in organising and responding to the needs of the people could be linked on a more permanent and sustained basis with national source of funding so that they could continue.
These suggestions require, more than anything else, a reorientation in the goals and attitude of those working in the health sector so that their organisations have "an institutional doctrine that sees service to people rather than provisions of output as the organisation's mission." 32 The emphasis in this chapter on administrative issues is not intended to imply that a reorientation of the bureaucracies of national health programmes, together with the implementation of activities by NGOs to build the capacity of communities to participate, would automatically produce meaningful involvement and self-reliance. There is much evidence to show that there are many political obstacles within the programmes, NGOs and communities that inhibit institutionalised and equitable participation. Moreover, the conventional approach to health care as a set of service delivery interventions, has become the norm in many places and people who expect and depend on such professionalised medical health care may not wish to become "self-reliant" if this could mean extra personal effort and a level of services perceived as less sophisticated.
Given these factors, a change in the approach to planning, managing and organising health care programmes and active political support are necessary prerequisites to any attempt to generate and encourage meaningful participation at the community level; without, it 'community participation projects' are doomed to continue to be mechanisms which seek to improve the efficiency of the existing health care system through mobilising community resources without the concomitant transfer of responsibility to the people that would enable them to influence the production and use of those resources.
There is a clear need, therefore, for the international funding agencies and government health ministries to recognise that their bureaucratically-organised structures and procedures ill-equip them to plan and implement meaningful community participation. A start should be made to consider ways in which such agencies can, in part, change their own procedures so that they will be able to fulfil the values they so often advocate. In particular, their relationships with NGOs and their ability to respond to localised small-scale requests for health resources could become the focus for immediate changes.