Challenging the official approach to health care through reflective practice: a case study of a community health NGO in Bolivia

The community health non-governmental organisation (NGO), CODGO Bolivia aims to foster two forms of critical reflective practice in its staff and trainees - critical practical reflectivity (perspective transformation) and critical political reflectivity (conscientisation). Reflective practice is seen as an integral aspect of the organisation's aim to counter a narrow biomedical view of health with what is termed 'integrated health'. This paper will analyse CODGO's ability to achieve its aims through using Yip's four levels of reflective practice (0 = absence of reflectivity, 1 = basic practical reflectivity, 2 = reflectivity in action, and 3 = critical practical reflectivity - perception transformation) and four categories of interlocking factors: philosophical/ideological, politico-economic, sociocultural and practical/pragmatic. A tool based on the four categories of factors is also discussed as a means of making explicit and mitigating against some of the potential difficulties surrounding CODGO's approach.