| Summary: | Recently, increasing attention has been given to behavioural and relational aspects of health systems, placing actors at the core. Indeed, health systems comprise of numerous actors, and one of the most important and influential is the medical doctor, playing a vital role in policy transfer at the national level (Benson 2013). The influence of medical professionals stems beyond shaping the implementation of health policies, to also potentially altering the policy content and process (Koon & Mayhew 2013). In lowand middle-income countries (LMICs) the health system is a dynamic mix of multiple stakeholders, including supra-national organizations, Global Health Initiatives and NonGovernmental Organizations (Samb et al. 2009), resulting in an environment where contesting interests and values are competing for relevance and authority. This study examined the power dynamics of medical professionals in the Nigerian health system through an in-depth case study of the interactions between the Global Fund grant and Nigerian medical professionals. Results are based on an in-depth qualitative study involving 34 semi-structured key informant interviews with policy makers, board-meeting observations, and documentary analysis. Data was analysed iteratively in order to gain insight into the power dynamics of medical professionals in policy processes and to analytically identify structural and agential factors within the health system that encourage or discourage professional dominance. Medical professionals maintained dominance and professional monopoly, thereby controlling policy spaces. Global actors and the local government were challenging interest groups, with a preference for rapid biomedical models that focus on medications and test kits, and the supply of health services, while neglecting social science narratives and demand creation. This work explores such issues in detail and presents contextual factors of relevance to the Nigerian setting, thereby adding to existing literature on health systems and the sociology of medical professionals.
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