IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v286y2021ics0277953621004846.html
   My bibliography  Save this article

The dynamics of TCAM integration in the Indian public health system: Medical dominance, countervailing power and co-optation

Author

Listed:
  • Patel, Gupteswar
  • Brosnan, Caragh
  • Taylor, Ann
  • Garimella, Surekha

Abstract

Hierarchies of power among healthcare professionals are well documented, nonetheless, power remains neglected, understudied and under-theorised in health systems analysis and policy discussions, especially in the domain of Traditional, Complementary and Alternative Medicine (TCAM). Sociological and public health scholarship has documented the persistence of medical dominance in the health system, theorised as the limitation, subordination, exclusion and incorporation of other professions. This paper explores how interprofessional power dynamics shape the integration of TCAM into Indian primary healthcare centres, as part of a nationwide policy of TCAM integration and medical pluralism implemented since 2005. We conducted interviews (n = 37) with health system administrators, nurses, pharmacists, TCAM and biomedicine doctors, and observed day-to-day activities of primary healthcare centres for six months in Odisha state, India. Thematic analysis enabled the identification of themes and exploration of sub-themes. The analysis revealed multilayered forms of medical dominance within the primary healthcare system and identified multiple sites where everyday power is mobilised. Biomedicine practitioners exercised authoritative power and restricted TCAM doctors' access to facility-level resources, i.e. financial and workforce support, which inhibited the integration policy implementation. Significantly, TCAM doctors were ‘ordered’ to practice biomedicine at primary healthcare centres, which was beyond the scope of the integration policy. However, TCAM doctors were also able to exercise countervailing power in their day-to-day activities in the primary healthcare centres and sought to assist patients' health behaviour change through their authoritative knowledge about ‘how to live a healthy life’. The health system actors involved in policy implementation hold a range of forms of power specific to the circumstances, influencing the integration processes. We explain these dynamics in relation to existing theories of medical dominance and countervailing power, while introducing a previously unreported dimension of dominance: ‘co-optation’, which enrols TCAM practitioners in the practice of biomedicine.

