Independent Consultant, 357 Sixth Ave., NY, 11215, Brooklyn, USA.
World Vision International, 39 Garden St, Blairgowrie, Victoria, 3942, Australia.
Int J Equity Health. 2021 Feb 6;20(1):56. doi: 10.1186/s12939-021-01398-2.
Over the past decade, social accountability for health has coalesced into a distinct field of research and practice. Whether explicitly stated or not, changed power relations are at the heart of what social accountability practitioners seek, particularly in the context of sexual and reproductive health. Yet, evaluations of social accountability programs frequently fail to assess important power dynamics. In this commentary, we argue that we must include an examination of power in research and evaluation of social accountability in sexual and reproductive health, and suggest ways to do this. The authors are part of a community of practice on measuring social accountability and health outcomes. We share key lessons from our efforts to conduct power sensitive research using different approaches and methods.First, participatory research and evaluation approaches create space for program participants to engage actively in evaluations by defining success. Participation is also one of the key elements of feminist evaluation, which centers power relations rooted in gender. Participatory approaches can strengthen 'traditional' health evaluation approaches by ensuring that the changes assessed are meaningful to communities.Fields from outside health offer approaches that help to describe and assess changes in power dynamics. For example, realist evaluation analyses the causal processes, or mechanisms, grounded in the interactions between social, political and other structures and human agency; programs try to influence these structures and/or human agency. Process tracing requires describing the mechanisms underlying change in power dymanics in a very detailed way, promoting insight into how changes in power relationships are related to the broader program.Finally, case aggregation and comparison entail the aggregation of data from multiple cases to refine theories about when and how programs work. Case aggregation can allow for nuanced attention to context while still producing lessons that are applicable to inform programming more broadly.We hope this brief discussion encourages other researchers and evaluators to share experiences of analysing power relations as part of evaluation of social accountability interventions for sexual and reproductive health so that together, we improve methodology in this crucial area.
在过去的十年中，健康的社会问责制已经凝聚成一个独特的研究和实践领域。无论是明确表述还是未明确表述，权力关系的变化都是社会问责制实践者所追求的核心，尤其是在性健康和生殖健康方面。然而，社会问责制方案的评估往往未能评估重要的权力动态。在这篇评论中，我们认为，我们必须在性健康和生殖健康领域的社会问责制研究和评估中纳入对权力的审查，并提出了一些方法。作者是衡量社会问责制和健康成果的实践社区的一部分。我们分享了从使用不同方法和方法进行权力敏感研究中吸取的一些关键经验教训。首先，参与式研究和评估方法为方案参与者提供了空间，使他们能够通过定义成功来积极参与评估。参与也是女权主义评估的关键要素之一，它将权力关系置于性别根源之中。参与式方法可以通过确保评估的变化对社区有意义，来加强“传统”健康评估方法。来自健康领域之外的方法提供了有助于描述和评估权力动态变化的方法。例如，真实评估分析了因果过程，或机制，这些过程或机制是由社会、政治和其他结构与人类能动性之间的相互作用所产生的；方案试图影响这些结构和/或人类能动性。过程追踪需要以非常详细的方式描述权力动态变化背后的机制，从而深入了解权力关系的变化与更广泛的方案之间的关系。最后，案例聚合和比较需要从多个案例中聚合数据，以完善关于方案何时以及如何发挥作用的理论。案例聚合可以在关注背景的同时，允许对细微差别进行细致的关注，从而产生更广泛地为方案提供信息的可应用的经验教训。我们希望这篇简短的讨论能鼓励其他研究人员和评估人员分享分析权力关系的经验，作为对性健康和生殖健康社会问责制干预措施评估的一部分，以便我们共同改进这一关键领域的方法。
