Paper short abstract:

Health systems have for a long time operated as neo-colonial paternalistic institutions. This paper explores the role of Citizens Health Watch Zimbabwe as a boundary spanning organisation, analysing the roles of location, credibility and , legitimacy in the navigation of entrenched social worlds.

Paper long abstract:

Health systems across the developing world have for a long time been viewed as neo-colonial paternalistic institutions, driven by the privileged knowledge, skills, intellect and insights of trained clinicians, regulators and allied professionals. This deeply embedded and pervasive model of operation, derived from and based-on western allopathic health care models, has remained enduring and tenacious, to the extent that efforts across many countries to 'put patients first' have remained mere aspirations with no programmes of work behind the rhetoric. This is highly unsurprising, as hegemonic models of practice do tend to proceed and survive by way of entrenching themselves and closing out spaces for alternatives. Citizens' Health Watch (CHW) Zimbabwe was established in 2013 to serve as an inclusive, citizen-centred, knowledge-based platform for harnessing and deploying individual and collective patient and care-giver experiences in health system strengthening. This paper explores the role of CHW as a boundary spanning organisation, in particular analysing the roles of location, credibility, legitimacy and salience in the organisation's navigation of multiple, contentious and entrenched social worlds, and contribution to the emergence of innovative, inclusive and accountable maternal and adolescent health care programmes across the country. In the final analysis, the paper argues how CHW is an illustration that untangling and decentring entrenched and privileged models of practice are exercises hinging on the quality of linkage between knowledge and action and the decision space that links the two. That space requires innovative interaction between, communication and stabilisation of, multiple messages.