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Learn MoreParticipation tools for Health
Rating: 4.3 out of 54.3(8 ratings)
1,104 students
Participation tools for Health
To include participatory logics in the design and implementation of health actions
Created byDaniel La Parra Casado, Francisco Frances Garcia
Last updated 1/2022
English
What you'll learn
- Learn to design plans and programs of public policies from a participatory logic
- Incorporate in an effective way the voice and demands of those who are recipients of the actions to undertake
- Review different tools to promote participation in the design, implementation, monitoring and evaluation stages.
- Evaluate the levels of participation
Explore related topics
Course content
5 sections • 32 lectures • 1h 27m total length
- Introduction2:16
- What is the operational definition of social participation?2:56
What is the operational definition of social participation?
To participate is to take part in something, and is also to play an active part and influence the public decisions that affect the community. When considered from this active dimension, participation entails the collective definition of what the community understands the common good ought to be. Through this conceptual vision of participation, women and men as subjects no longer play a passive role in planning processes and public management; instead they take on a central role as social agents with their own significance, as members of social networks, collectives or as individual stakeholders, with a whole host of possibilities to take part in the public decisions affecting them.
Based on the classic definitions provided in investigative literature, the World Health Organization (WHO) also emphasises this idea, understanding participating as “a process by which people are enabled to become actively involved in defining the issues of concern to them, in making decisions about factors that affect their lives, in formulating and implementing policies, in planning, developing and delivering services and in taking action to achieve change”* .
In 1978, focusing specifically on the sphere of health, the Alma-Ata International Conference on Primary Healthcare declared that participation in health is the “process by which individuals and families assume responsibility for their own health and welfare and for those of the community, and develop the capacity to contribute to their personal and community development. They come to know their own situation better and are motivated to solve their common problems. This enables them to become agents of their own development instead of passive beneficiaries”.
The operational definition of participation in health should be “processes of collective reflection through which the population is enabled to construct significant information in the area of health, and to deliberate on the basis of this in order to make decisions through participatory mechanisms in collaboration with the institutions responsible for them, involving them both in the planning and subsequent implementation of these decisions.”
* World Health Organization. (2002). Community participation in local health and sustainable development: Approaches and techniques.
- Levels and degrees of social participation3:28
Levels and degrees of social participation
Participation is not so much a question of nature (is there or is there not participation in the area of health) but rather of degrees (contexts with greater or lesser participatory potential).
Anyone should spend a few minutes thinking about the context in which they carry out their activity in relation to the existing scenario for participation. The decision to implement one participation model rather than another in relation to the Roma community largely defines how these men and women are viewed and the nature of participation in public action. Next figure outlines various models for fostering Roma participation in health.
- Dimensions of Social Participation3:31
Dimensions of Social Participation
Participation is a multidimensional concept. Archon Fung* systematized the three principal dimensions of any context or process of participation:
Inclusiveness is the degree of openness to participation of people who are not formally organized.
Intensity deals with the extent to which participants interact, exchange information and influence decision-making in participation processes.
Influence encompasses the orientation of participation processes in relation to government or institution actions.
The role of social participation as an effective strategy to reduce social inequities in health and promote social inclusion justify the need to design participatory mechanisms capable of progressing as far as possible with the Roma people within the three dimensions. In other words, the processes should be as inclusive as possible (permitting the participation of any Roma person who so wishes), develop the greatest possible intensity (enabling participants to carry out all the actions encompassed by the process) and have the capacity to influence public policy (recognizing the links between the decisions reached and institutional action).
*Fung A. Varieties of participation in complex governance. Publ Admin Rev. 2006;66(s1):66–75
- Main barriers to Roma participation3:04
Main barriers to Roma participation
The barriers that prevent Roma women and men from participating in decisions about health policies that affect them could stem from various sources and stakeholders.
Participatory barriers can be identified in the way that institutions understand their relationship with the Roma community. Others are grounded in the internal characteristics of the collectives and organizations in which the formal participation of Roma people is crystallized. Finally, participatory barriers in the Roma community itself can also be identified.
- Enablers of social participation2:45
Enablers of social participation
In a great majority of experiences relating to participation in health, the promoter of participatory processes is the institutional or administrative agent at the various levels involved. Without support and institutional commitment, it makes no sense to initiate a participatory process aimed precisely at generating programmes which, in many cases, must be developed by an institution. That is why the first step in a process relating to Roma participation in health should be the explicit commitment of the Government.
