Understanding community participation: a health programme in the Philippines

Abstract

The principle of community participation is so well recognized in international health circles that no declaration about primary health care is made without it. Yet in actually planning and implementing programs it is very difficult to find clear ways of following this principle. This paper analyzes the concrete aspects of community participation in the Munoz-community based health program a small non- government health program funded by Missionary Medical Actions (MEMISA - the Netherlands) and established in Munoz Nueva Ecija the Philippines. The program started as a parish-based charity clinic with a policy of free consultations and medicines but underwent a gradual evolution towards a mother and child health (MCH) program with a growing emphasis on the participation of the pregnant mothers and community health workers (CHWs) in the villages. The sponsoring agency staff members and CHWs agreed to strive for financial independence by the year 1990- 91. This would require better cooperation with the Rural Health Unit (the government public health sector) at the program level and a higher degree of community participation at the level of the community if the MCH-program was to be maintained after the discontinuation of external financial support. An intensive debate among staff members and CHWs revealed a lack of clear understanding of the concept of community participation. Specifically the absence of an insurance to assess the process of community participation resulted in a vague and unsatisfactory analysis of the situation. Recently an analytical framework for such an analysis has been developed which focuses on participation as a process enabling an assessment of participation to go beyond the limits of a merely quantitative analysis. It appears to be a useful instrument for analyzing community participation describing what has been achieved and identifying some of the elements that influenced this process. We have applied this framework retrospectively to our program examining the organization of the communities taking a needs assessment assessing resource mobilization and investigating management involvement of the community with self-management as a goal. (authors modified)