Poverty Reduction and Regional Integration
A comparative analysis of SADC and UNASUR health policies
Participatory Action Research
The challenges and benefits of regional integration initiatives
Regional integration initiatives can help generate synergies between Member States to jointly solve common social issues, learn from the successes of neighbouring countries and incentivise positive change. Monitoring regional action and influence on the development of pro-poor health policies can help better understand the significance and value of regional cooperation and coordination and, ultimately, stimulate better and faster progress in reducing poverty.
Involving stakeholders from the outset
Our research shows that weak or absent stakeholder participation in the development of regional integration monitoring initiatives is a principal reason why previous such initiatives have not been as successful as anticipated. We are using participatory action research (PAR) to develop, in partnership with key stakeholders in Southern Africa and South America, regional indicators of pro-poor success and change. Involving stakeholders and user groups from the outset helps lay the essential foundations for an inclusive, robust, and high quality regional monitoring system.
What is Participatory Action Research?
Participatory action research is used widely as a research strategy across the social and health sciences, and is associated with the production of knowledge for action that is of direct benefit and use to people, most of all to those living in conditions of social vulnerability, disadvantage and oppression. The PAR approach is based on the principle that research should 'be with the people and not on the people', involving the main affected constituencies throughout the research process.
Participatory approach advocates argue that valuing marginalised knowledge and experience through active participation in the research process and the purpose to which it is put democratises knowledge production while also improving the quality of the research and the likelihood that results will be put into practice.
Innovating the Participatory Action Research approach
PAR approaches in the area of health have traditionally entailed work with local, often very impoverished, people, patients or rural communities. Our innovative programme of work in PRARI engages diverse policy groups from the outset in an action research process to jointly develop regional indicators of pro-poor health policy success and change. Working together in this way brings diverse knowledge and expertise, shares information that can uncover extant good practices, generates awareness of the need for pro-poor health policies, and incentivises the development of significant regional initiatives in the interests of greater social equity and inclusion.
How are we using the Participatory Action Research approach?
The UNU-CRIS team is leading work to develop 'toolkits' of regional indicators capable of capturing pro-poor health policy success and change in SADC and UNASUR. We are working closely with indicator development teams for each of the regions in ways that reflect identified regional priorities and contexts. The regional teams are comprised of experts from the regions representing national ministries (primarily ministries of health), think tanks, academia, civil society organisations and regional organisations. Developmental work on the monitoring indicators 'toolkits' is taking place principally through a series of indicator development workshops in Southern Africa and South America.
| Date | Region | Location | Purpose |
|---|---|---|---|
| 10/11/2014 | 1st UNASUR Workshop | ISAGS, Rio de Janeiro, Brazil | Discuss regional priorities; assess the need for a regional health policy monitoring system; identify key actors |
| 08/12/2014 | 1st SADC Workshop | BIDPA, Gaborone, Botswana | Discuss regional priorities; assess the need for a regional health policy monitoring system; identify key actors |
| 16/03/2015 | SADC Consultation | Health Systems Trust, Johannesburg, SA | Finalize key agreements from 1st SADC workshop |
| 23/06/2015 | 2nd SADC Workshop | SADC Secretariat, Gaborone, Botswana | Develop toolkit conceptual framework; define indicators |
| 09/07/2015 | 2nd UNASUR Workshop | UNASUR Secretariat, Quito, Ecuador | Develop toolkit conceptual framework; define indicators |
| 14/09/2015 | 3rd SADC Workshop | SAIIA, Johannesburg, SA | Discuss final toolkit draft |
| 05/10/2015 | 3rd UNASUR Workshop | FLACSO-Argentina, Buenos Aires, Argentina | Discuss final toolkit draft |
PRARI PAR Indicators publications
Policy Briefs
- February 2015: Monitoring Pro-Poor Health-Policy Success in UNASUR by Ana B. Amaya, Cesar Cabral, Andrés Coitiño, Philippe De Lombaerde,Mariana Faria, M. Belen Herrero, Stephen Kingah, Pia Riggirozzi, Marcelo Rojas Mattos,Tomás Pippo, Katherine Tobar and José Ueleres
- April 2015: Monitoring Pro-Poor Health-Policy Success in the SADC Region by Ana B. Amaya, Khuteletso Bagapi, Isaac Choge, Philippe De Lombaerde, Stephen Kingah, Irene Kwape, Mubita Luwabelwa, Onkemetse Mathala, Enock Mhehe, Themba Moeti, Lillian Mookodi, Zubeda Ngware and Molefe Phirinyane
Working Papers
- Multi-Level Pro-Poor Health Governance, Statistical Information Flows, And The Role Of Regional Organizations In South-America And Southern Africa by Ana B. Amaya, Stephen Kingah and Philippe de Lombaerde.
