The functions of participation in a village-based health pre-payment scheme - What can participation actually do?

This article analyses micro-level interactions in one case study to argue t hat participation does not necessarily lead to accountability. The case stu dy covers the process of establishment, implementation and evaluation of a village-based health pre-payment scheme in a poor village in China. Judged on widely used criteria, the scheme and evaluation activities represent exa mples of high degrees of community participation. However. analysis of the process points to the influence that different interests, different channel s for voicing interests, and unequal power relations have in determining: t he outcome of decision-making processes.