| Compulsory power ‘direct and visible’: Direct and visible exercised by/through, e.g., police, local and national legislation | Institutional power ‘less visible’: Exercised through organizational rules, procedures, and norms, e.g., controlling information put into the public sphere, who is involved in decision-making | Structural power ‘invisible’: Invisible, systematic biases embedded in social institutions, generating/sustaining social hierarchies of class, gender, ethnicity and resources, opportunities, social status | Productive power ‘operates through practices’: Invisible, operates through diffuse social discourses and practices to legitimate some forms of knowledge, while marginalizing others. Shapes meanings of different social identities |
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Power limiting dynamics | - Community voice typically expressed through violent service delivery protests - Alcohol and drug abuse criminalised and stigmatised, less of public health response. Leads shift away from public health approach with collective action - Legislation shifting the system to COVID responses limited attention to other critical public health priorities | - Top-down governance. Pronounced ‘compliance culture’ in district health system. Limited spaces for learning, little recognition of resilience, ingenuity that exist at operational levels of the system – marginalises experiential knowledge - Poorly functional participatory governance. Limited, initial, recognition of community members as active change agents - Discussions open to capture by dominant or powerful actors - Parallel community governance systems and tensions. CDF varied roles within – limits potential. Traditional authorities and former tribal areas dominating democratic spaces, limits community voice | - Local politics seen in some discussions dominated by local politicians - Little recognition of expertise from the margins, little recognition of alternative forms of data and evidence (e.g., visual data) (academic institutions) - CHWs experience multiple challenges: lack of financial, logistic and health system support and training, lack of role clarity, insecure employment, low and no pay, poor safety, and low status - Deeply embedded social inequalities (ethnicity, gender, class, occupation), combines with institutional biases to marginalise some voices and privilege others | - Rural village contexts – former homelands direct/visible implications around inadequate infrastructure/ racial segregation endures. Economic inequalities—generational impact - HIV stigma endures. Systems structuring reinforces stigma in how services organised HIV/AIDs and TB remain deeply stigmatised - Legitimizing certain forms of knowledge and knowing over others – creates stigmatising identities for people experiencing hardship |
Forms of resistance/Areas that need attention | - ‘Safe spaces’ for dialogue between communities and authorities - Reframing of AOD abuse as public health priority - Process grounded in community needs and realities highlighted attention to HIV/TB treatment continuity, as services shifted to COVDI-19 responses | - Process claimed and protected spaces for new forms of ‘everyday leadership’ rooted in community voice, service response and data and evidence provision - Process strategically positioned to increase visibility and legitimacy—building alliances with and influencing formal structures and actors e.g., DHMT (district level), training resources (sub-district) OTLs and OMs (Clinic and community level) - More attention needed to enable and recognise significant resilience, capability, and ingenuity at operational levels of the system | - Consistent presence, navigating many different worlds to challenge established narratives around voice and power - Cooperative, appreciate approach to sensitive conversations, building of alliances, relationships, and trust - Working to strengthen platform to build collective power in different worlds: community, health system, academic spaces | - Sensitive and assertive facilitation, working to avoid imposing additional burdens in an already overburdened system - Dominant and stigmatising narratives challenged through consistent, predictable, transparent presence. ‘Neutrality’ conferred by virtue of connection to research/data centre - Use of different forms of media e.g., radio, podcasts to create positive narratives about community action and community health (narrative resilience) |