PRARI Working Paper 15-1
Multi-Level Pro-Poor Health Governance, Statistical Information Flows, and the Role of Regional Organisations in South America and Southern Africa
In the past decades, health governance has become multi-layered as the combined result of decentralisation, regional integration and the emergence of new actors nationally and internationally. Whereas this has –in principle – enhanced the installed capacity for health response worldwide, this complexity also poses serious challenges for health governance and policy-making. This paper focuses on one of these challenges, namely the organisation of statistical information flows at and between governance levels, and the emerging role that regional organisations play therein. Our aim is to understand the extent to which statistics are regionally coordinated and the role regional organisations are playing with respect to national health information systems.
In this paper, we address this aim by analysing regional to national-level data flows with the use of two case studies focusing on UNASUR (Bolivia and Paraguay) and SADC (Swaziland and Zambia). Special attention is given to pro-poor health policies, those health policies that contribute to the reduction of poverty and inequities. Our results demonstrate that health data is shared at various levels. This takes place to a greater extent at the global-country and regional-country levels, and to a lesser extent at the regional-global levels. There is potential for greater interaction between the global and regional levels, considering the expertise and involvement of UNASUR and SADC in health. Information flows between regional and national bodies are limited and the quality and reliability of this data is constrained by individual Member States’ information systems. Having greater access to better data would greatly support Member States’ focus on addressing the social determinants of health and reducing poverty in their countries. This has important implications not only for countries but to inform regional policy development in other areas. By serving as a foundation for building indicator-based monitoring tools, improving health information systems at both regional and national levels can generate better informed policies that address poverty and access to health. In addition, making this data available would provide a solid basis on which to identify the contribution of these organizations and ensure governments are upholding their commitments to addressing health challenges and reducing poverty. The rise of regional-level influence must be capitalised on to address poverty, particularly in the framework of the sustainable development goals. - Participatory Action Research: New Users, New Contexts, New Challenges? by Ana B. Amaya and Nicola Yeates.
PRARI Working Paper 15-6
Participatory Action Research: New Users, New Contexts, New Challenges?
The relevance of Participatory action research (PAR) within policy-facing social sciences research, while long established, is increasingly recognized due to a growing emphasis on research uptake and impact. This is because participatory research affirms stakeholders as agents bringing diverse knowledge and techniques, and a commitment to and ownership of research findings and outputs in ways that are deemed more likely to be translated into action. Reviewing why participatory research is relevant for research uptake and impact agendas, we consider the opportunities, tensions, dilemmas and limits of participatory research in impact contexts internationally, including where these involve 'non-standard' PAR populations. Participatory research, we argue, raises a number of challenges -- professional, political, logistical -- which take on further dimensions where research is conducted with policy stakeholders and is international. In addition, how PAR is applied in practice and the context of that practice bear significantly on the quality and nature of the research outcomes. Just as research pathways to impact are multiform and context-specific, so too are PAR pathways. We highlight the considerable potential of a better understanding of the relationship between PAR and policy change as a research topic in its own right.
