Power, Rights and Poverty

Norbert Goldfield, M.D.

Executive Director

Healing Across the Divides, Inc

Empowerment: Definition

• increasing the capacity of individuals and groups to make choices and to transform these choices into desired actions and outcomes

Self-Management Goals• Identify self-management tools, including the

following:– an action plan that includes goals and describes behavior

(e.g., increasing activity by walking 15 minutes 3 times per week)

– A review of the patient’s personal barriers (e.g., too busy to exercise)

– Steps to overcome barriers– The patient’s confidence level (e.g., on a scale of 1 to 10,

how confident are you that you can meet your goals?)– follow-up plan

Historical analysis of the development of health care

facilities in Kerala State, India• Though poor by standards of per capita

income, industrialization or agricultural production, the Indian state of Kerala has shown that these constraints need not hinder the development of social sectors. The state has achieved near universal literacy for both males and females and the health care indices are comparable to countries with more advanced economies

Illustration

If a team were trying to assess the degree of political empowerment of women as it pertains to health, information would first need to be gathered on the existence of women’s access to health services. Then the question would be asked, do women choose to access these services and why/why not? Finally, the team would assess the health outcome of these choices; that is, does the health of women actually improve?

Empowerment is dependent on interplay of two inter-related factors:

agency and opportunity structure.

• Agency is defined as an actor’s ability to make meaningful choices; that is, the actor is able to envisage and purposively choose options.

• Opportunity structure is defined as those aspects of the context within which actors operate that affect their ability to transform agency into effective action.

Different perspectives on power

• Power to: power is the capacity to have an effect.• Power over: power is relational and about social action.• Power is knowledge: knowledge is contingent on our time

and place and the power relations that shape our lives. Development efforts often fail because they treat knowledge as information, rather than as the construction of meaning.

• Power with: power to develop common ground among different interests and build collective strength.

• Power structures: power is embedded in the relationships that shape how one person or organization has more than others of all of the above.

Different approaches to empowerment.

• Capacity-building efforts, which emphasize power to, view power as an infinitely expanding resource. The counter to this is a struggle for resources, seeking power over, which is pursued by activist groups and social movements.

cont

• Empowerment efforts from the bottom up, such as community driven development (CDD), can address real needs and are more inclusive than elite-dominated local governments. However, these interventions may limit poor people’s potential to enhance political capabilities by de-mobilizing them.

cont

• Making poverty a public, moral, and political issue often helps the poor gain leverage. Rights-based approaches are similarly dependent on politicization. One problem with bringing empowerment issues into the political sphere is that political capacity is gained at the cost of conceding power to a political system and its own autonomous logic, which may be less than hospitable to poor people.

Holland and Brook suggest threetypes of empowerment indicators:

• data generated through household and other surveys;

• intermediate and direct indicators derived from existing survey instruments;

• and indicators not yet captured by existing instruments.

To understand whycertain groups persistently achieve poor

development outcomes, we must:

• identify more clearly who is excluded, why it matters, and how this exclusion is created and sustained. is requires bringing a greater conceptual and empirical rigor to debates around empowerment and exclusion. This research will always be controversial because data do not fit easily with the usual imperatives of large organizations. The way forward is a two-fold commitment to (1) expanding and improving existing household sources on development outcomes and their determinants, and (2) engaging in more context- and issues-specific research using mixed methods to understand the processes.

Donor agencies must understand theirown position and the implications of

their own actions.

• First, as part of their process of developing strategies, development actors need to ask questions about the likely impact of their actions on power relationships in the short and long term. All development activities—from building a road to providing budget support directly to governments—influence the evolution of power relations. Whether practitioners do this in ways that will strengthen the position of poor people or erode it is a key question, but one that is rarely factored into a decision-making process that remains largely technocratic in character.

cont

• Second, to develop implementable and realistic policy options, donor agencies must understand the political context of the environments they work in (whether national, international, or local). There is a persistent sense that the emergence of poverty as an issue in formal political arenas—and of categories of the poor as politicians’ constituencies—is a key feature of situations where rapid pro-poor change is likely to happen. Development agencies have little control over emerging political projects that create incentives for political participation among hitherto excluded populations.

Human rights are a priori about power relations.

cont

• despite the ideals of participation, “people become empowered not in themselves, but through relationships with outsiders; and not through the validation of their existing knowledge and actions, but by seeking out and acknowledging the superiority of modern technology and lifestyles, and by aligning themselves with dominant cultural forms”

Donor Client Power Relations

• One final point, which can only be mentioned, is that any poverty reduction strategy that boasts an empowerment component must take into account donor-client relations and the political interdependences of donor and country level coalitions.

Clientelism

• Clientelism refers to imbalanced bargaining relationships in which political loyalty is exchanged for material benefits. The qualified term authoritarian clientelism is distinctive because it refers to exchanges of loyalty for benefits that are backed up by actual or potential threats of coercion. Carrots that are backed up by sticks are a special kind of carrot.

Direct Indicators of Empowerment

• Direct indicators of empowerment relate to the four forms of empowerment identified by the ME study: passive access, active participation, influence, and control. These indicators measure empowerment in the following three areas:

• 1) Opportunity to use influence/exercise choice;• 2) Using influence/exercising choice; and• 3) Effectiveness of using influence/exercising

choice in terms of the desired outcome.

Local

• Number of publicly provided health services available locally• Percent able to access public services• Number of public services used • Score of quality of public services used• Percent individuals that have complained about public service delivery• Percent of households that have complained about public service

delivery• Frequency of complaints• Score of satisfaction with outcome of complaint• Score of equitability in addressing needs and concerns• Score of influence of social characteristics on the authorities treatment

of people

Financial Assets

• Employment history

• Level of indebtedness

• Sources of credit

• Household expenses

• Food expenditure

• Occupation

Informational Assets

• Journey time to nearest working post office • Journey time to nearest working telephone• Frequency of radio listening• Frequency of television watching • Frequency of newspaper reading• Passable road access to house• Perceived changes in access to information• Completed education level

Organizational Assets

• Membership of organizations

• Effectiveness of group leadership

• Influence in selection of group leaders

• Level of diversity of group membership

(cont): Human Assets

• Literacy Levels

• Numeracy Levels

• Health Status

Stage 1

• Who is excluded from what? Does it matter (instrumentally or intrinsically)? How and why is their exclusion created and sustained?

Stage 2

• If disempowerment is indeed the problem, are the corresponding policy/project responses technically sound, politically supportable, and administratively implementable?

Stage 3

• How do we know whether and how these responses are working, and, if so, that they are better than other plausible alternatives?

cont

• Moreover, given that certain influential voices in development see little need to focus on responses that are specifically geared toward empowerment — insisting, for example, that economic growth is the best approach to empowering the poor—it would be instructive to know the precise value of empowerment specific responses, where it lies, and how it can be improved.

Illustration

If a team were trying to assess the degree of political empowerment of women as it pertains to health, information would first need to be gathered on the existence of women’s access to health services. Then the question would be asked, do women choose to access these services and why/why not? Finally, the team would assess the health outcome of these choices; that is, does the health of women actually improve?