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Community Participation in Africa: My knowledge of my own society conflicted with the theory - Interview with Fred Golooba-Mutebi.

5/13/2013

7 Commentaires

 
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Jean-Benoît Falisse

We continue our exploration of community participation in Africa, 25 years after the Bamako Initiative. Dr. Frederick Golooba-Mutebi is a political scientist and Honorary Senior Research Fellow at the School of Environment and Development, University of Manchester and Research Associate of the Africa Power and Politics Programme at the Overseas Development Institute in London. He has widely published on health, local government and other topics, with a concentration on Uganda, Rwanda, South Sudan and South Africa.


Jean-Benoît Falisse: You have been working on issues of community participation for quite a few years now. What sparked off your interest for this topic?

Fred Golooba-Mutebi
: My interest stemmed from the knowledge I had of how the society I was born in works. I had grown up in it and knew roughly how people felt and thought about different things. A key aspect of participation is that it presumes that communities, wherever they are found, always want to assert themselves over their leaders or people in positions of power and authority. My own society is very hierarchical in orientation. People generally treat leaders with deference. And even if one does not respect a leader or has an issue against him or her, they are more likely to avoid than confront them. The idea of participation with people holding their leaders to account is therefore a difficult proposition. Traditionally local leaders did not account directly to the community. They accounted to their superiors, the senior chiefs, and ultimately to the king. In distant (pre-colonial) times, before the region I was born in became more populated, people could easily move house from one area to another one. The possibility of shifting enabled them to vacate areas presided over by leaders they did not like to those with leaders who had a reputation for being good. The consequences for a leader whose people “voted with their feet” included being deposed by the king. In short, my knowledge of my own society conflicted with the theory of popular participation. That triggered an interest in me to go and investigate the extent to which it was feasible. I found that it really is not. Like it or not, traditions and ways of seeing or doing things live very long.

Community participation was a key principle of the Bamako Initiative. Today is seems the Bamako Initiative hasn't quite reached its objectives. What do you think are the main reasons?

There are several reasons. One is that service delivery in health care fails because of factors that go way beyond what participation can address or rectify such as the availability of medicines and human resources in rural areas and the professional supervision necessary for delivering care according to established standards. The idea of wanting to ‘capture’ for the public sector money people were spending on private provision was a good one. However, its weakness lay in assuming that people would be as willing to pay for care in government facilities as they were in private ones. Experience in Uganda has shown that it certainly wasn’t the case. For many poor people, paying for care in government facilities alongside paying taxes was a contradiction in terms. “Why pay taxes and then pay for services as well?’ People knew that owners of private facilities were ‘doing business’ and therefore had to make a profit but the idea that government facilities should do the same clashed with many people’s understanding of what governments are supposed to do, which is provide free health care services. Rather than pay for inferior public services, people naturally preferred the higher-quality and more responsive private provision. The proliferation of private facilities of all sorts made the ‘exit’ from public provision fairly easy. Private providers in the highly unregulated health markets of poor countries are more than happy to provide their clients with the services they want, not necessarily those they need. In the 1990s, Susan Reynolds Whyte found that people in rural Uganda could turn up at drug shops and ask for whatever medicines they wanted in proportions they themselves had determined, in line with the amount of money they had. The Bamako Initiative therefore fell short of its aspirations because it was founded on plausible but questionable presumptions.

Why did community participation propositions such as the Bamako Initiative appear in the late 80s’? Could/should they have been designed differently?

The initiatives appeared at the time they did because there was a desperate need for change. Public provision of health services in much of the developing world was abysmal. There was need for radical thinking, to devise ways of bringing about improvement. Yes, they could have been designed differently. The key problem, as far as I can figure it out, was the one-size-fits-all approach, whereby development initiatives are introduced in every country in exactly the same way, without regard to contextual considerations. Clearly countries are different and cannot possibly follow the same path in the pre-determined ways the development industry promotes. There is something to be said for each country trying to do what fits its context rather than going for so-called ‘best practice’. If countries such as Rwanda have been more successful than others in reforming their health systems in ways that have proved to work for them, it is because, as research by the Africa Power and Politics Programme at the Overseas Development Institute discovered, they went for “good fit” rather than ‘best practice’ solutions. They provide us with the grounds for questioning the tendency within the development industry to promote universalist solutions to problems of development or governance.

You have been a critical voice of community participation and incidentally you come from Uganda - unlike quite a few prominent researchers on community participation who come from North America/Western Europe. Do you think there is a (Western) "doxa" of community participation? Was it mostly a donor fad?

