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PubMed1996

Paradigms lost: toward a new understanding of community participation in health programmes.

Community participation has been a critical part of health programmes, particularly since the acceptance of primary health care as the health policy of the member states of the World Health Organisation. However, it has rarely met the expectations of health planners/professionals. This paper argues that the reason for this failure is that community participation has been conceived in a paradigm which views community participation as a magic bullet to solve problems rooted both in health and political power. For this reason, it is necessary to use a different paradigm which views community participation as an iterative learning process allowing for a more eclectic approach to be taken. Viewing community participation in this way will enable more realistic expectations to be made. Community participation in disease control programmes focusing on community health workers is used as an example to show the limitations of the old paradigm. Participatory rapid appraisal is used to illustrate the new.

Community Health Planning↗
PubMed2002

Strategies for community participation in developing countries.

Community participation has been hailed as the panacea for most community programmes. Community participation at high levels empowers communities, increases self-reliance, self-awareness and confidence in self-examination of problems and seeking solutions for them. Behavioural changes are promoted and utilisation and support of services is facilitated, which are of great importance to all community health efforts, especially in areas where the incidence of HIV/AIDS is high or increasing. The purpose of this article is to explore community participation strategies adopted in different countries for providing community health care services. Recommendations are provided for enhancing community participation in developing countries.

Africa↗
PubMed1978

Community participation in health activities in an Amazon community of Brazil.

This article describes community participation in a comprehensive eight-year health program at Porto Nacional, a town in Brazils Amazon region. The authors discuss various techniques employed to encourage community participation, indicate methods used to resolve low-key conflicts in a positive manner, describe the major contributions made by community participation in this program, and present a number of conclusions considered applicable to other communities in this part of Brazil.

Brazil↗
PubMed2005

Perceptions of community participation and health gain in a community project for the South Asian population: a qualitative study.

BACKGROUND: The new public health rejects old individualist attempts at improving health and embraces community-based approaches in reducing health inequalities. Primary Care Trusts in England face the challenge of converting community participation in health into reality. This study explores differences in perception of participation between lay and professional stakeholders of a community health project for a South Asian population in Greater Manchester. METHODS: In-depth interviews and focus groups were used to explore the views of professional and lay stakeholders. All data were audio-taped, transcribed and analysed for emerging themes using a qualitative framework. RESULTS: Professionals talked of working in partnership with the community but lay stakeholders did not feel that they had control over the project. There were problems in engaging the community and local health professionals in the project. Lack of cultural awareness hampered participation in the project. There was agreement that the project improved the self-confidence of participants and created a more informed population. However, there was little support for claims of improvements in social cohesion and changes in lifestyle directly as a result of the project. CONCLUSION: Converting the rhetoric of community participation in health into reality is a greater challenge than was envisaged by policy makers. Marginalized communities may not be willing participants and issues of language and cultural sensitivity are important. Project outcomes need to be agreed to ensure projects are evaluated appropriately. Projects with South Asian communities should not be seen to be dealing with all 'ethnic health' issues without addressing changes in statutory organizations and other wider social determinants of health.

Asia↗
PubMed2000

Surgery and community participation in a community-based programme in war situations.

The paper presents the results and the experience gained from three 'mass surgical interventions' conducted in the Alpha Civil Hospital, Billing in south Sudan in the period between October 1996 and November 1997. The results showed that surgical services can be provided safely and economically even under most difficult conditions provided professional experience plus community commitment and participation are there. Such interventions lead to the development of strong community self-reliance and willingness which are fundamental if the programme is to be sustained.

Community Health Services↗
PubMed1991

Training primary health care workers to foster community participation.

A low level of community participation was identified as one of the weaknesses of the health sector in the United Republic of Tanzania. In order to remedy this situation, a systematic process of training trainers and students was established with full involvement of village people. Twenty-five themes were put forward as starting points for discussions between students and villagers. The students were encouraged to learn from the villagers by listening to them and asking them questions. They also participated in community activities and lived with villagers so as to obtain a good understanding of rural living conditions. In this way, problems were identified and solutions were jointly formulated. A workbook was developed during a series of workshops with students, trainers, village communities, and planners. At least two teachers were trained from each health training school; all schools were supplied with workbooks. The approach has been adopted by most health training schools in Tanzania, and the Ministry of Health is now committed to it. Both students and trainers find this to be a valuable learning experience.

Community Health Services↗
PubMed1999

Enhancing community participation in intervention research: farmworkers and agricultural chemicals in North Carolina.

The participation of affected communities in the development of public health intervention research improves project sustainability and effectiveness by making projects more relevant and acceptable to the communities. This article presents a multimode, multidomain model approach for community participation in different project components, which ensures the benefits of participation without requiring the same level of participation in every activity or by every community sector. A case study is used to illustrate the model, describing procedures for establishing and maintaining farmworker participation in developing an intervention to reduce exposure to chemicals. Farmworkers are a poor and underserved population for which the empowering and culturally appropriate benefits of community participation are especially needed. However, this population presents challenges for participatory health projects: geographic dispersion, ethnic diversity, lack of organization, sense of powerlessness, and communication and transportation difficulties. The lessons learned in this case extend the method and theory of community participation.

