Academic journal article Bulletin of the World Health Organization

Community Participation for Transformative Action on Women's, Children's and Adolescents' Health/ Participation Communautaire En Vue D'une Action Transformatrice Sur la Sante De la Femme, De L'enfant et De l'adolescent/Participacion Comunitaria En la Toma De Medidas De Transformacion Para la Salud De Mujeres, Ninos Y Adolescentes

Academic journal article Bulletin of the World Health Organization

Community Participation for Transformative Action on Women's, Children's and Adolescents' Health/ Participation Communautaire En Vue D'une Action Transformatrice Sur la Sante De la Femme, De L'enfant et De l'adolescent/Participacion Comunitaria En la Toma De Medidas De Transformacion Para la Salud De Mujeres, Ninos Y Adolescentes

Article excerpt

Introduction

The Global strategy for women's, children's and adolescents' health (2016-2030) calls for action towards three objectives for health: survive (end preventable deaths), thrive (ensure health and well-being) and transform (expand enabling environments). (1) The strategy recognizes that "women, children and adolescents are potentially the most powerful agents for improving their own health and achieving prosperous and sustainable societies". Global, national and sub-national development policies have until now been largely orientated towards addressing the objectives of helping people to survive and thrive. However, to accomplish the overall objectives of the strategy we need to address the third objective: "to transform societies so that women, children and adolescents everywhere can realize their rights to the highest attainable standards of health and well-being". Transforming societies requires participation, including communities working together with health services to reach health goals (what is termed co-production). In this paper, we examine what this implies in practice.

Community participation is promoted in global dialogue as a vital element of a human rights-based approach to health. This means not just ensuring the provision of health services and their use by the public but also tackling the underlying social determinants of health. (2) While proven clinical and health service interventions could save numerous lives by 2030, if they were made available to all, those people most in need of health care are often not reached. (3,4) Many factors wealth, environment, gender, education, geography, culture and other structural determinants--affect health outcomes directly through health services uptake, and indirectly via relationships and behaviours outside the clinic setting. (5,6) Community participation that is inclusive of underserved groups and is tailored to context is a fundamental principle of equitable primary health care as well as a way of optimizing interventions to improve health.

Participatory approaches

In this paper we examine the concepts of participation and co-production in health care with a focus on health services and communities working together to achieve health goals. Here we define communities as groups of people who share common interests, concerns or identities in settings that are defined by geography, culture, administrative boundaries or geopolitical region or that are identified with joint activities, such as work or recreation. (7,8)

Participatory approaches and the characteristics of participation have been defined in different ways. (9) Some authors (10) distinguish between organic participation such as community-organized actions, contrasting this with induced participation that is externally stimulated. Members of the community may be involved in the latter type to a greater or lesser extent, with participation ranging from outreach and consultation at one end of the spectrum of participation to collaboration and shared leadership at the other end. (11) Countries or programmes may move along the spectrum as they gain experience or according to their objectives.

In this paper we discuss externally-stimulated community participation that falls at the collaboration and shared leadership end of the participation spectrum. This is not to say the burden of resolving health issues is placed on communities. To be transformative, participatory approaches in health require power-sharing with health-service users. This is likely to mean new relationships, including a new culture in health-care institutions that supports participation. (9,12)

Participation does not usually operate as a linear intervention to improve health; rather participatory approaches form a set of complex processes and interactions. (10,11,13) An approach that is based on systems theory is useful to understand participation processes, whereby interdependencies between different parts of a system are explicitly recognized and nonlinear effects are expected to occur and are taken into account. …

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