Health Accountability for Indigenous Populations: Confronting Power through Adaptive Action Cycles
Health Accountability for Indigenous Populations: Confronting Power through Adaptive Action Cycles
复制标题
DOI：
10.19088/1968-2018.133
复制
发表时间：
2018-03-01
影响因子：
0.7
通讯作者：
Hernandez, Alison
中科院分区：
文献类型：
--
作者：
Flores, Walter;Hernandez, Alison
卫生保健提供者是社会上有影响力的人物。知情的服务用户可能能够识别这些行为者的违规行为和滥用行为，但报告这些行为不仅仅是一个行政程序。这是一种搅动现有权力关系和社会等级的行为。本文认为，问责制干预的本质是服务用户收集和分析证据的过程，然后使用这些证据来对抗不同治理级别的权力。在问责制行动的适应性周期中，评估当局的反应并相应地调整战略。基于十年来在危地马拉支持土著公民主导的问责行动的经验，作者描述了他们的方法如何从强调技术组成部分演变为具有跨学科合作和明确参与权力的政治知情方法。本文总结了经验教训及其对在高度不平等环境中从事卫生问责工作的组织的相关性。
Health-care providers are powerful figures in society. An informed service user may be able to identify regulatory non-compliance and abuses by these actors, but reporting them is not a mere administrative procedure. It is an act that stirs existing power relations and social hierarchies. This article argues that the essence of an accountability intervention is the process through which service users collect and analyse evidence that is then used to confront power at different governance levels. The response from authorities is assessed and strategies adjusted accordingly in adaptive cycles of accountability action. Based on ten years' experience supporting indigenous citizen-led accountability action in Guatemala, the authors describe how their approach evolved from an emphasis on technical components to a politically informed approach with interdisciplinary collaboration and explicit engagement with power. This article summarises lessons learned and their relevance for organisations working in health accountability in highly unequal settings.