Negotiating power relations, gender equality, and collective agency: are village health committees transformative social spaces in northern India?

International Journal for Equity in Health

Research

Steven A. Harvey¹  Shinjini Mondal²  Kabir Sheikh²  Kerry Scott³  Gupteswar Patel⁴  Asha S. George⁵ 

[1] Johns Hopkins School of Public Health, 21205, Baltimore, USA;Public Health Foundation of India, 122022, Delhi, India;Public Health Foundation of India, 122022, Delhi, India;Johns Hopkins School of Public Health, 21205, Baltimore, USA;Public Health Foundation of India, 122022, Delhi, India;The University of Newcastle, NSW 2308, Newcastle, Australia;University of the Western Cape, 7535, Cape Town, South Africa;

关键词: Village health committee;    Participation;    Agency;    Gender;    Power;    Social spaces;    Discourse;    India;   

DOI  :  10.1186/s12939-017-0580-4

 received in 2016-11-12, accepted in 2017-05-08,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundParticipatory health initiatives ideally support progressive social change and stronger collective agency for marginalized groups. However, this empowering potential is often limited by inequalities within communities and between communities and outside actors (i.e. government officials, policymakers). We examined how the participatory initiative of Village Health, Sanitation, and Nutrition Committees (VHSNCs) can enable and hinder the renegotiation of power in rural north India.MethodsOver 18 months, we conducted 74 interviews and 18 focus groups with VHSNC members (including female community health workers and local government officials), non-VHSNC community members, NGO staff, and higher-level functionaries. We observed 54 VHSNC-related events (such as trainings and meetings). Initial thematic network analysis supported further examination of power relations, gendered “social spaces,” and the “discourses of responsibility” that affected collective agency.ResultsVHSNCs supported some re-negotiation of intra-community inequalities, for example by enabling some women to speak in front of men and perform assertive public roles. However, the extent to which these new gender dynamics transformed relations beyond the VHSNC was limited. Furthermore, inequalities between the community and outside stakeholders were re-entrenched through a “discourse of responsibility”: The comparatively powerful outside stakeholders emphasized community responsibility for improving health without acknowledging or correcting barriers to effective VHSNC action. In response, some community members blamed peers for not taking up this responsibility, reinforcing a negative collective identity where participation was futile because no one would work for the greater good. Others resisted this discourse, arguing that the VHSNC alone was not responsible for taking action: Government must also intervene. This counter-narrative also positioned VHSNC participation as futile.ConclusionsInterventions to strengthen participation in health systems can engender social transformation. However they must consider how changing power relations can be sustained outside participatory spaces, and how discourse frames the rationale for community participation.

【 授权许可】

CC BY   
© The Author(s). 2017