- Participatory process scheme3:24
Participatory process scheme
Outlining the basic scheme for a participatory process is not an easy task. Participatory initiatives in the field of health can encompass very different areas of work and, furthermore, one of the features of any participatory process is the flexibility of its methodology and design, which adds complication.
Prior to the promotion of a participatory health initiative, at an institutional, technical or professional level, it is necessary to establish a strategy through which the Roma community will be contacted and their participation requested. The final decision regarding which strategy to adopt for this purpose will largely determine the nature of the stakeholders that will be involved in the participatory space and, therefore, the manner in which the relationship between the Roma community and public administration will be articulated. There are basically three options, which are not mutually exclusive by any means.
- 1
- Introduction1:14
- Participatory Diagnosis3:11
Description and objectives
Participatory diagnosis involves compiling and systematizing information by consulting the population affected by a specific area of social action, in this case public health.
It entails identifying and understanding problems and needs within a given context, their causes and evolution over time, as well as conditioning and risk factors and their foreseeable trends. Consequently, problems and needs are classified in order of importance, with a view to establishing priorities and intervention strategies, so that their feasibility can be determined in advance, considering both the resources available and the social agents and forces involved.
- Participatory Survey3:21
Description and objectives
The participatory survey follows the research logic of any conventional survey, but with one specific feature: it is the members of the population that determine the contents and questions to be asked by the questionnaire, based on the logic that the issues covered in the survey should be considered important by the population in order to analyse and understand the health problem being diagnosed.
The survey makes it possible to achieve dual objectives. First, as with any survey, it obtains significant information from the subjects with regard to the target area of health. Second, it allows for a certain degree of self-knowledge and initial collective reflection, since it is the population members themselves that must deliberate on the contents to be tackled in the questionnaire, thereby developing a certain capacity to analyse and prioritize the problems affecting them.
It is also a very useful resource for carrying out social and health research or interventions in cases of limited resources, both economic and human, since the sample itself is used for these purposes.
- Deliberative Survey2:37
Description and objectives
Deliberative polling was conceived in 1988 by Professor James Fishkin of Stanford University, Massachusetts*. It is essentially applied to a sample of the population involved in a problem to allow them to reflect and deliberate, with the help of experts, in relation to key decisions which should be taken in order to implement a strategy.
The difference between a deliberative survey and more traditional surveys is the mediation of a deliberative forum between two moments in the collection of data. Comparison between the results obtained in the surveys prior to and after the deliberative process make it possible to evaluate the impact that greater information and the possibility for reflection have on shaping people’s opinions and attitudes towards the issue at hand.
- Photovoice method3:02
Description and objectives
PhotoVoice, also known as participatory photography, is a method that uses images (normally photographs, but also videos, drawings or maps) created by members of a community to activate or catalyse discourse and participatory action around a common problem.
In the diagnosis stage, the use of participatory photography helps to increase the visibility of the contexts, problems or lifestyles of minority or marginalized social groups. With the assistance of facilitators, these communities use cameras to define, communicate and improve their situation or influence public policies.
- Focus Group3:47
Description and objectives
The focus group is a group dynamic in which a group of (between four and 12) people discuss a policy or social intervention that affects them. The main objective of a focus group is to obtain information from the participants about their opinions, perceptions, attitudes, experiences and even their expectations regarding the subject matter discussed. It can be defined as a combination between a focus interview and a discussion group, and as a resource it is able to build a picture quickly from information gathered.
Focus groups are used very frequently in institutional action for the initial exploration of problems, in order to generate creative ideas, as well as to analyse the impact of public decisions.
- Situational flow-gram3:16
Description and objectives
The flow-gram is a technique used in the situational strategic planning approach developed by the late Carlos Matus*, former economist at Harvard University, Massachusetts. The aim of the flow-gram is to compile valid information for the diagnosis of problems through the collective construction of a matrix. Collective work carried out on this matrix sheds light on the cause-and-effect relationships between the different elements that surround the issue being discussed and the stakeholders involved, with a view to establishing so-called critical nodes, and the main components which could be used to tackle the problem.
The aim of this technique is to link the problems defined by individuals (both women and men) from among the population with the different stakeholders responsible for dealing with them, determining the resolution capacity of each stakeholder in relation to each problem. Another purpose of this strategic technique is to prioritize the main critical nodes which hamper the process, in order to trace causal chains that link problems to the stakeholders responsible for them.
