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Citizen Participation in the Health Sector in Rural Bangladesh: Perceptions and Reality

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Citizen engagement with institutions and policy processes gives shape and content to the meaning of citizenship by placing obligation on both citizens and state, and helps to ground the abstract relationship between state and citizen within the consciousness of people. Participation meets the concern not only for citizen 'voice' but also for citizen agency. This article explores people's perceptions and reality about participation in newly opened spaces within the Bangladesh public health care delivery system. The empirical findings suggest that the effectiveness and ability of community groups to function as spaces for participation and provide the means for developing capabilities to participate is limited, being constrained by poverty, social inequality and dependency relationships, invisibility, low self-esteem and absence of political clout. Neither have these groups been able to foster a sense of community, since perceptions of rich-poor differences in capabilities and responsibility remain strong.

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... Like other developing countries the Government of Bangladesh has also taken several initiatives through decentralisation and reforms in the governing system, particularly in the local government system to ensure good governance through people's participation (Sarker, 2006;Siddiqui, 2005). Rural people in Bangladesh have now obtained opportunities to participate in local development programs, but several research studies showed that the participation in local development programs in rural Bangladesh is not being effective for the achievement of good governance (Mahmud, 2004;UNDP, 2002;Zafarullah and Khan, 2005). Mahmud (2004) argued that the local people are not mentally ready to participate in local development programs. ...
... Rural people in Bangladesh have now obtained opportunities to participate in local development programs, but several research studies showed that the participation in local development programs in rural Bangladesh is not being effective for the achievement of good governance (Mahmud, 2004;UNDP, 2002;Zafarullah and Khan, 2005). Mahmud (2004) argued that the local people are not mentally ready to participate in local development programs. According to her findings, local villagers cannot assess the value of their own engagement in local development programs, and thus they do not participate in such programs (Mahmud, 2004). ...
... Mahmud (2004) argued that the local people are not mentally ready to participate in local development programs. According to her findings, local villagers cannot assess the value of their own engagement in local development programs, and thus they do not participate in such programs (Mahmud, 2004). But participation is not a one sided event: it is a marriage between service providers and service receivers (Gaventa, 2004). ...
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Purpose – The objective of this research is to find out the barriers to people's participation for good governance in developing countries. The specific objective is to explore the attitude of stakeholders responsible for ensuring people's engagement with local development programs. Design/methodology/approach – Two rural development projects in each of three local government institutions in Bangladesh were selected for this research study. Qualitative methods were used to investigate how actors related to these projects valued people's participation while implementing and using outcomes of these projects. Findings – The findings showed that the meaning of the notion of good governance through effective people's participation that has been imported from the developed democratic economies through international aid agencies remains somewhat unclear and ambiguous in a country such as Bangladesh. Practical implications – This study has revealed that one of the major barriers to people's participation in local government affairs is the traditional attitude of related stakeholders. This study thus, unlocked the practical knowledge about making people's participation effective in implementing development programs, specifically in the developing countries. Originality/value – This paper offers originality and new insight into the participatory governance in developing countries.
... Finally, a disabled man who used to be a farmer from Chargau in Uttar Bordal Union (Sunamganj District) said 'Not everyone has to go [to the UP]; he [the businessman sitting next to him] is enough to talk for us. ' Mahmud (2004) describes the mutual enforcement of powerlessness from the marginalised when discussing such self-censorship; Kabeer (2011) presents this as the 'inner acceptance of inequality'. We have seen similar mechanisms in the previous section on gender differences. ...
... (Mohanty 2007: 81) Not all procedures and structures are clearly defined in the spaces presented so far; nonetheless, there seems to be a lack of meaningful political participation for different marginalised groups. This situation of exclusion also reflects a lack of legitimacy in local government, or as Mahmud (2004) argues when describing the Bangladesh context, a denial of the rights of certain parts of the population. The belief of certain groups that they are a 'lesser citizen', as Mahmud (2004) calls it, makes marginalised individuals perceive their relation with the UP as one in which they are clients, exchanging favours with patronsrather than citizen with rights, who can demand their government allow them to realise these rights. ...
... This situation of exclusion also reflects a lack of legitimacy in local government, or as Mahmud (2004) argues when describing the Bangladesh context, a denial of the rights of certain parts of the population. The belief of certain groups that they are a 'lesser citizen', as Mahmud (2004) calls it, makes marginalised individuals perceive their relation with the UP as one in which they are clients, exchanging favours with patronsrather than citizen with rights, who can demand their government allow them to realise these rights. Cornwall and Coelho (2007) further argue that it is necessary for the individual to recognise himself or herself as a citizen, rather than a beneficiary or a client, in order to engage in 'participatory spheres'. ...
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This paper, part of an IDS and Helvetas Swiss Intercooperation research project, is about the promotion of accountability at the local level in Bangladesh. By exploring in this context the legal grounds for accountability, the role of social hierarchies based on gender, education, family and wealth, and the impact of political alliances on accountability, the paper focuses on the social and political factors which may enable or prevent emerging accountability practices. The accountability practices studied in this context are local networks formed and supported by SDC's local governance programme Sharique. These networks strive to emerge as catalysts of social and economic development as well as good governance in Bangladesh. Composed of local governance actors, local networks bring information, spaces for participation and opportunities for oversight closer to citizens in rural Bangladesh, making it easier for them to benefit from accountability options provided by their government. This paper elaborates the strategy Sharique applies to help networks take on this role in a socially and politically divided context. It maintains that this strategy contributes to a transfer of power from a powerful individual to a group, setting off a process of collectivisation and affecting each member's role in engaging in local development and promoting accountability. However, the paper also draws attention to disparities that persist between members of the networks studied, with respect to different elements of accountability. It argues that the active promotion of all elements of accountability is necessary for Sharique to reach out to all populations through this initiative. It concludes that the success of accountability practices both on a conceptual and applied level is subject to clear differentiation between elements of accountability, which avoids relying on assumed casual connections between them.
... (OECD, 2005) Given the growing interest in public engagement among decision-makers and the corresponding increase in public engagement scholarship and practice in recent years, we were interested in determining whether this situation still exists. In our own public engagement evaluation research, we have drawn on the work of Frewer (2000 and2004), who have contributed substantially to the field of public engagement evaluation over the past decade. They have taken on the challenging task of trying to define what constitutes "effective public participation" and establishing which mechanisms work best in which situations and why (Rowe and Frewer, 2004). ...
... Seven documents were identified in our overall search that dealt specifically with this topic, but only two of them met our inclusion criteria (Quantz, 2001;Kilpatrick, 2009). We have included the other citations in the reference list of this report as they may serve as useful references about the design of public engagement processes in these populations and the particular concerns that are raised by rural communities (Nikniaz et al. 2007;Maalim, A. D. 2006;Mahmood et al. 2002;Mahmud, S. 2004;Mamary, E. M. et al. 2004). We note that only one of these references focuses on rural Canadian populations, so the applicability of the remaining works needs to be carefully assessed. ...
... Seven conditions of success are described based on the work of Rowe & Frewer and Forest et al. (2000;2004): Representativeness, independence, early involvement, influencing the policy decisions, providing information, resource accessibility, and structured decision-making. -There is lack of agreement between policy-makers, decision-makers, scholars, taxpayers, patients, and the general public about what constitutes a successful public involvement process. ...
... People must be empowered in order to feel able to influence the decision making process: local governments or decentralization is seen as a way of empowering communities through the mechanism of participation (e.g. local level planning, resource mobilization, administrative and judicial powers) (Simeen, 2004). The freedom of press and speech is an important condition; still research on its relation with citizens agency is not unambiguous. ...
... People must be empowered in order to feel able to influence the decision making process: local governments or decentralization is seen as a way of empowering communities through the mechanism of participation (e.g. local level planning, resource mobilization, administrative and judicial powers) (Simeen, 2004). ...
