New community participationPresentation Transcript
Community participaion Community participation1/5/2012 community participation 1
LESSON PLANSpeaker: Dr. S.SudharshiniTopic: COMMUNITY PARTICIPATIONDate: 27– 09 – 2011Day: TuesdayTime: 02.00 p.m.Duration: 75 minutesMethod: Socratic Method of LectureAudience: Post Graduates And Faculty, Institute Of Community Medicine,MMC, Chennai.A-V-Aids: LCD projectorEvaluation: Concurrent and Terminal1/5/2012 2
OBJECTIVES• At the end of the session the audience should be able to: – Define community participation – List the core features of community participation – List the advantages and disadvantages of community participation. – List the stages of community participation. – List and describe the steps involved in community participation. – List and describe Participatory Rural Appraisal1/5/2012 technique. community participation 3
Session overviewSUB HEADINGS Time break up (in minutes)Introduction 8Definition 8CORE FEATURES 4ADVANTAGES OF COMMUNITY PARTICIPATION. 4STAGES,DEGREE &LADDER OF COMMUNITY PARTICIPATION. 6DISADVANTAGES OF COMMUNITY PARTICIPATION. 2COMMUNITY ACTION CYCLE 12PRA AND ITS TECHNIQUES 15Community participation in health 1/5/2012 community participation 15 4
MALARIA INCIDENCE IN INDIA NMCP 1953-56 NMEP-1958 UMS MPO-PFCP EMCP-RBM NVBDCPSource: NVBDCP, New Delhi, India
Introduction• Development intervention approaches in INDIA over the past 60 years have been very much a ‘supply oriented one way traffic’.• The limitations of the approaches which we had been following include: • A top down approach • Target oriented • Non involvement of the people • Vertically controlled sectoral approach without any horizontal coordination at the micro level. • The dominant development thinking oriented towards greater inputs (supply) than what people demanded. • Near total absence of self confidence and even self respect. • Lack of appreciation and promotion of indigenous technical knowledge and resources. • The ever growing recipient attitude.1/5/2012 community participation 6
THE MAIN CHALLENGE• Dislodge the strong dependency culture.• Help them regain their self image and self respect• Create in them a strong sense of public consciousness to care about and to stand as the sentinel on the community infrastructure.• Prepare and transform them to realize the need for community led initiatives.1/5/2012 community participation 7
Key to the challenge• The basic logic for the success of any intervention in development and work depends on the confidence built and the power given to people to decide and take community initiatives. Consensus is its key.• The primary factor for promoting consensus and instilling confidence is participation.1/5/2012 community participation 8
What is a Community A Community is a set of people living together with common interest” We all live in a community. There are different things that bind us together. Let us try to identify them. Occupation Language Territory Beliefs Values Religion Culture1/5/2012 community participation 9
What is participation?•Oxford dictionary defines participation as “to have a share in ” or “ to take part in”.1/5/2012 community participation 10
Definition of community participation• A process by which individuals and families assume responsibility of their own health and develop their capacity to contribute to development .• Enables them to become agents for their own development instead of being passive beneficiaries of development aid.
Definition• a process by which people are enabled to become actively and genuinely involved in defining the issues of concern to them, in making decisions about factors that affect their lives, in formulating and implementing policies, in planning, developing and delivering services and in taking action to achieve change’ (WHO, 2002, p.10).1/5/2012 community participation 12
A more detailed definition of community participation Evaluati Mobilisi Implem ng andShaping Planning ng and monitor enting training ing 1/5/2012 community participation 13
CORE FEATURES OF PARTICIPATION• It is a voluntary involvement of the people• The people who participate influence and share control over development initiatives, decisions and resources.• It is a process of involvement of people in different stages of the programme.• The ultimate aim is to improve the well being of the people who participate.1/5/2012 community participation 14
Participatory development and participation in developmentParticipatory development Participation in developmentA top down participation in the Bottom up participation in thesense that the management of sense that the local people havethe project defines where, full control over the processeswhen and how much the and the project provides forpeople can participate. necessary flexibility.It1/5/2012 is introduced within the Entails genuine efforts to engage community participation 15
PARTICIPATION AS A MEAN AND AS AN END Participation as a mean Participation as an endIt implies use of participation to It attempts to empower people toachieve some predetermined goal or participate in their ownobjective development more meaningfully.An attempt to utilise the existing An attempt to ensure increased roleresource to achieve the objective of of people in development initiative.programmes or projectEmphasis is on achieving the objective The focus is on improving the abilityand not on the act of participation of the people to participate.itself. 1/5/2012 community participation 16
WHY COMMUNITYPARTICIPATION ISIMPORTANT?1/5/2012 community participation 17
“As an individual I could do nothing. As a group we couldfind a way to solve each other’s problems”. 1/5/2012 community participation 18
WHY PARTICIPATION MATTERS???• Providing an open forum for the community to discuss its problems and find indigenous solutions which may be efficient and economical.• Making people aware of their needs.• Results in better decisions• People are more likely to implement the decisions that they made themselves rather than the decisions imposed on them.• Motivation is frequently enhanced by setting up of goals during the participatory decision making process.
