similar concerns over the ways that donors may influence the policy process, leading to policies which they felt were often misaligned with local needs and capacities.
In both countries, we found that control of financial resources was the most commonly identified lever by which donors influenced policy, particularly at the priority setting and implementation stages. Many policy actors in Cambodia and Pakistan revealed a mismatch between what health activities they believe are important for their countries and what happens in practice.
While others have documented that control of financial resources directly influences health policy Buse et al. This study also found that the influence conferred by greater technical capacity was not only related to skills and expertise of donors, but also to better organizational mechanisms for coordination and collaboration among donors and international technical agencies and platforms they have set up to maximize interaction with policy elites. In contrast, policy actors in Cambodia and Pakistan acknowledged that domestic structures to support priority-setting were weak and collaboration with local research bodies and institutions was lacking.
In such conceptualizations, power is not just identified at discrete decision points, but rather seen to also be more diffuse: built into systems of interactions and discourses , which end up shaping what is considered relevant knowledge in the first place often to the advancement of particular interests. Our findings also illustrate that power relationships between donors and aid recipients are more complex and multifaceted than simply donors having direct influence over decisions by controlling resource allocation.
In addition, we found many instances of how power was exercised outside discrete decision-making points. In addition, our findings about specific mechanisms that can result in donors having greater power—beyond direct control of financial resources for health—may have implications for addressing the power imbalance.
Although increased funding for health from national and provincial governments in lower-income countries would be one way to alter power dynamics, this is not straightforward to achieve; the competing demands for budget allocation and development assistance for health from donors has been shown to reduce government spending on health in LMICs Lu et al.
However, policy actors in lower income countries could address the perceived power imbalance in technical expertise even with limited resources, for example, through better coordination of domestic stakeholders and organization of platforms for agenda setting and policy formulation. Appeals to technical evidence—typically of intervention effect or cost effectiveness measured over a small set of outcomes—is common; yet our findings illustrate just how many other concerns may be at stake in health decision making, and further point to important governance concerns around the process by which evidence is brought to bear and used to prioritize, legitimize, or justify particular policy actions.
Concerns over national autonomy, local accountability, local capacity building, and competing social values rarely are directly addressed in health policy development processes, yet all were touched on as important in these settings. We further saw some examples of activities by international actors to not only use evidence to inform specific decisions, but to build structures and institutions within countries as well that may shape how evidence is created and utilized to inform decision making.
Though Cambodia and Pakistan faced many challenges in the past four decades, which have slowed development and weakened state and health system infrastructure and institutions, recent institutional reform and economic growth in both countries have bolstered local capacities for decision-making and programme implementation. Therefore, a shift in power balance may occur going forward.
In , the Cambodian government introduced a Midwifery Incentive Scheme, which aimed to reduce maternal mortality rates by paying midwives with cash incentives based on the number of public health facility-based deliveries they attended.
This policy, which is entirely implemented and financed by the national government has been successful Ir et al. The Cambodian government has also taken greater financial responsibility for health policies which were originally introduced and supported only by international actors—such as the Health Equity Funds Annear et al.
As with Cambodia, in Pakistan there are indications of an increasing role of domestic policy actors in agenda setting, policy formulation and policy implementation. Much political literature suggests that African regimes can be broadly described as neo-patriotic. Such systems give prominence to relational power and influences, which tend to transcend bureaucratic, legal and administrative structures, as noted below,.
We at the sub - national levels have little say … We are often told to do several things since these dialogues began and sometimes they are contradictory … Of course you cannot question , you follow orders Sub-national level official, Guinea. In this study, another form of context that affected the power dynamics was the macroeconomic situation, which is a form of structural power.
In countries with weak and fragile economies the policy dialogues were dominated by the more economically powerful and wealthier stakeholders.
Examples include the policy dialogues in Liberia and Guinea, where it was evident that a lot of support was given to the dialogues spearheaded by technical officers from WHO. Jones [ 21 ] suggests that there are three forms of influence on perspectives: evidence and advice, public campaign and advocacy, and lobbying and negotiations.
There were several examples from our study where powerful stakeholders employed these strategies to influence perspectives and opinions, that could be regarded as use of power [ 21 ]. The declaration of the state of emergency during the Ebola outbreak in West Africa was a significant context in shaping the policy dialogues, rendering some actors powerless and others influential.
In Liberia and Guinea, policy dialogues during the Ebola outbreak were taken over by non-health stakeholders and there was more involvement of community members in the policy dialogues than was the case previously. The Ebola outbreak provided us with an important lesson about community involvement in the real sense.
Without the communities we would not have halted the Ebola outbreak National level official, Liberia. Policy processes have often been regarded as linear and rational, but experience suggests otherwise.
Policy dialogues, specifically are complex and irrational and involve many factors, one of which is power [ 9 , 21 ]. Power is not always corrupt as its definition connotes.
Power can have both positive and negative effects. Literature on power in policy dialogues argues that recognising and appreciating the different forms of power are important [ 1 , 4 , 9 ] as it provides a basis for using power in an effective manner during policy dialogues.
From our study we can confidently conclude that power has an important role to play in the policy dialogues. Using the Art and Tatenhoeve conceptual framework we were able to understand and appreciate the different forms of power and how they are used among actors.
It was also clear that contexts such as emergency situations, macroeconomic circumstances and type of governance have a major influence on the dynamics of power among actors [ 4 ]. As seen in our study, power dynamics differed and changed depending on the context, an important example of which was the power dynamics during the Ebola outbreak, where some stakeholders lost their power to other more senior and political stakeholders.
This is evident also from other studies where the context was shown to be a major influence in power dynamics [ 12 , 13 , 22 ]. One form of power is relational power, which can be either transitive or intransitive [ 4 ]. In our study transitional power was used on different occasions to benefit specific groups.