Article
Since the late 1990s, the prospect of using ICT (Information Communication Technologies) to improve accountability, transparency, access to information, and monitoring authorities has attracted general optimism. However, early hopes that e-initiatives would be the panacea of all the problems have given way to more modest claims. An aspect that has not received much attention so far is the use of ICT in support to citizen agency; to involve and inform communities and interact with and influence authorities. There are quite a few examples of successful smaller projects in this realm, also in developing countries. But new emerging technologies (e.g. mobile phones) create new momentum for strengthening citizen agency at larger scale. This paper focuses on the how ICT is already being used for this, and where the possibilities for the future lie.
... Mittler et al., 2013 Engaging consumers refers to the performance of specific behaviors ("engaged behaviors") and/or an individual's capacity and motivation to perform these behaviors ("activation") aimed at gaining health. Mahmud, 2004 It is a process that leads to setting healthcare priorities. It consists in empowering people to provide input in decisions that affect their lives and encourages support for those decisions, which in turn improves the public's trust and confidence in the healthcare system. ...
... They thus restrict the concept of "engagement" to the domain of therapeutic alliance (Higgins et al., 2017) and shared decision making (i.e., Davis et al., 2007;Mulley et al., 2012). Other studies suggest a broader vision of inter-individual factors at the basis of "engagement": in particular, they focus on the role of complex networks of peer-topeer exchanges (i.e., Dunston et al., 2009) and on the dialogue between the citizen and the healthcare system conceived as a whole (Mahmud, 2004;McBride and Korczak, 2007). ...
Article
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Organizations are experiencing increased competition, disruptive innovation, and continuous changes in their social and economic context. Furthermore, the decrease of resources (economic and human) in such a demanding context make it imperative for organizations to find new models and strategies to make their service delivery more sustainable at the economic, environmental and psychological levels. In such a complex scenario the concept of engagement of the individuals involved in organized settings (either as service providers or as final receivers) is a promising lever for innovation. However, despite the number of studies on the matter, the debate on engagement is still very fragmented because the corpus of literature addressing the different areas of engagement is divided and diverse in its nature. In this paper, we discuss the results of a conceptual analysis of the literature conducted in order to investigate overlapping features and areas of divergence among three different areas of investigation and application of the engagement phenomenon in organized settings: the domains of employee engagement, consumer engagement, and patient engagement. These are deliberately selected as prototypical of the phenomenon of engagement along the “inside/outside” of organizational settings. The analysis consisted in a qualitative conceptual survey? Of the scholarly literature indexed with the key terms “employee engagement,” “consumer engagement,” and “patient engagement.” We performed a key-word based survey? Of the literature in the Scopus database. A total of 163 articles were selected and analyzed. The analysis cast light on the following areas of conceptual overlap among employee, consumer and patient engagement: (1) engagement is different from empowerment and activation; (2) engagement is a multi-componential psychological experience; (3) engagement is a self-transformative experience; (4) engagement develops within a relational context; (5) engagement is a systemic phenomenon. These findings, although preliminary and in need of further investigation, suggest the feasibility of promoting a transdisciplinary reflection on the phenomenon of engagement in organized settings.
... This raises questions as to whether community representatives only put their personal concerns forward, rather than channelling the concerns of the rest of the community. This finding is consistent with past studies conducted in Bangladesh, the Philippines, and African countries, which showed that committees did not reflect the concerns of the population (Mahmud, 2004;Goodman et al., 2011;Falisse et al., 2012). Selection of members by wider public consultation (election or public gathering), together with activities to improve awareness of the HFMC and their roles, would possibly address this gap. ...
... Sepehri and Pettigrew (1996) also highlighted that Nepalese society is characterised by hierarchiesby caste/ethnicity, wealth, gender and powerand these hierarchies prevented health committees from adequately representing the interests of their community. Hence, inequalities apparent in society, of gender, caste, and wealth, were reinforced in the committee structure as Mahmud (2004) also found in Bangladesh. Continued efforts are necessary to empower community members to ensure their participation is more than token (Gurung et al., 2015). ...
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Background: Community participation has been recognised as one of the key components for the successful implementation of primary health care (PHC) strategies, following the 1978 Declaration of Alma-Ata. In low- and middle-income countries (LMICs), HFMCs are now widely considered as a mechanism to increase community participation in health through community representation. There is some research examining the implementation process, impact and factors affecting the effectiveness of HFMCs. Despite the documented evidence of the importance of factors such as adequate representation, links with wider community, and decision-making power, there is limited evidence about the nature of community representation and degree of decision making within HFMCs in the PHC setting, particularly in LMICs. Methods: Qualitative interviews with 39 key informants were held to explore different aspects of community representation in HFMCs, and the influence of the HFMC on health facility decision-making processes. In addition, a facility audit at 22 facilities and review of HFMC meeting minutes at six health facilities were conducted. Findings There were Dalit (a marginalised caste) and Janajati (an ethnic group) representations in 77% and 100% of the committees, respectively. Likewise, there were at least two female members in each committee. However, the HFMC member selection process and decision making within the committees were influenced by powerful elites. The degree of participation through HFMCs appeared to be at the 'Manipulation' and 'Informing' stage of Arnstein's ladder of participation. In conclusion, despite representation of the community on HFMCs, the depth of participation seems low. There is a need to ensure a democratic selection process of committee members; and to expand the depth of participation.
... From each location, two selected areas were chosen for collection of data from the youth through survey, interviews and FGD which allowed the study to observe their behavioral and response mechanisms. Before the main survey 10 , field visits to the selected study areas were conducted to have an idea about the concentration of young population and their characteristics. This also helped to determine the way for approaching the ultimate study samples. ...
... Institutional changes requiring the political actors both local and government to put more effort into offering engagement opportunities for youth need to be made. The 10 recent political culture needs to be modified. There has to be coordination among the political parties alongside mutual tolerance and integrity. ...
Article
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Youth in politics can be a creative force, a dynamic source of innovation which in turn brings positive changes in political systems. But today’s youth is neither deeply apathetic nor unconventionally engaged in mainstream politics due to its complex nature. This decreasing level of youth participation in politics not only endangers the quality of leadership but also jeopardizes the democracy of tomorrow. By using qualitative and quantitative data this study explored the trend of youth engagement and their disconnection with the current political systems. This study aimed to observe how the youth is unbundling the traditional concept of state power and identify the reasons for their non-engagement in politics which eventually challenges the political system of Bangladesh.Keywords: Engagement, Democracy, Politics, Young population, Leadership.
... Although formally, each health facility has a community representative committee to exert direct influence over the service, in practice, these committees are neither representative nor effective. Committee members are generally drawn from the village élite, with significantly higher levels of both education and income than the majority of clinic users and frequently with strong connections to local power structures (Mahmud, 2004). Central/local level politicians mostly head the committees and tend to control committee functions. ...
... Poverty and inequality also negatively impact the ability of citizens to influence service provision. In Bangladesh society, a sense of control and feeling of being able to contribute is essential for citizen agency and is strongly linked to access to material resources like land and education and to non-material resources like position and authority within the community (Mahmud, 2004). Figure 3 seeks to capture the relationships between political economy constructs, national policy and institutions, and the quality of PHC services, found in the Bangladesh case study. ...
... This is because personal empowerment encompasses a sense of connectedness to the community and empowered people perceive they are in control and can contribute through participation. On the other hand, those who do not participate feel they have no control, are not important and feel marginalized or excluded as citizens (Mahmud 2003; Higgins 1999). 'Activists' dominate the world of participatory politics and ordinary citizens are excluded. ...
... Good reviews of the strengths and weaknesses of the voice and accountability mechanisms in the health system of Bangladesh can be found in GK(2000),Jasimuddin et al. (2001),Barakat, Hoque and Syeduzzaman (2003), CPD (2003), S.Mahmud (2004Mahmud ( , 2006,BIDS (2006),Zaman and Abdul (2006), BHW (2007, 2010,IRT (2009b, Technical Appendix 2) andSchurmann and Mahmud (2009). ...
Article
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Bangladesh has made great strides in improving the health of its population, much more than a country at its level of development can be expected to do. Serious problems still remain in reducing child malnutrition and maternal mortality in particular; nonetheless, the aggregative results achieved in the last three decades are quite impressive. These achievements have certainly have gone a long way towards fulfilling the right to health in Bangladesh. This paper argues, however, that despite overall progress the health sector of Bangladesh suffers from a number of inadequacies that militate against the rights-based approach to health. These include persistent inequities in access to healthcare (including gender inequity, and inequity along the poor versus non-poor divide), lack of meaningful participation of citizens in the running of the health system, and the absence of effective accountability mechanisms through which the providers of healthcare can be held responsible for their actions.