WHY PARTICIPATION MATTERS???• Participation improves communication and cooperation.• Identification and development of the local resources, thereby generating self reliance among the community.• To develop local leaders who can further educate and mobilise the people in the area.• People may learn new skills through participation; leadership potential may be identified and developed.• Higher achievement at a lower cost.1/5/2012 community participation 20
Stages of participation • Community receives benefits from the service butLevel I. contributes nothing • Some personnel, financial or material contribution from theLevel II community ,but not involved in decision making. • Community participates in lower level decision makingLevel III • Participation goes beyond lower level decision making toLevel IV monitoring and policy making • program is entirely run by the community ,except for someLevel V external financial and technical assistance. 1/5/2012 community participation 22
DEGREES OF COMMUNITY PARTICIPATION Collective action Co-learning Cooperation Consultation Compliance Co-option1/5/2012 community participation 23
DEGREES OF COMMUNITY PARTICIPATION• Co-option • Token involvement of local people • Representatives are chosen, but have no real input or power• Compliance • Tasks are assigned, with INCENTIVES • Outsiders decide agenda and direct the process• Consultation • Local opinions are asked • Outsiders analyze and decide on a course of action.1/5/2012 community participation 24
• Cooperation • Local people work together with outsiders to determine priorities • Responsibility remains with outsiders for directing the process• Co-learning • Local people and outsiders share their knowledge to create new understanding • Local people and outsiders work together to form action plans with outsiders facilitation1/5/2012 community participation 25
Original Arnsteins Citizen control ladder of participation Delegated power Degree of partnership citizen power placation consultation Degree of tokenism informing therapy Non manipulation participation1/5/2012 community participation 26
DISADVANTAGES OF COMMUNITY PARTICIPATION• Participation does not occur automatically. It is a process. It involves time. Hence it may lead to delayed start of a project.• In a bottom-up participation process, we have to move along the path decided by the local people. This entails an increased requirement of material as well as human resources.• Participation leads to decentralization of power. People at the top should be ready and willing to share power with the people.• Participation sometimes develop dependency syndrome.• Participation can result in shifting of the burden into the poor.1/5/2012 community participation 30
Community Action Cycle Explore the common issue & Set prioritiesPrepare to mobilize Organize the community Plan together For action Prepare to scale up Evaluate together Act together
How can you build community participation community mobilization• A process whereby a group of people become aware of a shared concern or common need and decide to take action in order to create shared benefits. (Joint United Nations Programmed on HIV/AIDS)
Role of Community Mobiliser A mobiliser is a person who mobilizes, i.e. gets things moving. Social animator. A Catalyst• Bringing People Together• Building Trust• Encouraging Participation• Facilitating Discussion and Decision-making• Helping Things to Run Smoothly .• Facilitation in community mobilization process 1/5/2012 community participation 33
Some Qualities• Good communication skills• Good facilitation skills• Good listener• Committed• Decision maker• Active• Negotiation skills• Honest• Known to culture and values of society• Well dressed• Catalyst• Conflict resolution.• Management skills
Community diagnosis• What are the main problems?• What are the underlying causes?• What are the resources available?• Focus is identification of basic health needs or health problems of the community (felt need) and the factors contributing to it.
Action plan• Steps taken to meet the health needs of the community based on the resources available and the wishes of the people (felt need).
