The elusiveness of representation

During the early hay days of international development in the 1980s, the limits of conventional top-down, expert-oriented approaches were gaining attention. Before long, the likes of the World Bank, UNDP and Oxfam began to implement cross-cutting participation requirements for their international programs.

By making “people” central to development and ensuring beneficiary participation, development could be more responsible, effective and accountable. Increasing participation also meant that projects had a greater chance of being sustained over time and more relevant to community needs and wants.

This line of thinking was important given alternatives at the time, but how far has it gotten us? After six months of working with an organization in India that serves a community of female sex workers, I’ve made a few observations about how the approach is working on the ground. The work being done in India raises questions about participation and representation in not only the broader field of international development, but also community health in the U.S.

As a corollary, I should mention that this organization is rather unconventional. The organizational style is far removed from that of the international health and development giants. It came about as an effort to serve the interests and general well-being of a community of brothel-based female sex workers. Both an outright absence of public services and a mistrust in receiving help from “outsiders” contributed to its formation. Over time, trends in development funding pressured the organization to focus, almost exclusively, on stemming the HIV epidemic in India.

There was little resistance to the increased presence of outsiders, partly because they acted as observers, maintaining care not to spoil the sanctity of participation. The forum prided itself in encouraging dialogue across all membership. Simultaneously, managing international grants meant filling the roles of project director, coordinator, accountant, outreach worker, peer educator and the like. What resulted was a distinctly family-like organizational structure within the forum.

Membership in the organization, either as a forum member or as an employee, meant membership in the family. Warmth, laughter and sincere care for one another made the organization function unlike any other. At the same, the family-like dynamics reinforced in several ways social structures and power dynamics that favored the literate, college-educated, and in this case, those that were no longer sex workers. More than a decade later, its unconventional organizational structure led it to being recognized as a community-based organization; a title that carries prestige in the industry and that is awarded by the state government only after meeting several criteria.

Unfortunately, the criteria measures only the inclusion of platforms for community participation and the number of routine community meetings. This reflects an all-too-common inattention to the quality of community participation. It seems that the novelty of participation in the industry and the urgency to replace ineffective top-down methods has precluded efforts to ensure an equitable chance at participating. In other words, one inequitable model of program implementation is sometimes only replaced with another.

When working with difficult, paternalism-inspiring topics, this flaw is especially apparent. Until a few years ago, moralistic anti-prostitution ideology dominated the realm of public health work within red light areas. The success of sex worker rights movements around the world, but particularly in India, has made it disadvantageous in recent years to proclaim anti-prostitution beliefs within an organization. While this has propelled groups working sincerely for sex worker rights, it has predictably forced anti-prostitution-minded groups to contain these convictions internally and to alter the language in their mission statements.

However, these convictions, with the support of social structures and organizational hierarchies, are manifested day-to-day in the suppression of dissenting opinions. It begs the question of how exactly this is an improvement over top-down approaches.

Rethinking participation
My purpose in writing this is to highlight the need for research on participation in development and public health contexts. Over the last two decades, a sacred cow has emerged that applauds any approach that is participatory, so long as top-down approaches are actively rejected. The complexity of individual motivation, group-think and social structures needs to be considered when implementing a participatory approach. This is especially true when it involves sensitive topics subject to paternalism such as prostitution.

For instance, baseline studies—usually conducted before the start of a project—could involve an assessment of group and conflict dynamics, looking at how decisions happen and consensus is reached. This way donors concerned with promoting participation could be sure that their models are adapted appropriately in the field. Similarly, funding agencies would do well to loosen participation requirements in exchange for suggestions to promote representativeness.

Above all, this is an opportunity for universities and research institutions to take the lead in investigating what works. Program implementors are too-often distracted with fulfilling grant administration requirements that they forgo this effort.

Diego Solares, formerly a research assistant at the Community Knowledge Project, writes from a red light area in Central India where he is currently serving as a William J. Clinton Fellow for Service in India, under a program managed by the American India Foundation.