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Advocates of participatory approaches to service delivery see devolution as key to empowering people to take charge of their own affairs. Participation is portrayed as guaranteeing the delivery of services that are in line with user preferences. It is assumed that people are keen to participate in public affairs, that they possess the capacity to do so, and that all they need is opportunities. Using evidence from ethnographic research in Uganda, this article questions these views. It shows that, to succeed in the long term, devolution and participation must take place in the context of a strong state, able to ensure consistent regulation, and a well‐informed public backed up by a participatory political culture.

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BackgroundCases of premature death in Africa may be attributed to witchcraft. In such settings, medical registration of causes of death is rare. To fill this gap, verbal autopsy (VA) methods record signs and symptoms of the deceased before death as well as lay opinion regarding the cause of death; this information is then interpreted to derive a medical cause of death. In the Agincourt Health and Demographic Surveillance Site, South Africa, around 6% of deaths are believed to be due to ‘bewitchment’ by VA respondents.MethodsUsing 6874 deaths from the Agincourt Health and Socio-Demographic Surveillance System, the epidemiology of deaths reported as bewitchment was explored, and using medical causes of death derived from VA, the association between perceptions of witchcraft and biomedical causes of death was investigated.ResultsThe odds of having one's death reported as being due to bewitchment is significantly higher in children and reproductive-aged women (but not in men) than in older adults. Similarly, sudden deaths or those following an acute illness, deaths occurring before 2001 and those where traditional healthcare was sought are more likely to be reported as being due to bewitchment. Compared with all other deaths, deaths due to external causes are significantly less likely to be attributed to bewitchment, while maternal deaths are significantly more likely to be.ConclusionsUnderstanding how societies interpret the essential factors that affect their health and how health seeking is influenced by local notions and perceived aetiologies of illness and death could better inform sustainable interventions and health promotion efforts.

The paradigm of 'inclusive neoliberalism' that currently characterises international development places a particular emphasis on community-based responses to the often structural problems of poverty and exclusion. Such approaches have become increasingly controversial: celebrated by optimists as the most empowering way forward for marginal citizens on the one hand, and derided as an abrogation of responsibility by development trustees by sceptics on the other. Uganda provides a particularly interesting context to explore these debates, not least because it has become a standard bearer for inclusive neoliberalism at the same time that regional inequalities within it have become increasingly apparent. Our investigation of the flagship response to deep impoverishment in its northern region, the World Bank-funded Northern Uganda Social Action Fund, offers greater support to the sceptics, not least because of the ways in which the more pernicious tendencies within inclusive neoliberalism have converged with the contemporary politics of development in Uganda.