indispensable and the concept of governance is central to this.
This paper focuses on governance, participation, intersectoral action and the distribution of power and how these all contribute to health equity in and among urban settings. The provision of water and sanitation presented later serves as an analytical lens to examine governance and health equity.
Governance is defined as: “the process of collective decision making and processes by which decisions are implemented or not implemented13”: the power to / capacity to act and power-with. Governance is understood as a dynamic process and structure that is changing over time and embedded in context. Analysis of governance should focus on the actors involved in collective decision-making and implementation processes as well as on the structures established to ensure the effective implementation of the decisions (UNESCAP).
Governance is concerned with the distribution, exercise and consequences of power (Hay, 2003). Analysis of the (re)production of power relations in governance is necessary (Navarro, 2000). Although there appears to be general agreement that the quality of governance is important for development, much less agreement appears to exist on what the concept really implies and how it should be used. The ambiguities, dilemmas and concerns surrounding the concept can be explained by the fact that many developmental agencies have employed the concept for various purposes, in different contexts and to advance their own agendas (Hyden et al., 2004). Thus, understanding participation and urban governance from a perspective of power and power relations requires knowledge of the historical, social and economic processes that have characterized the social relations and citizenship in specific local, national, regional and global contexts (Barten et al, 2002; Flores et al, 2009).
Power is a contested concept and understood in different ways14 (Dahl, 1961; Clegg, 1989; Scott, 2001; Pearce, 2007). According to Clegg (2007, p. 190-227), power manifests at the level of agents and at the level of structures, in which actors interact; and these multiple levels influence each other. A multi-dimensional perspective of social power is based upon the following mechanisms: the possession of superior resources (Dahl, 1969); the control of participation and debate (Lukes, 1974); and the capacity of shaping interests (Gaventa,
13 See http://www.unescap.org.
14 In Spanish power – Poder - has a double meaning: “power over” as well as “power to/capacity to act”.