Adult↗
PubMed2005

Orthopedic impairment after medical rehabilitation: functional performance and satisfaction with community participation.

OBJECTIVE: To determine the prevalence of satisfaction with community participation and to examine associations between change in functional status and satisfaction with community participation for persons with orthopedic impairments. DESIGN: Retrospective study of 3832 patients discharged from medical rehabilitation facilities in 2001 using information from the IT Health Track database. RESULTS: Primary measures were the FIM instrument and satisfaction with community participation. The majority of patients (86.9%) were satisfied (very or somewhat) with their level of community participation. Positive-change scores in FIM total from admission to the 80- to 180-day follow-up were associated with an 8% increased odds of being in a higher satisfaction with community participation level (odds ratio, 1.08; 95% confidence interval: 1.07, 1.09) after controlling for age, gender, marital status, race/ethnicity, insurance source, length of stay and functional status. Similarly, positive-change score in motor (odds ratio, 1.09; 95% confidence interval: 1.08, 1.10) and cognition (odds ratio, 1.26; 95% confidence interval: 1.19, 1.32) FIM measures from admission to follow-up were associated with greater satisfaction with community participation. CONCLUSION: Gains in functional status were significantly associated with greater satisfaction with community participation. Satisfaction with community participation provides information useful to evaluate patient recovery after discharge from inpatient medical rehabilitation.

Adult↗
PubMed1991

Community participation and attitudes of decision-makers towards community involvement in health development in Saudi Arabia.

National policies and government strategies in Saudi Arabia are adequate for the promotion of community involvement in health development (CIH). The system of government is decentralized and has ample scope for intersectorial cooperation. In Ha'il and Qasim regions active efforts are being made to realize intersectorial coordination through regional committees in which community leaders are involved; unfortunately, however, such mechanisms are lacking at the central level. Decision-makers and community leaders adequately recognized and interpreted the importance of CIH. Most of the respondents advocated community participation in planning and evaluation, while less than 50% thought that communities could participate in the implementation of health services. A survey in Ha'il and Qasim regions of 2417 residents indicated that community participation in health activities was in its infancy and that considerable effort is still needed at the central, regional, and peripheral levels to achieve meaningful community involvement in health.

Community Participation↗
PubMed2005

Ascribing quantitative value to community participation: a case study of the Roll Back Malaria (RBM) initiative in five African countries.

OBJECTIVES: There are two objectives. The first is to outline the processes involved in the estimation and use of quantitative values to measure community participation. The community participation value (Cp value) is a new concept being introduced in this study. The second is to compare the levels of community participation in the RBM programmes in five African countries, namely, Burkina Faso, Ghana, Nigeria, Tanzania and Uganda. STUDY DESIGN: The study design is based on the Rifkin and Pridmore Spidergram model for assessing the level of community participation in a development programme. METHODS: The methods involved a structured review of web-based and published secondary data. Appropriate indices were used to capture the extent of malaria control in the respective countries. Comparisons were then made between the Cp values and the results obtained for malaria control in order to arrive at a judgement of the significance of community participation to the success of the RBM programmes. RESULTS: The findings from this study showed that community participation was present in varying degrees in the RBM programmes of the different countries. The computed Cp values for the five countries under consideration were as follows: Uganda (12.5), Ghana (10.5), Tanzania (10.0), Nigeria (9.0) and Burkina Faso (8.0). Based on a maximum attainable Cp value of 25, it was observed that the level of community participation in the RBM initiative is still generally low in the countries studied. CONCLUSIONS: Although community participation was present and relevant to the Roll Back Malaria initiative, other factors appeared to have more significant influence on the success, or otherwise, of the initiative. Such factors include the availability of financial resources for malaria control, competent health personnel, and the general health infrastructure available in a given country.

Africa↗
PubMedDate not supplied

[Expenditure evaluation of the construction of health units: example of community participation].

OBJECTIVE: Demonstrate the economic benefits that community participation may render in the construction of health units. MATERIALS AND METHODS: The purpose of this study was to analyze the efficiency in the construction of 21 auxiliary health units and 81 rural health built through the Program to Support the Development of Health Services for the Non-Insured Population (PASSPA) through three different construction models (national public bidding, restricted invitation and community participation). Comparisons were also made with the units built through regular construction procedures of the Ministry of Health and other institutions. To evaluate the expenditure/m2, a univariate analysis using non-parametric statistics and a mathematical model of bootstrapping were used. RESULTS: The median expenditure/m2 and the delivery times for auxiliary health units, and the median expenditure/m2 for rural health units were smaller when using community participation. The expenditure/m2 of those units built through PASSPA was considerably lower than that of health units built through regular construction procedures. CONCLUSIONS: The use of community participation in the construction of auxiliary health units and rural health units may impact positively the resource investment and the delivery times when compared with units built through national public biddings and restricted invitations. The possibility of using community participation in other health activities (supervision, maintenance) should be evaluated. The English version of this paper is available at:http://www.insp.mx/salud/index.html.