... The country can also boast world class human resources in the areas of surgical and healthcare facilities. Bangladesh also holds the academic settings for alternative medicinal or healthcare procedures like herbal, homeopathy, Unani or Ayurveda (Mahmud, 2004). ...
Chapter
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Medical tourism is recent phenomenon. All such tourism is based on three main factors (tourists, service providers and facilities, and the policy frameworks required to put these together), that contribute to its development. Bangladesh has put these main factors in place for medical tourism, and now wishes to make better use of available service providers and facilities. The country is believed to have the capacity to become a major medical tourism destination, if its development is properly orchestrated. Bangladesh produces a considerable number of medical tourists, however the country has in recent years witnessed huge investment in public and private medical services, and health infrastructure development. This chapter is an analytical study that aims to explore the existing patterns of medical tourism in Bangladesh, while offering suggestions that would allow the country to gain a competitive edge.
... In the food and education sectors for instance, there is no accountability mechanism for seeking redress against the huge leakages that characterise programmes such as the Food for Work (FFW) and Food for Education (FFE) programmes. In the health sector, the National Health Policy of 1998 did envision 32 BWH (2007BWH ( , 2010 and S. Mahmud (2004Mahmud ( , 2006 offer detailed accounts of many initiatives taken by the civil society to promote citizen's voice in the conduct of the healthcare system in Bangladesh. 33 The Awami League government that came to power in late 2008 has decided to revive the institution of Community Clinics, as part of a new health policy initiative which is currently under discussion. ...
Article
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By signing and ratifying various human rights instruments, the State of Bangladesh has committed itself to pursuing socio-economic policies in a way that would promote its people's right to development, understood as integrated realisation of the whole range of human rights—including economic, social and cultural rights on the one hand and civil and political rights on the other. But does the development policy of Bangladesh actually conform to the demands of the right to development? This is the question investigated in the present paper. The paper first develops a methodology for answering the question, and then applies it to three specific rights—viz., the right to food, the right to health and the right to education—by drawing upon three case studies on the realisation of these rights in Bangladesh. The investigation finds that while Bangladesh can claim to have made a lot of progress in each of the three areas in terms of standard socio-economic indicators, serious deficiencies remain when judged by the criteria of human rights norms. The major areas of concern relate to the principles of equity, participation and accountability. Although successive governments have paid lip service to all three of these principles, the policies they have pursued in practice have actually undermined them more often than not. Fundamental reorientation is needed in the way the government functions before the development policy of the State of Bangladesh can be said to conform to the demands of the right to development approach. * S. R. Osmani is Professor of Development of Economics at the University of Ulster, UK. This is an revised and updated version of a paper originally prepared as a synthesis of three sector studies on the rights to food, education, and health in Bangladesh, prepared respectively by Quazi Shahabuddin, Mustafa Mujeri and Omar Haider Chowdhury for a multi-country Right to Development Project, jointly conducted by the School of Public Health of Harvard University and the Centre for Development and Human Rights of the Jawaherlal Nehru University, Delhi. The inputs from these three authors as well as the support provided by the project team, especially by Arjun Sengupta and Stephen Marks, in preparing the paper are gratefully acknowledged. All responsibility for any remaining errors and inadequacies lies with the author alone.
... The engagement of citizens in the policy development of the state and government promises greater efficiency and effectiveness. Through this mechanism citizens can claim their rights based on equality rather than traditional notions of 'norms, charity, benevolence or patronage' (Mahmud, 2004). It is logical to assume that people are not willing to participate if their opinions aren't making the right differences. ...
... However, people's participation in the local government of Bangladesh is still lacking (Mahmud, 2004). Asaduzzaman (2008) stated that the engagement of local people in various development initiatives is still an elusive golden deer, which was one of the primary concerns of the government for the previous three decades or more. ...
Article
Public participation in local government is considered very crucial for ensuring good governance and quality service at the local level. This study aims to measure the level of public participation in the local government of Bangladesh. For this purpose, Arnstein’s citizen participation theory is used in this study. A cross-sectional quantitative approach has been followed in this study. To fulfill the research objectives, 400 samples were collected using the survey method from two divisions of Bangladesh namely Dhaka and Rangpur. A semi-structured questionnaire was used in this study for conducting the survey. Major findings of this study revealed that existing mechanisms for citizens’ participation in the local government of Bangladesh is merely for eye-washing rather than for ensuring actual citizen’s participation. People cannot influence local government decisions through these existing mechanisms. In terms of Arnstein’s citizen’s participation theory, the level of public participation in the local government of Bangladesh is at the therapy level. It indicates that the existing mechanisms are only for making people cured by showing that the people have the opportunity to participate rather than using these mechanisms for ensuring actual citizens’ participation. However, the government and other respective authorities need to take necessary measures for ensuring public participation in the local government of Bangladesh.
... Other scholars adopted a more holistic analysis of the organizational and contextual factors in play in the patients' engagement process. Mahmud (2004), for instance, sees engagement as an organizational process that leads to a revision of the healthcare priorities in the direction of empowering people to provide input in decisions that affect their lives encourages support for those decisions, which in turn improves the public's trust and confidence in the healthcare system. Finally, Mc Bride and colleagues (2007) also point at the importance of informal care and define engagement as the element that will allow, at different levels, the wider community to have a say in the future direction of their health. ...
Chapter
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The concept of patient engagement offers a unique opportunity to inform our understanding of patients' ability to be active in managing their care. However, unless promoting the active role of patients is today identified as a priority to promote care quality, a wide debate still exists on how to translate this principle into practice and how to assess initiatives aimed at increasing the level of patient participation in their care. Measuring patient engagement along the care course might ensure that the medical care truly serves patients' needs, priorities, and preferences. Unless the measurement of patient engagement is today a big issue for policy makers and healthcare practitioners, only few scientifically validated assessment tools currently exist to identify patients' level of involvement in their healthcare. In this chapter authors review the main validated tools currently available in the scientific community devoted to assess the patients' ability and availability to be actively engaged in their care, with a particular focus on the recently developed Patient Health Engagement Scale, specifically designed to assess the emotional and psychological adaptation of patients along their care process and their level of engagement in the healthcare management.
... This is a difficult issue involving the interplay of multiple factors and forces. Mahmud (2004) depicts that in societies such as Bangladesh, the acceptance of inequality and tolerance of invisibility of the poor and the marginalised represent major barriers of the poor and the marginalised represent major barriers to the establishment of this virtuous cycle. ...
Article
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Bangladesh is a least developed country and its health care management industry is miserably underdeveloped. Main reason behind underdevelopment of the health sector is inefficient hu man resources. Lack of efficient human skill in the health sector and level of corruption in this sector creates an explosive situation in Bangladesh. As such a good number of people per day is going to abroad for health treatment purpose. Research questio n of the study is whether people have been going other countries from Bangladesh due to inefficient human resources for treatment purposes? The study uses both primary and secondary sources. Studies prepared two questionnaires and respondents are 5 00 out o f 611 questionnaires were distributed. On the basis of the se questionnaire s , the study does the statistical analysis . Time period of the study was from July 2011 to November 2011 . A uthor observes that high costs, poor services, improper treatment and long w aiting lists at home; new technology and skills in destination countries alongside reduced transport costs and I nternet marketing have all played a pivotal role in the expansion of medical tourism from Bangladesh to abroad. Govt. hospitals and health cente r s are lacking basic health management skill. Private hospitals and nursing centers are also mostly engaged in earning super normal profit. But no systematic world class hospitals in ratio to population density have been established all over the Banglades h.
... Despite these initiatives (including the stronger focus on citizen participation), research on Bangladesh reveals that barriers to success have principally been because government bureaucrats still fail to engage citizens and civil society groups in the participatory process (Mahmud 2004;Siddiqui 2005). Some researchers have pointed to a general lack of appetite for civil participation amongst government bureaucrats (Hossain and Matin 2007;Zafarullah and Khan 2005). ...
