An Analysis of the Promises and Pitfalls of Participatory Processes in Health Policy: The Need for Empowerment Education within Marginalized Communities

Abstract

With their roots in Paulo Freire’s writing on pedagogy, participatory processes have now become adapted for use in a broad range of applications within national and international health development work. Advocates claim that they make projects more relevant to local priorities and perspectives, create more lasting effects, and foster empowerment among community members. Studies on their inclusion, however, have uncovered great diversity in their usage that complicates the attainment of these goals. A review of their use within the Ugandan Nutrition and Early Childhood Development Project (NECDP) found that participatory processes failed to alleviate insider/outsider differences in perspectives and priorities or motivate villagers to address the problems facing their community through the project. An analysis of these failures compared with more successful interventions points to a need to incorporate a type of “empowerment education” modeled after Freirean pedagogy to foster the active participation of community members. Such a comparison suggests that it is this type of education that leads to collective action and results in the promised goals of relevancy, sustainability, and empowerment.