Lessons from community participation in health programmes (original) (raw)
Related papers
Paradigms lost: Toward a new understanding of community participation in health programmes
Acta Tropica, 1996
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 booth 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 electric 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.
Introduction: This paper synthesises reports on community participation (CP) concept and its practicability in countries' health service systems, much focus being on developing countries. Methodology: We narratively reviewed the published and grey literature traced from electronic sources and hard copies as much as they could be accessed. Findings: CP is a concept widely promoted, but few projects/programmes have demonstrated its practicability in different countries. In many countries, communities are partially involved in one or several stages of project cycles -priority setting, resource allocation, service management, project implementation and evaluation. There is tendency of informing communities to implement the decisions that have already been passed by elites or politicians. In most of the project/programmes, professionals dominate the decision making processes by downgrading the non-professionals or non-technical people's knowledge and skills. CP concept is greatly...
Lessons from community participation in health programmes: a review of the post Alma-Ata experience
International Health, 2009
The year 2008 marked the 30 year anniversary of Primary Health Care, the health policy of all member nations of the WHO. Community participation was one of the key principles of this policy. This article reviews the experiences of and lessons learned by policy makers, planners and programme managers in attempting to integrate community participation into their health programmes. The lessons, identified in an earlier article by the author, are still relevant today. They help to identify three reasons why integrating community participation into health programmes is so difficult. These reasons are: (1) the dominance of the bio-medical paradigm as the main planning tool for programmes, leading to the view of community participation as an intervention; (2) the lack of in-depth analysis of the perceptions of community members regarding the use of community health workers; and (3) the propensity to use a framework that limits investigation into what works, why and how in community participation in health programmes. Despite these challenges, evidence suggests that community participation has contributed to health improvements at the local level, particularly in poor communities, and will continue to be relevant to programme professionals.
Social Science & Medicine, 2010
Community participation was identified as one of the key components of Primary Health Care as articulated in the Alma Ata declaration of 1978 and is enjoying a renewal of interest in both low and high income countries. There remains, however, an on-going challenge in how to assess its role in achieving health improvements. This is largely due to the multiplicity of definitions of community participation, which has made it difficult to evaluate its impact on desired programme outcomes, such as uptake and sustainability, as well as broader health improvements. This paper addresses this challenge by first defining a continuum of community participation that captures its many forms, and then incorporates this into an evaluation framework that enables an analysis of the process of participation and links this with health and programme outcomes. The continuum of participation and framework is based upon the spidergram of Rifkin, Muller, and Bichmann (1988), but modified in the light of the growing literature on community participation and also in relation to our original requirements to evaluate the role of community participation in nutrition-related child survival programmes. A case-study is presented to provide a worked example of the evaluation framework and its utility in the evaluation of community participation. While this is a literature-based and retrospective analysis, it demonstrates how the evaluation tool enables a nuanced analysis of the different ways in which communities can participate in the delivery of health-related interventions. It could be used prospectively by those involved in programme design and implementation to further our understanding of community participation and its relationship with health outcomes, as well as key programme outcomes, such as sustainability.
Policy & practice Community participation in health
2017
Marston, C; Hinton, R; Kean, S; Baral, S; Ahuja, A; Costello, A; Portela, A; (2016) Community participation for transformative action on women’s, children’s and adolescents’ health. Bulletin of the World Health Organization, 94 (5). pp. 376-82. ISSN 0042-9686 DOI: https://doi.org/10.2471/BLT.15.168492 Downloaded from: http://researchonline.lshtm.ac.uk/2548679/ DOI: https://doi.org/10.2471/BLT.15.168492
BMC Health Services Research
Background: Many international health policies recognise the World Health Organization's (2008) vision that communities should be involved in shaping primary healthcare services. However, researchers continue to debate definitions, models, and operational challenges to community participation. Furthermore, there has been no use of implementation theory to study how community participation is introduced and embedded in primary healthcare in order to generate insights and transferrable lessons for making this so. Using Normalisation Process Theory (NPT) as a conceptual framework, this qualitative study was designed to explore the levers and barriers to the implementation of community participation in primary healthcare as a routine way of working. Methods: We conducted two qualitative studies based on a national Initiative designed to support community participation in primary care in Ireland. We had a combined multi-stakeholder purposeful sample (n = 72), utilising documentary evidence (study 1), semi-structured interviews (studies 1 and 2) and focus groups (study 2). Data generation and analysis were informed by Participatory Learning and Action (PLA) Research Methodology and NPT. Results: For many stakeholders, community participation in primary healthcare was a new way of working. Stakeholders did not always have a clear, shared understanding of the aims, objectives and benefits of this way of working and getting involved in a specific project sometimes provided this clarity. Drivers/champions, and strong working partnerships, were considered integral to its initiation and implementation. Participants emphasised the benefits of funding, organisational support, training and networking to enact relevant activities. Health-promoting activities and healthcare consultation/information events were generally successful, but community representation on interdisciplinary Primary Care Teams proved more challenging. Overall, participants were broadly positive about the impacts of community participation, but were concerned about the scope to sustain the work without the 'protected' space and resources that the national Initiative afforded.