- SWOT analysis2:12
Description and objectives
The SWOT method is a technique which essentially tackles the prospective capacity of social diagnosis; in other words, looking at operational strategies for the future based on an analysis of the present situation. The SWOT method involves organizing the information generated through a group dynamic into a dual-entry table, which situates this information in accordance with limitations (weaknesses and threats) and potential capacity (strengths and opportunities) provided by a social stakeholder or a certain situation.
Through the application of this technique, information is obtained about the positive and negative aspects of a specific context, both for the present and the future.
- 2
- Introduction1:15
- Participatory Budgeting2:43
Description and objectives
Participatory budgeting is a participation, decision-making and management instrument for the prioritization of public spending in a specific area.
The main objective of participatory budgeting is the direct participation of individuals (both women and men) who belong to a community, with a view to establishing their main daily needs and including them in the annual public budgeting process, prioritizing the most important areas and monitoring the commitments made.
Among other things, it can: improve transparency in institutional management; increase the co-responsibility of the population in the management of resources and reporting in relation to institutional development; improve communication between a community and various institutions; and identify agreed solutions to the community’s problems.
Participatory budgeting is also compatible with gender-responsive budgeting.
- Citizen's Jury2:03
Description and objectives
The citizens’ jury is a consultative mechanism for citizen participation, based on the collective deliberation of a group of subjects selected randomly, to help with the making of certain public decisions.
For this purpose, a small group of people is chosen to discuss an issue over the course of a few days. Citizens’ juries are inspired by the juries typically used in law courts. The difference between the two is based on two aspects: discussions are led by neutral mediators, and the jury simply issues a series of recommendations about the matters at hand, which makes them consultative, not binding.
In general, citizens’ juries are deliberative bodies which draft political reports, helping to improve and facilitate the traditional process of decision-making. On occasion, the findings of citizens’ juries are incorporated into reports about the issue at hand.
- Future Workshops/Scenario Workshops2:52
Description and objectives
Future workshops or scenario workshops are very similar techniques. They both involve participants proposing descriptions of possible future scenarios, based on reflections related to the dynamic of events that occur, changes in relations between stakeholders, and any decisions stakeholders make over time. In the development of this technique, participants identify desirable futures and tackle proposals for change, so that the problem they are dealing with can evolve as desired.
Such workshops are usually used to analyse possible alternatives with regard to past or present situations that are viewed as negative. The basis for such analysis is often complex problems, situations where there is a high probability of change, or contexts in which the foreseeable future is deemed to be undesirable.
- Participatory Action Research3:01
Description and objectives
Participatory Action Research (PAR) is a method that combines research, planning and socio-community intervention. Essentially, it aims to compile the demands of stakeholders involved in a process of social action, with a view to transforming existing realities and helping the community to appropriate organizational resources (networks, proposals, actions) and knowledge (tools for analysis and self-diagnosis).
Its main aim is to construct, by means of participatory analysis, institutional programmes which involve citizens in both the design and subsequent development of such actions.
- Participatory Strategic Planning2:42
Description and objectives
Participatory Strategic Planning (PSP) is a planning and management tool which aims to guide the endeavours of a community towards a desired future. Based on the principles of population participation and consensus among stakeholders, viable community development projects are programmed in detail. Its principles are, therefore: participation as a method of organization and collective learning; monitoring of changes; the collective evaluation of achievements; seeking to create large spaces for synergies; and social articulation.
PSP is also integral in nature, as (at least in theory) it aims to encompass the multiple dimensions of the social, cultural, political, economic and ecological reality surrounding a problem.
- 3
- Introduction1:50
- Co-Management of Health Services3:01
Description and objectives
The co-management of health services is a specific way of structuring participatory spaces linked to the idea of community governance. Co-management involves the community and the different groups it comprises participating and cooperating under equal conditions with institutions in the management of public health services. This participatory resource seeks to increase the creativity, commitment and co-responsibility of community stakeholders in designing and monitoring health programmes.
Ideally, the co-management of health services should be the product of a PSP process. We have seen that participatory planning tools develop a series of areas for action. Within this sphere, co-management is often one of the working areas resulting from a participatory planning process, while also providing a coherent indicator of participatory management. The ultimate objective is to generate stable platforms and/or partnerships for collaboration on health care between a country’s administration and civil society.
- Friendly Hospital2:16
Description and objectives
The friendly hospital is a model of intervention in hospitals aimed at minority groups (ethnic minorities, migrants, groups that are discriminated against, and so on). The main objective is to ensure the suitability of communication and health care protocols to encourage these groups to cooperate in the area of health care and, thereby, improve the state of their own health.
