Department of Public Health and Clinical Medicine, Umea University, Sweden; Centre for Technology and Policy, Indian Institute of Technology Madras, India.
Department of Public Health and Clinical Medicine, Umea University, Sweden.
Soc Sci Med. 2017 Sep;188:82-90. doi: 10.1016/j.socscimed.2017.06.043. Epub 2017 Jul 1.
Community participation as a strategy for health system strengthening and accountability is an almost ubiquitous policy prescription. In 2005, with the election of a new Government in India, the National Rural Health Mission was launched. This was aimed at 'architectural correction' of the health care system, and enshrined 'communitization' as one of its pillars. The mission also provided unique policy spaces and opportunity structures that enabled civil society groups to attempt to bring on to the policy agenda as well as implement a more collective action and social justice based approach to community based accountability. Despite receiving a lot of support and funding from the central ministry in the pilot phase, the subsequent roll out of the process, led in the post-pilot phase by the individual state governments, showed very varied outcomes. This paper using both documentary and interview based data is the first study to document the roll out of this ambitious process. Looking critically at what varied and why, the paper attempts to derive lessons for future implementation of such contested concepts.
社区参与作为加强卫生系统和问责制的策略，几乎是无处不在的政策处方。2005 年，印度新政府上台后，启动了国家农村卫生使命。其目的是对医疗保健系统进行“结构调整”，并将“社区化”作为其支柱之一。该使命还提供了独特的政策空间和机会结构，使民间社会团体能够尝试将更具集体行动和社会正义的社区问责制纳入政策议程，并加以实施。尽管在试点阶段得到了中央部委的大力支持和资金投入，但随后由个别邦政府领导的推广过程却显示出非常不同的结果。本文使用文献资料和访谈数据，首次记录了这一雄心勃勃的进程的推广情况。本文批判性地审视了差异的原因，并试图为未来实施此类有争议的概念汲取经验教训。
