Chapter overview on population engagement and decision-making: the deliberation-to-policy gap
What do we mean by this topic?
• The currently available literature reports heavily on the process of participatory governance mechanisms; what happens once the process is over, and how the input is used and analysed is unclear
• Often the step of incorporating participation results into policy is not very transparent
• Throughout the various country case studies, we note policy follow-up challenges once participatory mechanisms have been undertaken
Why is it important for policy-makers to address this topic?
• We acknowledge that participation is a value in and of itself and an intrinsic goal
• Many objectives exist for participatory processes. The participation effectiveness literature uses different end points (not necessarily policy uptake) in attempting to measure effectiveness
• In terms of the handbook’s target audience however, policy-makers (should) set up population engagement mechanisms in order to get input for their mandate – making policy decisions
• The views and needs of population, communities, and civil society should be reflected in health policies which affect their collective health system
Selected key messages
• The level of government involvement seems to be critical. High-level commitment is crucial but not sufficient; mid-level cadres who hold budgets and influence policies need to be on board as well
• Policy-makers seem more willing to endorse participation-based input if they are perceived as being representative of the people and/or certain constituencies
• It is possible to distinguish two complementary approaches to participation: governance and service delivery
• The former’s principal purpose is to ensure good governance of the health sector, which focuses on listening and capturing people’s voice to establish a responsive health system; the latter has the primary objective of improving health service delivery and augmenting service coverage
• Naturally, the two approaches overlap in practice as much of the population‘s voice pertaining to health will be closely linked to health service availability and quality
• However, the governance versus service delivery ‘mind-set’ with which participatory processes are organized by governments seems to make a tangible difference as to how far people’s voices are taken up in health policies
• The ‘service delivery’ approach tends to be more focused on bringing information to communities and incentivizing them to use health services. Information tends to flow one-way from decision-makers to communities. The ‘governance’ approach on the other hand has the explicit interest of having a two-way flow of communication, with the flow from people to health authorities being of particular interest.
At this stage, do you have any comment on the content of this chapter? How does this resonate with your organisation?
Are there any gaps?