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Health Policy and Planning Advance Access published online on July 29, 2008
Health Policy and Planning, doi:10.1093/heapol/czn021
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Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2008; all rights reserved.

Start thinking about investigating power in the organizational settings of policy implementation

Ermin Erasmus1,* and Lucy Gilson1,2,3

1 Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa.
2 Health Economics and Financing Programme, London School of Hygiene and Tropical Medicine, UK.
3 School of Public Health and Family Medicine, University of Cape Town, South Africa.

* Corresponding author. Centre for Health Policy, PO Box 1038, Johannesburg 2000, South Africa. E-mail: ermin.erasmus{at}nhls.ac.za

Power, a concept at the heart of the health policy process, is surprisingly rarely explicitly considered in the health policy implementation literature for low and middle income countries. In an attempt to support empirical research on power, this paper outlines some of the key insights on power from implementation theory. It then describes examples of power that might be seen in health policy implementation settings, such as hospitals, clinics and the local bureaucracies in which these are embedded, and concludes with suggestions for ways of investigating power and ensuring sound judgments are made about its existence and its influence over policy implementation.

Key Words: Health policy, power, implementation, policy analysis, methods

Accepted for publication 22 June 2008.


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