Concepts and methods of ‘participation’ are used increasingly to shape policy and deliver services. Such approaches throw new light on complex interactions within and between society and state institutions at all levels. They lead to questions about how different kinds of knowledge and values shape policy choices. What are the societal and political processes through which power operates that inform whose voice is heard and whose is excluded? What is power? Is it about making people act against their best interests; or is it the glue that keeps society together? What are the connections between power and social change? These questions are at the core of research and teaching by the Participation, Power and Social Change Team at IDS, and this IDS Bulletin presents current work on the practice of power in development and the entry points for change. Contributions to this issue, and ways in which power is interrogated, are very varied – despite a shared commitment to exploring its meaning for social change. In categorising power in the way the team has, the intention has not been to offer a comprehensive or exclusive framework for analysis. Rather, a positive spiral between reflection and transformation is constructed, concluding that the role of the action researcher/teacher is to explore with others how power can be harnessed for change, and to work alongside them in tracing and learning from the myriad of micro-level efforts, successes and failures.
In recent years there has been a major shift in attitudes to community involvement in health care. Approaches that saw communities primarily as passive recipients of health care have given way to those which seek to make more of the potential that more active community participation might offer for enhanced accountability and improved responsiveness of services. With this shift has come a greater emphasis on issues of governance and on institutional dimensions of participation, whilst the introduction of partnership models in the health sector has further increased debates about participation in health care. In 1999 the IDS Participation and Health and Social Change groups convened a workshop to share experiences of the use of participatory approaches in enhancing accountability in the health sector and to explore some of these challenges. The fifteen articles in this Bulletin reflect some of the richness of experience on the ground in building effective participation as well as some of the many issues that arise in moving towards more active citizen engagement with service provision. They draw experience from current work in countries such as Zimbabwe, Cambodia, China, Nepal, Zambia and Pakistan to reflect on links between participation, accountability and improvements in health.