Extending the System: Citizen Participation as Outreach Work

Abstract

Chapter 3 explored committee work in health systems as a mode of participation, arguing that it requires formal bureaucratic skills and a long-term commitment to the organisation, and generates problematic dilemmas around questions of representation. In this chapter we turn to a mode which is to some extent designed to solve these dilemmas, by explicitly aiming to engage as wide a spectrum of the population as possible. What I term outreach work encompasses a wide range of short-term or one-off projects which seek to elicit a wide range of public perspectives on a specific issue. This is the quintessential terrain of contemporary participation, where the lay committee representative or small standing groups discussed in the previous chapter are seen as reliant on too small a section of the population. Methods for ‘doing’ participation are promoted by organisations such as the International Association for Public Participation, catalogued by Participedia (www.participedia.net), and eagerly adopted by a range of actors including large multinational consultancies (Mann et al 2013). Mitton et al.’s (2009) international scoping review of participation in health found that just under half (49%) of studies reported one-off engagements, rather than ongoing processes. The same review also found that 38% of studies ‘reported that particular attention was paid to soliciting the input and participation of disadvantaged populations or groups with special needs’ (Mitton et al 2009. p 223).