Ten Best Readings on Community Participation and Health
This article reviews, In the opinion of the author, the 10 most Influential reading on community participation and health development. The introduction notes that some of the articles do not address health directly but stili do bring crucial Interpretations to the topic. All articles view community participation as an intervention by which the lives of people, particularly the poor and marginalised can be Improved. In addition, they all address the issue of the value of participation to equity and sustainability. The article considers the readings under four heading: concepts and theory; advocacy; critiques and case studies. It highlights the important contributions each reading makes to the understanding of participation in the wider context of health and health development.
Examining the links between community participation and health outcomes: a review of the literature
Health policy and planning, 2014
As a key principle of Primary Health Care (PHC) and Health Systems Reform, community participation has a prominent place in the current global dialogue. Participation is not only promoted in the context of provision and utilization of health services. Advocates also highlight participation as a key factor in the wider context of the importance of social determinants of health and health as a human right. However, the evidence that directly links community participation to improved health status is not strong. Its absence continues to be a barrier for governments, funding agencies and health professionals to promote community participation. The purpose of this article is to review research seeking to link community participation with improved health status outcomes programmes. It updates a review undertaken by the author in 2009. The search includes published articles in the English language and examines the evidence of in the context of health care delivery including services and pr...
Curationis, 2007
Curationis 30(2): 36-47 A fter numerous teething problems (1974-1994), the Department o f Nursing Education o f W ITS University took responsibility for the M uldersdrift Health and Development Programme (MHDP). The nursing science students explored and implemented an empowerment approach to community participation. The students worked with MHDP health workers to improve health through community participation, in combination with primary health care (PHC) activities and the involvement o f a variety o f community groups. As the PHC projects evolved overtim e, the need arose to evaluate the level o f community participation and how much com m unity ownership was present over decision-making and resources. This led to the question "W hat was the level o f community participation in PHC projects o f the M H D P?" Based on the question the following objectives were set, i.e. i) to evaluate the com m unity participation in PHC initiatives; ii) to provide the project partners with motivational affirmation on the level o f community participation criteria thus far achieved; iii) to indicate to participants the mechanisms that should still be implemented if they w anted to advance to higher levels o f community participation; iv) to evaluate the M H D P's im plementation o f a people-centred approach to community participation in PHC; and v) the evaluation o f the level o f community participation in PHC projects in the MHDP. An evaluative, descriptive, contextual and quantitative research design was used. Ethical standards were adhered to throughout the study. The MHDP had a study population o f twentythree (N=23) PHC projects. A purposive sample o f seven PHC initiatives was chosen according to specific selection criteria and evaluated according to the "Criteria to evaluate community participation in PHC projects" instrument (a quantitative tool). Structured group interviews were done with PHC projects' executive committee members. The Joint Management Committee's data was collected through mailed self administered questionnaires. Validity and reliability were ensured according to strict criteria. Thereafter results were analysed and plotted on a radiating arm continuum. The following factors had com ponent scores: organization, leadership, resources, m anagem ent; needs and skills. A spider graph was produced after each factor's Correspondence address: continuum was connected in a spoke figuration that brought them together at the Prof Hester Klopper base where participation was at its most narrow. The results are presented and a graph Private Bag X 6001 an(j discussion is provided on each o f the PHC projects. School o f Nursing Science NorthWest University (Potchefstroom researc[1 resuits indicated that although community participation was broadened, there was minimal success in forcing a shift in power over decision-making and resources. This demonstrated that power over planning and resources should remain in the hands o f the partners if community participation was to remain progressive and sustained. R esults furtherm ore indicated that the people-cen tred approach to community participation enabled participants to broaden community participation.