Rural public health systems and accountability politics: insights from grassroots health rights defenders in Guatemala

Abstract

As the pandemic reveals how multiple intersecting inequalities affect public health, the work of rural activists defending their communities' rights to health, land, and gender, ethnic and environmental justice demonstrate how intersectional analysis can be put into practice. In the interviews that follow, Guatemalan Maya Tz'utujil activists Paulina Culum and Benilda Batzin describe how 'health rights defenders' seek justice for rural indigenous communitieswork that the pandemic makes more critical than ever. Their strategies and insights have implications for addressing rural health rights around the world.

‘History obligates us to do it’: political capabilities of Indigenous grassroots leaders of health accountability initiatives in rural Guatemala

“…CEGSS’ approach to supporting citizen action for health accountability can be characterised as a deepening democracy strategy that focuses on strengthening the citizenship of the rural Indigenous population and collaborating with them in their efforts to influence public policy and services. 14 Their approach starts with individuals nominated by their communities to join the network of defenders. These individuals typically also have roles as community-level authorities, traditional healers and midwives and/or in grassroots organisations, while providing for their families through subsistence farming, migrant labour and the informal sector.…”

“…This is particularly visible in highly segmented systems like Guatemala’s where the public health services attending disadvantaged populations are understocked, understaffed and provide inferior quality of care 12. The public health system represents an important interface between the state and rural communities, and the interactions that occur there can either reproduce or combat the histories of disenfranchisement and discrimination that underpin the vulnerability and poor health outcomes these communities experience 13 14. Recognising the health system as a site of state interaction with historically excluded communities implies that overcoming health inequities is primarily a political undertaking rather than a technical one.…”

COVID-19, lockdown and peasants in Zimbabwe

“…In this article, the new virus is treated broadly as an agrarian problem, rather than narrowly as a biomedical problem as is the norm in current dominant views (see Eaton and Kalichman 2020), thereby broadening the horizons of understanding the pandemic. Notable initiatives to delve beyond the biomedical dimensions of the pandemic are documented (see Fischer-Mackey et al 2020;Montenegro de Wit 2021;van der Ploeg 2020). Furthermore, the transformative approach adopted in interrogating peasant communities in a time of pandemic, and the drive to engage various actors in rural development, expands opportunities for policy change relating to improvements of the living conditions of the peasants.…”

“…These are explored later in the article, but it should be understood from the onset that some of the ideas were developed in a different context, and that some aspects do not rigidly apply to the Zimbabwe case. However, significant literature that is specifically grounded on peasants, other aspects of critical agrarian studies and COVID-19 is accumulating (see Altieri and Nicholls 2020;Clapp and Moseley 2020;Fischer-Mackey et al 2020;Montenegro de Wit 2021;van der Ploeg 2020;Xiuhtecutli and Shattuck 2021).…”

COVID-19 and pastoralism: reflections from three continents

“…COVID-19 has brutally exposed deep structural inequalities in societies across the world, whether through axes of wealth, age, gender health condition, ethnicity, race or knowledge (e.g. Liu et al, 2020;Fischer-Mackey et al, 2020;Mendes and Carvalho, 2020;Wenham, Smith, and Morgan, 2020). Much analysis to date has focused on the macro-consequences of the pandemic on national economies and the impacts on poverty (e.g.…”