Article
Participatory governance in developing countries is broadly viewed as an essential prerequisite for successful implementation of public projects. However, it poses many challenges for public bureaucrats in terms of their skills and willingness to engage citizens. Despite the growing evidence of the pervasiveness of participatory governance, research to date has not explored bureaucratic readiness to adopt participatory practices. This research presents findings of a bureaucratic readiness assessment for participatory governance in Bangladesh by exploring how public bureaucrats perceive the value of participation; how they are educated to collaborate with stakeholders; and the extent to which their attitudes are amenable to enhancing participatory governance. Our findings suggest that we can classify readiness in terms of both motivational and educational factors. The study has implications for how readiness can be developed in public officials that may assist in fostering participatory governance in Bangladesh and be informative to other countries experiencing similar issues.
... ent in these activities. Salahuddin, Ali, Alam and Ali (1988) stated that Bangladesh, being a poor country with scarce resources, cannot afford to provide sophisticated medical care to the entire population. Emphasis is therefore given to primary health care covering the unnerved and undeserved population with the minimum cost in the shortest time. Mahmud (2004) explored people's perceptions and reality about participation in newly opened spaces within the Bangladesh public health care delivery system. The empirical 1 Bangladesh's National Health Policy (2000) envisages a participatory approach to caring for people's health, at least at the local level. It calls for the decentralization of serv ...
Article
Health is a basic requirement to improve the quality of life. A national economic and social development depends on the state of health. A large number of Bangladesh’s people, particularly in rural areas, remained with no or little access to health care facilities. The lack of participation in health service is a problem that has many dimensions and complexities. Education has a significant effect on participation in health services and administrative factors could play a significant role in increasing the people’s participation in Bangladesh’s health sector. But the present health policy is not people oriented. It mainly emphasizes the construction of Thana Health Complexes (THCs) and Union Health and Family Welfare Centers (UHFWCs) without giving much attention to their utilization and delivery services. The study reveals that financial and technical support is very helpful to ensure health service among village people. However, the Government allocates only 5 percent of the budget to the health sector, while it allocates 13 percent for defense. The paper shows that the Government’s allocation and technical support (medical equipments) are not sufficient in the rural health complex and that the people’s participation is far from being satisfactory. The paper concludes with a variety of recommendations.
... Extant studies have identified bureaucratic control as the main barrier of implementing participatory governance (Mahmud 2004;Sarker 2006;Zafarullah and Huque 2001). This study, however, has found that the lack of democratic practices within an apparently participatory framework as the primary barrier for such lapses where both bureaucrats and elected representatives share responsibilities for the variety of its shortcomings in practice. ...
Article
In recent years, “participatory governance” has emerged as an impor- tant concept within the governance domain. It is a policy that insinu- ates participation of local citizens to implement locally based propeople development initiatives. International aid agencies have been pursuing this agenda with an aim to provide greater legitimacy to development projects for economic growth in developing countries. In response, the government of Bangladesh has been trying to imple- ment participatory governance policies for aid-assisted development projects for the last three decades. However, empirical studies reveal that the level of participation of local citizens in development projects has hardly been improved despite such attempts. Relying on six aid- assisted project-based case studies, this article explores the reasons of such a failure and has found out that the dysfunctional political system and corruption in Bangladesh have compromised the role of the state in ensuring any meaningful participation of ordinary citizens in local-level development activities.
... However, people's participation in the local government of Bangladesh is still lacking (Mahmud, 2004). Asaduzzaman (2008) stated that the engagement of local people in various development initiatives is still an elusive golden deer, which was one of the primary concerns of the government for the previous three decades or more. ...
Article
Full-text available
Public participation in local government is considered very crucial for ensuring good governance and quality service at the local level. This study aims to measure the level of public participation in the local government of Bangladesh. For this purpose, Arnstein's citizen participation theory is used in this study. A cross-sectional quantitative approach has been followed in this study. To fulfill the research objectives, 400 samples were collected using the survey method from two divisions of Bangladesh, namely Dhaka and Rangpur. A semi-structured questionnaire was used in this study for conducting the survey. Major findings of this study revealed that existing mechanisms for citizens' participation in the local government of Bangladesh are merely for eye-washing rather than for ensuring actual citizen participation. People cannot influence local government decisions through these existing mechanisms. In terms of Arnstein's citizen's participation theory, the level of public participation in the local government of Bangladesh is at the therapy level. It indicates that 2 the existing mechanisms are only for making people cured by showing that the people have the opportunity to participate rather than using these mechanisms for ensuring actual citizens' participation. However, the government and other respective authorities need to take necessary measures to ensure public participation in the local government of Bangladesh.
... In the absence of a widespread sense of full citizenship, there is a tendency for activists to dominate the world of participatory politics and for ordinary citizens to be excluded. (Svara & Denhardt, 2010;Mahmud, 2004). ...
... Like other developing countries the Governments of Bangladesh has also taken several initiatives through decentralization and reforms in the governing system, particularly in the local government system to ensure people"s participation for good governance (Sarker, 2006;Siddiqui, 2005). All though rural people in Bangladesh have now obtained opportunities to participate in local development programs, but several researches documented that their participation in local development programs in rural Bangladesh is not effective for the achievement of good governance (Mahmud, 2004;UNDP, 2002;Zafarullah and Khan, 2005). ...
Article
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This study seeks to understand political attitude and determining variables those are assumed to relate and explain the variance degree of political attitude of rural youth. The study revealed that 37.9 percent youth are not involved with politics and almost half of the respondents had moderate positive attitude towards present politics. Among the involved youth 35 percent are general members, 18.1 percent executive committee member and 8.6 percent served as president or secretary in the local bodies of political parties. Bi-variate analysis estimated that family size, agricultural knowledge, organizational participation and communication exposure were significantly correlated with political attitude of rural youth whereas, age, organizational participation, communication exposure, perceived prevalence of leadership traits and political attitude had positive significant correlation with involvement in politics. Stepwise multiple regressions mirrored that agricultural knowledge; organizational participation and communication exposure jointly contributed to 30.6 percent variation in prediction of political attitude.
... Barriers to Mechanism Functionality Similar to the provincial case, at a national level in SA, it is acknowledged that public participation in the health system is still under-developed, and that the mechanisms intended to support this face massive implementation barriers, including a basic lack of information about their functioning. 15,58 Common barriers found in this case, are echoed in the broader national and regional literature. For example, resource constraints are the most prominent factor: expressed in relation to the sustainability of committees, the functioning of the Health Ombud, 25 and the lack of formalization of the CHWs. ...
Article
Background: Despite governments striving for responsive health systems and the implementation of mechanisms to foster better citizen feedback and strengthen accountability and stewardship, these mechanisms do not always function in effective, equitable, or efficient ways. There is also limited evidence that maps the diverse array of responsiveness mechanisms coherently across a particular health system, especially in low- and middle-income country (LMIC) contexts. Methods: This scoping review presents a cross-sectional 'map' of types of health system responsiveness mechanisms; the regulatory environment; and evidence available about these; and assesses what is known about their functionality in a particular local South African health system; the Western Cape (WC) province. Multiple forms of indexed and grey literature were synthesized to provide a contextualized understanding of current 'formal' responsiveness mechanisms mandated in national and provincial policies and guidelines (n = 379). Various forms of secondary analysis were applied across quantitative and qualitative data, including thematic and time-series analyses. An expert checking process was conducted, with three local field experts, as a final step to check the veracity of the analytics and conclusions made. Results: National, provincial and district policies make provision for health system responsiveness, including varied mechanisms intended to foster public feedback. However, while some are shown to be functioning and effective, there are major barriers faced by all, such as resource and capacity constraints, and a lack of clarity about roles and responsibilities. Most mechanisms exist in isolation, failing to feed into an overarching strategy for improved responsiveness. Conclusion: The lack of synergy between mechanisms or analysis of varied forms of feedback is a missed opportunity. Decision-makers are unable to see trends or gaps in the flow of feedback, check whether all voices are heard or fully understand whether/how systemic response occurs. Urgent health system work lies in the research of macro 'whole' systems responsiveness (levels, development, trends).
