Participatory decision making practices were introduced into the Cambodian health sector in the late 1990s by the international development community. These practices were consolidated into a government policy in 2003. The participation policy requires lay citizens and other community representatives to be involved in management committees for health centres. In this thesis I report my research to ascertain if a participation policy results in strong participation.
I did an ethnographic study of seven health centres in regional Cambodia. I found that participation levels of all lay citizens and other community representatives in health centre management were very low – the committees were only established where an international NGO supported them. Where the committees were operational, they were not decision making bodies. Community representatives including lay citizens had low levels of participation partly because of poor process design and lack of policy institutionalisation. This context enabled international NGOs to dominate and manipulate the committees. They used committees as a forum to educate community leaders about health, mobilise leaders to promote health centres, and lobby the government for changes in health centre management.
By drawing together and extending the work of others, I show how in Cambodia both the participation process used in the study area and the national participation policy became commodities that were consumed in the game of international development. International development actors produced, marketed, and “sold” participation policies and processes and, in return, offered an implicit promise of resources to the government. As a result, lay citizens and other community representatives in Cambodia were short-changed by the consumption of participation policies and processes, being left without meaningful involvement in government decision making.