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Table 1 Dimensions of Gaventa’s power cube (Barasa et al. 2016; Rowlands 1997; Veneklasen et al. 2002)

From: “Sometimes it is difficult for us to stand up and change this”: an analysis of power within priority-setting for health following devolution in Kenya

Spaces for power

Closed spaces

Elites make decisions behind closed doors, which in Kenya include discussions between county executive committee members and the governor or among members of county assembly;

Invited spaces

Citizens are invited to participate by authorities, which in Kenya includes the public participation forums;

Claimed spaces

Less powerful actors claim spaces from the power holders, which in Kenya includes the use of social media platforms by citizens to raise awareness about poor quality services.

Places for power

Global

Globalisation shifts traditional understandings of the location and exercise of power. Global actors, forces and structures in turn influence and shape national and local level power relationships. In Kenya this includes international pressure for devolution.

National County Health worker

The role of the national level in power dynamics, influences the legitimacy and power dynamics at other (sub-national) and local levels. Decentralisation, transforms national and local power relationships.

In Kenya, this has contributed to reduced power for national level to identify, plan and budget for health priorities and actions at sub-national levels, with greater power now held at county level and lower levels of power held by health workers at sub-county and health facility level compared with prior to devolution.

Local

Local levels may be dependent on other levels for the extent to which power is legitimated. In Kenya, community level actors may be involved with priority-setting through public participation forums, or through community representation in other existing committees at community and facility levels.

Forms and visibility of power

Visible power’

Observable decision making. This includes the visible and definable rules, structures, authorities, institutions and procedures for decision-making. Strategies targeting this level seek to change the ‘who, how and what’ to increase accountability of priority-setting processes.

‘Hidden power’

Setting the political agenda, is less obvious. Certain powerful people and institutions maintain their influence by controlling who is involved with decision-making and what is on the agenda. Actions to address this level include empowering advocacy strategies that seek to strengthen organisations of poor and marginalised people to influence the way in which political agenda is shaped.

‘Invisible power’

Shaping meaning and what is important. Problems and issues are kept from the minds of the actors involved, by influencing how they think about their place in the world and controlling access to information, so that people are unable to make informed choices. In this dimension power operates at a deeper ‘invisible’ level, so that actors may unwittingly follow against their own best interests, thereby avoiding conflict by making it impossible for people to imagine anything different to the status quo. Power is closely associated with ideology. Beliefs, values, attitudes and ways of analysing life, enforced by structures such as family, education system, religion, the media, the economy and the state, tend to reinforce the dominant ideology and power of the dominant groups within it. Change strategies at this level target social and political culture and individual consciousness.