... In Saturia Upazila Health Complex in Bangladesh, the rate of staff absenteeism is 1% and the facility is clean, organised and responsive to patients (Mahmud, 2004). The reason behind this success is proper top-down monitoring of staff from the district level, regular interaction between the community and health workers, and active involvement of the Union Parishad Chairman and officials involved in health service delivery. ...
... Di ujung lain, masyarakat lokal perlu maju untuk berbagi pengetahuan dan keprihatinan dengan manajer publik dan perwakilan untuk mengembangkan upaya holistik untuk mencapai hasil terbaik dari proyek pengembangan (Bozeman, 2002;Dollery, 2003;Geddes, 2005). Warga perlu konsepsi yang jelas tentang peran mereka dalam urusan pemerintah daerah, yang akibatnya akan membantu mereka menjadi lebih berdaya untuk berpartisipasi dalam lokal program pengembangan (Macintosh dan Whyte, 2008;Mahmud, 2004;Stoker, 2006). ...
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Pengembangan sektor pariwisata telah menjadi prioritas pembangunan ekonomi yang berbasis pada potensi daerah. Potensi daerah dibidang pariwisata yang menjadi perhatian bagi pemerintah saat ini yaitu lebih pada potensi kekayaan alam, kekayaan ragam kuliner, pertumbuhan wisata buatan, penguatan wisata budaya dan kearifan lokal. Potensi wisata unggulan tersebut masih memiliki bentuk lain jenis pariwisata yang dapat dikembangkan. Bentuk dan jenis potensi wisata yang beranekaragam ini dapat dikembangkan dan dikelola dengan baik, melalui kolaborasi atau kerjasama oleh semua pihak atau dengan kata lain melalui Collaborative Governance. Kolaborasi yang dilakukan oleh pemeritah pusat, pemerintah daerah, masyarakat, komunitas, pelaku swasta, pihak akademis, Non Governmental Organization (NGO) dan lain sebagainya, merupakan kekuatan dalam mengembangkan potensi pariwisata yang ada. Pada saat ini banyak negara telah berupaya mengemas pariwisata yang dapat memberikan perbedaan dan daya saing yang kuat terhadap negara-negara lain, yaitu melalui dasar pola pengembangan pada sektor budaya dan kearifan lokal. Pengembangan pariwisata berbasis pada budaya dan kearifan lokal ini dengan kata lain dapat disebut dengan pengembangan pariwisata berbasis Indigenous Tourism. Pengembangan potensi pariwisata daerah yang berbasis pada indgenous tourism merupakan pilihan baik dalam meningkatkan daya saing disisi dimensi nilai pada konsep governance, hal ini yang menjadi dasar mengenai model collaborative governance dalam analisis pengembangan potensi pariwisata berbasis indigenous tourism
... Care is also needed to ensure that policies and institutions do not re-enforce existing hierarchy or undermine the participation of the most vulnerable. 18,19 With these caveats in mind, establishing patient and public involvement policies and institutions in low and middle income countries has promise to move toward justice and greater inclusivity in research, going some of the way to addressing the well documented inequities and exploitation that remain pervasive issues. This more inclusive model could also benefit the development of more diverse models of patient and public involvement in higher income countries, 15 help enable a greater understanding about the factors influencing Black, Asian and minority ethnic involvement in health and social care research 20 and in producing research that is more relevant not only to otherwise marginalised individuals and communities 17 but to broader populations and society more generally. ...
... Finally, the environmental consequences of the vehicle have been evaluated. The vehicle has been recognized through many types of research as one of the most important elements to the rural transportation system and it has been established as a growing industry for the rural transportation system in Bangladesh (Mahmud, 2004). ...
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The Easy Bike has brought revolutionary changes in the rural transportation system in Bangladesh. This paper aims to evaluate the supply chain of the battery based electric charged vehicle popularly known as Easy Bike and identify the role of Easy Bike for the development of the country’s rural transportation system. The method of data collection was both interview and questionnaire in the form of closed and open-ended questions. The researchers have selected three different stakeholders associated with the industry such as passengers, drivers and importers or Assemblers of the easy bike and developed three separate questionnaires for identifying the problems, opportunities, and the actual condition of this newly developed industry. The role played by the related authority has been identified and analyzed through extensive literature review and interview with the selected stakeholders. The collected data has been analyzed through different statistical tools. Research findings show that the vehicle has become the most reliable and one of the fastest mediums of the transportation system for the rural people as well as urban people. The reasons behind the popularity of the vehicle are reduced fare, safe to travel, environment-friendly, faster than the previous transport mode and easy to operate the vehicle. The availability of the auto rickshaw in the current time has reduced the mortality rate in case of different emergency need for Medicare services. This vehicle is also making the contribution to girls’ secondary higher education by easing their movement to the remote area where most of the colleges are situated. There are problems like higher electricity cost, poor road structure, illegal extortion, lack of driving training facility etc. faced by the industry. The removal of these problems will accelerate the growth of the industry and will ensure long-term benefits for the industry.
... In fact, given the long-term care and the high component of cardiac disease self-management, in addition to taking their pills, cardiac patients need to learn strategies and skills to manage their own health care (Barello et al., 2014;Graffigna, Barello, & Bonanomi, 2017;Graffigna, Barello, Riva, et al., 2017). Among antecedents of patient activation, there are patient clinical and socio-cultural characteristics (Gruman et al., 2010;Hibbard et al., , 2015, patient's psychological adjustment and adaptation to the illness (Graffigna, Barello, & Bonanomi, 2017;Graffigna, Barello, Riva, et al., 2017), the organisational and structural characteristics of the healthcare setting (Mahmud, 2004;McBride & Korczak, 2007). ...
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Cardiac patients show alarming levels of nonadherence to medications. It is important to consider also patient activation levels. Furthermore, the partner could have a supporting role in these processes. The aim of this study was to investigate the mediating role of patient health self-efficacy (HSE) in the link between dyadic coping (DC) and two self-management outcomes (i.e., medication adherence and patient activation) across the first six months of cardiac disease. One hundred couples completed two self-report questionnaires during the hospitalization for cardiac disease and six months after discharge. A longitudinal and dyadic research design was adopted. Cross-sectional analyses at T0 revealed that patient-provided and perceived positive DC and common DC are positively associated with HSE, which in turn is positively associated with medication adherence. HSE mediated the association between patient positive and common DC styles, with the only exception of Patient-provided positive DC, and patient activation. Conversely, patient-provided and perceived negative DC are negatively associated with HSE, which in turns is positively associated with medication adherence and patient activation. Prospective analyses showed that only patient-perceived negative DC at discharge is negatively associated with HSE at T1, which in turns is positively associated with patient activation over time. These results suggest to consider patient perceived and provided DC as antecedents of self-management outcomes via patient HSE. Furthermore, our results recommend to pay particular attention to negative DC, whose negative consequences are manifested also over time, planning interventions targeting partners’ awareness of their own DC style.
... In Saturia Upazila Health Complex in Bangladesh, the rate of staff absenteeism is 1% and the facility is clean, organised and responsive to patients (Mahmud, 2004). The reason behind this success is proper top-down monitoring of staff from the district level, regular interaction between the community and health workers, and active involvement of the Union Parishad Chairman and officials involved in health service delivery. ...
Research
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The research is a systematic approached review. This is a first published working paper of a anti-corruption evidence (ACE) project entitled “Corruption, Provider Practice, Motivation & Health system Performance in Bangladesh".
... In Saturia Upazila Health Complex in Bangladesh, the rate of staff absenteeism is 1% and the facility is clean, organised and responsive to patients (Mahmud, 2004). The reason behind this success is proper top-down monitoring of staff from the district level, regular interaction between the community and health workers, and active involvement of the Union Parishad Chairman and officials involved in health service delivery. ...
... There are some other scholars who have argued that participation means empowering local communities (Eilola et al. 2015). That is, participation and empowerment are inter-linked (Chowdhury 2004;Mahmud 2004). ...
