Abstract
BackgroundMedical specialization is a key feature of biomedicine, and is a growing, but weakly understood aspect of health systems in many low- and middle-income countries (LMICs), including India. Emergency medicine is an example of a medical specialty that has been promoted in India by several high-income country stakeholders, including the Indian diaspora, through transnational and institutional partnerships. Despite the rapid evolution of emergency medicine in comparison to other specialties, this specialty has seen fragmentation in the stakeholder network and divergent training and policy objectives. Few empirical studies have examined the influence of stakeholders from high-income countries broadly, or of diasporas specifically, in transferring knowledge of medical specialization to LMICs. Using the concepts of socialization and legitimation, our goal is to examine the transfer of medical knowledge from high-income countries to LMICs through domestic, diasporic and foreign stakeholders, and the perceived impact of this knowledge on shaping health priorities in India.MethodsThis analysis was conducted as part of a broader study on the development of emergency medicine in India. We designed a qualitative case study focused on the early 1990s until 2015, analyzing data from in-depth interviewing (n = 87), document review (n = 248), and non-participant observation of conferences and meetings (n = 6).ResultsFrom the early 1990s, domestic stakeholders with exposure to emergency medicine in high-income countries began to establish Emergency Departments and initiate specialist training in the field. Their efforts were amplified by the active legitimation of emergency medicine by diasporic and foreign stakeholders, who formed transnational partnerships with domestic stakeholders and organized conferences, training programs and other activities to promote the field in India. However, despite a broad commitment to expanding specialist training, the network of domestic, diasporic and foreign stakeholders was highly fragmented, resulting in myriad unstandardized postgraduate training programs and duplicative policy agendas. Further, the focus in this time period was largely on training specialists, resulting in more emphasis on a medicalized, tertiary-level form of care.ConclusionsThis analysis reveals the complexities of the roles and dynamics of domestic, diasporic and foreign stakeholders in the evolution of emergency medicine in India. More research and critical analyses are required to explore the transfer of medical knowledge, such as other medical specialties, models of clinical care, and medical technologies, from high-income countries to India.
Highlights
Medical specialization is a key feature of biomedicine, and is a growing, but weakly understood aspect of health systems in many low- and middle-income countries (LMICs), including India
Our goal is to examine the transfer of medical knowledge from high-income countries to LMICs with a particular focus on diasporic and foreign stakeholders and the means that they have to build societal support and commitment to particular ideas, and in turn how this shapes health priorities in India
Development of emergency medicine in India through socialization The development of emergency medicine as a medical specialty in India emerged out of a need to improve weak systems of emergency care in both public and private sectors, systems marked by poor quality, limited coordination, and inadequate prioritization by administrators and policymakers [77]
Summary
Medical specialization is a key feature of biomedicine, and is a growing, but weakly understood aspect of health systems in many low- and middle-income countries (LMICs), including India. Medical specialization is a central feature of biomedicine, and is a growing aspect of health systems in many low- and middle-income countries (LMICs) [6]. Since the mid-1980s, the for-profit private sector has significantly invested in tertiary hospitals in primarily urban settings, steadily increasing its share of hospitals and beds in the country [11,12,13] These tertiary care hospitals primarily focus on specialist and super-specialist care, some driven by India’s booming medical tourism industry [14,15,16]. Policies to expand centrally-supported public sector tertiary hospitals and medical colleges in all states have received attention from national political parties [17, 18]
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