Despite being considered to lead to a zero-sum game, in this context transitional power was used to facilitate changes in the dynamics of policy-making and discussion. The exercise of this power encouraged the government to think creatively and to contemplate some of the implementation issues often not regarded during policy-making.
This form of power use should be encouraged. The civil society, other ministries, professional groups and unions should be invited to policy dialogues and provided with the opportunity to contribute to and negotiate for issues pertinent to specific policies.
Our study found that intransitive power was used in a positive manner to achieve the intended outcomes. Forums, meetings and formal groups worked in a unified manner to deliver on common outcomes. This is in line with what good policy dialogues are considered to be: participatory, debate-filled and engaging [ 14 , 20 ].
There is a danger that the way transitional power is used might lead to doing things the usual way, without allowing room for innovative discussions and debate, as highlighted in some literature [ 9 ]. In this form of power, resources, knowledge and capacity have an influential role. It is also open to abuse if there are imbalances in negotiation capital among the actors [ 9 ].
In such instances the weaker actors can be easily coerced into decisions driven by powerful counterparts. There is a need to ensure that negotiation capital among actors is balanced for better policy dialogues. This can be achieved by building the capacity of actors to participate in policy dialogues.
Capacity building can be in the areas of negotiation, policy influencing and persuasion [ 11 , 15 , 23 ]. However, policy dialogues should not be entirely dependent on knowledge and evidence. There is a tendency to favour the elite with evidence and knowledge, or what is referred to as technocratic policy-making [ 21 ].
Structural power is concerned with macro-societal structures that shape and guide the conduct of individuals and agents [ 4 ]. Our study found that all forms of this power were manifested during the policy dialogues. Cultural or social power was used to shape the manner of the participants, while legal structures were used to direct policy dialogues from the lower levels.
Both structural and economic powers were exhibited to justify the discourses on UHC and harmonisation or coordination of partners. The right thing to do as a politician was demonstrated with the active participation of both Guinean and Liberian presidents during the devastating Ebola outbreaks. Our study found that power was positively used during the dialogues to prioritise positive agendas, fast-track processes, reorganise positions, focus attention to details and involve communities.
The negative effects of power during the dialogues included the use of position to control and shape the dialogues, using limited innovation, and influencing decisions and directions through the use of knowledge power. This study shows us that we need to be cognisant of the role of power during policy dialogues and that it is important to put in place mechanisms to control it effectively.
There is need for more research in this area to determine how to engender policy-making processes that are debate- filled and interactive through the positive use of power. Erasmus E, Gilson L. How to start thinking about investigating power in the organizational settings of policy implementation. Health Policy Plan. Article PubMed Google Scholar. Gilson L, Raphaely N. The terrain of health policy analysis in low and middle income countries: a review of published literature — Dahl RA.
The concept of power. Behav Sci. Article Google Scholar. Arts B, Van Tatenhove J. Policy Sci. Lipsky M. Street level bureaucracy, vol. New York: Russell Sage; Google Scholar. Gilson L, McIntyre D.
Removing user fees for primary care in Africa: the need for careful action. Walt G, Gilson L. Reforming the health sector in developing countries: the central role of policy analysis. Mobilisation of public support for policy actions to prevent obesity. The influence of power dynamics and trust on multidisciplinary collaboration: a qualitative case study of type 2 diabetes mellitus.
Deliberative dialogues as a mechanism for knowledge translation and exchange in health systems decision-making. Soc Sci Med. Deliberative dialogues as a strategy for system-level knowledge translation and exchange. Health Policy. Clay EJ, Schaffer B. Room for manoeuvre: an exploration of public policy planning in agricultural and rural development. Chicago: Associated University Presse; Government of Canada. A code of Good Practice on Policy Dialogue. Power and pro-poor policies: the case of iCCM in Niger.
Bernard HR. Research methods in anthropology: qualitative and quantitative approaches. Qualitative Research Methods, vol. New Delhi: Sage; Whitfield L, Fraser A. Negotiating Aid: The structural conditions shaping the negotiating strategies of African governments. Int Negot. Moat KA, Abelson J. Analyzing the influence of institutions on health policy development in Uganda: a case study of the decision to abolish user fees.
Afr Health Sci. Washington DC; Jones H. Donor engagement in policy dialogue: navigating the interface between knowledge and power. Improving the use of research evidence in guideline development: 4. Managing conflicts of interests. Health Res Policy Syst. Health policy project. Download references. We owe profound gratitude to Jehovah Jireh for sustenance during the entire process of writing this paper.
The policy dialogue programme on which this study is premised, was supported by the European Union and Luxembourg. The support of WHO country offices in data collection is acknowledged. The content of the article represent the analysis, perceptions and views of the authors only and does not represent the decisions or stated policies of the World Health Organization. Ethical approval and consent were only granted for anonymised reporting and write up and given this understanding, data will not be shared.
DD and JNO conceptualized the study, supported data collection and participated in the drafting of the manuscript. KOB supported data collection and participated in data analysis, AM participated in data analysis and led the drafting of the manuscript.
All the authors read and approved the final manuscript. Informed consent was obtained from all the respondents prior to the interview. The purpose of the study was explained to the respondents, who were also informed that they were free to withdraw from the study at any time.
The respondents were assured of confidentiality in data analysis and reporting. Subject identifiers were accessible only to the research team, and only aggregate data were reported. Data were saved on password protected computer files and Dropbox applications. You can also search for this author in PubMed Google Scholar. Correspondence to Aziza Mwisongo. Reprints and Permissions. Mwisongo, A. The role of power in health policy dialogues: lessons from African countries.
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