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The process of social participation in primary health care: the case of Palencia, Guatemala
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0001-7234-3510
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0001-7087-1467
2014 (English)In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 17, no 1, 93-103 p.Article in journal (Refereed) Published
Abstract [en]

Background In 2008, the World Health Organization issued a callback to the principles of primary health care, which renewed interests in social participation in health. In Guatemala, social participation has been the main policy for the decentralization process since the late 1990s and the social development council scheme has been the main means for participation for the country's population since 2002.

Aim The aim of this study was to explore the process of social participation at a municipal-level health commission in the municipality of Palencia, Guatemala.

Methods Analysis of legal and policy documents and in-depth interviews with institutional and community-level stakeholders of the commission.

Results The lack of clear guidelines and regulations means that the stakeholders own motivations, agendas and power resources play an important part in defining the roles of the participants. Institutional stakeholders have the human and financial power to make policies. The community-level stakeholders are token participants with little power resources. Their main role is to identify the needs of their communities and seek help from the authorities. Satisfaction and the perceived benefits that the stakeholders obtain from the process play an important part in maintaining the commission's dynamic, which is unlikely to change unless the stakeholders perceive that the benefit they obtain does not outweigh the effort their role entails.

Conclusion Without more uniformed mechanisms and incentives for municipalities to work towards the national goal of equitable involvement in the development process, the achievements will be fragmented and will depend on the individual stakeholder's good will.

Place, publisher, year, edition, pages
2014. Vol. 17, no 1, 93-103 p.
Keyword [en]
Guatemala, health commissions, primary health care, social participation
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-48353DOI: 10.1111/j.1369-7625.2011.00731.xPubMedID: 21902774OAI: oai:DiVA.org:umu-48353DiVA: diva2:448911
Available from: 2011-10-18 Created: 2011-10-18 Last updated: 2017-12-08Bibliographically approved
In thesis
1. The role of social participation in municipal-level health systems: the case of Palencia, Guatemala
Open this publication in new window or tab >>The role of social participation in municipal-level health systems: the case of Palencia, Guatemala
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Social participation has been recognized as an important public health policy since the declaration of Alma-Ata presented it as one of the pillars of primary health care in 1978. Since then, there have been many adaptations to the original policy recommendations, but participation in health is still seen as a means to make the health system more responsive to local health needs, and as a way to bring the health sector and the community closer together.

Aim: To explore the role that social participation has in a municipal-level health system in Guatemala in order to inform future policies and programs.

Methods: The fieldwork for this study was carried out over eight months and three field visits between early January of 2009 and late March of 2010. During this time, 38 indepth interviews with provincial and district-level health authorities, municipal authorities, community representatives and community health workers were conducted. Using an overall applied ethnographic approach, the main means of data collection were participant observation, in-depth interviews, group discussions and informal conversations. The data was analyzed in two different rounds. In the first one we used documentary analysis, role-ordered matrices and thematic analsis (see papers I-IV) and in the second round, thematic analysis was utilized.

Results: We found four themes that frame what the role of social participation in the municipality of Palencia is. The first theme presents the historical, political and social context that has contributed to shaping the participation policies and practices in Guatemala as a whole. The second theme takes a deeper look at these policies and how they have been received in the municipality of Palencia. The third theme presents data regarding the three situated practices of participation, each occurring at a different level: municipal, community and the individual level. Finally, the last theme presents reflections on what it means to participate to the people that were involved in this study.

Conclusion: In the process of social participation there are two different and complementary kinds of power that depend on the amount and the kind of resources available at each level of the participation structure. Stakeholders that have higher levels of power to formulate policies will have better access to financial, human and material resources while stakeholders that have higher levels of power to implement policies will have resources like community legitimacy, knowledge of local culture, values and mores, as well as a deep understanding of local social processes. The coordination of financial, human and material resources is just as important as the legitimacy that comes from having community leaders involved in more steps of the process. True collaboration can only be obtained through the promotion and creation of meaningful partnerships between institutional stakeholders and community leaders and other stakeholders that are working at the community level. For this to happen, more structured support for the participation process in the form of clear policies, funding and capacity building is needed.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2012. 71 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1517
Keyword
Social participation, community participation, community heath workers, primary health care, Palencia, Guatemala
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-59865 (URN)978-91-7459-470-6 (ISBN)
Public defence
2012-10-19, Bergasalen, Byggnad 27, NUS, Umeå, 09:00 (English)
Opponent
Supervisors
Funder
FAS, Swedish Council for Working Life and Social Research, 2006-1512
Available from: 2012-09-28 Created: 2012-09-26 Last updated: 2015-04-29Bibliographically approved

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Ruano, Ana LorenaSan Sebastián Chasco, MiguelHurtig, Anna-Karin

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