TY - JOUR
T1 - Bureaucracies and power
T2 - Examining the medical council of India and the development of emergency medicine in India
AU - Sriram, Veena
AU - Baru, Rama
AU - Hyder, Adnan Ali
AU - Bennett, Sara
N1 - Funding Information:
Fieldwork for this study conducted by VS was supported by the American Institute of Indian Studies and the Department of International Health at the Johns Hopkins Bloomberg School of Public Health . VS is currently supported by the Agency for Healthcare Research and Quality under grant award K12 HS 023007 (PI: Meltzer). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of AHRQ.
Publisher Copyright:
© 2020 Elsevier Ltd
PY - 2020/7
Y1 - 2020/7
N2 - In many countries, professional councils are mandated to oversee the training and conduct of health professionals, including doctors, nurses, pharmacists and allied health workers. The proper functioning of these councils is critical to overall health system performance. Yet, professional councils are sometimes criticized, particularly in the context of low- and middle-income countries, for their misuse of power and overtly bureaucratic nature. The objective of this paper is to understand how professional councils use their bureaucratic power to shape health policy and systems, drawing upon the recent development of emergency medicine in the context of the former Medical Council of India. We undertook a qualitative case study, conducting 87 interviews, observing 6 meetings and conferences, and reviewing approximately 96 documents, and used the Framework method to analyze our data. The passive exercise of bureaucratic power by the Council resulted in three challenges – 1) Opaque policy processes for recognizing new medical specialties; 2) Insular, non-transparent training policy formulation; 3) Unaccountable enforcement for regulating new courses. The Council did not have the requisite technical expertise to manage certain policy processes, and further, did not adequately utilize external expertise. In this time period, the Council applied its bureaucratic power in a manner that negatively impacted emergency medicine training programs and the development of emergency medicine, with implications for availability and quality of emergency care in India. The successor to the Council, the National Medical Commission, should consider new approaches to exercising bureaucratic power in order to meet its objectives of strengthening medical education in India and ensuring access to high-quality services. Future studies should also explore the utilization of bureaucratic power in the health sectors of low- and middle-income countries in order to provider a deeper understanding of institutional barriers to improvements in health.
AB - In many countries, professional councils are mandated to oversee the training and conduct of health professionals, including doctors, nurses, pharmacists and allied health workers. The proper functioning of these councils is critical to overall health system performance. Yet, professional councils are sometimes criticized, particularly in the context of low- and middle-income countries, for their misuse of power and overtly bureaucratic nature. The objective of this paper is to understand how professional councils use their bureaucratic power to shape health policy and systems, drawing upon the recent development of emergency medicine in the context of the former Medical Council of India. We undertook a qualitative case study, conducting 87 interviews, observing 6 meetings and conferences, and reviewing approximately 96 documents, and used the Framework method to analyze our data. The passive exercise of bureaucratic power by the Council resulted in three challenges – 1) Opaque policy processes for recognizing new medical specialties; 2) Insular, non-transparent training policy formulation; 3) Unaccountable enforcement for regulating new courses. The Council did not have the requisite technical expertise to manage certain policy processes, and further, did not adequately utilize external expertise. In this time period, the Council applied its bureaucratic power in a manner that negatively impacted emergency medicine training programs and the development of emergency medicine, with implications for availability and quality of emergency care in India. The successor to the Council, the National Medical Commission, should consider new approaches to exercising bureaucratic power in order to meet its objectives of strengthening medical education in India and ensuring access to high-quality services. Future studies should also explore the utilization of bureaucratic power in the health sectors of low- and middle-income countries in order to provider a deeper understanding of institutional barriers to improvements in health.
KW - Bureaucracy
KW - Emergency medicine
KW - India
KW - Low- and middle-income countries
KW - Policy
KW - Power
KW - Regulation
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U2 - 10.1016/j.socscimed.2020.113038
DO - 10.1016/j.socscimed.2020.113038
M3 - Article
C2 - 32464416
AN - SCOPUS:85084950329
SN - 0277-9536
VL - 256
JO - Social Science and Medicine
JF - Social Science and Medicine
M1 - 113038
ER -