Suggested Citation

  • Patel, Gupteswar & Brosnan, Caragh & Taylor, Ann & Garimella, Surekha, 2021. "The dynamics of TCAM integration in the Indian public health system: Medical dominance, countervailing power and co-optation," Social Science & Medicine, Elsevier, vol. 286(C).
    • Handle: RePEc:eee:socmed:v:286:y:2021:i:c:s0277953621004846
    DOI: 10.1016/j.socscimed.2021.114152
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953621004846
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2021.114152?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Shuval, Judith T. & Mizrachi, Nissim & Smetannikov, Emma, 2002. "Entering the well-guarded fortress: alternative practitioners in hospital settings," Social Science & Medicine, Elsevier, vol. 55(10), pages 1745-1755, November.
    2. Broom, Alex & Doron, Assa & Tovey, Philip, 2009. "The inequalities of medical pluralism: Hierarchies of health, the politics of tradition and the economies of care in Indian oncology," Social Science & Medicine, Elsevier, vol. 69(5), pages 698-706, September.
    3. Kelner, Merrijoy & Wellman, Beverly & Welsh, Sandy & Boon, Heather, 2006. "How far can complementary and alternative medicine go? The case of chiropractic and homeopathy," Social Science & Medicine, Elsevier, vol. 63(10), pages 2617-2627, November.
    4. Josyula, K. Lakshmi & Sheikh, Kabir & Nambiar, Devaki & Narayan, Venkatesh V. & Sathyanarayana, T.N. & Porter, John D.H., 2016. "“Getting the water-carrier to light the lamps”: Discrepant role perceptions of traditional, complementary, and alternative medical practitioners in government health facilities in India," Social Science & Medicine, Elsevier, vol. 166(C), pages 214-222.
    5. Hollenberg, Daniel, 2006. "Uncharted ground: Patterns of professional interaction among complementary/alternative and biomedical practitioners in integrative health care settings," Social Science & Medicine, Elsevier, vol. 62(3), pages 731-744, February.
    6. Nunes, João & Lotta, Gabriela, 2019. "Discretion, power and the reproduction of inequality in health policy implementation: Practices, discursive styles and classifications of Brazil's community health workers," Social Science & Medicine, Elsevier, vol. 242(C).
    7. Lambert, Helen, 2012. "Medical pluralism and medical marginality: Bone doctors and the selective legitimation of therapeutic expertise in India," Social Science & Medicine, Elsevier, vol. 74(7), pages 1029-1036.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Moore, Erin V. & Ddaaki, William & Hirsch, Jennifer S. & Chang, Larry & Nalugoda, Fred & Santelli, John S., 2022. "“Sex is supposed to be naturally more pleasurable”: Healers as providers of holistic sexual and reproductive healthcare in Uganda," Social Science & Medicine, Elsevier, vol. 296(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Keshet, Yael & Simchai, Dalit, 2014. "The ‘gender puzzle’ of alternative medicine and holistic spirituality: A literature review," Social Science & Medicine, Elsevier, vol. 113(C), pages 77-86.
    2. Perrotta, Manuela & Geampana, Alina, 2020. "The trouble with IVF and randomised control trials: Professional legitimation narratives on time-lapse imaging and evidence-informed care," Social Science & Medicine, Elsevier, vol. 258(C).
    3. Cant, Sarah & Watts, Peter & Ruston, Annmarie, 2011. "Negotiating competency, professionalism and risk: The integration of complementary and alternative medicine by nurses and midwives in NHS hospitals," Social Science & Medicine, Elsevier, vol. 72(4), pages 529-536, February.
    4. Ben-Arye, Eran & Karkabi, Khaled & Karkabi, Sonia & Keshet, Yael & Haddad, Maria & Frenkel, Moshe, 2009. "Attitudes of Arab and Jewish patients toward integration of complementary medicine in primary care clinics in Israel: A cross-cultural study," Social Science & Medicine, Elsevier, vol. 68(1), pages 177-182, January.
    5. Josyula, K. Lakshmi & Sheikh, Kabir & Nambiar, Devaki & Narayan, Venkatesh V. & Sathyanarayana, T.N. & Porter, John D.H., 2016. "“Getting the water-carrier to light the lamps”: Discrepant role perceptions of traditional, complementary, and alternative medical practitioners in government health facilities in India," Social Science & Medicine, Elsevier, vol. 166(C), pages 214-222.
    6. Hollenberg, Daniel, 2006. "Uncharted ground: Patterns of professional interaction among complementary/alternative and biomedical practitioners in integrative health care settings," Social Science & Medicine, Elsevier, vol. 62(3), pages 731-744, February.
    7. Ijaz, Nadine, 2022. "The reluctant and the envious: Therapeutic subalternity and the practice of homeopathy in North America," Social Science & Medicine, Elsevier, vol. 311(C).
    8. van der Sijpt, Erica, 2010. "Marginal matters: Pregnancy loss as a social event," Social Science & Medicine, Elsevier, vol. 71(10), pages 1773-1779, November.
    9. Schupmann, Will, 2023. "“We are not the ethics police”: The professionalization of clinical ethicists and the regulation of medical decision-making," Social Science & Medicine, Elsevier, vol. 322(C).
    10. Almeida, Joana & Gabe, Jonathan, 2016. "CAM within a field force of countervailing powers: The case of Portugal," Social Science & Medicine, Elsevier, vol. 155(C), pages 73-81.
    11. Brosnan, Caragh, 2017. "Alternative futures: Fields, boundaries, and divergent professionalisation strategies within the Chiropractic profession," Social Science & Medicine, Elsevier, vol. 190(C), pages 83-91.
    12. Hsiao, An-Fu & Ryan, Gery W. & Hays, Ronald D. & Coulter, Ian D. & Andersen, Ronald M. & Wenger, Neil S., 2006. "Variations in provider conceptions of integrative medicine," Social Science & Medicine, Elsevier, vol. 62(12), pages 2973-2987, June.
    13. Gaboury, Isabelle & Bujold, Mathieu & Boon, Heather & Moher, David, 2009. "Interprofessional collaboration within Canadian integrative healthcare clinics: Key components," Social Science & Medicine, Elsevier, vol. 69(5), pages 707-715, September.
    14. Santah, Colette & Bröer, Christian, 2022. "Agency through medicalization: Ghanaian children navigating illness, medicine and adult resistance," Social Science & Medicine, Elsevier, vol. 315(C).
    15. Shuval, Judith, 2006. "Nurses in alternative health care: Integrating medical paradigms," Social Science & Medicine, Elsevier, vol. 63(7), pages 1784-1795, October.
    16. Chung, Vincent C.H. & Hillier, Sheila & Lau, Chun Hong & Wong, Samuel Y.S. & Yeoh, Eng Kiong & Griffiths, Sian M., 2011. "Referral to and attitude towards traditional Chinese medicine amongst western medical doctors in postcolonial Hong Kong," Social Science & Medicine, Elsevier, vol. 72(2), pages 247-255, January.
    17. Hök, Johanna & Wachtler, Caroline & Falkenberg, Torkel & Tishelman, Carol, 2007. "Using narrative analysis to understand the combined use of complementary therapies and bio-medically oriented health care," Social Science & Medicine, Elsevier, vol. 65(8), pages 1642-1653, October.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:286:y:2021:i:c:s0277953621004846. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.