Participatory Rural Appraisal• PRA is “a family of approaches and methods to enable local (rural or urban) people to express, share, enhance, and analyze their knowledge of life and conditions, to plan and to act.” (Mascarenhas et al., 1991)
PRA• Participatory Rural Appraisal is a methodology for interacting with villagers/community, understanding them and learning from them.• It shifts the initiative from outsider to villager.• PRA seeks to empower. It empowers the weak, the powerless and the marginalised, by enabling them to anlyse, discuss and deliberate on their condition.• Believes in flexibility in choosing methods.• Reversal of learning.
PRA Techniques / Tools• Village mapping• Transect walks• Mobility mapping• Seasonal Diagram• Matrix scoring and ranking• Trend analysis• Venn Diagram• Daily activity Chart• Force Field Analysis• Causal Impact Diagram• All undertaken by local people.
Participatory mapping/modelling• using local materials, villagers draw or model current or historical conditions. This technique is used to show water sheds, forests, farms, houses, hospital or dispensary distance, wealth ranking, household assets, land use patterns, health and welfare conditions and distribution of various resources.1/5/2012 community participation 41
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Transect Walks/Group Walk• The researcher and key informant conduct a walking tour through the areas of interest to observe, to listen, to identify different zones or conditions, ask relevant questions to identify solutions1/5/2012 community participation 43
MOBILITY MAPPING• A map drawn by the people to explore the movement pattern of an individual,a group or a community.1/5/2012 community participation 44
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Seasonal calendar• Diagram drawn by villagers with locally available materials• Depicting Local language months, seasons• Festivals/ social events, crops grown• Occupation / income generation• Periods of plenty/ scarcity• Common diseases
Daily Activity chart• Daily Activity Clock illustrates the different kinds of activities carried out in one day.• Time management - Effective utilisation of time• To look at relative work-loads in different groups.• How is his or her time spent?• Whether the leisure time is spent usefully ?• Period of relaxation, recreation, physical activity, Personal care, rest.• Income generation, productive work, community work• Whether women spend more time in collecting water and firewood?
Daily Activity chart
Venn diagram• To know the individual and institutional linkages and relationships with the community.• Visual depiction of key institutions, organisations and individuals active in the community, responsible for taking decisions.• Degree of contact between them in decision-making• Size of circle – importance• Degree of overlap – Degree of contact
FLOW DIAGRAMS CAUSAL AND IMPACT DIAGRAMS• To identify the causal factors of health problems• The various impacts of diseases, as perceived by the villagers.• This also acts a planning and evaluation tool.1/5/2012 community participation 53
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Trend analysis• Attempts to study people’s account of the past of how things that were closer to them have changed at different points of time.• A useful tool for monitoring and evaluating a project.1/5/2012 community participation 55
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Pair wise ranking • Compares pairs of elements, such as the preference for needs, problems, etc. • Leads to analysis of the decision making rationale.item A B C D score rankA _ A C A 2 2B _ C B 1 3C _ C 3 1D 1/5/2012 _ community participation 0 4 57
Impact / Matrix ranking and scoring • To rank the problems in the community based on the intensity, the need for immediate or late action. • Helps to prioritise the problems and needs. Effectiv Easy Trust Friendly Timely Total rank e accessibili approach help score service tyPanchaya 35 35 30 45 15 160 1tSchool 20 30 30 10 30 120 2
Force field analysis• Developed by Kurt Lewin Kurt Lewin• Technique to visually identify and analyse forces affecting a problem situation so as to plan a positive change.
Interviewing and dialogues• Semi structured interview• Focus group discussion• Direct observation1/5/2012 community participation 60
PROCESS OF COMMUNITY PARTICIPATION IN HEALTH PROGRAMMESAnalysis of the needs and requirements of the peoplein the community Designing the primary health program to meet the needs of the people with the involvement of the people. Educating the people through formal and informal channels to make them aware of the program and utilizing the resources available with them Kindling and generating interest among people to keep up the momentum through the provision of resources not available locally. Leaving the program to the care of the people with aided guidance
Providing aided guidance to handoverthe programme to the people Occasional follow up to sort out any problem Birth of a permanent community managed PHC Birth of a healthy society
QUALITATIVE ANALYSIS OF COMMUNITY PARTICIPATION• How much does the community know about theprogramme?• How much do they know about the organization carrying outthe programme?• How often do they come face to face with the programmepersonnel?• What responsibilities do they carry out on behalf of theprogramme?• What kinds of difficulties do they find in undertaking theseresponsibilities?
