<div dir="ltr"><div class="gmail_default" style="font-size:large"><br></div><br><div class="gmail_quote"><br><div dir="auto"><blockquote type="cite"><div><div dir="ltr"><br><div><div class="gmail_quote"><div dir="ltr"><br></div><div dir="ltr"><div dir="ltr"><div dir="ltr"><div dir="ltr"><div dir="ltr"><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times"><b><font size="4">Pathways to accountability in rural Guatemala: A qualitative</font></b></p>
<p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times"><b><font size="4">comparative analysis of citizen-led initiatives for the right to health of</font></b></p>
<p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times"><b><font size="4">indigenous populations</font></b></p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">Alison Hernández <span style="font-stretch:normal;line-height:normal;color:rgb(0,147,188)">a</span><span style="font-stretch:normal;line-height:normal">,</span><span style="font-stretch:normal;line-height:normal;font-family:Helvetica;color:rgb(0,147,188)">⇑</span>, Ana Lorena Ruano <span style="font-stretch:normal;line-height:normal;color:rgb(0,147,188)">a</span><span style="font-stretch:normal;line-height:normal">,</span><span style="font-stretch:normal;line-height:normal;color:rgb(0,147,188)">b</span>, Anna-Karin Hurtig <span style="font-stretch:normal;line-height:normal;color:rgb(0,147,188)">c</span>, Isabel Goicolea <span style="font-stretch:normal;line-height:normal;color:rgb(0,147,188)">c</span>, Miguel San Sebastián <span style="font-stretch:normal;line-height:normal;color:rgb(0,147,188)">c</span>,</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">Walter Flores<span style="font-size:10.5px"> <span style="font-stretch:normal;font-size:7px;line-height:normal;color:rgb(0,147,188)">a</span></span></p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times"><font size="1"><span style="font-stretch:normal;line-height:normal">a </span>Center for the Study of Equity and Governance in Health Systems (CEGSS), Guatemala, Guatemala</font></p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times"><font size="1"><span style="font-stretch:normal;line-height:normal">b </span>Center for International Health, University of Bergen, Bergen, Norway</font></p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">



</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times"><font size="1"><span style="font-stretch:normal;line-height:normal">c </span>Division of Epidemiology and Global Health, Umeå University, Umeå, Swede</font>n</p><p style="margin:0px;font-stretch:normal;font-size:6.5px;line-height:normal;font-family:Times"><br></p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times"><b>Abstract:</b></p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">Strengthening citizen-led accountability initiatives is a critical rights-based strategy for improving health</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">services for indigenous and other marginalized populations. As these initiatives have gained prominence</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">in health and other sectors, there is great interest in how they operate and what makes them effective.</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">Scholarly focus is shifting from measuring the efficacy of their tools and tactics to deepening understanding</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">of the context-sensitive pathways through which change occurs. This paper examines how citizen-led</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">initiatives’ actions to strengthen grassroots networks, monitor health services and engage with authorities</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">interact with local sociopolitical conditions and contribute to accountability achievements for indigenous</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">populations in rural Guatemala. We used qualitative comparative analysis to first systematize and</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">score structured qualitative monitoring data gathered in 29 municipal-level initiatives, and then analyze</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">patterns in the presence of different forms of citizen action, contextual conditions and accountability outcomes</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">across cases. Our study identifies pathways of collective action through which citizen-led initiatives</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">bolster their power to engage and negotiate with authorities and bring about solutions to some</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">of the health system deficiencies that they face. While constructive engagement is widely advocated</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">as the most effective approach to interaction with authorities, our study indicates that success depends</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">on wider processes of community mobilization. To overcome the power asymmetries that marginalized</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">groups face when engaging with authorities, iterative processes of network building and participatory</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">monitoring as well as persistence in their demands are critical. These processes further provide an</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">enabling environment for moving beyond the local and projecting indigenous voices to engage with</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">authorities at higher governance levels. Initiatives also applied adversarial legal action as an alternative</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">engagement strategy that contributed to bolster citizen power. Our findings indicate the potential of collective</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">power generated by the actions of citizen-led initiatives to enable marginalized populations to</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">




















</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times">hold authorities accountable for health system failures.</p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times"><br></p><p style="margin:0px;font-stretch:normal;line-height:normal;font-family:Times"><b>To download the PDF press here: <a href="https://www.sciencedirect.com/science/article/pii/S0305750X18303528" target="_blank">https://www.sciencedirect.com/science/article/pii/S0305750X18303528</a></b></p></div></div></div></div></div>
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