PHM-Exch> Citizen-led initiatives for the right to health of indigenous populations: Guatemala

[Claudio Schuftan]

*Pathways to accountability in rural Guatemala: A qualitative*

*comparative analysis of citizen-led initiatives for the right to health of*

*indigenous populations*

Alison Hernández a,⇑, Ana Lorena Ruano a,b, Anna-Karin Hurtig c, Isabel
Goicolea c, Miguel San Sebastián c,

Walter Flores a

a Center for the Study of Equity and Governance in Health Systems (CEGSS),
Guatemala, Guatemala

b Center for International Health, University of Bergen, Bergen, Norway

c Division of Epidemiology and Global Health, Umeå University, Umeå, Sweden


*Abstract:*

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.


*To download the PDF press here:
https://www.sciencedirect.com/science/article/pii/S0305750X18303528
<https://www.sciencedirect.com/science/article/pii/S0305750X18303528>*
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