In these processes, the participation of the target community is fundamental, so that hospitals can correctly assess their needs and tailor their communication accordingly. The cooperation of community-based social organizations in implementing the model allows a receptive vision of hospitals to be generated by these minority population groups, who will also act as advisors and bridge the communication gap between hospitals and subjects.
- Health Mediators Programmes2:25
Description and objectives
Health mediator programmes offer an intervention resource aiming to facilitate communication and dialogue between minority groups and public authorities, with a view to improving or tailoring health for these groups. This tool refers to a job profile with a series of specific skills, rather than a community process.
The important participatory element in this case is the prominent role of agents linked to the community as mediators. From this position, perceptions, opinions and behaviours of the minority population can be considered when implementing health services. Consequently, the mediator acts as a bridge between the minorities and the social and health services.
- Participatory monitoring2:50
Description and objectives
Participatory monitoring involves critically monitoring programmes or plans through the active involvement of the community. This process represents a continuation of participatory diagnosis and planning, although it can also be used even if previous stages have not been constructed or carried out in a participatory way.
The fundamental objective of this method is to verify the programmes set in motion and to adapt them according to the results, based on the reflections of the stakeholders involved.
- Participatory Health Councils2:31
Description and objectives
Participatory health councils are citizen participation bodies that advise health authorities on management-related aspects: informing, proposing, promoting, consulting, evaluating and decision-making. These councils usually comprise members of citizens’ organizations, volunteer groups, groups of users or patients, technical staff members of the administration and political leaders, although there are often channels set up to encourage the participation of individual members of the public.
The functions performed by such participatory councils include: drafting reports about the health needs of the population for decision-making; monitoring health care services from an executive perspective; setting up local strategic partnerships; implementing publicity or health information campaigns; and organizing community events related to public health.
- Health Services Users Ombudsman/-woman2:39
Description and objectives
Patient ombudsmen/-women are not strictly speaking a participatory method, but rather figures who mediate and allow for participatory monitoring elements to be introduced into health services.
Health Services Users Ombudsmen/-women (SUOs), present in many EU countries, are dedicated to supervising and ensuring that the rights and interests of health service users are defended and promoted vis-à-vis actions, errors, malpractice or omissions in public health services.
- 4
- Introduction2:15
- Evaluating the level of social participation3:26
As we have seen, different levels of social participation exist. The selected model of social participation determines how the Roma community is defined, along with the purpose and level of social participation.
- Evaluating dimensions of social participation3:31
Evaluating inclusiveness
The dimension of inclusiveness refers to the people eligible for the participatory processes and how they become participants. This answers the question of who participates. For instance, gender parity is a basic criteria to assess the degree of inclusiveness.
- Evaluating gender equality2:11
Social participation can be gender blind if gender is not addressed in the participation process.
- 5
Requirements
- Everyone can make this course.
- Suitable for those working in the health sector
Description
Learn to design plans and programs of public policies from a participatory logic, allowing to incorporate in an effective way the voice and demands of those who are recipients of the actions to undertake.
Social groups in a minority situation have usually been excluded in the decision-making processes of programs and policies that affect them.
The course provides conceptual and methodological tools to include participatory logics in the design and implementation of health actions, programs and policies aimed at the Roma population, allowing to effectively incorporate the voice and demands of the population protagonist of these actions, at the local, regional or state level.
The course provides examples and case studies mainly based on experiences of promoting social participation of the Roma population in Europe. It is understood that social participation processes must explicitly include Roma, but not exclusively. This document is intended for use by policy-makers, project coordinators, professionals and non-governmental organizations (NGOs) involved in promoting social participation of the general population, including Roma and other social groups.
The units and modules of the course are based on the publication "Toolkit on Social Participation", published by the European Office of the World Health Organization and prepared by a team of the WHO Collaborating Center (CC) on Social Inclusion and Health, of the Inter-University Institute Social Development and Peace, University of Alicante (Spain).
This course was produced and coordinated by the Interuniversity Institute of Peace and Social Development, WHO Collaborating Centre on Social Inclusion and Health (University of Alicante), and UniMOOC as part of the agreed work plan for the WHO CC on Social Inclusion and Health. The project has been supported by the Open Society Public Health Program.
We are always looking to keep the course updated. We really appreciate your help in reporting any broken link or error you encounter. You can send us an email directly to moocparticipation@gmail.com
Who this course is for:
- This course is intended for use by policy-makers, project coordinators, professionals and non-governmental organizations (NGOs) involved in promoting social participation of the general population, including Roma and other social groups.
- The contents are elaborated with an explicit, but not exclusive focus on ethnic minorities.