Distinguished Professor and Director, Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India.
Senior Research Scientist, Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India.
Int J Equity Health. 2020 Jul 8;19(1):111. doi: 10.1186/s12939-020-01221-4.
This paper addresses a critical concern in realizing sexual and reproductive health and rights through policies and programs - the relationship between power and accountability. We examine accountability strategies for sexual and reproductive health and rights through the lens of power so that we might better understand and assess their actual working. Power often derives from deep structural inequalities, but also seeps into norms and beliefs, into what we 'know' as truth, and what we believe about the world and about ourselves within it. Power legitimizes hierarchy and authority, and manufactures consent. Its capillary action causes it to spread into every corner and social extremity, but also sets up the possibility of challenge and contestation.Using illustrative examples, we show that in some contexts accountability strategies may confront and transform adverse power relationships. In other contexts, power relations may be more resistant to change, giving rise to contestation, accommodation, negotiation or even subversion of the goals of accountability strategies. This raises an important question about measurement. How is one to assess the achievements of accountability strategies, given the shifting sands on which they are implemented?We argue that power-focused realist evaluations are needed that address four sets of questions about: i) the dimensions and sources of power that an accountability strategy confronts; ii) how power is built into the artefacts of the strategy - its objectives, rules, procedures, financing methods inter alia; iii) what incentives, disincentives and norms for behavior are set up by the interplay of the above; and iv) their consequences for the outcomes of the accountability strategy. We illustrate this approach through examples of performance, social and legal accountability strategies.
本文探讨了通过政策和计划实现性健康和生殖健康及权利方面的一个关键问题，即权力与问责之间的关系。我们从权力的角度审视性健康和生殖健康及权利方面的问责策略，以便更好地理解和评估其实际效果。权力通常源于深层次的结构性不平等，但也渗透到规范和信仰、我们所认为的“事实”以及我们对世界和自身在世界中的看法中。权力使等级制度和权威合法化，并制造出同意。其毛细血管作用使其渗透到各个角落和社会极端，但也为挑战和争议提供了可能性。
通过说明性的例子，我们表明，在某些情况下，问责策略可能会直面和改变不利的权力关系。而在其他情况下，权力关系可能更难改变，导致争议、妥协、谈判，甚至是对问责策略目标的颠覆。这就提出了一个关于衡量的重要问题。鉴于实施问责策略的基础是不断变化的，如何评估问责策略的成就？
我们认为，需要进行以权力为重点的现实主义评估，以解决以下四组问题：i）问责策略所面临的权力维度和来源；ii）权力如何融入策略的具体形式，包括其目标、规则、程序、供资方法等；iii）上述因素相互作用所产生的行为激励、抑制和规范；iv）其对问责策略结果的影响。我们通过绩效、社会和法律问责策略的例子来说明这种方法。
