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Social participation within a context of political violence: implications for the promotion and exercise of the right to health in guatemala
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. (Strengthening Primary Health Care)
2009 (English)In: Health and Human Rights: An International Journal, ISSN 1079-0969, Vol. 11, no 1, 37-48 p.Article in journal (Refereed) Published
Abstract [en]

Social participation has been understood in many different ways, and there are eventypologies classifying participation by the degree of a population’s control in decisionmaking. Participation can vary from a symbolic act, which does not involve decisionmaking, to processes in which it constitutes the principal tool for redistributing powerwithin a population. This article argues that analyzing social participation from a perspectiveof power relations requires knowledge of the historical, social, and economicprocesses that have characterized the social relations in a specific context. Applyingsuch an analysis to Guatemala reveals asymmetrical power relations characterized bya long history of repression and political violence. The armed conflict during the secondhalf of the 20th century had devastating consequences for a large portion of thepopulation as well as the country’s social leadership. The ongoing violence resulted innegative psychosocial effects among the population, including mistrust toward institutionsand low levels of social and political participation. Although Guatemala madeprogress in creating spaces for social participation in public policy after signing thePeace Accords in 1996, the country still faces after-effects of the conflict. One importanttask for the organizations that work in the field of health and the right to healthis to help regenerate the social fabric and to rebuild trust between the state and itscitizens. Such regeneration involves helping the population gain the skills, knowledge,and information needed in order to participate in and affect formal political processesthat are decided and promoted by various public entities, such as the legislative andexecutive branches, municipal governments, and political parties. This process alsoapplies to other groups that build citizenship through participation, such as neighborhoodorganizations and school and health committees.

Place, publisher, year, edition, pages
Harvard School of Public Health , 2009. Vol. 11, no 1, 37-48 p.
Keyword [en]
social participation
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Public health
URN: urn:nbn:se:umu:diva-59846OAI: diva2:556937
Available from: 2012-09-27 Created: 2012-09-26 Last updated: 2012-09-28Bibliographically 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.
Umeå University medical dissertations, ISSN 0346-6612 ; 1517
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
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)
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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