When communication falters, progress halts

We thought we were asking a simple question.

Action Against Hunger UK recently commissioned a student consultancy literature review of community-led health and nutrition initiatives for children under five in low- and middle-income countries. In essence, we wanted to identify programmes where communities had meaningful control from concept to evaluation, and to understand what could be learned from them.

It sounded straightforward. It was not.

As we reviewed two thousand one hundred article abstracts, we quickly found ourselves in a semantic quagmire. The term “community-led” was applied to a wide range of practices, many of which were difficult to understand from the scant details provided. And “community-led” was only one term among many.

Community-led. Co-creation. Co-design. Community engagement. Participatory design. Localisation.

These words appeared frequently, but not consistently. “Community-led” in one article did not necessarily mean the same thing as “community-led” in another. In some cases, similar approaches were described as “localisation”, “co-design” or “participatory” work. Often, the terms were used without clear definitions or explanation of what participation involved.
This raises some uncomfortable but necessary questions.

Who is “the community”? What counts as “participation”? How does “community-led” differ from “community-based”? Who makes decisions? Who holds resources? Who defines the problem, designs the intervention, leads implementation and evaluates success?

Too often, the answers are unclear.

Not a new problem

Since the 1978 Alma-Ata Declaration helped bring participatory language into global health discourse, the sector has adopted successive waves of terminology: participatory development, community engagement, localisation, co-design, co-creation and co-production. Each term has brought useful ideas. But each has also added to an increasingly crowded vocabulary that does not always carry shared meaning^{1 2}.

A systematic scoping review of co-production and co-design in health and social care found that approximately one third of publications did not define or explain the terms they used. Among those that did include at least one definition, the authors mapped the sixty most common definitions³.

In other words, even when definitions are provided, there may still be little consensus. There is an entire global health language that many of us have adopted, often without noticing. We may be using the same words while meaning very different things.

This does not mean every concept needs to be tied down with rigid definitions. Some flexibility is both unavoidable and useful. Concepts such as participation, localisation and community leadership need to be adaptable across contexts.

Too much flexibility creates risk

Ambiguous language makes it harder to compare evidence, learn across programmes, and understand what has been done. It also makes it easier for the sector to move from one fashionable term to the next without reflecting on what has, or has not, changed in practice.

Global health is constantly evolving and rightly seeks new strategies to replace approaches that are not working. But when new language becomes popular, it can also become a badge of legitimacy. Organisations may feel pressure to adopt the latest terminology because it signals alignment with current priorities, attracts attention, or becomes increasingly linked to funding and resources².

This is where buzzwords can become dangerous.

Development scholar Andrea Cornwall captured this clearly in Buzzwords and Fuzzwords: Deconstructing Development Discourse⁴:

That critique may sound cynical. But the consequences are real. Ambiguity does not only create confusion. It creates accountability gaps.

If no one agrees on what “community-led” means, almost any project can claim the label. A programme may describe itself as locally led while strategic decisions, funding priorities and accountability remain largely in the hands of external actors. This is not necessarily done maliciously. But vague language makes it difficult to distinguish genuine shifts in power from changes in terminology.

Too often, changing the vocabulary risks being mistaken for changing the practice.

This is particularly concerning in community-led health and nutrition work, where language about participation is closely tied to questions of power. If communities are described as leading, but have limited control over priorities, resources, implementation or evaluation, then the language may obscure more than it reveals.

A failure to understand and learn from previous approaches also risks trapping the sector in a cycle of repackaging familiar ideas. We face the same challenges, rediscover similar lessons, and present them under slightly different labels.

Stein, Storeng and Pyvallée have challenged the “global health nonsense” of ambiguous buzzwords, convoluted jargon and empty rhetoric⁵. Their critique matters because language shapes what we see, what we value, and what we are willing to question.

So what can we do?

First, we can approach buzzwords cautiously. When terms such as “community-led”, “localised”, “participatory” or “co-designed” are used, we should not assume shared understanding. We should ask what they mean in practice.

Second, we can be clearer in our own language. We can define the terms we use, describe who was involved, explain where decision-making power sat, and be honest about the limits of participation.

Third, we can challenge vague language when we encounter it. Not to be pedantic, but because clarity matters. It matters for evidence. It matters for learning. It matters for accountability. Most importantly, it matters for the communities whose involvement is so often named, but never clear.

The next time we read a paper, funding proposal or strategy document that describes an initiative as community-led, co-designed or locally led, we should pause and ask one simple question: what happened?

If the answer is not clear, neither is the language.

For more reading, check out these articles:

• Buzzwords and fuzzwords: deconstructing development discourse 
• Global health nonsense
• International Development Buzzwords: Understanding Their Use Among Donors, NGOs, and Academics
• What do buzzwords do for development policy? a critical look at ‘participation’, ‘empowerment’ and ‘poverty reduction’  

References:

1. Morgan, L. M. (2001) ‘Community participation in health: perpetual allure, persistent challenge’, Health policy and planning, 16(3), pp. 221–230. https://doi.org/10.1093/heapol/16.3.221.
2. Schnable, A., DeMattee, A., Sullivan Robinson, R. and Brass, J. N. (2021) ‘International Development Buzzwords: Understanding Their Use Among Donors, NGOs, and Academics’, The journal of development studies, 57(1), pp. 26–44. https://doi.org/10.1080/00220388.2020.1790532.
3. Masterson, D., Areskoug Josefsson, K., Robert, G., Nylander, E. and Kjellström, S. (2022) ‘Mapping definitions of co-production and co-design in health and social care: A systematic scoping review providing lessons for the future’, Health Expectations, 25(3), pp. 902–913. https://doi.org/10.1111/hex.13470.
4. Cornwall, A. (2007) ‘Buzzwords and Fuzzwords: Deconstructing Development Discourse’, Development in Practice, 17(4/5), pp. 471–484. http://www.jstor.org/stable/25548244.
5. Stein, F., Storeng, K. T. and de Bengy Puyvallée, A. (2022) ‘Global health nonsense’, BMJ, 379, pp. o2932. https://doi.org/10.1136/bmj.o2932.