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The present paper attempts to quantify the level of participation of local communities comprising women, landless people, illiterate people, scheduled caste and scheduled tribes (SC/ST), youth and elders who are involved in the participatory forest management program of India. The paper also tries to estimate the factors responsible for participation in different stages like planning, implementation and monitoring. This paper is based on primary data collected from 252 households in Bagmundi forest range office under Purulia forest division of West Bengal, India, in the month of January 2020. A multistage sampling technique and a questionnaire method have been used for data collection. Linear regression model is applied to estimate factors affecting participation at various stages. The level of participation is higher for scheduled caste and scheduled tribes, landless and illiterate households. The overall participation of the households is influenced by gender, family size, occupation, landholdings, forest income to total income, distance from residence to forest, distance from residence to market and cooperation on the part of forest department. The paper has an important policy implication for social and economic development.
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Drawing on case studies from the Citizenship Development Research Centre, this paper contends that mechanisms aimed at enhancing citizen engagement need to be contextualised in the states of citizenship in which they are applied. It calls for more attention to be focused on understanding trajectories of citizenship experience and practice in particular kinds of states. It suggests that whilst efforts have been made by donors to get to grips with history and context – such as DFID's Drivers of Change analyses or Sida's Power Studies – less attention has been given to exploring the implications of the dissonance between the normative dimensions of global narratives of participation and accountability, and the lived experience of civic engagement and the empirical realities of ‘civil society’ in diverse kinds of states. By exploring instantiations of citizenship in different kinds of states, the paper reflects on what citizen engagement comes to imply in these contexts. In doing so, it draws attention to the diverse ways in which particular subject-positions and forms of identification are articulated in the pursuit of concrete social and political projects.
Article
In Bangladesh, many forestry projects have been launched with the objective of involving local people in managing forest resources. However, only a few of them have been sustained. In a reaction, the Forest Department (FD) of Bangladesh initiated a project in the Madhupur Sal forest area to protect forests and improve the livelihoods of forest-dependent people in a sustainable way. This study analysed the nature and extent of peoples' participation in Madhupur projects, and evaluated the project's impacts on the livelihoods of participating people through empirical data. The result revealed that capacity building of encroachers and forest-dependent families were the basic achievements of this project. Natural assets, social relationships, and the utilization of human capital through alternative livelihood strategies have provided security and improved livelihood assets of participants. All participants were appointed as paid community forest workers, received incentives, and established a good relationship with the FD, which dismissed participants' forest offences and mobilized their participation. Moreover, protection of encroacher intervention in Sal forests and substantial re-vegetation went hand-in-hand in a synergistic way that made the project initially successful, but community empowerment issues will need more attention from the FD to ensure the sustainability of the project.
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Social participation has been understood in many different ways, and there are even typologies classifying participation by the degree of a population's control in decision making. Participation can vary from a symbolic act, which does not involve decision making, to processes in which it constitutes the principal tool for redistributing power within a population. This article argues that analyzing social participation from a perspective of power relations requires knowledge of the historical, social, and economic processes that have characterized the social relations in a specific context. Applying such an analysis to Guatemala reveals asymmetrical power relations characterized by a long history of repression and political violence. The armed conflict during the second half of the 20th century had devastating consequences for a large portion of the population as well as the country's social leadership. The ongoing violence resulted in negative psychosocial effects among the population, including mistrust toward institutions and low levels of social and political participation. Although Guatemala made progress in creating spaces for social participation in public policy after signing the Peace Accords in 1996, the country still faces after-effects of the conflict. One important task for the organizations that work in the field of health and the right to health is to help regenerate the social fabric and to rebuild trust between the state and its citizens. Such regeneration involves helping the population gain the skills, knowledge, and information needed in order to participate in and affect formal political processes that are decided and promoted by various public entities, such as the legislative and executive branches, municipal governments, and political parties. This process also applies to other groups that build citizenship through participation, such as neighborhood organizations and school and health committees.
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We investigated the role of Information and Communication Technologies (ICT, namely mobile phones) in support of citizen agency and its potential in calling authorities to account. We focused on Eastern Africa and we used a mixed methodology, which allowed us to explore the current uses of ICT to strengthen accountability and to forecast the growth of mobile phones' adaption in that region. Evidence from both analyses suggests that there are two main areas where citizen agency and ICT can reinforce each other in bottom–up and horizontal processes: participation and engagement of citizens, and the diffusion of information.
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Objectives The objectives of the Rural Site Visit Project (SV Project) were to develop a successful model for engaging all 201 communities in rural British Columbia, Canada, build relationships and gather data about community healthcare issues to help modify existing rural healthcare programs and inform government rural healthcare policy. Design An adapted version of Boelen’s health partnership model was used to identify each community’s Health Care Partners: health providers, academics, policy makers, health managers, community representatives and linked sectors. Qualitative data were gathered using a semistructured interview guide. Major themes were identified through content analysis, and this information was fed back to government and interviewees in reports every 6 months. Setting The 107 communities visited thus far have healthcare services that range from hospitals with surgical programs to remote communities with no medical services at all. The majority have access to local primary care. Participants Participants were recruited from the Health Care Partner groups identified above using purposeful and snowball sampling. Primary and secondary outcome measures A successful process was developed to engage rural communities in identifying their healthcare priorities, while simultaneously building and strengthening relationships. The qualitative data were analysed from 185 meetings in 80 communities and shared with policy makers at governmental and community levels. Results 36 themes have been identified and three overarching themes that interconnect all the interviews, namely Relationships, Autonomy and Change Over Time, are discussed. Conclusion The SV Project appears to be unique in that it is physician led, prioritises relationships, engages all of the healthcare partners singly and jointly in each community, is ongoing, provides feedback to both the policy makers and all interviewees on a 6-monthly basis and, by virtue of its large scope, has the ability to produce interim reports that have helped inform system change.
Chapter
The concept of patient engagement offers a unique opportunity to inform our understanding of patients' ability to be active in managing their care. However, unless promoting the active role of patients is today identified as a priority to promote care quality, a wide debate still exists on how to translate this principle into practice and how to assess initiatives aimed at increasing the level of patient participation in their care. Measuring patient engagement along the care course might ensure that the medical care truly serves patients' needs, priorities, and preferences. Unless the measurement of patient engagement is today a big issue for policy makers and healthcare practitioners, only few scientifically validated assessment tools currently exist to identify patients' level of involvement in their healthcare. In this chapter authors review the main validated tools currently available in the scientific community devoted to assess the patients' ability and availability to be actively engaged in their care, with a particular focus on the recently developed Patient Health Engagement Scale, specifically designed to assess the emotional and psychological adaptation of patients along their care process and their level of engagement in the healthcare management.
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People's Participation' in community development is a much discussed issue. The high and rapidly growing population in Bangladesh is placing great strain on all resources. Increasing people's voice and influence in the social forestry policy in Bangladesh is believed to be an effective way of improving the condition of the forest sector by increasing access to services of the most vulnerable and disadvantaged groups. Bureaucracy has an important role primarily in ensuring people's participation because it is the arm of government intervention in the rural areas. It is the responsibility of bureaucrats to aware local people about the programme especially about the importance of people's participation and help the SF farmers in arranging the project meetings and it is also their duty to make sure that proper participation of farmers is ensured. This article tries to map the role of bureaucrats in ensuring people's participation. It identifies whether the rule-oriented or programme-oriented bureaucrats are required to ensure people's participation in this policy. Introduction 'People's Participation' in community development is a much discussed and debated issue. This is because participation enhances democracy and at the same time allows people to decide their own fate. Across the world, as new democratic experiments meet and transform older forms of governance, public engagement in governance is widening. In this regard, a renewed concern with rights, power and difference in debates about participation in development has focused greater attention on the institutions at the interface between publics, providers and policy makers (Cornwall, 2004: 1). Increasing people's voice and influence in the Social Forestry 1 (SF) policy in Bangladesh is believed to be an effective way of improving the condition of the forest sector by increasing access to services of the most vulnerable and disadvantaged groups.
