PAHO's 75th anniversary highlights role of "community participation.".
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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.
Study of some Latin American experiences of community participation in health programs permit consideration of the following as minimum requirements for the establishment of interrelationships between local health agencies and the community: a local health system; a participating health team; respect for the community; contact with community organizations; and contact with private and governmental organizations at a local level. The models for community participation in health are manifold and the experiences have been countless. For teaching purposes and based on Latin American experiences several considerations are made regarding: community health volunteers; local health councils; local councils for community development; and health brigades. Finally, it is stressed that active and organized community participation in health activities is the best guarantee of success in implementing integral health programs.
The study of some Latin American experiences of participation of the community in health programs allows us to consider the following as minimum requirements to establish interrelationships between local health organisms and the community: a) To have a local health system. b) To have a participating health them. c) To show respect for the community. d) To have contact with community organizations. e) To have contact with private and government organizations at a local level. The models for participation of the community in health are manifold and the experiences have been countless. For teaching purpose and based on Latin American experiences, some considerations are made regarding: 1) Community health volunteers. 2) Local health councils. 3) Local councils for community development. 4) Health brigades. Finally, it is concluded that the active participation of the community organized in health activities is the best guarantee of success in implementing integral health programs.
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A two and a half year's experience of a community participation group has shown that this can have a valuable role in suggesting practicable improvements in a group practice. Topics discussed by the group (which is composed of one representative from every known organization in the area) have included problems of receptionists; the role of the individual ancillary worker; and teaching in general practice. The high attendance rate at the group's meetings testifies to the community's interest in primary health care services.
PAHO's Directing Council recently requested a special Health Ministers' meeting to examine the subject of extended health coverage and to look into adjustments needed to achieve goals established in this field with all possible speed. The present document, which was prepared for that meeting, outlines the basic concepts involved in extending health coverage through adapted and expanded primary care and community participation. Its principal purpose is to serve as a reference source for subsequent analyses that PAHO's member countries will wish to carry out.
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The achievement of significant levels of influence on six program decision areas by communities served by health care program is investigated using Guttman scale analysis in a sample of 50 Children and Youth comprehensive health care projects in the United States to determine whether such achievement occurs in an ordered or a random sequence. Evidence presented indicates that the achievement of relative levels of community influence is orderly for initial levels of influence; higher levels of community influence apparently do not follow the same order. Implications of these findings for planning and predicting the development of personal health service programs are discussed.
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Certificate-of-need statutes give designated state agencies veto power over investment in health care facilities. Some states have sought to temper the arbitrary character of this power by expanding the opportunities for community input into the certificate-of-need process. Massachusetts, for example, has enacted a statute that allows groups of ten taxpayers to petition for a public hearing on any certificate-of-need application. Some observers question whether the benefits of taxpayer-group participation are substantial enough to compensate for the delays and abuses that the statute allegedly invites. To help resolve this question, this Comment examines historical data on Massachusetts taxpayer groups and on their activities and assesses the significance of their composition and tactics to the certificate-of-need process. Although flaws exist in the Massachusetts ten-taxpayer mechanism, in this writer's view it has succeeded partially in making the certificate-of-need process responsive to community opinion. Many groups lack the skills and qualities needed to make constructive use of the ten-taxpayer mechanism. Nevertheless, it serves a valuable purpose by creating a public forum for and by encouraging public participation in the certificate-of-need process, especially by those who might otherwise try to circumvent that process through use of special legislation, of private pressure, or of other similar means.
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