Spaces for Negotiation and Mass Action within the National Rural Health Mission: ‘Community Monitoring Plus’ and People’s Organizations in Tribal Areas of Maharashtra, India

The first phase of the Community-Based Monitoring of Health Services program of the National Rural Health Mission has seen involvement of civil society actors at every stage, from the formation of policy in Delhi to program implementation in villages across the country. For many of the civil society actors involved, the program presents a unique opportunity to advance their rights-based agendas from within the government system by making creative and innovative use of the spaces that the program opens. In the implementation of the program by people’s organizations in tribal areas of Maharashtra, “innovations” have been introduced that go beyond the scope of the guidelines set in Delhi; these have been dubbed “community monitoring plus.”

Drawing upon actor-network theory and recent work in the anthropology of development, this paper explores the dynamics, achievements and tensions of “community monitoring plus” through a narrative that travels the length of the policy process. The analysis describes how categories such as “state,” “civil society” and “community” are constructed within spaces of policy and practice, and examines the crucial enabling role that such constructions play in the policy process. The necessity of such constructions leads to a disconnect between policy making and implementation, so that policy makers remain ignorant of the realities of implementation practice and subordinate actors can carve out spaces for carrying out their own agendas around and against the policy framework. The implications of the analysis extend beyond the case study, as the dynamics described are also features of policy processes elsewhere.

全國農村健康使命中的協商空間和大眾行動：印度馬哈拉施特拉部落地區的“外加社區監督”和人民組織

在第一期對全國農村健康使命的健康服務項目進行的以社區為基礎的監督裏，公民社會行動者參與了從在德裏的政策形成到在全國範圍的項目實施的每一個階段。對很多參與其中的公民社會行動者來說，這一項目提供了一個創造性地利用該項目所開放的空間在政府體製內部推進他們的以權利為本的議程的獨特機會。在馬哈拉施特拉部落地區的人民組織實施這一項目時，很多“創新”被引進，大大超出了德裏的指導方針的範圍。這些創新被稱為“外加社區監督”。採用行動者網絡理論和近來的發展人類學論著，本文通過分析貫穿於整個政策過程的敘事探討了“外加社區監督”中的動態、成就和矛盾。本文追溯了“國家”、“公民社會”和“社區”等類別如何在政策和實踐的空間中被建構出來，並攷察這些建構在政策過程中所起的關鍵性能動作用。對這些類別的建構的必要性導致了政策制定和實施之間的分離，以至於政策製訂者始終對施行實踐的現實一無所知，而其下屬行動者也因此得以開拓出一個空間推行他們自己的與政策框架或相匹配或相違背的議程。本項研究的意義超越了個案研究，因為其所描述的動態也適用於其它地方的政策過程。