The principle of participation is central to the way Healthlink operates and relates to its partners and stakeholders. Programmes and workshops are designed with partner participation, in this way the whole culture of work is participatory. There is also an emphasis on linking between partners, so that they can learn from each other, contribute to reviews of each others’ work and so on.
As all of Healthlink’s work is done through partners at national or local level, the issues of how community level participation processes function or influence other work is inevitably tied up with issues of how the organisation, and its partnerships, function. Healthlink’s own staff find out about programme-related activities through partners, and while after-action reviews are held to assess the effectiveness of work, the contribution of community members is again dependent on the partner’s own working culture and values. A key issue identified in the analysis of information flows and decision making, therefore, was dependency on partners and the quality of partnerships. This suggests that an interesting discussion could be had on the criteria for choosing partners, or the types of partnership which facilitate good information flows from participatory practice.
Healthlink’s mission is to facilitate the sharing of learning and knowledge, and within their offices they also have a strong culture of learning. Staff consider that knowledge seeking behaviour is central to how people are recruited to the organisation, how their work load and priorities are managed, and how they relate to each other. As Healthlink is a relatively small NGO, sharing of learning and ideas through personal relationships and informal conversations is much easier. In fact, staff reflected that while they are happy to contribute to the more structural and formal ways of sharing, they are much less likely to use them to seek relevant information. However, this knowledge seeking and sharing culture and way of working is not necessarily shared by the partners on whom they are dependent for access to relevant information generated through programme activities, and in particular community-level participation. In practice, this means that more of the learning is about methodologies and how to use particular participatory processes, than about community perspectives and analysis, i.e. what are in practice good health solutions. In general, staff reflected that these shared values and strong, honest communication were based on trust and confidence, which itself is developed over long-term relationships with partners. These types of relationships, which continue over several different projects, tend to create deeper and richer learning partnerships.
Because of Healthlink’s clear commitment to, and focus on, participatory communication, their relationships with funders were by their nature supportive of this approach. This means that external funding was not currently much of an issue, as it is negotiated according to Healthlink’s values and expertise and as such there is less room for distortion of objectives or relationships. Furthermore, the organisation’s focus on health, while useful in order to give a strong focus to the work and common ground to partners, also limits the space available to respond to different issues emerging through partners and the participatory processes that they facilitate and means that some information is ignored.
Conclusion: Healthlink is a conduit, taking seeds from one experience and sowing them elsewhere, in a process guided by values such as participation and knowledge sharing, and with a focus on health. For this to happen there needs to be investment in sharing experiences between partners, and this requires organisational flexibility - to be able to learn and adapt. The reflection on the tree showed that it takes time to nurture good use of information generated by participatory processes, and sometimes it is hard to see the connections before they emerge – it is much easier with hindsight.