QUALITATIVE ANALYSIS OF COMMUNITY PARTICIPATION• How satisfied are they with the involvement in the programme and why?• Do they have any suggestions to improve their participation in the programme?• Are all sections of the community equally involved in the programme?• If there is a differential advantage to some group, why does it happen and who gets the preferential advantage?1/5/2012 community participation 64
OBSTACLES TO COMMUNITY PARTICIPATION• Absence of confidence and ability of people in the machinery of health administration.• Unequal domination of power relations in favour of rich and to the disadvantage of the poorer sections of the society.• Inaccessible services in right quantity and quality• Rigid bureacratic set up impeding the people to participate.• Legal hurdles
OBSTACLES TO COMMUNITY PARTICIPATION• Inadequate understanding of local talent, abilities and resources.• Absence of identity with the community among people.• People’s dependence on GOVERNMENT and not on their self• Heterogenity of interests• Resistance to empower people• Resistance on the part of certain segment of population to participate• Sustained efforts missing1/5/2012 community participation 66
Guiding principles to resolve the obstacles• Channelizing the NGO’s to promote health plans• Effective training of Health personnel in Appropriate technology• Responsive administration • Openness in the sense of having wide contact with the people • A sense of justice, fair play and impartiality in dealing with men and matters. • Sensitivity and responsiveness to the urges, feeling and aspirations of the common man. • Securing the honour and dignity of the human being ,however humble s/he might be. • easy accessibilty. • Honesty and integrity in thought and action.
Guiding principles to resolve the obstacles• Effective public relations • Spread of awareness about the health activities of the government with the expectations and aspirations of the people. • Speedy redressal of public grievances through a systematic and well thought out mechanism.• Sound health system• Empowerment of the poor• Developing social networks1/5/2012 community participation 68
The Primary Health Care Movement towards Health for All by 2000AD Alma Ata, 1977 The International Conference on Primary Health Care calls for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of1/5/2012world by the year 2000. community participation the 69
Alma atta declaration• The Alma Ata Declaration defined PHC as “essential health care based on practical, scientifically sound, and socially acceptable methods and technology• made universally accessible to individuals and families in the community• through their full participation and• at a cost that the community and country can afford to maintain at every stage of their development• in the spirit of self-reliance and self-determination” (WHO, Alma Ata Declaration VI, 1978, p.1).1/5/2012 community participation 70
• Emphasis from “Health care for the people” “Health care by the people” concept of primary health care1/5/2012 community participation 71
COMMUNITY PARTICIPATION IN INDIA• The establishment of primary health units at the village level to bring the service as close to the people as possible, cooperation of the people in the health programme, and adequate medical care for all individuals, irrespective of their ability to pay for it, were included in the Bhore Report.1/5/2012 community participation 72
COMMUNITY PARTICIPATION IN INDIA• the Community Development Programme launched in 1952, the setting up of one Primary Health Centre (PHC) per Block was accepted by the Central Council of Health in 1953 .1/5/2012 community participation 73
THE SHRIVASTAVA COMMITTEE: The employment of paraprofessional or semi- professional workers from the community itself as a link between the Sub-Centers and the community to provide simple services was one proposal.they opted for the Community Health Worker scheme to meet the insufficiency of doctors.1/5/2012 community participation 74
• The state of National Emergency under Congress rule from 1975 to 1977 with its forcible campaign to control population growth was shortly replaced by community- oriented approaches of the Bharatiya Janata Party (BJP) government.1/5/2012 community participation 75
THE COMMUNITY HEALTH VOLUNTEER SCHEMETHE NATIONAL PLANNING COMMITTEE 1946. It was planned to train young men from the villages for 9 month in simple curative care and hygiene for primary health service at the village level.Program was withdrawn in 1951 .voluntary agencies which picked up the idea in the 1960ies and 1970ies, and used auxiliary personnel for the delivery of primary health care.Successes from the voluntary sector in India received international recognition and together with the China example of “barefoot” doctors served as role models for the Indian government1/5/2012 community participation 76