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This document provides a policy framework for public participation in South Africa. This builds on the commitment of the democratic government to deepen democracy, which is embedded in the Constitution, and above all in the concept of local government, as comprising the community as part of the municipality. This government is committed a form of participation which is genuinely empowering, and not token consultation or manipulation. This involves a range of activities including creating democratic representative structures (ward committees), assisting those structures to plan at a local level (community-based planning), to implement and monitor those plans using a range of working groups and CBOs, supporting community-based services, and to support these local structures through a cadre of CDWs (CDWs). In addition, we look to deepen the involvement of local communities in local governance by incorporating ward committees and the community at large in consultation around key municipal process like integrated development planning (IDP), the budget, performance management and service delivery. This applies in respect of implementation, monitoring and evaluation as well as planning.
Article
Tanzania introduced the decentralisation of its health systems in the 1990s in order to provide opportunities for community participation in health planning. Health facility governing committees (HFGCs) were then established to provide room for communities to participate in the management of health service delivery. The objective of this study was to explore the challenges and benefits for the participation of HFGCs in health planning in a decentralised health system. Data were collected using semi-structured interviews and focus group discussions (FGDs). A total of 13 key informants were interviewed from the council and lower-level health facilities. Five FGDs were conducted from five health facilities in one district. Data generated were analysed for themes and patterns. The results of the study suggest that HFGCs are instrumental organs in health planning at the community level and there are several benefits resulting from their participation including an opportunity to address community needs and mobilisation of resources. However, there are some challenges associated with the participation of HFGCs in health planning including a low level of education among committee members and late approval of funds for running health facilities. In conclusion, HFGCs potentially play a significant role in health planning. However, their participation is ineffective due to their limited capacities and disabling environment.
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Background: Engaging patients in their own healthcare is now widely acknowledged as a critical ingredient for high-performance health system as it may improve quality of care and reduce service delivery costs. However, despite the increasing debate about “patient engagement” (PE), this phenomenon remains conceptually and empirically under-developed, often used as a synonymous of other terms such as patient involvement or patient participation. Objective: In order to contribute to the conceptual foundation of PE, the aims of this study are twofold: 1) mapping the current trend of peer reviewed literature about “engagement” in health in term of time frames, disciplinary perspectives, countries more active in the debate, terms mainly used to connote individuals in the process; 2) detecting, comparing and synthesizing the main definitions that are currently orienting the literature debate, by casting light on theoretical gaps and suggesting potential lines for future research development Methods: The key-words “patient engagement” OR “consumer engagement” OR “client engagement” OR “citizen engagement” were searched using the databases more likely to cover the core research publication in health issues (PubMed/Ovid MEDLINE; Ovid PsycInfo; SCOPUS), within the peer-reviewed literature in the years 2000-2013. We conducted both bibliometric analysis and qualitative content analysis on a sub-sample constituted by the only studies that provided a definition of “engagement”. Results: Out of 1286 papers initially retrieved, only 753 resulted pertinent because explicitly concerning “patient engagement”. Furthermore out of them only 16 contributes attempted to provide a definition of PE as an autonomous concept. However these definitions are fragmented and various depending on the disciplinary landmarks to which authors belong. Furthermore, also among the contributes that attempt a specific conceptualization of PE, the frameworks provided appear often partial, merely taxonomic and not able to cast light on the dynamic nature of “engagement”. Conclusions: Basing on these results, we suggest to look at “engagement” as an evolving concept that needs for a recover of an “ecological” foundation, mainly rooted in the deeper analysis of patients’ perspectives, and finalized to provide insights about this process drivers at the individuals, relational, and organizational levels.
Article
As a condition of receiving foreign aid, developing country governments have actively tried to achieve pro-people development through community participation in local-level development projects. Based on a case study of Bangladesh, this article analyses the impact of community participation on the various governance-related issues such as accountability, transparency, responsiveness and predictability during the implementation of such projects. The empirical findings reveal that efforts to achieve such objectives have mostly been futile, leaving community participation in the local governance process as an inchoate and piecemeal affair. Political manipulation, clientelism and inadequate governance structure and processes have been the key stumbling blocks contributing to such failures. This study provides important insights into governance at the local level, implying that greater awareness and participation are needed to formulate and implement effective community-based local governance in developing countries such as Bangladesh. 作为接收外国援助的一项条件,发展中国家的政府会积极通过地方层面的发展项目的社区参与,来取得民生的发展。本文基于对孟加拉的一项个案研究,分析了社区参与对各种治理相关话题的影响,诸如项目实施期间的问责、透明度、因应、可预见性等等。实证研究发现,实现这些目标的努力大多劳而无功,搞得地方治理过程中的社区参与有始无终,七零八落。政治操控、裙带关系、不到位的治理结构及过程都是导致失败的绊脚石。本文深入考察了地方层面的治理,指出在孟加拉国这样的发展中国家,需要更大的自觉和更多的参与来规划并实施有效的社区层面的地方治理。
Article
The Government of Bangladesh with the help of international development agencies has been trying to develop good governance through effective people's participation with the aim of realizing effective outcomes from aid-assisted development projects. This research was conducted to explore how theories of people's participation could be understood and adapted to support effective implementation of development programs through good governance in Bangladesh. Findings from case studies, including the interviews of different stakeholders responsible for ensuring participatory governance, reveal that existing structural, conceptual, and cultural gaps hinder the proper implementation and interpretation of the theory of participatory governance in rural Bangladesh.
Purpose: Quantitative indicators show that Bangladeshi maternal and child healthcare is progressing satisfactorily. However, healthcare quality is still inadequate. It is hypothesised that modern technology enhances healthcare quality. Therefore, the purpose of this paper is to investigate how modern technology such as electronic record keeping and the internet can contribute to enhancing Bangladeshi healthcare quality. This study also explores how socio-economic and political factors affect the healthcare quality. Design/methodology/approach: This paper is based on a qualitative case study involving 68 in-depth interviews with healthcare professionals, elected representatives, local informants and five focus group discussions with healthcare service users to understand technology's effect on health service quality. The study has been conducted in one rural and one urban service organisations to understand how various factors contribute differently to healthcare quality. Findings: The findings show that modern technology, such as the internet and electronic devices for record keeping, contribute significantly to enhancing health service transparency, which in turn leads to quality health and family planning services. The findings also show that information and communication technology (ICT) is an effective mechanism for reducing corruption and promoting transparency. However, resource constraints impact adversely on the introduction of technology, which leads to less transparent healthcare. Progress in education and general socio-economic conditions makes it suitable to enhance ICT usage, which could lead to healthcare transparency, but political and bureaucratic factors pose a major challenge to ensure transparency. Practical implications: This paper can be a useful guide for promoting governance and healthcare quality in developing countries including Bangladesh. It analyses the ICT challenges that healthcare staff face when promoting transparent healthcare. Originality/value: This paper provides a deeper understanding of transparency and healthcare quality in an ICT context using empirical data, which has not been explored in Bangladesh. This critical thinking is useful for policy makers and healthcare practitioners for promoting health service quality.
Article
Electronic Government (e-Government) has been considered as an essential strategy for many governments in their efforts to ensure qualities of participatory good governance. Various e-Government applications have been recognised as effective methods of enhancing governance qualities, such as accountability, transparency, collaboration and trust. However, previous studies that focused on participatory good governance are so far limited, especially in bringing an e-Government solution strategy using a bottom-up approach. Using a qualitative case study1 this paper identifies a participation gap in achieving participatory good governance and aims to address this gap through an e-Government approach in rural sector of a developing country. The outcomes of the study demonstrate that e-Government strategy can play a significant role to address the participation-gap in implementing qualities of good governance.
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Youth in politics can be a creative force, a dynamic source of innovation which in turn brings positive changes in political systems. But today’s youth is neither deeply apathetic nor unconventionally engaged in mainstream politics due to its complex nature. This decreasing level of youth participation in politics not only endangers the quality of leadership but also jeopardizes the democracy of tomorrow. By using qualitative and quantitative data this study explored the trend of youth engagement and their disconnection with the current political systems. This study aimed to observe how the youth is unbundling the traditional concept of state power and identify the reasons for their non-engagement in politics which eventually challenges the political system of Bangladesh.
