1. An Invitation to Participation
Countervailing power in Health Committee participation
Hanne Jensen Haricharan, University of Cape Town

2. Overview
Topic: Health Committees. In South Africa statutory bodies at PHC level composed of the facility manager, a local government councillor, community members.
Research questions:
1. How do different forms of power impact on health committee participation.
2. Is invited participation a viable option?
Background: Limited research on power despite acknowledgement of its central role.
Methods: Multiple qualitative case study with rural and urban committees.
The broader context: promulgation and implementation of new health committee legislation.
Data analysis approach: both inductive and deductive, using different theories/understanding of power.

3. Health committees as Invited spaces
Conceptual Frameworks: (from Gaventa 2006/The Power Cube, 2011)
Participatory democracy, human rights and Primary Health Care approaches:
Participation is about influence in decision-making.
Closed spaces
Invited spaces
collaborative
Claimed spaces
adversarial

4. COUNTERVAILING POWER IN COLLABORATIVE Participation
Fung and Wright (2003): Deepening Democracy. Institutional Innovations in Empowered Participatory Governance.
Participation without power likely to fail.
Limited knowledge on power in collaborative structures. Power in adversarial engagement.
Potential sources of collaborative countervailing power:
a. Policy
b. Politicians
c. Communities
d. Transfer from adversarial structures?

5. FINDINGS: different models AND countervailing power
Appointment model
Organisational model
Self-appointed model
Election model
Where?
Envisioned in the Act
Practiced in urban committee
Practiced in rural committee
Practiced in other participatory structures envisioned in other policies
Main source of countervailing power
The Act
Community mandate
Limited
Community mandate?
Problematic issues
Gives health committees a mandate, but limited by other forms of power.
Much power remains with health system.
Challenged legitimacy – poor community links .
Challenged legitimacy.
Stakeholder disengagement.
More legitimate?
More inclusive?

6. Findings (cont.) Additional sources of countervailing power:
a. Collaboration between collaborative/adversarial structures.
b. The existence of adversarial structures.
c. Rights discourse.
d. Collectivity.
Limited countervailing power results in limited influence in decision-making:
a. Contestation around appointment model
a. Disengagement
b. Exploration of claimed/alternative spaces.

7. Conclusion
Invited participation is a viable option if participatory structures have sufficient countervailing power.
Attention to source of countervailing power in design of participatory structures.
Participatory spaces with sufficient countervailing power: rights based, legislated, based on election model with sufficient decision-making influence, attention to other forms of power that constraints and enables participation, sufficient support for participation.