COMMUNITY PARTICIPATION

OBJECTIVES

• At the end of this lesson, the leaner’s shall be able to:-• Define a community• Define community participation• Discuss the aims of community participation• Discuss the differences between community

participation and involvement• Determine the community participation process• Identify factors that influence community participation

WHAT’S A COMMUNITY?• It is a social entity made of people or families who

have the following characteristics:• Live in the same geographical area• Share common goals or problems• Share similar development aspirations• Have similar interests or social network or

relationship at local level• Have a common leadership and tradition• Have common system of communication• Share some resources-water, school, etc • Are sociologically and psychologically linked.

COMMUNITY PARTICIPATION

• DEFINE• A process by which a community mobilizes its

resources, initiates and takes responsibility for its own development activities and share in decision making for and implementation of all other development programmes for the overall improvement of its health status.

• The key to the successful organization of PHC is community participation, through the process, the people gain greater control over the social, political, and economic and environmental factors determining their health.

AIMS OF COMMUNITY PARTICIPATION

• The community develops self-reliance• The community develops critical awareness• The community develops problem solving

skills

• TYPES OF PARTICIPATION• Passive – (Manipulation)• Active – (consultation)• Involvement – (Community control)

• PASSIVE PARTICIPATION• In this type of participation, individuals or

families are mere spectators

ACTIVE PARTICIPATION

• In this type of participation, they may be carrying out some tasks in a programme but are not involved with the final decision making in what is to be done. The final decision in such cases are made by people who are not members of the community in such situations, the community does not develop a sense of self-reliance.

COMMUNITY PARTICIPATION AND INVOLVEMENT

• In this type of participation, the community is involved in all aspect of a programme. This type of approach enables the community to participate willingly to improve its own health status.It is important for a community to participate in every stage of the health programme for it to have long lasting results i.e., thinking, planning, acting and evaluating.

• Community participation and involvement empowers or enables the community to make informed decisions in matters affecting their health or development

INVOLVEMENT• This entails involving the community in planning,

implemention,management and evaluation of programmes.• This is important because, it contributes towards a feeling

of responsibility and involvement in such a programme. In other wards we could refer to the process as that by which active partnership is established between a developmental programme within the community and the community itself. Thus community participation and involvement contributes to the attainment of community responsibility and accountability over all development programmes. Therefore preventing a community from alienating itself from such a programme. The community develops self-reliance and social control over its own infrastructure.

• DIMENSIONS OF COMMUNITY PARTICIPATION

• Community participations has three dimensions;

• Involvement of all those affected in decision making about what should be done and how

• Mass contribution to the development efforts i.e to the implementation of decision

• Sharing in the benefits of the programme (World Bank, 1978).

• COMMUNITY PARTICIPATION IN DIFFERENT SITUATIONS

• Top-down – approach• Bottom-up – approach

• TOP-DOWN – APPROACH• IN traditional approach health care planning ,

the decisions are made by senior persons in health services, the so called “experts”. Research may be carried out through surveys to what the community thinks or believes to be the problem, but in the end it’s usually the health workers who makes the decisions on what goes into the programme based on medically-defined needs.

• Traditional education is often indoctrinating .We make decisions and expect them to follow. This is always the case and you will need to look carefully to findout what is really going on. All the decision-making and priorities are set by the external agency.

• BOTTOM-UP – APPROACH• In this approach members of the community

make decisions.

• FACTORS WHICH INFLUENCE THE DEGREE OF COMMUNITY PARTICIPATION POSITIVELY

• Relevance and accountability• Education status of the community• Community infrastructure (including

communication network)• Economic factors• Social and cultural factors• The level of intersectoral collaboration

• Suppression of involvement and initiative by projects which create dependency

• Political stability• Good leadership• Motivated community• A sense of ownership• Locally available resources

• THE PARTICIPATORY METHODS USED IN RAPID ASSESSMENT OF SITUATIONS

• Daily routine schedule• Seasonal calendar• Time trends• Direct observation• Transect walk• Venn diagram• Key informants interviews of individuals from

the community• Focus group discussion (FGD)

BENEFITS FROM COMMUNITY PARTICIPATION

• Justification for community participation come from a variety of sources, including lessons learned from the failures of conventional top-down planning as well as the achievement of community based programmes.

THE NEED FOR A COMMUNITY APPROACH• The need to shift the emphasis from the

individual to the community. This is because many influences on a behavior are at the community level and not under the control of individuals, these include;

• Social pressure from other people through norms,

• Shared culture and the local social economic situation.

• Even when the influences are at the national level, it is often through pressure from communities that governments will change. Furthermore government budgetary resources can be complemented by the efforts which can be made within local communities, but they go well beyond this.

DRAWING ON LOCAL KNOWLEDGE

• Communities often have detailed knowledge about their surroundings. It makes sense to involve communities in making plans because they know local conditions and the possibilities for change

MAKING PROGRAMMES LOCALLY RELEVANT AND ACCEPTABLE

• If the community is involved in choosing priorities and deciding on plans, it is much more likely to become involved in the programme and take up the services.

DEVELOPING SELF-RELIANCE, SELF CONFIDENCE, EMPOWERMENT AND PROBLEM – SOLVING SKILLS.

• The enthusiasm that comes from community participation can lead to a greater sense of self-reliance for the future e.g. communities are usually willing to participate in water a programme because they see that benefits will come. The feeling of community solidarity and self-reliance from participating in decisions over, their own future through a water project can lead to future activities.

• BETTER RELATIONSHIP BETWEEN HEALTH WORKERS AND COMMUNITY

• Community participation leads to a better relationship between the community and the health workers instead of a servant master relationship, there is trust and partnership.

PRIMARY HEALTH CARE• The Alma-Ata declaration on PHC in

1978extended the notion of appropriate health care beyond that of simply providing decentralized services, it also considered the need to tackle economic and social causes of ill-health.

• Health education and community participation are essential ingredients of PHC (WHO).

• TYPES OF COMMUNITY GROUPS• SELF-HELP GROUPS• Run by people for their own benefits e.g. co-

operatives, church saccos etc

PRESSURE GROUPS• A group of self-appointed citizens taking

action on what they see to be the interests of the whole community putting on pressure to improve the school, get garbage collected, do something about a dangerous road etc.

TRADITIONAL ORGANIZATIONS

• E.g Njuri Njeke in (Meru), these are well established groups, usually meeting the needs of a particular section of the community, others rotary, club, mothers union parent-teacher associations, and church groups.

WELFARE GROUPS

• Exist to improve the welfare of a group; merry go round, feeding programmes etc.