How Can Evidence Bolster Citizen Action? Learning and Adapting for Accountable Public Health in Guatemala
Date: February 2018
Authors: Walter Flores
Publication type: Accountability Note
Published by: Accountability Research Center, CEGSS
Most theories of change in the field of transparency and accountability assume that scientifically rigorous evidence increases the possibility of influencing officials and decision-makers. Generating this evidence has been the work of academic experts. Over the last decade, the Centro de Estudios para la Equidad y la Gobernanza de los Sistemas de Salud (the Center for the Study of Equity and Governance in Health Systems, or CEGSS) has considered the question of how to use evidence to influence authorities and promote participation by users of public services in rural indigenous municipalities of Guatemala.
Our initial approach relied on producing rigorous evidence through the surveying of health care facilities using random samples. However, when presented to authorities, this type of evidence did not have any influence on them. In the follow-up phases, we gradually evolved our approach to employ other methods to collect evidence (such as ethnography and audiovisuals) that are easier to grasp by the non-expert public and the users of public services. The involvement of users of services in evidence collection was accompanied by civic action strategies to engage with authorities in the resolution of problems. Throughout a decade of work, we learned that methods for gathering evidence that draw in participation from the wider community, that help communities to tell their stories, and that facilitate collective action among service users tend to be the most powerful to influence responsiveness from authorities at local and regional levels of government.
In addition, using participatory approaches to generating and interpreting evidence fosters pedagogical processes of civic action that empower service users by activating their roles as citizens and voters. This process has been used to open space for negotiating the allocation of public resources with authorities at different governance levels.
Walter Flores is the executive director the Center for the Study of Equity and Governance in Health Systems (CEGSS). He obtained his doctorate (PhD) and master’s in community health from the Liverpool School of Tropical Medicine (England). Walter has worked as a lecturer, researcher, and consultant in more than 30 countries in Latin America, Africa, Asia, and Europe. He is currently a member of the Steering Committee of the Community of Practitioners on Accountability and Social Action in Health (COPASAH), an international community of practice on social action in health and accountability.
Guatemala has no formal mechanisms for citizens to demand their right to healthcare. Patients have no way to hold public healthcare employees accountable. Negligence is met with impunity and silence. When there is no medicine available, patients are sent home in pain and empty handed. They get sick. Can citizens organize around this issue and come up with a different healthcare model? Over the past four years, over a hundred Guatemalans have joined the Network of Healthcare Defenders, which is fighting to ensure that healthcare is effectively treated as a human right.
Oxfam blog: From Poverty to Power
I met Walter Flores at a Twaweza seminar in Tanzania a couple of months ago, but have only just got round to reading his fascinating paper reflecting on 10 years of trying to improve Public Health in Guatemala. It is short (12 pages), snappily written, with a very crisp, hard-hitting thesis, so no need to do more than provide some excerpts to whet your appetites.