THE COMMUNITY HEALTH VOLUNTEER SCHEME• the Bharatiya Janata Party (BJP) government came to power in 1977, it adopted the approach but changed the length of training to 3 month. Additionally, it was planned to add one doctor per Primary Health Centre for training purposes.• The implementation progress was slow and further delayed by the reelection of Congress in 1980• The new government renamed the programme in Community Health Volunteers (CHV)1/5/2012 community participation 77
SELECTION OF CHV• The community used to select one of its own members as the community health volunteer or the VHW.• The most common procedure adopted for selection of VHGs was that Village Panchayats (village self-government councils) recommended two or three names to the primary health centre .• A final decision made by a committee consisting of Medical Officer, Block Development Officer and the elected chairperson of the Block Panchayat Committee.• Although the selection was to be made in an open meeting of the total village council, in practice, most often, only a few important village leaders were involved in the selection.1/5/2012 community participation 78
PROBLEMS ENCOUNTERED BY CHVS• in 1981, the central government had decided to reduce its contribution from 100 to 50 percent of the costs of the scheme and asked the State Government to meet the remainder.• Later, following the conviction that women should be employed as VHGs, the central government decided to fund the scheme fully once again.• All this led to employment considerations becoming more important to VHGs than social service and ultimately they were demanding for higher remuneration.• One of the main issues enveloping the VHGs was their medicalization.Trained for three months, they focused on providing curative services, to the neglect of preventive and promotive tasks.• The VHGs began to perceive themselves as village medical practitioners, often even demanding further training for this purpose.• Poor role definition1/5/2012 community participation 79
THE INTEGRATED CHILD DEVELOPMENT SERVICE SCHEME,1975The programme is community-based.A local woman is selected and trained for three month to become the Anganwadi worker.She then works in the village covering a population of 1000.In the Anganwadi centre (childcare centre) she prepares and distributes food, maintains growth charts, weighs children and gives non-formal education to the beneficiaries.The Anganwadi also cooperates with the Primary Health Centre staff for health check up, immunization and referral.
THE PROBLEMS ENCOUNTERED BY ICDS• Communication with the health staff of Primary Health Centres was weak.• The programme was more perceived as a feeding scheme by the communities and demand for health services did not increase.• The educational efforts fell short to increase health knowledge of mothers, thus, prevention of malnourishment was not achieved.
COMMUNITY PARTICIPATION IN NATIONAL FAMILY WELFARE PROGRAM- MAHILA SWASTHYA SANGHS• CONSTITUTED IN 1990-1991• CONSISTS OF 15 WOMEN , 10 representing the varied social segments in the community• five functionaries involved in womens welfare activities at village level such as the Adult Education Instructor, Anganwadi Worker, Primary School Teacher, Mahila Mukhya Sevika and the Dai. Auxiliary Nurse Midwife(ANM) is the Member-Convenor. 1/5/2012 community participation 83
COMMUNITY PARTICIPATION IN NRHM1/5/2012 community participation 84
VILLAGE HEALTH AND SANITATION COMMITTEE (VHSC)This committee would be formed at the level of therevenue village (more than one such villages may comeunder a single Gram Panchayat).• COMPOSITIONThe Village Health Committee would consist of: » Gram Panchayat members from the village » ASHA, Anganwadi Sevika, ANM » SHG leader, village representative of any Community based organisation working in the village, user group representative• CHAIRPERSON the Panchayat member (preferably woman or SC or ST candidate.)• CONVENOR ASHA if not Anganwadi Sevika• TRAINING The members would be given orientation training toequip them to provide leadership as well as plan andmonitor the health activities at the village level.
SOME ROLES OF THE VHSC Create Public Awareness about the essentials of health programmes, with focus on People’s knowledge of entitlements to enable their involvement in the monitoring Discuss and develop a Village Health Plan based on an assessment of the village situation and priorities identified by the village community. Analyze key issues and problems related to village level health and nutrition activities, give feedback on these to relevant functionaries and officials. Present an annual health report of the village in the Gram Sabha. Participatory Rapid Assessment to ascertain the major health problems and health related issues in the village. Mapping will be done through participatory methods with involvement of all strata of people. The health mapping exercise shall provide quantitative and qualitative data to understand the health profile of the village.