As I indicated at the beginning, my skepticism about participation stemmed from my understanding of how the community I was born in and grew up in functioned, and how things such as leadership were understood. It never derived from theorizing about what is good for poor communities. The trouble with the development industry is that it is dominated by theorists whose understanding of the world or worlds they want to change or improved is limited and informed by short visits and to a large extent superficial interactions with the people whose lives they want to improve. It seems to me as if the problem really is the naïve liberalism of well meaning but misguided outsiders working with insiders who are too willing to play along without asking some hard questions. In my opinion the Rwandans get a lot right by refusing to be dragged along, by questioning and rejecting things they believe will not work for them and going for what works.

Do you think it would make sense to consider using similar mechanisms of community participation in North America/Western Europe?

I don’t think so. For one thing, participatory mechanisms demand lots of people’s time. You cannot expect people in a community to hold all these meetings and make all the decisions; what time would they have left for ‘living’? I have lived in Europe. I never sat in a single community meeting and if anyone had required me to attend as many meetings as my mother in the village in Uganda is required, I would never have had the time to do so. My mother attends very few meetings and misses most for the same reasons. Things in the areas of London where I lived, worked the way they did because the UK has a functioning state. That is what we need in Africa and the developing world, not participation. This is not to say that participation has no value; it does. It can complement a strong, functioning state when people could rise up and express dissatisfaction whenever they may judge it necessary. And in that case, it can only be sustained in a context where the state is responsive. Otherwise people will see no reason to engage in citizen action that produces no results.

If I understand correctly, community participation in social services in Uganda was also quite heavily promoted by the state. What do you think is
the reason? Wasn't it in a sense weakening the state a bit more?

As a fashion in development, participation coincided with the rise to power of the National Resistance Movement (NRM). The NRM leadership had tested the benefits of citizens participating in decision making during the civil war when they organized citizens into local councils in order to enable them to take charge of things such as security and also to vet recruits into the rebel army. The arrangements worked well enough for the Movement to want to apply them to post-war governance once they seized power, not least because they offered a window of opportunity for the state to penetrate the entire countryside, undermine traditional authority structures and entrench itself. Further, the NRM’s rise to power coincided with the early post-cold-war period when democratization and accompanying phenomena such as decentralization were top on the agenda of the donor community. In this sense there was a coincidence of interests between the NRM leadership and the donor community. Two decades down the road, we know that there was a great deal of naivety in assuming that ordinary people actively wanted and were capable of watching over their leaders and questioning as well as directing their activities. I do not think participation weakened the state. Rather, it did nothing to strength states that were already weak. It allowed governments to shirk their responsibility for making things work and to load it onto citizens who possessed neither the inclination nor the capacity for doing so.

In a recent article, you argue that "vertical and horizontal co-ordination, inspection and supervision, and the strength of accountability enforcement mechanisms" are the keys for efficient social services delivery. What is exactly the role of communities there? What is the future of community participation in social services delivery?

Yes, indeed, those are the keys in my opinion. Communities ought to be accorded avenues through which they can pressurize their leaders if they judge that to be the thing to do at any one moment. This could happen if, say, they find the quality of service provision is below their expectations. For this to happen, educational campaigns should be mounted to ensure they know it is their right to do so. This is more or less the situation in Western democracies. People are not required – and I mean required – to participate in decision making on the scale those in poor countries are. However, when leaders make decisions they find objectionable, they have the right to demonstrate or engage in forms of citizen action that put their message or messages across to whoever they are intended for. Even then, we should not expect this change to happen overnight. The kind of activism we see in advanced democracies took root over long periods of time.

It seems to me that popular participation is rarely considered as a political act. From your research and experience, would you say that popular participation is a political act?

Well, if we agree that participation is intended to influence decision making and in a sense even resource allocation, then it is about making a choice between or among competing ideas. It is therefore a political act. That in a sense is also a reason why it is a difficult proposition in contexts where relations between leaders and the people they lead are highly hierarchical and don’t entail direct confrontation or contestation.


7 Commentaires
Kingsley Pereko
5/14/2013 04:05:23 am

This is a nice piece of work. I am currently working on community participation in child health and nutrition service delivery which I see some of the issues raised come to play. One size does not fit all but good fit is the best option. I would advocate for local based social determinant research which must be funded by state resource other than focusing on western directed developmental research that are mostly market brings and offer superficial solutions to our developmental needs.

As much as I agree with the concept of participation by Dr. I do somehow disagree with the lash out at community participation as a western concept which only function in functional states.

