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CAS Open Seminar: Dr Jean-Benoît Falisse, University of Edinburgh - Power, authority, and community participation in primary health-care centres: contrasting evidence from health facility committees in South Kivu (DR Congo) and Burundi

When Nov 19, 2018
from 05:00 PM to 07:00 PM
Where S1, Alison Richard Building
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Since the 1987 Bamako Initiative, community participation has become a mainstream approach for managing primary health-care in Africa. There is, however, little empirical evidence that local participatory institutions ultimately improve service provision, and health in general. This paper considers the case of the elected health facility committees (the comités de santé), the quintessential institution of community governance in health, in the contexts of rural Burundi and the province of South Kivu, DR Congo, between 2011 and 2014. It focuses on the effects of a project implemented by ministries of health and aid organisations, which supported and trained health committee members.
Using a mix of qualitative and quantitative methods --including interviews, grey document analysis, and a randomised control trial-- stark differences are found between cases: training the committees led to remarkable improvements in primary health-care management in South Kivu, but much less so in Burundi. The core of the paper discusses this very visible difference; it argues that an oft-neglected, yet critical, element to the efficiency of community participation initiatives in health is ordinary people's relationship to medical and non-medical authority. Diverse experiences of war and violence, distinct histories of autocratic rule, and different types of settlements suggest that this relationship is more horizontal in South Kivu, where power is openly contested and discussed, than in Burundi.