Community agency and empowerment—a need for new perspectives and deepened understanding

Abstract

Background: In an increasingly globalized and interlinked world it becomes ever more important to find strategies to prevent, detect, and respond to emerging public health threats. Local communities have a central role in this effort and need to be empowered and strengthened to be able to meet the challenge, and local knowledge and participation are key. This paper outlines a theoretical framework for community intervention dynamics and explores perceptions, priorities, and perspectives of stakeholders involved in community interventions.

Methods: A deductive discourse analysis was performed based on the proposed theoretical framework consisting of three levels: intervention design, intervention delivery, and community agency. The setting was a workshop on community preparedness at Uppsala Health Summit 2017. Thirty-eight participants representing government officials, international organizations, and researchers as well as community implementers underwent a value exercise and were asked to prioritize good practices, challenges, and needed solutions to empower communities to meet emerging health threats.

Results: The value exercise revealed a large variation in basic values among participants. Discussions mainly focused on intervention delivery and choice of methods. Need and allocation of resources at any level was not an issue. Despite being probed to take a deeper look at contextual factors and the underlying drivers of community engagement, participants scarcely mentioned and problematized community agency mechanisms.

Conclusion: There is a need for new perspectives and a deepened reflection among decision-makers and public health implementers engaging at the local level to strengthen communities to face public health threats. A greater understanding and focus on contextual factors is needed which necessitates stronger interdisciplinary approaches.

Key words:

• Agency
• community
• discourse analysis
• empowerment
• stakeholder

Acknowledgements

The author would like to acknowledge the enthusiastic engagement of all workshop participants and give a special thanks to Gunilla Hallonsten, Paul Richards, Anders Nordström, and Samson Haumba for inspirational and insightful presentations. Many thanks to co-organizer Kerstin Stewart, Uppsala Health Summit, and workshop moderator Maria-Therese Bejerano, Swedish International Development Cooperation Agency (Sida). Finally, thanks to Pernilla Svefors, Uppsala University, for assistance in planning and note-taking during the workshop.

Disclosure statement

The author reports no conflicts of interest.

Additional information

Funding

Uppsala Health Summit is an invitation-only conference with fees for participants. Scholarships are provided for participants from low- and middle-income countries in an effort to extend diversity in the conference. No specific funding was made available for the presented study.

Notes on contributors

Mats Målqvist

Mats Målqvist is Professor in Global Health at Uppsala University. He is a medical doctor and social scientist with an extensive experience of managing and evaluating community-based interventions to promote maternal and child health. He has mostly worked in the Kingdom of eSwatini, Vietnam and Nepal. In eSwatini he set up and developed a local community-based organization working with peer support for improved maternal and child health, Siphilile Maternal and Child Health. For further information please visit https://researchfeatures.com/2018/05/01/saving-lives-vulnerable-babies-around-world/.