umu.sePublications
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Pathways to accountability in rural Guatemala: a qualitative comparative analysis of citizen-led initiatives for the right to health of indigenous populations
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0001-7087-1467
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
Show others and affiliations
2019 (English)In: World Development, ISSN 0305-750X, E-ISSN 1873-5991, Vol. 113, p. 392-401Article in journal (Refereed) Published
Abstract [en]

Strengthening citizen-led accountability initiatives is a critical rights-based strategy for improving health services for indigenous and other marginalized populations. As these initiatives have gained prominence in health and other sectors, there is great interest in how they operate and what makes them effective. Scholarly focus is shifting from measuring the efficacy of their tools and tactics to deepening understanding of the context-sensitive pathways through which change occurs. This paper examines how citizen-led initiatives' actions to strengthen grassroots networks, monitor health services and engage with authorities interact with local sociopolitical conditions and contribute to accountability achievements for indigenous populations in rural Guatemala. We used qualitative comparative analysis to first systematize and score structured qualitative monitoring data gathered in 29 municipal-level initiatives, and then analyze patterns in the presence of different forms of citizen action, contextual conditions and accountability outcomes across cases. Our study identifies pathways of collective action through which citizen-led initiatives bolster their power to engage and negotiate with authorities and bring about solutions to some of the health system deficiencies that they face. While constructive engagement is widely advocated as the most effective approach to interaction with authorities, our study indicates that success depends on wider processes of community mobilization. To overcome the power asymmetries that marginalized groups face when engaging with authorities, iterative processes of network building and participatory monitoring as well as persistence in their demands are critical. These processes further provide an enabling environment for moving beyond the local and projecting indigenous voices to engage with authorities at higher governance levels. Initiatives also applied adversarial legal action as an alternative engagement strategy that contributed to bolster citizen power. Our findings indicate the potential of collective power generated by the actions of citizen-led initiatives to enable marginalized populations to hold authorities accountable for health system failures. 

Place, publisher, year, edition, pages
Elsevier, 2019. Vol. 113, p. 392-401
Keywords [en]
Accountability, Health system, Indigenous peoples, Qualitative comparative analysis, Guatemala
National Category
Social Sciences Interdisciplinary
Identifiers
URN: urn:nbn:se:umu:diva-153629DOI: 10.1016/j.worlddev.2018.09.020ISI: 000449310800029OAI: oai:DiVA.org:umu-153629DiVA, id: diva2:1266147
Funder
Swedish Research Council, 2015-05898Available from: 2018-11-27 Created: 2018-11-27 Last updated: 2018-11-27Bibliographically approved

Open Access in DiVA

fulltext(887 kB)8 downloads
File information
File name FULLTEXT01.pdfFile size 887 kBChecksum SHA-512
093cf3b934012b5325dc2f4592a3f6550913198fcd589f170786e398ff9ddb8d33b3c49c380a1aed0bcf5e3e533b450c9ee3d8383c4af21b8a16283c5f782876
Type fulltextMimetype application/pdf

Other links

Publisher's full text

Authority records BETA

Hurtig, Anna-KarinGoicolea, IsabelSan Sebastian, Miguel

Search in DiVA

By author/editor
Hurtig, Anna-KarinGoicolea, IsabelSan Sebastian, Miguel
By organisation
Epidemiology and Global Health
In the same journal
World Development
Social Sciences Interdisciplinary

Search outside of DiVA

GoogleGoogle Scholar
Total: 8 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 236 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf