Whose Ownership? Which Stakes? Communities And Health Workers Participating In The Zambian Health Reform

Abstract

After years of deterioration of the health care system, due to the declining economy and the World Bank Structural Adjustment Programs of the 1980s, Zambia has initiated a health reform entailing a radical decentralization of the health care system. The reform combines neoliberal tendencies of the 1980s with a renewed focus upon the development of human resources and community participation. Participation now carries connotations of ownership and responsibility rather than democracy and empowerment as it did in the 1970s, and the goal of the reform is to achieve equal access to health through increased cost-effectiveness of the health care system. This article explores how some of these policy terms translate into concrete social interactions around health units. Rather than attempting to measure the extent to which participation is achieved, we discuss how social relations are altered due to activities implemented as part of the reform. We explore what these social interactions teach us about the direction