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Inaugural KEYSTONE Course on Health Policy and Systems Research 2015

A peek into Participatory Action Research (PAR)

A peek into PAR

withrakhal gaitonde

A Worker's Speech To A DoctorBrecht

When we come to youOur rags are torn off usAnd you listen all over our naked body.As to the cause of our illnessOne glance at our rags wouldTell you more. It is the same cause that wears outOur bodies and our clothes.

The pain in our shoulder comesYou say, from the damp; and this is also the reasonFor the stain on the wall of our flat.So tell us:Where does the damp come from?

Objectives

• An appreciation of the “participatory” perspective.

• The imperative for the “action” turn in research.

• The core philosophy of PAR.• The core methodology.• Issues of ethics and reliability.

A participatory approach to a dengue epidemic

• Setting – post-tsunami rehabilitation work, building up a dynamic group of community health workers.

• Discussion and the recognition of the simple prevention strategy.

• Education strategy.• Feedback and the inevitability of stored water.• Drinking water or mosquito spray?

A story in Cuddalore

• https://www.youtube.com/watch?v=sQC2Q6W9vjQ

PAR is….• participatory; • cooperative, engaging community members and researchers

in a joint process in which both con-tribute equally; • a co-learning process for researchers and community

members; • a method for systems development and local community

capacity building; • an empowering process through which participants can

increase control over their lives by nurturing com-munity strengths and problem-solving abilities; and

• a way to balance research and action.

The development of PAR

• Two broad streams:• Action Research of Kurt Lewin. ‘‘pioneering

approach toward social research which combined generation of theory with changing the social research system through the researcher acting on or in the social system’’.

• Participatory development – of the Latin American struggle / Africa - Paulo Friere and others. “the dialogical method …….with its accent on co-learning and action based on critical reflection”

List of Core Principles

• Emergent development form. The concept of co-creation. Multiple Epistemologies.

• Practical issues as the core for research. The goal of research usable knowledge. “not being a simple mirror held up to reality but a

hammer with which to shape it” – Brecht

• Participation and democracy – the distribution of power.

• Knowledge in action – to understand a system one must act on it and try to change it.

• .

• Human flourishing – “as the peoples’ memory is only liberating when it

registers the substantial side of their pains and happiness, when it nourishes and celebrates a different tomorrow”. From the Latin America Alternative Health Report

The PAR cycle (O’Hara, P. (2006)

PAR• Participatory Action Research sees that action and

reflection must go together. Praxis cannot be divided into a prior stage of reflection and a subsequent stage of action. When action and reflection take place at the same time they become creative and mutually illuminate each other.

• Through praxis, critical consciousness develops, leading to further action through which people cease to see their situation as ‘dense, enveloping reality or a blind alley’ and instead as ‘an historical reality susceptible of transformation’. This transformative power is central to participatory action.

Issues of Bias

• Fair subject selection requires that the goals of the research, not the vulnerability or privilege of the individuals and groups involved.

Issues of validity• Outcome validity – who benefits from the resolution of

the problem.• Democratic validity – are all relevant stakeholders

participating fully.• Process validity – the way problem is investigated and

process allows for ongoing learning and improvements.• Catalytic validity – extent to which research collaborators

are invigorated to understand and change social reality. • Dialogical validity – review from critical dialogue with

peers about research findings and actions.

Validity depends on…

• How relevant the community involved perceives the issues to be.

• How far the processes engage experiential knowledge without losing information.

• Whether the research takes into account the cultural context.

• Whether the collective process of analysis is well-facilitated and rigorous.

Generalizability

Ethics in participatory research

• Community level risks as distinct from individual level risks. – Bias in who represents communities. – Tension over whose interests are driving the process.– Managing privacy and protecting information (DWT).– Tension over how evidence and analysis is

documented and reported. Especially unfavorable and negative information.

– Social Risks.

The Nobodies - Galeano• Fleas dream of buying themselves a dog, and nobodies dream

of escaping poverty: that one magical day good luck willsuddenly rain down on them- will rain down in buckets. But good luck doesn't even fall in a fine drizzle, no matterhow hard the nobodies summon it, even if their left hand istickling, or if they begin the new day with their right foot, orstart the new year with a change of brooms.The nobodies: nobody's children, owners of nothing. The nobodies: the no ones, the nobodied, running like rabbits, dying through life, screwed every which way.Who don't speak languages, but dialects.Who don't have religions, but superstitions.Who don't create art, but handicrafts.Who don't have culture, but folklore.Who are not human beings, but human resources.Who do not have names, but numbers.Who do not appear in the history of the world, but in thepolice blotter of the local paper.The nobodies, who are not worth the bullet that kills them

The divorce of research and analysis from pragmatic efforts to remediate inequalities of access is a tactical and moral error – it may be an error that constitutes, in and of itself, a human rights abuse.

Paul Farmer

I referred to the following for my presentation• https://structuralhealth.wordpress.com/2012/03/29/a-workers-spee

ch-to-a-doctor/• http://www.poemhunter.com/poem/the-nobodies-written-by-eduar

do-galeano/• Reason, P. and Bradbury, H. eds., 2001. Handbook of action research:

Participative inquiry and practice. Sage.• Lewenson R, Laurell AC, Hogstedt C, D’Ambruoso L, Shroff Z (2014)

Participatory action research in Health systems: a methods reader, TARSC, AHPSR, WHO, IDRC Canada, EQUINET, Harare.

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