RESUMO
In the realm of global health policy, the intricacies of power dynamics and intersectionality have become increasingly evident. Structurally embedded power hierarchies constitute a significant concern in achieving health for all and demand transformational change. Adopting intersectional feminist approaches potentially mitigates health inequities through more inclusive and responsive health policies. While feminist approaches to foreign and development policies are receiving increasing attention, they are not accorded the importance they deserve in global health policy. This article presents a framework for a Feminist Global Health Policy (FGHP), outlines the objectives and underlying principles and identifies the actors responsible for its meaningful implementation. Recognising that power hierarchies and societal contexts inherently shape research, the proposed framework was developed via a participatory research approach that aligns with feminist principles. Three independent online focus groups were conducted between August and September 2022 with 11 participants affiliated to the global-academic or local-activist level and covering all WHO regions. The qualitative content analysis revealed that a FGHP must be centred on considerations of intersectionality, power and knowledge paradigms to present meaningful alternatives to the current structures. By balancing guiding principles with sensitivity for context-specific adaptations, the framework is designed to be applicable locally and globally, whilst its adoption is intended to advance health equity and reproductive justice, with communities and policymakers identified as the main actors. This study underscores the importance of dismantling power structures by fostering intersectional and participatory approaches for a more equitable global health landscape. The FGHP framework is intended to initiate debate among global health practitioners, policymakers, researchers and communities. Whilst an undeniably intricate and time-consuming process, continuous and collaborative work towards health equity is imperative to translate this vision into practice.
RESUMO
Community-Based Monitoring (CBM) is a participatory process in which citizens gather evidence on services to hold governments accountable to their commitments. Research on CBM for health in developing countries has mostly measured its impact on service performance. Overall, these studies have produced mixed evidence of CBM's effectiveness. This has led some authors to question the role of civic engagement, especially in communities where expectations from public services and power to demand for change are low. This conclusion, we argue, overlooks the role of the CBM process in fostering both participation and social change. Drawing from qualitative research with the Indian grassroots women's organisation Mahila Swasthya Adhikar Manch, we argue that CBM can foster political capabilities through mediating communities' relationships with the state as well as relationships within communities. The engagement of women and their power to demand for change in the health sector and beyond emerges at the intersection of these two spheres. This suggests that measuring the impact of CBM on health services is not sufficient. Expanding the focus of research on CBM to its process is necessary to fully understand the role of civic engagement and to restore its political relevance.