ROLES OF VHSC Maintenance of a village health register and health information board/calendar: The health register and board will have information about mandated services, along with services actually rendered to all pregnant women, new born and infants, people suffering from chronic diseases etc. Similarly dates of visit and activities expected to be performed during each visits by health functionaries may be displayed and monitored by means of a Village health calendar Ensure that the ANM and MPW visit the village on the fixed days and perform the stipulated activity;oversee the work of village health and nutrition functionaries like ANM, MPW and AWW
PHC Monitoring and Planning Committee• This Committee monitors the functioning of Sub-centres operating under jurisdiction of the PHC and develops PHC health plan after consolidating the village health plans.Composition• 30% members from PRI (from the PHC coverage area;2 or more sarpanchs of which at least one is a woman)• 20% members non-official representatives from VHSC, (under the jurisdiction of the PHC, with annual rotation to enable representation from all the villages)• 20% members representatives from NGOs / CBOs and People’s organizations working on Community health and health rights in the area covered by the PHC• 30% members representatives of the Health and Nutrition Care providers, including the Medical Officer – Primary Health Centre and at least one ANM working in the PHC area• CHAIRPERSON: Panchayat Samiti member,• EXECUTIVE CHAIRPERSON: Medical officer of the PHC,
BLOCK MONITORING AND PLANNING COMMITTEE• This Committee monitors the progress made at the PHC level health facilities in the block, including CHC and develops annual action plan for the Block after consolidating PHS level health plans.• COMPOSITION• 30% - representatives of the Block Panchayat Samiti (Adhyaksha/Adhyakshika or members with at least one woman)• 20% - non-official representatives from the PHC health committees in the block, with annual rotation to enable representation from all PHCs over time• 20% - from NGOs/CBOs and People’s organizations working on Community health and health rights in the block, and involved in facilitating monitoring of health services• 20% - officials such as the BMO, the BDO, selected MO’s from PHCs of the block• 10% - CHC level Rogi Kalyan Samiti• CHAIRPERSON: Block Panchayat Samiti representative,• EXECUTIVE CHAIRPERSON: Block medical officer,• SECRETARY: NGO / CBO representatives
ROGI KALYAN SAMITI (RKS) /PATIENT WELFARE COMMITTEE/HOSPITAL MANAGEMENT COMMITTEE (HMC) . This initiative is taken to bring in the community ownership in running of rural hospitals and health centres, which will in turn make them accountable and responsible.• BROAD OBJECTIVES OF RKS • Ensure compliance to minimal standard for facility and hospital care • Ensure accountability of the public health providers to the community • Upgrade and modernize the health services provided by the hospital • Supervise the implementation of National Health Program • Set up a Grievance Mechanism System • at PHC and CHC will have the mandate to undertake and supervise improvement and maintenance of physical infrastructure. RKS would also develop annual plans to reach the IPHS standards.*
• RKS would be a registered society.• It may consists of following members Group of users i.e. people from community Panchayati Raj representatives NGOs Health professionals• According to IPHS, it is mandatory for every CHC to have “Rogi Kalyan Samiti” to ensure accountability.
MICROFILARIA RATE IN INDIA NFCP 1955 NHP ELIMINATION-2015 NVBDCP MDASource: NVBDCP, New Delhi, India
INDIA’S COMMUNITY PARTICIPATION LAW: THE MODEL NAGARA RAJ BILL, 2008• The Model Nagara Raj Bill, 2008 (hereinafter ‘the Bill’) is India’s first community participation legislation and creates a new tier of decision making in each municipality called the Area Sabha.• The Bill is a mandatory reform under the Jawaharlal Nehru National Urban Renewal Mission (JNNURM), which means that the various states in India must enact a community participation law to be eligible for funds under the JNNURM program.• This is crucial because the Bill has the potential to empower people by ensuring regular citizen participation in decision-making that affects the conditions of their lives.
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REFERENCES1. Participatory rural appraisal ,principles, methods and application ,N.Narayanaswamy,2002. Primary health care management,chapter 3, community participation ,pg 76-101.3. Community participation in local health and sustainable development Approaches and techniques European Sustainable Development and Health Series: 44. Training Manual On Community Participation, Ms. Bismita Dass5. Community Participation, How People Power Brings Sustainable Benefits to Communities J. Norman Reid USDA Rural Development Office of Community Development June 20006. Developing a Good Practice Guide to Community Participation, Community Participation Project ,March 2008, Inner City Organisations Network/North West Inner City Network7. National Rural Health Mission, A Promise of Better Healthcare Service for the Poor, A summary of Community Entitlements and Mechanisms for Community Participation and Ownership For Community Leaders Prepared for Community Monitoring of NRHM - First Phase8. E:community participationcommunity participationIndia’s Community Participation Law The Model Nagara Raj Bill, 2008 Critical Twenties.htm1/5/2012 community participation 101