I Ghana where I come from community participation has been practiced in various levels of society from the family level to community. Various self help initiative has been done in the past before the the whiteman's coming to learn of us and present it as their concept. We had concepts like the "Noboah" Omandwuma" which are all community participation concept. It would have been much better knowing in which context he is defining community participation.

He has really shared very thoughtful issues.

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Kristof Decoster
5/14/2013 06:00:40 am

Very nice interview, thanks for this, JB & Fred. Lots of interesting insights.

However, this discourse sounds at times a bit too much like Singapore's Lee Kuan Yew's who suggested that the "Western concepts" of democracy and human rights will not work in Asia as they are not the Asian way. Even if Fred admits there's a role for participation, the Chinese also like to argue that good governance, a functioning state, etc. are what matters most to people. That's probably true, but to get a functioning and healthy state that delivers, you need citizens who know their rights and don't feel politically powerless. In every polity, you need a balance of effectiveness & voice. If not, it won't be sustainable.

In fact, even if these might "sound" like Western notions, the situation is actually not that different in the West nowadays - we obviously lack real democracy and participation in plenty of Western countries, ordinary citizens are no longer in charge. The financial sector is. Which is why many European citizens feel powerless these days. In the end, the eurozone will prove not sustainable for this reason, I'm afraid. But that's another story.

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Jean-Benoît Falisse
5/16/2013 04:03:56 am

Thanks for the comments and let the debate started. I think an interesting and important question is, if we start from the premise that community participation in local social services may indeed not be common or socially accepted in a series of context, whether it is still to be encouraged and if so, how?

I am also re-posting here a comment we received (from Cameroon) on the PBF CoP working group:

" I agree on most points which Dr Golooba share expanded upon in his interview. Community participation in Cameroon is still more of a myth than reality. Dr Golooba rightly stated that one of the main problems in the implementation of the community participation theory was that of "one size fits all". This theory needs to be personalized and contextualized to the various countries in which it is due to be implemented. The idea of best practices is laudable but still fall short of the many expectation of the country. We need to understand that the concept of authority or hierarchy in Africa is that of paternalism where the masses look up to their leaders for their needs and are forced to accept all that is given to them even though they may not satisfy or meet their demand. They seldom have the right to complain or question the decisions of the leaders and even if they do their plea would fall on depth ears as the leaders are only answerable to their superiors.
For community participation to be worth while it is imperative that the whole concept be made known to the community and that local governments be encouraged to decentralize their powers to give more responsibility to the community. there is a dying need for the authorities to be more responsible and responsive to the needs of the community and encourage the population to take active roles in decision making.
Conclusively I would say that the concept of community community participation has not met its objectives in Africa because it has been considered in isolation where as its is a concept which is linked directly or indirectly to other concepts such as decentralization, political frame work and contextualization of policies. I wish to share in the thoughts of Dr Golooba that mass education would go a long way to sure the realization of the concept of community participation."

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Marc RAMAEKERS link
5/21/2013 05:12:26 am

Thank you to the publisher for posting his view on the topic of community participation.

In my point of view, I think that it's hard to compare one country with another as there are always socio-cultural differences which makes that one form of community participation fits better in society "A" than "B", and vice versa, so every country needs to look for a model that suits best. The fact that community members do have a vote in the way how health related issues are been taken care of in their own community seems to me though always a positive evolution as it results in ownership.

Here in Cameroon we have already since almost 30 years the so called "dialogue structures" as one of the 3 "members" (beside the Government and the Technical and Financial partners) representing the population in the Regional Funds for Health Promotion who exist, for the moment, in 3 out of the 10 Regions . From grass root level (health center) via district level (district hospital) to Regional level (Regional Funds for Health Promotion) community representatives are elected and co-manage health related topics together with governmental staff in the service delivery points on the different levels. The far most important domain at this moment is the management and logistics of drugs, as it's income generating and ensures sustainability, besides other interventions such like mutual health- initiatives, PBF-initiatives and hospital maintenance-initiatives.

We're now in the process, together with the Ministry of Public Health, to re-boost the dialogue structures also in the other Regions to be sure that the community members (through transparent elections) have an input in the way that health services are managed. To achieve this, our strategy was to first sensitize the population (including local authorities and decision makers), afterwards to organize elections, to end with the training of new elected community members in order to ensure a good performance in the different health committees.

Certainly we had to overcome and tackle some practical problems that occurred along the process but in general I can state that this initiative is very well appreciated by, as well the community as the Ministry of Public Health and the Financial and Technical Partners.




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