Empowerment for Primary Health Care and Child Survival: escalating community participation, community competence, and self-reliance in the Pacific.

Abstract

Community participation is universally held to be central to the achievement of Health For All through Primary Health Care (PHC) and Child Survival (CS) strategies. Nevertheless, community participation remains a little understood and underachieved precept in public health. Some propositions and principles on the theory of community empowerment through escalating community participation in health are presented to help health planners, administrators and educators to implement PHC and CS programmes. The “expert driven” model of participation, employing persuasion, coercion, and incentives, is contrasted with a new paradigm of empowerment and community competence, the “community driven, ” expert guided model. A case study from Micronesia (Yap) is presented as one application of the community driven paradigm. Shifts in the ways experts think about communities are proposed. Implications are discussed for Primary Health Care and Child Survival as complementary strategies toward achieving Health For All.