Mapping power in community engagement: methodological reflections from health emergencies.

Abstract

Community engagement is increasingly seen as a key component of public health responses to health emergencies. Recent outbreaks, from Ebola in West Africa to COVID-19 across the world, have highlighted the importance of working through existing structures and identifying trusted local leaders who can help response workers design context-appropriate interventions. However, community engagement efforts often rely on homogenous understandings of 'community' that underestimate the significance of power. This creates a risk of exclusionary practices. In this article, we discuss the use of participatory power mapping workshops as a useful method to identify who has authority and who is trusted by whom, and consider its implications for how we think about trust-building during emergencies. We detail the implementation of this method using participatory workshops conducted in Sierra Leone. We show how these workshops provided granular insights on authority structures and the relationship between power and trust. These discussions highlighted that trust is not homogeneous nor static, and helped kickstart conversations about the role of citizens not simply as recipients of health interventions but also as active participants in how health interventions are designed and delivered. Tracing power dynamics with and within communities can help develop allows us to make power visible in health interventions, maintaining a critical lens on how interventions themselves intervene dynamically on its distribution. In practice, a systematic application of this methodology can encourage more diversified community engagement efforts, and potentially set the foundations for citizen-led collective action around health emergency resilience.