2.1.3 Algunos Factores contextuales que afectan al sector salud 2.1.3.1 Demografía.
2.1.4. Relación entre la salud y la economía de los países.
The operational representation of micro level entrepreneurial activity exposes a structural gap between the micro- meso (non-governmental) civil society organisational sphere where civic engagements at the communal level represented by groups of individuals and groups of like groups linked with formal service structures often lack coordinated flow resulting in a stalemate in initiated activities. Communally, groups of like groups such as savings and producer groups largely indigenous in nature lack efficient alignment with formal structures in terms of information and technology flow, thus stand the risk of not being involved in detailed arrangements in the provision of support in providing comprehensive strategies.179 The paucity in vertically oriented activities from micro to meso levels result in the lack of structured coordination associated with the organisational development of micro level groups of individuals. Savings groups such as the traditional susu lack the structural form through which borrowing and lending activities can be adequately coordinated within the savings scheme. Micro operational strategies practised in producer groups include traditional farming practices such as tool sharing as well as unstructured labour rotation practices. For farmer groups, the collection of individual farmers at the micro level are organised based on types of produce which demands coordination of needs of individuals within groups to allow for measuring the different levels of assistance within the groups to be sought externally.180 Where horizontal networks are regularly engaged in across communities in view of their indigenous structure, individual groups such as savings, trading and, agricultural clusters experience unequal spatial distribution of technological capacity, both agro and market based, partly the result of the maintenance of closely knit community based ties.
The spatial gap created between the representation of groups of like groups at the district level as against groups of individuals to an extent ethnically represented groups articulates the missing link, where the function of traditional representation could serve as the essential ingredient in focusing on drawing such structures within their closely knit periphery towards the inclusion of indicators for formal structures to reach occupational goals.
179
Mc Cormick, in King, K. et al (1999:132-138)
180
Mc Cormick, in King, K. et al (1999:136) mentions the formation of clusters as well as need for the joining together of formed clusters for the efficient function of vertical collaboration amongst occupational associations
Table 2.5: A range of structures in micro level associational activity Indigenous structures Structural
characteristics Formal structures
Structural characteristics Labour/development groups Village/community focused Often ethnically focused
Union of Traders and Farmers Associations Transcend village – spread across communal divide
Savings groups Credit Union
Associations
Village/youth groups Consumer
Groups/Cooperatives
Festivals Food Processors
Associations Source: Author’s construct
The development of communal associational life and linkages to formal structures has experienced waves of stifled activity in the quest for empowerment and ownership in community development processes. Micro level activity appears to be a more complex process largely concentrated on mobilizing efforts towards the realization of community led initiatives through top bottom macro and meso governmental and non-governmental engagements.181 In more recent times, governance structures have attempted to bridge the gap created through the lack of inclusion of micro level civil society by initiating diverse programmes focusing on association concerns. The re- assemble of governance structures at the district level and unit levels in decentralisation processes has effected changes geared towards championing participatory processes. The developments in working towards harmonious relations between governmental representation at the district level in attempting to buffer cooperation between district chief executives and traditional leaders in community development engagements allows for dialogue. The possibility of engagement on this sphere between micro civic association and government representation has contributed to the awareness of civic associations striving towards better representation and participation in processes determining their welfare.
Varying degrees of structural set ups at the micro level in relation to organisation and strength may be prevalent depending on government influences as well as development opportunities. In this vein, it may be typical to find associations based on sectoral interests having varying degrees of strength depending on resources and opportunities open to them. Developments in such micro clusters thus lies within their structural form in turn determining activities which
181
could promote or restrain engagements in forming and sustaining formal structures. Even in the activities of said structurally developed forms, Mc AREAVEY 182 observes the tendency for participation in interest seeking to take up an irregular complex process in failing to include the wider community.
The vital role played by formal as well as informal associational structures in community development should be viewed holistically, in view of a clear separation between both forms in participatory processes being hardly achievable. Communally, clustering of individuals to support engagements in forms such as serving cooperative, savings and credit needs and occupationally oriented purposes often serve as umbrella bodies for individual local economic actors from representation such as ‘susu’, and women`s groups towards drawing in vertically on services from more formally structured occupational groups. Whereas micro informal structures could tend to be more inward looking in the representation of community interests, structures more formal in nature tend to possess a bridging effect in participatory engagements, playing a vital role in negotiation processes. As such, community traders and farmers besieged by fluctuating commodity prices tend to make efforts to invest more in formal associations at meso levels during these periods in the quest to seek better market and price arrangements. Inadvertently, producers remaining engaged in horizontal engagements portray susceptibility to being highly vulnerable in terms of market fluctuations.183
Aside the existence of classical governmental and non - governmental bodies such as the district assemblies and occupational associations respectively filtered to micro levels to support communal growth, frameworks structured for communal development projects from internal and external donor organisations tend to tie the vibrance of such groupings to the terms and duration of funding.
The proliferation of development organisations at the community level providing funding for specific projects184 result in the creation of civic association emerging from parent development funded groups. It is notable to identify informal structures such as youth and village groups as well as traditional men and women’s groups aligning themselves to the more formal structures to achieve common goals in community development. Aside their organisational capacity in the realisation of internal goals, activities particularly within formal associational structures have witnessed engagements largely related to development projects 182 Mc Areavey, R. (2009:136) 183 Widner, J. in Harbeson, J.W. et al (1994:201) 184
see Northern Region - USADF grant (no. 2043) - CMA Damongo- Shea butter project; JICA / CMA project, Sagnarigu, Tamale; Walewale -West Mamprusi ; Western region - SNV women’s soap making project - Mpohor Wassa East district.
determined by district assemblies as well as other local government structures, implying in such instances the presence of some form of control by and dependence on government structures, which in comparison to informal structures, could be less significant.
Figure 2.5: Civil Association - Micro-level operational Framework
District Assembly
Formal organisation Unit Committee Indigenous groups
Communal Association Source: Author’s construct
Whilst forms of civic organisation formal in nature representing cooperatives, trader and farmer groups such as the CUA and GUTA represented at the macro level portray a wider communal base and are more inclined towards serving micro level societal interests, other forms of organisation such as representation from religious bodies; the Christian Council of Ghana among others, largely have stronger representation remaining in the upper district periphery.185 Towards realising accelerated entrepreneurial activity, the vertical bondage of communal occupational organisation to more formally structured bodies owe their capacities in engagements to participatory processes initiated by decentralised power structures
185
see CUA operational structure – Asiama, P. (2007); see Hart, E., et al - Critical Perspectives (2000:14) on GUTA communal activism.
Organisational/ Occupational development dev’t ational Village/commmunity oriented development
represented by district assembly bodies as well as the communal harnessing of social values exhibited through norms and perceptions influencing group dynamics.
2.7 Significance of civil society in micro level economic activity -