Counting the voices to the voices that count

Dr. Priti Biswas, University of East Anglia


Recently, while defending government policy on social care funding on TV, a politician was emphasising that decisions are based on having listened to ‘the lived experiences of people’.  I could not help but wonder whose lived experiences do they mean? Over the years, I have been a little puzzled by this question.  In the context of inclusive and participatory policy-making, whose voices are listened to. Whose voices really count?

As an international development practitioner and researcher, I have listened while evaluating projects that seek positive impacts on destitute women in hard-to-reach communities. From remote villages in Bangladesh, refugee camps in Ethiopia, war-torn communities in Chechnya, or the remotest corners of Sierra Leone, there is always a common thread. The projects target the most vulnerable and seek the engagement of the ‘beneficiary’ community – where will the community water pump be installed, the health centre established, the food aid distributed. These are donor-funded projects with strict timelines and milestones to achieve, and measured by a mid-term or end line evaluation. They reveal that over the project life, some number of community groups were formed and consulted and project interventions were implemented. Successes are tabulated and voices are counted. As an external evaluator, I would often find bright colourful display of such data on tables and charts handed to me. Yet during the rare opportunity to talk to a so-called ‘destitute woman’, this beneficiary usually had a different story to tell. She did not attend the meeting because of her many burdens and the inconvenience of place or timing, so she remained voiceless…powerless within her own community.

Things may have changed in development projects by now or maybe not. I have not been up to date with it in recent years, and I work exclusively in the UK health and social care arena these days. However, some things do not seem to change from rural Bangladesh to rural Norfolk where I endeavour to learn what matters to people in the context of dementia care. Who would know this better than the people who are living with the condition? But it does need patience, commitment to listen, and time, that we at times do not have. We all know that a person living with dementia can take much longer to reply to a question, whether living at home or in a carehome, and the answer may or may not be clearly constructed. It is much easier to let someone else, a family member, a friend, a carer or a professional to talk on their behalf, to tell us what the person with dementia thinks. Of course, others have their knowledge too.  But only the person with dementia will know their own points of view. With time, patience, and total commitment we can reach this hard-to-reach group of people and access their preferences, ideas, concerns.

I suppose the point I am trying to make is a simple one. As researchers, our work is recognised and used by politicians and by project funders. We have a complete responsibility to make every effort to listen to that voice that counts, even when it might not be more than a whisper of semi- constructed words delivered long after the question was asked.  It is our job to make it count. We cannot just count voices in a time-bound project world.  Rather, we must always seek, self-reflect and uphold a total commitment to listen to those voices that really count. It is not easy, but it matters!


Funding Acknowledgement and Disclaimer

This study/project is funded by the National Institute for Health Research (NIHR) Health Service Research and Delivery programme (HS&DR NIHR127234) and supported by the NIHR Applied Research Collaboration (ARC) East of England.

The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.