PRARI Toolkits of regional indicators
- Measuring Regional Policy Change and Pro-Poor Health Policy Success: A PRARI Toolkit of Indicators for the Southern African Development Community (SADC) (December 2015) [English]
- Measuring Progress and Success of Regional Health Policy: A PRARI Toolkit of Indicators for the Union of South American Nations (UNASUR) (December 2015) [Spanish] [English]
Conference and Workshop Papers
- Ana B. Amaya and Nicola Yeates (2015) Participatory Action Research as a methodology for achieving embedded pro-poor regional health, paper to ALARA 9th Action Learning Action Research and 13th Participatory Action Research World Congress Collaborative and Sustainable Learning for a Fairer World: Rhetoric or Reality? 4-7 November 2015, Centurion, South Africa.
Participatory Action Research as a methodology for achieving pro-poor regional health policy
Keywords: collaborative PAR, health, poverty, policy change
Background: Participatory action research (PAR) is gaining greater attention within conventional policy-facing social sciences research due to the emphasis placed on research uptake for wider public benefit. In affirming stakeholders as agents bringing diverse knowledge and techniques to the research process, it is often claimed that PAR results in a commitment to ownership of research findings and outputs in ways that are more likely to be translated into action (Cornwall & Jewkes 1995; Bergold & Thomas 2012). This paper reflects on this claim by discussing experiences of using an innovative application of PAR among policy-makers working at the interstices of national and regional organisations in Southern Africa and South America.
Methods: The research uses collaborative modes of PAR to construct pro-poor indicators of regional policy success and change with regard to access to health and medicines.
Results: Increased interest in participatory research by funding councils gives rise to significant opportunities for researchers and policy-makers to collaboratively engage in research for wider public benefit, but all actors in the research process need to be sensitive to the tensions, dilemmas, and limits of PAR as a methodology for realising those benefits under conditions of social and political complexity and in the interests of sustainability and inclusivity.
Conclusions: The 'problem' identified in PAR studies of transposing participatory approaches from the project context where they were developed to the policy one presents a challenge for funding councils and researchers alike. Funders and research teams using PAR need to be ever-mindful of the challenges that transposition presents to the non-extractive nature of methodology that PAR seeks to practice and the particular context in which it is practiced, while also ensuring that the connections between policy, power and poverty remain as foreground concerns throughout the collaborative research endeavour. - Ana B. Amaya, Stephen Kingah and Philippe de Lombaerde (2015) Transforming transnational expertise using the Participatory Action Research approach to construct regional health monitoring systems in South America and Southern Africa, paper presented at "Don’t worry! We have it under control." Transnational expertise in environmental and health policy', Workshop on Environment and Security, August 28-29, 2015 Université Libre de Bruxelles.
Abstract:
This paper reports on the process of constructing a monitoring system at the regional level by organizing a group of regional and national experts with the use of the Participatory Action Research (PAR) methodological approach. Given that PAR is generally applied at the local level, there is little evidence of this approach being used at the supra-national level or with elites. The Poverty Reduction and Regional Integration (PRARI) project, a two year ESRC/DFID-funded study, seeks to do this by using collaborative PAR with identified partners in South America and Southern Africa to build a ‘toolkit’ of input, process, output and outcome indicators that capture regional policy change and pro-poor regional health policy success and which can be used by a range of users to press for democratic accountability and progressive social policies.
The Union of South American Nations (UNASUR) and the Southern African Development Community (SADC) have been increasingly involved in the area of health albeit with different priorities. Their interest in addressing health inequalities among their member states has been evident in their five year work plan and health protocol, respectively. Following this participatory process, the research will propose regional indicator systems for these two regions, in agreement with the co-researchers (stakeholders and end users) from the two regions. The challenges and opportunities, methodologically and theoretically, involved in using the collaborative mode of PAR combining scientific knowledge and policy expertise will be discussed as will the implications of the research process for understanding the institutional and political ‘topographies’ of these two regional social policy regimes.
- PRARI-led workshop on participatory research methods (ESRC-DfID Conference on Poverty Alleviation) London, 9 September 2014
