Citizens Committees and Local Elites: Elite Capture, Captured Elites, and Absent Elites in Health Facility Committees

Abstract

Mainstream development policies often promote citizens committees to oversee basic social services. Such committees require influence over, and legitimacy among, service providers and citizens to perform their roles, which local elites can help or hinder. Using a mixed-methods approach, we analyse the situation in 251 health facility committees in Burundi, part of which benefited from interventions designed to bolster their relationship with local leaders. Interviews and focus groups reveal that leaders’ support is essential for committees to access citizens and work with nurses, but the failure of the interventions show it is hard to nurture. The local socio-political elites (politicians, faith leaders) bypass and ignore the committees. In a ‘fragile’ context such as Burundi’s, the lack of political elite capture attempt suggests a largely vacuous committee system. The committees remain a façade participatory institution. Understanding and engaging with local everyday local politics is crucial for committee-based development approaches.

Do community health committees participate in governing health workers in primary healthcare facilities under fiscal decentralization?—An explanatory qualitative study from Tanzania

“…Indeed, the findings imply that, despite giving communities fiscal and decision‐making powers, those powers cannot be used effectively because other factors must be addressed in order for the DHFF reform to be meaningful and work as intended. This result is similar to the findings in Burundi after fiscal decentralization, where community committees continued to function as they had before fiscal decentralization because some aspects were overlooked 12,17,33 …”

“…This result is similar to the findings in Burundi after fiscal decentralization, where community committees continued to function as they had before fiscal decentralization because some aspects were overlooked. 12 , 17 , 33 …”

“…Indeed, developing countries have established community governance structures through decentralization to ensure meaningful community participation in the governance of primary healthcare facilities. Given that they are the apex decision makers at the facility level, one of their roles has been to make major decisions about the management of health workers in their facilities 11,12 . These governance structures at the facilities are expected to make decisions such as recruiting new workers based on the required health worker force, motivating workers through various incentives, training, rewarding, and sanctioning health workers based on their performance 13,14 .…”

“…Given that they are the apex decision makers at the facility level, one of their roles has been to make major decisions about the management of health workers in their facilities. 11 , 12 These governance structures at the facilities are expected to make decisions such as recruiting new workers based on the required health worker force, motivating workers through various incentives, training, rewarding, and sanctioning health workers based on their performance. 13 , 14 However, empirical literature has reported poor functionality of these community governance structures in accomplishing their devolve mandates including governing health workers in many countries.…”

Strengthening the community governance of healthcare services in ‘fragile’ settings: Evidence from Burundi and South Kivu, DR Congo

“…The present article follows two articles on the Burundi case [ 12 , 13 ]. The interventions they focussed on–attempting to strengthen the relationship between HFC and local elite and training the HFC on acquiring and analysing HF data–came on top of the intervention described in the present article.…”