Planning and Implementing Community Participation in Health Programmes
IAN D. ASKEW
In recent years the term community participation has been appearing with increasing regularity in the policy statements of national health programmes and international funding agencies, as well as in the literature describing certain health care projects and programmes. Despite the obvious popularity of the term and the apparently strong commitment that most of those involved in health and development seem to have to community participation, there is still a vagueness attached to the concept which seems to put it beyond specific definition. This vagueness has allowed an apparently endless variety of development projects to be labelled community participation, particularly among those concerned with health care and family planning.
The interest in reorienting health care away from the conventional clinic-based medical service delivery system and towards a community-based participatory approach grew strongly in the early 1970s following the documentation of a number of "successful" projects. 1 The ideas underlying these health care projects, both governmental and non-governmental, were incorporated and endorsed by the United Nations system through the concept of Primary Health Care (PHC). 2 Since the Alma Ata Declaration, the PHC approach has come to dominate the field of health care planning in developing countries with particular emphasis on community participation. Community participation has been termed the "heart" of Primary Health Care 3 and the prominence given to the concept in the Declaration of Alma Ata 4 certainly supports this:
Primary Health Care is essential health care based on appropriate and acceptable methods and technology made universally accessible to individuals and families in the community