This brief describes a secondary cross-country qualitative analysis that investigated how power manifests and can be shifted to optimize provider behavior change (PBC) approaches across health areas and geographical contexts. Breakthrough RESEARCH explored how four interrelated domains of power are differentially experienced by health care providers (HCPs) based on one’s position and function within the health system in Kenya, Malawi, Madagascar, and Togo. The results are intended to help promote quality reproductive, maternal, and newborn care by offering insights for PBC programming. Key findings showed that HCPs’ power was often constrained by limited access to resources, opportunities for advancement, and supportive supervision and restrictive or shifting institutional policies, and that integrating power-enhancing, equity-promoting approaches in PBC programming can improve collaboration and feedback among HCPs and offer structural changes for quality. Further incorporation and investigation of power domains into implementation research design, intervention selection, and PBC outcomes—including shifting power dynamics among HCPs—is needed.
Breakthrough RESEARCH. 2022. "Expressions of power in health care providers’ experiences and behavior," Breakthrough RESEARCH Programmatic Research Brief. Washington, DC: Population Council.