Loewenson et at.
Reviewed by Karen Pesse
This brief paper presents the results of two sessions held at the First Global Symposium on Health System Research -in terms of conceptualization, potential and limitations of Participatory Action Research (PAR). Its value is twofold: 1) it argues (successfully I would say) for considering PAR as an important methodology in the domain of health systems research and as a valuable tool to shape public policy ; and 2) it represents the process of consensus-building among different actors working with this approach. This paves the ways for a learning network (or a community of practice) on PAR. And I am sure many of us would be very interested in becoming active members of one or more of these initiatives!
The article includes a short summary of four experiences with using PAR to strengthen health systems and to contribute to universal health coverage, from Guatemala, India, South Africa and Canada. More examples from other countries and various methods for PAR are mentioned but not described in detail. In order not remain a catalogue of good intentions, some of the authors’ statements on the relative value and impact of PAR would need more supporting evidence, for especially those related to empowerment. Since one of the main aims of this research approach is to understand and challenge existing power imbalances and to reduce inequities and the role of health systems in doing so, such supporting evidence is important.
The authors could have complemented the discussions by presenting delegates’ observations, conclusions and recommendations on PAR. Instead of some of the present statements in this section that are ‘common knowledge’, information on how to carry out some of the recommendations is lacking (i.e. “making clearer links between PAR and health equity…”), these insights are a key input for further reflections and actions for anyone involved with PAR.
One final remark concerns the view on ‘community’. Most studies seem to conceptualize community as the population “outside” health services… it would have been interesting to include studies where ‘community’ is (also) represented by health staff.
NB: A more extensive version of this paper by the same group of authors is “Experiences of Participatory Action Research in Building People-Centred Health Systems and Approaches to Universal Coverage; report of the sessions at the Global Symposium on Health Systems research, Montreux, Switzerland, november2010”. Recommended for all who need more in-depth insights about the methodology, its conceptual background and also its limitations.