Power Plays: How Influence Shapes Health Teamwork in Developing Countries

In the realm of global health, working together across different sectors is key to tackling big issues. This is especially true in Low- and Middle-Income Countries (LMICs). However, power struggles between groups can make or break these collaborations. A recent study dug deep into how these power dynamics play out in LMICs, offering valuable lessons for improving health policies. The study began by exploring how power dynamics influence the success of intersectoral collaborations. It looked at how power imbalances show up in these settings. Five initial ideas were developed through a mix of reviews, document analysis, and interviews. A thorough search of medical and social science databases, along with grey literature, turned up 2, 850 records, with 23 making the cut after a careful screening process. The study focused on the period from 2012 to 2023. This timeframe was chosen because it captures significant shifts in how countries work together on health issues. The 2012 UN Political Declaration on Non-Communicable Diseases and the WHO's 2013 Health in All Policies framework were game-changers, pushing for more multi-sectoral governance in LMICs. The study also built on previous research to provide an up-to-date look at power dynamics in these collaborations. The findings were eye-opening. Power imbalances often come from hierarchical governance, unequal resources, and historical injustices. These factors shape how well different sectors work together. Six key insights emerged from the study: First, involving everyone in policy development can reduce power imbalances. However, this requires active efforts to ensure that less powerful sectors aren't left out. Second, strong leadership and shared goals can boost collaboration, but competing priorities can also fuel power struggles. Third, fair resource sharing can build trust but can also cause conflicts, especially when donor influence comes into play. Fourth, rigid communication norms in LMICs can hinder transparency, but informal networks can help bypass bureaucratic hurdles. Fifth, unclear roles and responsibilities can create power vacuums, allowing dominant actors to control the agenda. Finally, long-term relationships can balance out structural power imbalances, promoting accountability and flexible problem-solving. The study shows that power dynamics in LMICs are influenced by both structural factors, like funding and hierarchies, and relational factors, like trust and negotiation. Successful collaboration requires recognizing and addressing both aspects. In essence, understanding power dynamics is crucial for effective intersectoral collaboration in LMICs. This study provides policymakers with practical insights to navigate these challenges and improve health outcomes.