Cargando…

‘History obligates us to do it’: political capabilities of Indigenous grassroots leaders of health accountability initiatives in rural Guatemala

Growing interest in how marginalised citizens can leverage countervailing power to make health systems more inclusive and equitable points to the need for politicised frameworks for examining bottom-up accountability initiatives. This study explores how political capabilities are manifested in the a...

Descripción completa

Detalles Bibliográficos
Autores principales: Hernandez, Alison, Hurtig, Anna-Karin, San Sebastian, Miguel, Jerez, Fernando, Flores, Walter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9073391/
https://www.ncbi.nlm.nih.gov/pubmed/35508334
http://dx.doi.org/10.1136/bmjgh-2022-008530
_version_ 1784701275473969152
author Hernandez, Alison
Hurtig, Anna-Karin
San Sebastian, Miguel
Jerez, Fernando
Flores, Walter
author_facet Hernandez, Alison
Hurtig, Anna-Karin
San Sebastian, Miguel
Jerez, Fernando
Flores, Walter
author_sort Hernandez, Alison
collection PubMed
description Growing interest in how marginalised citizens can leverage countervailing power to make health systems more inclusive and equitable points to the need for politicised frameworks for examining bottom-up accountability initiatives. This study explores how political capabilities are manifested in the actions and strategies of Indigenous grassroots leaders of health accountability initiatives in rural Guatemala. Qualitative data were gathered through group discussions and interviews with initiative leaders (called defenders of the right to health) and initiative collaborators in three municipalities. Analysis was oriented by three dimensions of political capabilities proposed for evaluating the longer-term value of participatory development initiatives: political learning, reshaping networks and patterns of representation. Our findings indicated that the defenders’ political learning began with actionable knowledge about defending the right to health and citizen participation. The defenders used their understanding of local norms to build trust with remote Indigenous communities and influence them to participate in monitoring to attempt to hold the state accountable for the discriminatory and deficient healthcare they received. Network reshaping was focused on broadening their base of support. Their leadership strategies enabled them to work with other grassroots leaders and access resources that would expand their reach in collective action and lend them more influence representing their problems beyond the local level. Patterns of representing their interests with a range of local and regional authorities indicated they had gained confidence and credibility through their evolving capability to navigate the political landscape and seek the right authority based on the situation. Our results affirm the critical importance of sustained, long-term processes of engagement with marginalised communities and representatives of the state to enable grassroots leaders of accountability initiatives to develop the capabilities needed to mobilise collective action, shift the terms of interaction with the state and build more equitable health systems.
format Online
Article
Text
id pubmed-9073391
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-90733912022-05-18 ‘History obligates us to do it’: political capabilities of Indigenous grassroots leaders of health accountability initiatives in rural Guatemala Hernandez, Alison Hurtig, Anna-Karin San Sebastian, Miguel Jerez, Fernando Flores, Walter BMJ Glob Health Original Research Growing interest in how marginalised citizens can leverage countervailing power to make health systems more inclusive and equitable points to the need for politicised frameworks for examining bottom-up accountability initiatives. This study explores how political capabilities are manifested in the actions and strategies of Indigenous grassroots leaders of health accountability initiatives in rural Guatemala. Qualitative data were gathered through group discussions and interviews with initiative leaders (called defenders of the right to health) and initiative collaborators in three municipalities. Analysis was oriented by three dimensions of political capabilities proposed for evaluating the longer-term value of participatory development initiatives: political learning, reshaping networks and patterns of representation. Our findings indicated that the defenders’ political learning began with actionable knowledge about defending the right to health and citizen participation. The defenders used their understanding of local norms to build trust with remote Indigenous communities and influence them to participate in monitoring to attempt to hold the state accountable for the discriminatory and deficient healthcare they received. Network reshaping was focused on broadening their base of support. Their leadership strategies enabled them to work with other grassroots leaders and access resources that would expand their reach in collective action and lend them more influence representing their problems beyond the local level. Patterns of representing their interests with a range of local and regional authorities indicated they had gained confidence and credibility through their evolving capability to navigate the political landscape and seek the right authority based on the situation. Our results affirm the critical importance of sustained, long-term processes of engagement with marginalised communities and representatives of the state to enable grassroots leaders of accountability initiatives to develop the capabilities needed to mobilise collective action, shift the terms of interaction with the state and build more equitable health systems. BMJ Publishing Group 2022-05-04 /pmc/articles/PMC9073391/ /pubmed/35508334 http://dx.doi.org/10.1136/bmjgh-2022-008530 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Hernandez, Alison
Hurtig, Anna-Karin
San Sebastian, Miguel
Jerez, Fernando
Flores, Walter
‘History obligates us to do it’: political capabilities of Indigenous grassroots leaders of health accountability initiatives in rural Guatemala
title ‘History obligates us to do it’: political capabilities of Indigenous grassroots leaders of health accountability initiatives in rural Guatemala
title_full ‘History obligates us to do it’: political capabilities of Indigenous grassroots leaders of health accountability initiatives in rural Guatemala
title_fullStr ‘History obligates us to do it’: political capabilities of Indigenous grassroots leaders of health accountability initiatives in rural Guatemala
title_full_unstemmed ‘History obligates us to do it’: political capabilities of Indigenous grassroots leaders of health accountability initiatives in rural Guatemala
title_short ‘History obligates us to do it’: political capabilities of Indigenous grassroots leaders of health accountability initiatives in rural Guatemala
title_sort ‘history obligates us to do it’: political capabilities of indigenous grassroots leaders of health accountability initiatives in rural guatemala
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9073391/
https://www.ncbi.nlm.nih.gov/pubmed/35508334
http://dx.doi.org/10.1136/bmjgh-2022-008530
work_keys_str_mv AT hernandezalison historyobligatesustodoitpoliticalcapabilitiesofindigenousgrassrootsleadersofhealthaccountabilityinitiativesinruralguatemala
AT hurtigannakarin historyobligatesustodoitpoliticalcapabilitiesofindigenousgrassrootsleadersofhealthaccountabilityinitiativesinruralguatemala
AT sansebastianmiguel historyobligatesustodoitpoliticalcapabilitiesofindigenousgrassrootsleadersofhealthaccountabilityinitiativesinruralguatemala
AT jerezfernando historyobligatesustodoitpoliticalcapabilitiesofindigenousgrassrootsleadersofhealthaccountabilityinitiativesinruralguatemala
AT floreswalter historyobligatesustodoitpoliticalcapabilitiesofindigenousgrassrootsleadersofhealthaccountabilityinitiativesinruralguatemala