Common Health: The Role of Non-Profit Organizations in Supporting Community Action for Health Equity and Justice

This dissertation explores the ways in which reporting requirements, evaluations, management decisions and other metrics and processes contribute to a growing gap between community development goals of community health centres and their practice. My argument is that there is a gap between the community development mandate of non-profit organizations and their practices, which is increasingly shaped toward direct service-delivery and steered away from the advocacy and community development pillars of their mandates. As a result, the capacity of non-profit organizations to support equitable community participation is curbed. Such a gap is largely facilitated through funding relations that prioritise functional accountability and results-based performance measurement that are consistent with extractivist capitalism. Extractivist goals of neoliberal capitalism imposed on non-profits undermine the goals of equity and social justice in urban community development. The purpose of this research is a careful examination and explication of power relations in everyday work of practitioners in the non-profit sector. I examine non-profit organizations as civil society actors, situated in the broader context of neoliberal capitalism where some actors are subordinate to others, and where subordination results from unequal access to and distribution of resources. I employ institutional ethnography and participatory action research as a methodology. I collected data from two community health centres and one inter-organizational network located in Torontos priority neighbourhoods and interviewed community volunteers, frontline workers, management staff and funders. I also reviewed documents such as reporting requirements and templates, evaluation frameworks and reports. In order to capture the ways in which reporting and functional accountability systems normalize extractivist processes in the non-profit sector, I constructed maps and diagrams to make such processes explicit. My research analyses how the role of non-profit organizations in regard to community action is shaped within capitalist power relations. To counteract and resists extractivist processes, I propose directions for strengthening the role of non-profit organizations as partners in collaborative processes involving co-production with community members.