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.


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