Health Committees as Vehicles for Democratic Governance in Health Systems: Lessons from Selected Health Unit Management Committees in Uganda

Introduction: For over forty years, community participation has been a central component of a well-functioning health system. Despite its important role there are many difficulties in defining and understanding community participation as part of governance. Through a case study of selected health unit management committees in Uganda, this paper demonstrates that these committees can be structures for community participation and vehicles for democratic governance in health systems that advance health equity. Guided by the theoretical underpinnings of deliberative democracy the paper evaluates the performance of health unit management committees as a mechanism for citizen participation in health systems. Methods: This paper uses a qualitative, case-study methodology. Through an in-depth look at the health unit management committees of Kiboga and Kyankwanzi in Uganda, the study considered these as examples of structures for democratic community participation in health system. The study undertook literature review on the theories of deliberative democracy and human rights principles, and this provided the theoretical underpinnings of the study. Findings: Our findings underscore that community participation in health systems through health unit management committees ought to be grounded in the principles of deliberative democracy. The core of deliberative democracy is considered to be authentic deliberation and consensus decision-making, which can happen in both direct and representative democracies, giving rise to the notions of populist and elitist deliberative democracy, respectively. As such, a balance needs to be struck between the competitive notions of democracy and the public health requirements of inclusive and direct participation of communities in decision making processes on matters that affect their health. Conclusions: Community participation in the health sector in Uganda hinges on health unit management committees at the lower service provision points. These HUMCs are also perceived as vehicles to strengthen health governance through realizing the right to health of the communities. However, these have been established without attention to investing in capacity building needed to enable them to exercise community voice in the health system.

Nationality and Equal Political Rights: A Necessary Link?

Main justifications for regarding common nationality as a necessary condition for holding equal political rights – Critique of collective self-determination, equal stakes, nature of political activity, and stability justifications – Rejection of the incommensurability of legitimacy and justice – Socioeconomic interdependence and liberal democratic values as the normative grounds for equal stakes – Risk of entrenchment of hostility among national groups as a consequence of a competitive conception of political activity – Instrumental value of stability – Stability through democratic inclusion – Possibility of sustainable pluralism through deliberative democracy – Modified version of the equal stakes argument – Equal political rights on the basis of long-term residence – Association of citizenship with nationality in contemporary European states – Redefinition of citizenship as top-down redefinition of nationality – Need to reconceptualise equal political rights independently of citizenship – Legal argument for interpreting references to popular sovereignty in national constitutions in accordance with long-term residence, rather than nationality – Available legal remedies

Achieving a Representative Democracy in Europe

The concept of public spheres is based on the classic notion of deliberative democracy. The emergence of a European Public Sphere (EPS) at the European Union (EU) level has been widely discussed in the literature. However, the deliberative quality of this sphere is questioned because of its weak connection with citizens. This chapter explores how recent research addresses the EPS. Three categories are defined: (1) political and public communication of the EU, (2) citizen participation through technologies, and (3) the growing politicization and polarization of the European project. The methods in use, as well as remaining challenges in research, are also analyzed. This study contributes to discussions on the future of EU democracy, arguing that politicization and the interrelation of digital platforms and legacy media may enhance a true public discussion in Europe.

Institutional listening in deliberative democracy: Towards a deliberative logic of transmission

This article explores the role of institutional listening in deliberative democracy, focusing particularly on its contribution to the transmission process between the public sphere and formal institutions. We critique existing accounts of transmission for prioritizing voice over listening and for remaining constrained by an ‘aggregative logic’ of the flow of ideas and voices in a democracy. We argue that formal institutions have a crucial role to play in ensuring transmission operates according to a more deliberative logic. To substantiate this argument, we focus on two recent examples of institutional listening in two different democracies: Australia’s Royal Commission into Institutional Responses to Child Sexual Abuse and the United States’ Senate Judiciary Committee’s confirmation hearing for Supreme Court nominee, Brett Kavanaugh. These cases show that institutional listening can take different forms; it can be purposefully designed or incidental, and it can contribute to the realization of deliberative democracy in various ways. Specifically, institutional listening can help enhance the credibility and visibility of minority groups and perspectives while also empowering these groups to better hold formal political institutions accountable. In these ways, institutional listening helps transmission operate according to a more deliberative logic.

