IDEAS home Printed from https://ideas.repec.org/a/eee/wdevel/v113y2019icp392-401.html
   My bibliography  Save this article

Pathways to accountability in rural Guatemala: A qualitative comparative analysis of citizen-led initiatives for the right to health of indigenous populations

Author

Listed:
  • Hernández, Alison
  • Ruano, Ana Lorena
  • Hurtig, Anna-Karin
  • Goicolea, Isabel
  • San Sebastián, Miguel
  • Flores, Walter

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.

Suggested Citation

  • Hernández, Alison & Ruano, Ana Lorena & Hurtig, Anna-Karin & Goicolea, Isabel & San Sebastián, Miguel & Flores, Walter, 2019. "Pathways to accountability in rural Guatemala: A qualitative comparative analysis of citizen-led initiatives for the right to health of indigenous populations," World Development, Elsevier, vol. 113(C), pages 392-401.
    • Handle: RePEc:eee:wdevel:v:113:y:2019:i:c:p:392-401
    DOI: 10.1016/j.worlddev.2018.09.020
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0305750X18303528
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.worlddev.2018.09.020?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Anuradha Joshi & Peter P. Houtzager, 2012. "Widgets or Watchdogs?," Public Management Review, Taylor & Francis Journals, vol. 14(2), pages 145-162, February.
    2. Speer, Johanna, 2012. "Participatory Governance Reform: A Good Strategy for Increasing Government Responsiveness and Improving Public Services?," World Development, Elsevier, vol. 40(12), pages 2379-2398.
    3. Helene Grandvoinnet & Ghazia Aslam & Shomikho Raha, 2015. "Opening the Black Box," World Bank Publications - Books, The World Bank Group, number 21686.
    4. Anuradha Joshi, 2013. "Do They Work? Assessing the Impact of Transparency and Accountability Initiatives in Service Delivery," Development Policy Review, Overseas Development Institute, vol. 31, pages 29-48, July.
    5. Joshi, Anuradha, 2017. "Legal Empowerment and Social Accountability: Complementary Strategies Toward Rights-based Development in Health?," World Development, Elsevier, vol. 99(C), pages 160-172.
    6. Sophie King, 2015. "Increasing the Power of the Poor? NGO-led Social Accountability Initiatives and Political Capabilities in Rural Uganda," The European Journal of Development Research, Palgrave Macmillan;European Association of Development Research and Training Institutes (EADI), vol. 27(5), pages 887-902, December.
    7. Fox, Jonathan A., 2015. "Social Accountability: What Does the Evidence Really Say?," World Development, Elsevier, vol. 72(C), pages 346-361.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Ruppen, Désirée & Brugger, Fritz, 2022. "“I will sample until things get better – or until I die.” Potential and limits of citizen science to promote social accountability for environmental pollution," World Development, Elsevier, vol. 157(C).
    2. Zinda, John Aloysius & Zhang, Zhiming, 2019. "Explaining heterogeneous afforestation outcomes: How community officials and households mediate tree cover change in China," World Development, Elsevier, vol. 122(C), pages 385-398.
    3. Kovacs, Roxanne J. & Lagarde, Mylene & Cairns, John, 2022. "Can patients improve the quality of care they receive? Experimental evidence from Senegal," World Development, Elsevier, vol. 150(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Davison Muchadenyika, 2017. "Civil society, social accountability and service delivery in Zimbabwe," Development Policy Review, Overseas Development Institute, vol. 35, pages 178-195, October.
    2. Harry Blair, 2018. "Citizen Participation and Political Accountability for Public Service Delivery in India," Journal of South Asian Development, , vol. 13(1), pages 54-81, April.
    3. Dewachter, Sara & Holvoet, Nathalie & Kuppens, Miet & Molenaers, Nadia, 2018. "Beyond the Short versus Long Accountability Route Dichotomy: Using Multi-track Accountability Pathways to Study Performance of Rural Water Services in Uganda," World Development, Elsevier, vol. 102(C), pages 158-169.
