Scene of a meeting of the "Club des mères" in Eleme, Togo. At the meetings, the women receive information on issues of reproductive health. (Foto IAMANEH)
Participation can take varying degrees - from a mere gathering and voicing of needs to real empowerment and self-determination. While the first only marginally involves communities, the latter makes people actors of development in health. However, self-determination requires awareness and involvement in the political process. So, how can this political awareness and involvement best be achieved? International NGOs (INGOs) must define what processes and mechanisms they can or should facilitate and become clear as to how far their support to local organizations for greater participation should go. In light of this context, the discussion touched on various aspects of INGO support to local organizations including the questions of representation and legitimacy of CSO in speaking on behalf of society and the sustainability of civil society strengthening outcomes of external support to CSOs as well as the risks evolving from the potential mismatch between internationally defined development agendas such as the recently adopted Sustainable Development Goals and actual community concerns.
CSOs - legitimate representatives of society?
International Organizations often have very clear ideas as to the type of local partners they wish to work with – a choice in many cases steered by an interest in a very specific topic of restricted scope (e.g. HIV, Malaria, etc.). By determining the intervention area and partners, international organizations influence who gets a say and who does not. International organizations must thus be aware that, through their choice of local partners they influence whose concerns are represented and must thus pay attention as to the selection of partners and groups they are working with.
Group participants further pointed out that legitimate representation could only be achieved through a process determined by civil society itself, and not through outside actors. Rather than allowing individual needs to be overrepresented, INGOs should seek to facilitate the development of civil society structures that allow representative civic participation and democratic decisions-making. The creation and maintenance of such structures require resources and the lack of these is often a key impediment for civil society actions, including advocacy and lobbying. International NGOs can have an important role in financially supporting the building and strengthening of representative civil society bodies and platforms for exchange and leverage.
When support ends: Sustainability of CS strengthening outcomes
But what about the sustainability of outcomes of such external support? Are there any strategies in strengthening civil society and community participation that have the best chances to be sustainable after support ends? The case of community groups was brought forward. Experiences had shown that beyond a certain degree of “natural” attrition such groups in many cases were self-sustaining. They open opportunities for building on them and support training and coaching for empowerment as well as network and alliance building. Little experience existed however among participants as to whether community groups that had profited from capacity strengthening remained empowered and continued to actively get involved in determining local health agendas or whether such external initiatives for self-determination require continued support beyond the self-sustaining capacities of groups. As for the most effective strategies to achieve sustainable outcomes of civil society strengthening measures aiming at facilitating civic participation and self-determination, the group agreed however as to the importance to build on existing local structures such as village health committees or other community groups. As much as possible, local resources should be used for the implementation of community concerns in order to allow them to be actors of their own development.
Thomas Gass (Swiss Red Cross), Cecilia Capello (Enfants du Monde) and Kate Molesworth (Swiss TPH) at the MMS Symposium (Photo: Christoph Engeli / MMS)
Sustainable Development Goals - Change from the bottom vs. international agenda
In light of the theme of the symposium, the tension between the different levels of agenda-setting and the difficulties resulting from this tension for civil society to attract funding was further brought up. The recently adopted Sustainable Development Goals well illustrate this tension: a top-down driven international agenda versus community concerns and priorities that may differ from what is set out as such at the international level. This tension may bring about difficulties for communities to attract interest in their concerns and attract funding given that resource allocation is most likely to be driven by the top-down determined priorities.
Conclusions
The common understanding of the working group as to what should be the role of the international community, and here in particular INGOs, with regard to the strengthening of community participation and advocacy for health includes the following:
- INGOs have an important role to play when it comes to supporting and promoting community mobilization and participation in health. One means of support is to facilitate capacity strengthening and coaching of local structures to empower these and build awareness about the political process.
- INGOs should facilitate the gathering of peoples concerns and voicing of society´s concerns vis-à-vis the national level, governments, as well as the international level by financially supporting the creation and maintenance of representative platforms that increase leverage of civil society through networks and coalitions.
- INGOs themselves should be attentive to the way they influence representation through their choice of local partners and take measures to ensure best possible representation of communities.
- True participation in health sector development can only be achieved through communities´ self-determination. The aim of civil society actions and support must be that society´s concerns are heard and addressed. The simple voicing without concerns being heard and consecutive action will lead to the opposite of empowerment.
- In order to allow for sustainable capacity strengthening outcomes, INGOs should build on existing structures and institutions. Partners should be empowered to use local resources for the implementation of action so as to allow them to be actors of their own development.
- There is a need to better explore and research the effectiveness and sustainability of empowerment actions. This should include asking feedback from communities whether they indeed have been able to get access to decision-making processes and to see their concerns put into action.
