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Citizen participation is a crucial aspect of the national health system, empowering individuals to contribute to improving local health services through Health Committees (HCs). HCs promote the participation of citizens in the delivery of primary healthcare services. The study explores the perceptions of citizen participation in the context of the Ruhama County Ntungamo local government area, Uganda. This study aims to understand the impact of HCs on healthcare service delivery. Using a qualitative approach of inquiry grounded in thematic analysis and rooted in principal-agent theory in a single case study, this study examined citizens' participation in the delivery of a local healthcare service. The study is based on interviews with 66 participants comprising health workers, patients, residents, health administrators, local councillors, and HC members. The findings reveal a notable absence of a health committee in healthcare delivery in Ruhama County. The absence is attributed to a need for a formalised citizen participation structure in managing health facilities and service delivery. It raises concerns about the limited influence of citizens in shaping healthcare policies and decision-making processes. The study recommends the incorporation of health committees into the local health systems to enhance participation and grant communities greater influence over the management of health facilities and service delivery. Incorporating health committees into local health systems strengthens citizen participation and leads to more effective and sustainable healthcare services aligned with people's needs and preferences. Integrating health committees within Itojo Hospital and similar facilities can grant citizens a meaningful role in shaping the future of their healthcare.

Participatory monitoring and evaluation (PM&E) approaches have been touted as an important concept for local participation in social interventions programmes. Utilizing a process analysis approaches, the PM&E data gathered through key informant interviews, formal surveys, and policy frameworks were analyzed. The study revealed three dominant power struggles between youth and programme implementers in three districts at the Greater Accra region, Ghana. The first and pervasive form of power dynamics involves the youth and programme implementers. The second involves a variety of arrangements with the government on one hand and implementers and youth on the other side. The third is who qualifies to be a beneficiary and for that matter participate in the PM&E. In these three forms of power struggles the paper reveals superior implementers control of who participate in the programme PM&E and at what stage in the process. The power imbalance between programme implementer and target beneficiaries impeded the level of beneficiaries' participation in the PM&E., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

To trickle down poverty in rural areas, development partners and national governments have instituted enterprise development programmes which call for the establishment of some participatory frameworks to enable rural entrepreneurs determine for themselves, the exact Business Development Service (BDS) they desire to bring about economic improvement and social change. In ensuring that the concept of participation is not merely a wish list, the article modified Choguill's ladder of community participation as a de facto lens to examine whether "participation" really exists in these programmes by drawing on evidence from the Rural Enterprises Programme (REP) in Ghana. Using qualitative in-depth interviews grounded in a single case study design (REP), the study observed that despite the existence of structures that appear to involve entrepreneurs at all stages of the decision-making process, beneficiaries think otherwise. Notwithstanding, some context and power-induced factors were identified to have accounted for these discrepancies. [ABSTRACT FROM AUTHOR]