    4. Alawattage, Chandana & Azure, John De-Clerk, 2021. "Behind the World Bank’s ringing declarations of “social accountability”: Ghana’s public financial management reform," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 78(C).
    5. Fox, Jonathan A., 2015. "Social Accountability: What Does the Evidence Really Say?," World Development, Elsevier, vol. 72(C), pages 346-361.
    6. Lars Waldorf, 2017. "Legal empowerment and horizontal inequalities after conflict," WIDER Working Paper Series wp-2017-50, World Institute for Development Economic Research (UNU-WIDER).
    7. Joshi, Anuradha, 2017. "Legal Empowerment and Social Accountability: Complementary Strategies Toward Rights-based Development in Health?," World Development, Elsevier, vol. 99(C), pages 160-172.
    8. Mayka, Lindsay & Abbott, Jared, 2023. "Varieties of participatory institutions and interest intermediation," World Development, Elsevier, vol. 171(C).
    9. Anuradha Joshi, 2023. "What makes “difficult” settings difficult? Contextual challenges for accountability," Development Policy Review, Overseas Development Institute, vol. 41(S1), March.
    10. World Bank Group, 2014. "Strategic Framework for Mainstreaming Citizen Engagement in World Bank Group Operations," World Bank Publications - Books, The World Bank Group, number 21113.
    11. Ludger Niemann & Thomas Hoppe, 2021. "How to Sustain Sustainability Monitoring in Cities: Lessons from 49 Community Indicator Initiatives across 10 Latin American Countries," Sustainability, MDPI, vol. 13(9), pages 1-16, May.
    12. Gaduh,Arya Budhiastra & Pradhan,Menno Prasad & Priebe,Jan & Susanti,Dewi, 2021. "Scores, Camera, Action : Social Accountability and Teacher Incentives in Remote Areas," Policy Research Working Paper Series 9748, The World Bank.
    13. David William Walker, 2016. "How Systemic Inquiry Releases Citizen Knowledge to Reform Schools: Community Scorecard Case Studies," Systemic Practice and Action Research, Springer, vol. 29(4), pages 313-334, August.
    14. Simon O'Meally, 2014. "The Contradictions of Pro-poor Participation and Empowerment: The World Bank in East Africa," Development and Change, International Institute of Social Studies, vol. 45(6), pages 1248-1283, November.
    15. Ruppen, Désirée & Brugger, Fritz, 2022. "“I will sample until things get better – or until I die.” Potential and limits of citizen science to promote social accountability for environmental pollution," World Development, Elsevier, vol. 157(C).
    16. Brunnschweiler, Christa & Edjekumhene, Ishmael & Lujala, Päivi, 2021. "Does information matter? Transparency and demand for accountability in Ghana's natural resource revenue management," Ecological Economics, Elsevier, vol. 181(C).
    17. Dupas, Pascaline & Jain, Radhika, 2023. "Can beneficiary information improve hospital accountability? Experimental evidence from a public health insurance scheme in India," Journal of Public Economics, Elsevier, vol. 220(C).
    18. Igor Francetic & Günther Fink & Fabrizio Tediosi, 2021. "Impact of social accountability monitoring on health facility performance: Evidence from Tanzania," Health Economics, John Wiley & Sons, Ltd., vol. 30(4), pages 766-785, April.
    19. Jean-Benoit Falisse & Hugues Nkengurutse, 2022. "Citizens Committees and Local Elites: Elite Capture, Captured Elites, and Absent Elites in Health Facility Committees," The European Journal of Development Research, Palgrave Macmillan;European Association of Development Research and Training Institutes (EADI), vol. 34(3), pages 1662-1683, June.
    20. Abu Elias Sarker & Syed Awais Ahmad Tipu & Farhana Razzaque, 2022. "An Integrative Dynamic Framework of Social Accountability: Determinants, Initiatives, and Outcomes," Public Organization Review, Springer, vol. 22(1), pages 117-133, March.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:wdevel:v:113:y:2019:i:c:p:392-401. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/worlddev .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.