Resources

An abstract given at Institute for Development Policy and Management Conference in Manchester titled 'Participation - the New Tyranny?' The discourse on the influence of participation on equity and health inequalities is relatively recent and the presentation aimed to stimulate a response and further discussion at the conference.

This paper considers the reasons behind the under-utilisation of the health care system in Eastern Nepal and it then presents an alternative approach to health action with women's groups. The Health Analysis Cycle (HAC) enables both literate and illiterate Nepalese women to examine their health and environmental situations. The HAC conceives health in a socio-environmental context and allows women to consider their own beliefs surrounding health and illness, exchange knowledge, and plan and take action for themselves. The paper details the steps involved in piloting the health analysis cycle with women's groups providing a detailed description of the process and the context within which it is implemented.

This is a handbook that discusses the Childscope approach in Ghana, which aims to improve primary education, enrolment, and attendance (particularly by girls). It offers a guide of how to do this through the use of participatory, school and community-based approaches. It gives descriptions of processes used to enhance community participation, teacher development, health promotion, networking and capacity building, as well as practical experiences from the Childscope project in the Afram plains, advice to practitioners based on lessons learnt there, and references for further information.

In this literature review, the author, in describing the origins of participatory approaches and methods, discusses their application in animal health services and research in developing countries. The focus is on dryland areas of Africa particularly pastoral and agropastoral areas of the Greater Horn of Africa. The author reports that most experiences with veterinary uses of participatory approaches and methods remains with community based animal health projects and have proved to be more effective in comparison to more conventional approaches to service delivery. He also contends that while participatory methods are being used increasingly by epidemiologists, in general, there is a continued reliance on conventional survey tools such as questionnaires. He is of the view that as veterinary epidemiology has a history of borrowing from other disciplines it may be helpful to consider participatory methods including quantitative and qualitative perspectives and enhance the understanding of animal health and well being.

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 catalogue comprises various sets of visual training materials used for training communities in family health, safe use of water and good sanitation. Zimbabwe Applied Health Education and Development (A.H.E.A.D.) has pioneered this method of 'participation with a structure', whereby health education becomes the entry point into a community, prior to any implementation of a water and sanitation project.

'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.