Article
Objective: Burkina Faso has been implementing a strategy of community participation in the health system for several years.The main objective of this strategy is to involve people in the decision-making process in order to improve the use of health services and to encourage massive support of communities for health promotion activities. Empirical data indicate a low involvement of communities in activities designed to promote participation. This article aims to identify the perceptions of local people in relation to community participation in health. Methods: The study was conducted in the Tenkodo go health district, located in the administrative region of East-Center, about 190 km from the capital. This exclusively qualitative study used two data collection methods: individual interviews and focus groups. Data were collected in two health areas. Results: The results show that communities have negative perceptions on the community participation in health strategy,which is perceived by the majority as a mechanism of exploitation of the population by health workers and members of health center management committees. Conclusions: These negatives perceptions of the participation strategy have a negative impact on the behaviour of communities,reflected by the very low participation rate in community activities.Urgent action is needed to revitalize the existing participation mechanisms.
Chapter
The concept of patient engagement offers a unique opportunity to inform our understanding of patients' ability to be active in managing their care. However, unless promoting the active role of patients is today identified as a priority to promote care quality, a wide debate still exists on how to translate this principle into practice and how to assess initiatives aimed at increasing the level of patient participation in their care. Measuring patient engagement along the care course might ensure that the medical care truly serves patients' needs, priorities, and preferences. Unless the measurement of patient engagement is today a big issue for policy makers and healthcare practitioners, only few scientifically validated assessment tools currently exist to identify patients' level of involvement in their healthcare. In this chapter authors review the main validated tools currently available in the scientific community devoted to assess the patients' ability and availability to be actively engaged in their care, with a particular focus on the recently developed Patient Health Engagement Scale, specifically designed to assess the emotional and psychological adaptation of patients along their care process and their level of engagement in the healthcare management.
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Summaries This article explores approaches to participation in social policy, setting them within broader debates on the rights and responsibilities of citizenship. Drawing on studies of participation in a range of social policy arenas in the North and South, it explores the implications of a shift from a focus on clients or consumers of social policies as users and choosers to a more active engagement of citizens as agents in the making and shaping of the social policies that affect their lives.
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If states would interact more synergistically with communities, they could tap local energies and resources for development-- and help create a development-oriented society and polity in the process. The authors analyze experience in several countries to identify the actions required for state-community synergies in development. Two actions that seem especially important: 1) Broadening the distribution of power within communities, to facilitate collective action and reduce the potential for local capture. In rural areas, much can be done by expanding access to credit, strengthening tenants'rights, and expanding non-crop sources of income. 2) Creating state-community alliances toimprove the effectiveness of local public sector institutions and the delivery of services. Case studies from East Asia and Latin America show that such alliances can effect rapid improvements in local institutions, benefiting not only communities but also politicians seeking support and legitimacy. Local bureaucratic reform, combined with more egalitarian community social organizations, allows the creation of powerful coalitions and synergies for rapid, self-sustaining development. This model has been used to achieve outcomes ranging from better health care and drought relief to the generation of agrarian and industrial economic growth. In China and Taiwan, China, these state-community synergies helped produce not only for local consumption but for a rich export market. The cases show that with creative political thinking it is possible to effect rapid change even in poor institutional settings. The Brazilian experience shows how difficult institutional change is in highly inegalitarian settings, but also how such obstacles can be overcome by changes designed to bring grassroots electoral pressure to bear on local government. Experience elsewhere shows, however, how fragile such efforts can be if political support from above is prematurely withdrawn.
Article
The article begins by identifying the shared features of participation, empowerment and citizenship by reviewing the literature and grounding the discussion in the case study in health reform in one region of British Columbia. The ethnographic case study followed four health planning groups' efforts to foster community participation in developing local community health plans over an 11 month period. Data were also collected through interviews with participants, and focus groups with non-participants. As the article chronicles, despite the best intentions of the health planning groups, their work more closely resembled a social planning orientation than a community development one. The findings suggest that the concepts of citizenship and empowerment are useful in explaining why some individuals engaged in the work of the health planning groups and others did not. The sense of full citizenship—enjoying the formal status and substantive effects of civil, political and social rights as an equal member of the community—distinguished participants from non-participants. The article concludes with a discussion of the findings from the case study in terms of informing the theory and practice of community development.
Article
This paper is an attempt to do four things: first, to review key phases in the post-war development of community work and to identify the discourses of citizenship implicit within them (i.e. social democracy: the problem of the inactive citizen; the structuralist critique: the problem of citizen action; marketization: the problem of the citizen as customer; democratic renewal: the challenge of active citizenship); second, to argue that the contemporary context requires new ways of thinking about the relationship between community work, citizenship and democracy; third, to assess the significance of the recent history of community work for this task; finally, to consider the extent to which the current interest in democratic renewal presents opportunities for reconstructing this relationship. At a time when community work seems to be so directly tied to the apron strings of the state – indeed, increasingly incorporated within state policy – it is all the more important to stand back and take stock. The main elements of the argument are brought together in a summary table at the end of the text.
Article
New perceptions of citizenship emerging in poor countries of the developing world are identifying a conceptual shift that emphasises inclusive citizenship as the exercise of agency and the recasting of. rights by citizens themselves. These perceptions are fuelled by the 'rights based' approach to development, which sees exclusion itself as a denial of rights. Collective action can be a way of materialising rights in poor countries and of realising this new citizen role. Contemporary collective action in Bangladesh indicates that although the space for citizen action is limited by unequal power sharing in society and fear of anticipated reaction, power hierarchies can themselves be utilised for achieving group objectives. Collective action enables Citizen action in claiming rights that have direct bearing upon people's lived realities, but is less effective in enabling agency in claiming rights that involve conflict of interest. Thus, the process of articulating and claiming rights takes place in a situation of continuing social differentiation where inclusiveness remains an elusive concept.
Article
This article explores the simultaneous processes of inclusion and exclusion as they have occurred in different places and at different times in order to understand better the vision of society, the material interests and the notions of identity which have helped to delineate different understandings of the concept. This article aims to contribute to the development of a research agenda on the theme of inclusive citizenship', particularly the challenges it presents in the context of poorer southern countries today Building on Fraser and Gordon's historical analysis of civic and social citizenship, it is argued that the notions of citizenship constructed in the West are inappropriate in post-colonial contexts, in which pre-existing differences within the population have been exacerbated or artificially suppressed by the strategic manoeuvrings of colonial powers. As a result, prevailing ideas about personhood, identity and affiliation, lead to fractured notions of citizenship and exclusionary outcomes. The author concludes with a proposal of four themes for future research into inclusive citizenship in the South.
Community Involvement in Health Development: A Review of theConcept andPractice,Geneva:WorldHealth Organisation Sen,A.Development asFreedomCommunity work, citizenship and democracy: re-making the connections
  • P Kahssay
  • M Oakley
  • I Andmartin
Kahssay and P. Oakley (eds), Community Involvement in Health Development: A Review of theConcept andPractice,Geneva:WorldHealth Organisation Sen,A.,1999,Development asFreedom,Oxfordand New York: Oxford University Press Shaw,M.andMartin,I., 2000,‘Community work, citizenship and democracy: re-making the connections’, Community Development Journal, Vol 35 No 4: 401–13 2Mahmud10/03/04 03:16 pmPage 18
Inpursuit of power:localelites and u nion level governancei n r ural northwesternBangladesh',C ARE Draft, Bangladesh:CARE CommonwealthFoundation and CIVICUSFrom users and choosers tom akers and s hapers: repositioning participation in socialpolicy
  • B A Bode
  • J Gaventa
Bode,B., 2002,'Inpursuit of power:localelites and u nion level governancei n r ural northwesternBangladesh',C ARE Draft, Bangladesh:CARE CommonwealthFoundation and CIVICUS, 1999, Citizens and Governance,London:Commonwealth Foundation Cornwall,A.,and Gaventa, J., 2001,'From users and choosers tom akers and s hapers: repositioning participation in socialpolicy', IDS Bulletin,V ol 31No4:50–62
Increasing voiceand influence in the health sector in ruralBangladesh:is there a role for community participation?',I DS Workshop Draft,B righton:I nstituteo f Development Studies
  • S Mahmud
Mahmud,S., 2003,'Increasing voiceand influence in the health sector in ruralBangladesh:is there a role for community participation?',I DS Workshop Draft,B righton:I nstituteo f Development Studies