Capital Expenditures↗
PubMed2001

Community participation and the delivery of veterinary services in Africa.

Community participation is now widely promoted as an important feature of aid projects in less-developed countries. However, definitions, uses and expectations of community participation vary considerably among professionals (including veterinarians). A lack of common understanding of community participation hinders the comparison of experiences between projects and can lead to false hopes regarding how community participation should be used and what it might deliver. This paper provides an overview of experiences with community participation in animal-health service development and research in Africa. By examining two types of community-based animal-health intervention, the paper also describes how community participation can vary in veterinary projects and relates this variation to project impact and sustainability. Projects that encourage types of community participation such as interactive participation and self-mobilisation are most likely to result in sustained benefits for livestock keepers.

Africa↗
PubMed1982

The demand for human resources by the community: the implications of a community participation approach.

The author states that community participation needs to be designed at the national level and executed at the local level, which therefore places greater demands on the organizational efficiency and communication skills of national agencies. The ramifications of a community participation approach reach all aspects of national planning, including budget procedures and allocations of responsibility. Above all, the approach requires that authority, responsibility, and procedures be clearly spelled out and understood by all involved. Only when national strategies have been set for numbers of communities to be served, level of service, and degree of community involvement, can the specific implications for manpower needs, training, and national support services be discussed, evaluated, and quantified. Given a clear indication of national policy directions for community participation, sector planners can begin discussions with their regional offices, other agencies, and community leaders on how to implement it. This article reviews some of the major issues about human resources that need to be addressed in the planning process.

Community Participation↗
PubMed1991

Community participation in vector borne disease control: facts and fancies.

The community involvement in solving their problems was spontaneous when the society as a whole had extensive control over the natural resources. However, this trend was lost during the industrial revolution when the social structure started disintegrating. Simultaneous discovery of antiparasitic drugs and powerful insecticides created a euphoria that all vector borne diseases could be controlled if not eradicated. Though the use of these tools resulted in control or eradication of vector borne diseases in many parts of the developed world, in poor developing countries the initial gains could not be sustained. This is partly due to non acceptance of technology by the beneficiary. Realizing that technology without the people is not going to solve the problem, the idea of community participation was revived. Since then, community participation has become a popular slogan and most programmes claim to have achieved community participation. The projects have not originated from the community and fail to differentiate between the gain achieved due to community effort and that due to the project personnel. The technical and material inputs provided are much higher than the national programmes can afford, carried out in limited areas for short periods and sustainability never demonstrated. Community participation in vector borne disease control has considerable potential specially in source reduction, reduction in man vector contact or accepting antiparasitic or antivector measures. True sustainable participation is possible only when the present trend of top-down planning is reversed to bottom-up planning; decision making power is handed over to the community; the people involved in conceiving, planning, implementation and evaluation of all developmental programmes and if the programmes are responsive to local needs and priorities.

Animals↗
PubMedDate not supplied

Resource dependency and community participation in primary health care.

Great hope is accorded to community participation in health. A large number of potential benefits are attributed to participatory processes, including better addressing community needs through more locally adapted organizational processes and improvement in health outcomes. To this end, many governments around the world have adopted policies and programmes of community participation as part of their strategy to implement primary health care services. In Mexico this is, in great part, realized through the module programme of the Ministry of Health. A module is characterized by various village based health posts (casas de salud), each operated by a community volunteer and associated with a health committee, all of which are supervised by a nurse from a nearby health centre. The southern Mexican state of Oaxaca was chosen for a study of the module programme (during the period 1987-1992) to gain a better understanding of how organizational processes impact on the implementation and outcomes of community participation programmes in large institutions (i.e. the Ministry of Health). The resource dependency perspective formed the basis for the theoretical framework used. Some 75 towns and villages were visited and about 170 health related personnel from all over the state were interviewed to obtain data on the operation and impact of the module programme. As predicted by resource dependency theory, which postulates that organizations will react to pressures in their external environment to secure the resources needed for survival, the findings of this research led to the conclusion that the Ministry of Health had co-opted the resources of the communities it was involving in the module programme in order to meet its policy objectives, especially those related to expanding service coverage. Community participation in the module programme was found to have been implemented entirely for its utility in supplying resources and not for democratic or intrinsic values. This strategy, identified as the resource dependency approach to community participation, led to several flaws in the participatory process and resulted in far less than what could potentially have been achieved in terms of improving health outcomes. Ultimately, the participatory mechanisms became additional dependencies of the health system and not integral components of a process of community development. Large institutional programmes of community participation can benefit by understanding this approach and avoiding its inherent problems.

Community Participation↗