Abstract
After numerous teething problems (1974-1994), the Department of Nursing Education of WITS University took responsibility for the Muldersdrift 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 of a variety of community groups. As the PHC projects evolved over time, the need arose to evaluate the level of community participation and how much community ownership was present over decision-making and resources. This led to the question "What was the level of community participation in PHC projects of the MHDP?" Based on the question the following objectives were set, i.e. (i) to evaluate the community participation in PHC initiatives; (ii) to provide the project partners with motivational affirmation on the level of community participation criteria thus far achieved; (iii) to indicate to participants the mechanisms that should still be implemented if they wanted to advance to higher levels of community participation; (iv) to evaluate the MHDP's implementation of a people-centred approach to community participation in PHC; and (v) the evaluation of the level of 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 of twenty-three (N=23) PHC projects. A purposive sample of 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 component scores: organization, leadership, resources, management; needs and skills. A spider graph was produced after each factor's continuum was connected in a spoke figuration that brought them together at the base where participation was at its most narrow. The results are presented and a graph and discussion is provided on each of the PHC projects. The research results 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 of the partners if community participation was to remain progressive and sustained. Results furthermore indicated that the people-centred approach to With regard to the Joint Management Committee's evaluation of community participation, it was concluded that power over decision-making and resources remained with health professionals rather than with the community, and that a people-centred approach had not been adopted.
Highlights
The University o f the W itwatersrand’s (W ITS) M uldersdrift H ealth and Development Programme (MHDP) was initiated in 1974 by a group o f concerned medical students who responded to the health needs o f a deprived community, living in a peri-urban area on the north western outskirts of Johannesburg, called Muldersdrift
The study sought to answ er the question: “W hat was the level of com m unity participation in Prim ary Health Care projects o f the Muldersdrift Health and Development Programme? The question was answered, the aims of the study were met by measuring the community participation achieved by the participants o f seven (n=7) PHC projects o f the M HDP by using C hetty and O w en’s (1994) evaluation instrum ent
Chetty and O w en’s evaluation instrument is recommended for the evaluation o f com m unity participation in individual PHC projects and for multiple PHC projects within a PHC programme
Summary
The University o f the W itwatersrand’s (W ITS) M uldersdrift H ealth and Development Programme (MHDP) was initiated in 1974 by a group o f concerned medical students who responded to the health needs o f a deprived community, living in a peri-urban area on the north western outskirts of Johannesburg, called Muldersdrift. A partnership was negotiated betw een the G auteng D ep a rtm entofHea lth ’s W est R and Regional Office (WRRO), the University of the Witwatersrand (WITS) and the M uldersdrift Community through the Muldersdrift Clinic Committee (MCC). A Joint Management Committee (JMC), with four representatives each from these three partners, was form ed.
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