Birgit Kvernflaten: Conflicting Health Interventions: Participation in Health in Rural Nicaragua
In Forum for Development Studies, 2017.
Nicaragua has a long history of health activism and government policies aimed at achieving various models of participation in health. Drawing on ethnographic research in rural Nicaragua, this article situates contemporary participation within this larger historical and political context and critically explores how participation in health is understood and practised. Contemporary health interventions focus on compliance in their endeavour to improve maternal health. This focus, I argue, creates a productive tension between health seekers’ and health workers’ understanding of themselves as citizens and the government’s attempt at achieving public health aims. My empirical focus is on the brigadistas (community health workers), women and expectant mothers. I describe how brigadistas work as interlocutors between the government and the people. In this relation, women and brigadistas express expectations of and dissatisfaction with the healthcare services offered. Drawing upon an extensive literature on participation, I suggest that within this particular relational space a new political space may appear where demands for improved healthcare services can be articulated and recognized.
Keywords: Nicaragua, participation, health system, maternal health, community health workers