ABSTRACT

The Center for the Study of Equity and Governance in Health Systems (CEGSS) is a civic association founded in 2006, in Guatemala, which supports a large network of volunteer community health defenders. Its aim is to contribute to reducing social exclusion and inequality in health care affecting the rural indigenous population. The interdisciplinary team provides technical assistance and conducts action research, capacity building for grassroots groups and advocacy with public officials using participatory approaches. In its efforts to understand social exclusion and marginalisation, CEGSS has developed participatory tools and approaches to analyse asymmetrical power relations among, within and between community-based organisations and government authorities. These methods began as card games, categorising of actors and tools for scoring and ranking, but these were then abandoned in favour of facilitating rich ‘generative conversations’. Interview guides were developed to deepen discussion and explore: a) specific examples of power and influence; b) the most relevant power resources in the locality; and c) ideas about how to change power relations. From these generative conversations, the CEGSS team, together with communities, developed their own theories and concepts of ‘micro-power’ to inform their strategies and actions aimed at shifting power in health care service delivery for rural indigenous populations