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 is a workshop report in Hindi, which discusses the use of PRA methods with Dalits and women in India, focusing on three major themes. The first is the need to involve the people who are the 'target' of PRA approaches. Despite the emphasis on 'bottom-up' approaches, this has not been the reality, hence the call to revise and refocus on people. Secondly, PRA practitioners are urged to re-examine their roles and change themselves as part of returning to the roots of PRA. They need to become more helpers and facilitators and less teachers and leaders of PRA projects. Finally, literature on PRA should be in a range of local languages to be more accessible

This paper has its origins in a participatory action research project by Roofless Women's Action Research Mobilization (RWARM). The organisation seeks to consult directly with those who have experienced homelessness to seek their expertise on how to restructure the current system to effectively combat homelessness. Narratives or stories of formerly homeless women are shared in order to promote understanding of reasons why women become homeless and of issues faced by women once they are homeless.

The article traces the mobilisation of rural women in the drylands of Andhra Pradesh, India, to preserve the local biodiversity in order to combat the advent of cheap rice through the Public Distribution System which effectively wiped out their consumption of nutritious grains, pulses and vegetables. The authors chronicle the history of the movement under the aegis of the women sanghams of the Deccan Development Society and report that the women farmers have set up an innovative and highly successful decentralised community-management system for producing, storing and distributing coarse grains. They contend that the dalit (low caste) women have taken control of this variant of the government Public Distribution System and that the local food security, community resilience and biodiversity have also been dramatically enhanced by the process.

'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.

The seminar report highlights the major themes that emerged from the presentations and discussions and outlines key principles that need to guide recommendations for service delivery. The report concludes by offering general recommendations to NGOs at national, regional and international levels.

The article outlines the main features of collaborative planning with NGOs to improve women's health in Egypt by taking readers through the Beni Suef initiative. Details of the workshop for NGO training, a discussion of emergent issues and an assessment of NGO receptiveness are offered.