Resources

In recent years there has been a major shift in attitudes to community involvement in health care. Approaches that saw communities primarily as passive recipients of health care have given way to those which seek to make more of the potential that more active community participation might offer for enhanced accountability and improved responsiveness of services. With this shift has come a greater emphasis on issues of governance and on institutional dimensions of participation, whilst the introduction of partnership models in the health sector has further increased debates about participation in health care. In 1999 the IDS Participation and Health and Social Change groups convened a workshop to share experiences of the use of participatory approaches in enhancing accountability in the health sector and to explore some of these challenges. The fifteen articles in this Bulletin reflect some of the richness of experience on the ground in building effective participation as well as some of the many issues that arise in moving towards more active citizen engagement with service provision. They draw experience from current work in countries such as Zimbabwe, Cambodia, China, Nepal, Zambia and Pakistan to reflect on links between participation, accountability and improvements in health.

This folder on training for sustainability contains eight booklets, which are designed to be used together, and share a common framework and key principles. Four linked steps are seen as key to understanding sustainable and equitable development:

À Wholeness. People are an important part of the ecosystem and people/environment interactions are poorly understood;
À Asking Questions. We cannot assess anything unless we know which questions to ask;
À Reflective Institutions. The context for the questioning approach is institutional, andà.
À People Focussed. People are both the problem and the solution and the principal arena for action lies in influencing the motivation for human behavior.

The series starts with the summary document, Overview of Methods, Tools and Field Experiences: Assessing Progress Towards Sustainability. The other seven volumes fall into three sets:

Methods of system assessment (people and the ecosystem)
À Participatory and Reflective Analytical Mapping (PRAM)
À Assessing Rural Sustainability
À Planning Action for Rural Sustainability

Methods of self assessment (for organisations and communities to examine their own attitudes, capacities and experiences)
À Reflective Institutions

Tools (for use in conjunction with any of the methods or with other methods)
À Barometer of Sustainability
À Community-Based Indicators
À Questions of Survival

Methods and tools may well have to be adapted to local circumstances and solutions must be people focussed to be sustained.

ActionAid's Impact Assessment Unit convened a five-day workshop in Oct 1999 in Malawi. The focus of the workshop was the use of video as a participatory tool for development. In this report, examples of videos from Malawi, Ghana and Pakistan are drawn on to illustrate the potential use of participatory video. The pros and cons of video as a tool to understand change are also discussed.

Large-scale participatory natural resource management programmes often include national governments, large NGOs and donor agencies as major actors. The scaling up of participation to include more people and places constantly challenges these large organisations to become flexible, innovative and transparent. More specifically, the emphasis on diversity, decentralisation and devolution of decision making powers in the management of natural resources for complex and dynamic livelihoods implies procedures and organisational cultures which do not impose "particiaption" from above through bureaucratic and standardised practices. Under what conditions can bureaucracies be refashioned or transformed to ensure that their outcomes (policies, programmes, resource allocation and projects) actually facilitate, rather than inhibit, participation and the adaptive management of natural resources? What is the impact of institutionalising participatory approaches on the social dynamics, livelihoods and well-being of low-income rural and urban groups and local organisations? To focus on these issues and questions, IIED and IDS have inititiated an action-oriented research project to examine the dynamics of institutionalising people-centred processes and participatory approaches for natural resource management in a variety of social and ecological contexts. This bibliography includes about 390 references and critical overviews on seven key themes. Theories of the organisational change for participation Towards learning organisations Gender and organisational change Transforming environmental knowledge and organisational cultures Nuturing enabling attitudes and behaviour Policies for participation Methods for institutional and impact analysis

'Voices of the Poor' is a series of three books that collates the experiences, views and aspirations of over 60,000 poor women and men. This second book of the series draws material from a 23-country comparative study, which used open-ended participatory methods, bringing together the voices and realities of 20,000 poor women, men, youth and children. Despite very different political, social and economic contexts, there are striking similarities in poor people's experiences. The common underlying theme is one of powerlessness, which consists of multiple and interlocking dimensions of illbeing or poverty. The book starts by describing the origins of the study, the methodology and some of the challenges faced. This is followed by an exploration of the multidimensional nature of wellbeing and illbeing. Most of the book comprises the core findings - the 10 dimensions of powerlessness and illbeing that emerge from the study - and is organised around these themes. These include livelihoods and assets; the places where poor people live and work; the body and related to this, accessing health services; gender roles and gender relations within the household; social exclusion; insecurity and related fears and anxieties; the behaviour and character of institutions; and poor people's ratings of the most important institutions in their lives. These dimensions are brought together into a many-stranded web of powerlessness, which is compounded by the lack of capability, including lack of information, education, skills and confidence. The final chapter is a call to action and dwells on the challenge of change.

A review of an event held at the Hague in late 1999 which provided an opportunity for participatory development practitioners from around the world to showcase their efforts and share experiences.

This article uses observations from a training session in Papua New Guinea to raise questions about the use and validity of ranking techniques in participatory research. They discuss the limitations and suggest solutions. The article also includes a response from Robert Chambers.