Is the Solution More Democracy?

Philosophers often try to “solve” democracy’s problems by arguing we need more and better democracy. They tend to think certain kinds of democratic systems could unleash the hidden “wisdom of the crowds.” Some defenders of democracy propose deliberative democracy and some extol the reliability of large groups. However, both ideas have limitations in the real world. This chapter objects to such arguments as they rely upon mistaken applications of certain mathematical theorems, or they end up retreating toward unrealistic ideals of how people ought to behave. In effect, they say that democracy would be wonderful if only people behaved the right way.

Let’s Try Real Democracy

This chapter lays out a general theoretical case for democracy, specifically the kind of democracy that democratic theorists call “deliberative democracy,” which traces the legitimacy of laws and policies to the reasoned exchange of arguments among free and equal citizens. The chapter shows the benefits of distributing political decision-power in an inclusive and egalitarian manner, especially in the deliberative phase of the legislative process. The core idea is that many minds deliberating together are better than few when it comes to dealing with the uncertainty and complexity of the world and figuring out solutions that work for all within it.

Landemore: Response to Brennan

Despite the avalanche of facts that Jason Brennan brings against the average voter and his skepticism of deliberation among ordinary citizens, the resulting attack on democracy turns out to be surprisingly limited. In the end, Brennan concedes, democracy is still the best regime around, no matter how flawed, and we have a duty to fix it. He also concedes that deliberation among randomly selected citizens is going to be part of the solution. Landemore argues that Brennan’s solution, however—a combination of randomly selected mini-publics designing questionnaires and a weighted vote system based on these questionnaires—is still too elitist, empirically inattentive to existing experiments in deliberative democracy, and unlikely to work.

Diversifying the Deliberative Turn: Toward an Agonistic RRI

In its “deliberative turn,” the field of science and technology studies (STS) has strongly advocated opening up decision-making processes around science and technology to more perspectives and knowledges. While the theory of democracy underpinning this is rarely explicitly addressed, the language and ideas used are often drawn from deliberative democracy. Using the case of synthetic biology and Responsible Research and Innovation (RRI), this paper looks at challenges of public engagement and finds parallels in long-standing critiques of deliberative democracy. The paper suggests that STS scholars explore other theories of decision-making and explores what an RRI grounded in agonistic pluralism might entail. An agonistic RRI could develop empirical research around questions of power relations in contemporary science and technology, seek to facilitate the formation of political publics around relevant issues, and frame different actors’ stances as adversarial positions on a political field rather than “equally valid” perspectives.

Contemporary Nigeria and the Deficit of Deliberative Democracy: Exploring the Indigenous Value of Àgbájọ ọwọ́ as Collegiality

The paper advances three groups of interrelated claims. First, a fundamental deficit of democratic practice in contemporary Nigeria is that electoral choices/candidates are largely disconnected from the spirit of vibrant deliberation/consideration by the Nigerian demos. Second, candidates that emerge tend to be more parochially disposed to serving the interests of the political sponsors, rather than working towards the promotion of the common good. Third, to address the problem of the research, it is argued that well-meaning, democratically conscious Nigerians should practically embrace the indigenous value of àgbájọ ọwọ́as collegiality to resist electoral choices/candidates of the noted politically influential elites. As one of the socio-moral values of an ideal Yoruba persona, or ọmọlúwàbí, àgbájọ ọwọ́ underscores the critical point that the realty of the common good properly derives from a rational collaboration of the members of a political collectivity. Ultimately, this understanding of collegiality helps in the promotion of deliberative democracy and its benefits in Nigeria.