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Table 3 Stakeholder interests and power of respondents interviewed

From: Stakeholder perspectives on proposed policies to improve distribution and retention of doctors in rural areas of Uttar Pradesh, India

 

Interests (Extent to which a stakeholder is impacted or affected by a change in policy) [22]

Power (Potential capacity to influence policy decisions in this context) [23]

1. Department of Medical Education, Uttar Pradesh

Increasing numbers of available health personnel through expansion of undergraduate and postgraduate education, increasing exposure to rural contexts, establishing/administering medical colleges, complying with regulations

Moderate influence in expanding seats and improving quality, due to involvement of national-level authorities, such as National Medical Commission; high influence over setting health worker renumeration, ensuring coordination with Medical and Health Department.

2. Department of Medical Health and Family Welfare, Uttar Pradesh (i.e., Directorate of Medical and Health Services, National Health Mission and other central government programs)

2a. Frontline medical officers (i.e., government medical officers working in primary and community health centers)

2b. District-level administration (i.e, Chief Medical Officers, Additional Chief Medical Officers, NHM staff)

Increasing numbers of available health personnel in rural areas, coordinating stakeholders at the state level and with the central government

Ability to provide services effectively; ensuring proper renumeration and working/living conditions in rural areas; career pathways

Managing health services within the district, ensuring adequate staffing, managing performance, liaising with higher levels within Medical and Health

High ability to initiate and implement policy pertaining to the public sector health system, including renumeration, performance management and transfers

Ability to organize through public doctors’ medical associations – however, views and priorities of rank-and-file members might not be reflected in positions taken by association leadership

High ability to exercise discretion in implementing policy decisions at the district level, but lesser ability to influence the policy adoption

3. Regulatory agencies (i.e., Uttar Pradesh Medical Council, U.P. State Medical Faculty)

Managing quality of medical, nursing and allied health worker education, liaising with national level regulators in the case of nursing and allied health education

Moderate level of power in nursing and allied health worker education; considerable ability to improve quality of nursing and allied health worker education

4. Private sector hospital associations

Responsible for representing interests of private sector nursing homes and hospitals including those facilities in rural areas; advocating for inclusion of unregulated health workforce

Moderate levels of power relative to decision-makers, and consists of sizeable membership

5. Doctors’ associations (i.e., government doctors’ association, combined public and private doctors’ associations)

In the private sector, advocating for policies in support of doctors’ interests and opposing regulation on their practices; in the public sector, ensuring appropriate living and working conditions, advocating for functioning HR processes for members such as promotions, benefits, etc. (public and/or private sector depending on the association); in both sectors, maintaining relative power of medical profession vis-à-vis traditional providers or non-qualified doctors

Moderate levels of power relative to decision makers, but higher level of power compared with other health professions and occupations; ability to mobilize and advocate for policy positions through mechanisms such as strikes, etc.

6. Nurses’ associations

Ensuring acceptable levels of reimbursement, and working and living conditions for nurses; advocating for functioning HR processes for members such as promotions, benefits, etc. (primarily in the public sector)

Moderate levels of power relative to decision makers, but lesser ability to influence policy compared with doctors; sizeable membership and significant ability to mobilize and organize

7. AYUSH doctors’ associations

Advocating for AYUSH health professionals in the public and private sector, ensuring AYUSH providers receive adequate training and support in the context of task shifting and other policies, advocating for other HR benefits.

Lower levels of power relative to biomedical professional associations and decision-makers

8. Rural medical practitioners association

Advocating for health professionals serving in rural areas (from different backgrounds - allopathic, traditional, etc.) and uniquely representing those private sector providers serving in rural areas with limited options for health care

Lower levels of power relative to biomedical professional associations and decision-makers

9. National-level health agencies (i.e., national-level government health agencies and institutions, quasi-government think tanks, etc.)

Supporting distribution of health professionals in rural areas through policy development, financial support, support for implementation, and monitoring and evaluation

High levels of power in terms of policy prioritization, but cannot directly manage state-level policies for HRH; certain national level groups can control NHM workforce distribution within the state

10. Civil society organizations

Ensuring access to health services in rural areas, supporting human rights-based approaches and community engagement in health service delivery/oversight

Moderate levels of power relative to decision makers due to direct access to communities, but infrequently engaged by policymakers on HRH policy