The document discusses the importance of community participation in health care, defining key terms and concepts like empowerment, mobilization, and community involvement. It outlines various types of participation, including manipulative, passive, and self-mobilization, and emphasizes the need for a bottom-up approach in program implementation to ensure community ownership and effectiveness. Challenges and factors influencing community participation are also highlighted, alongside methods for conducting participatory appraisals to enhance community engagement in health-related initiatives.

1. COMMUNITY INVOLVEMENT
AND PARTCIPATION IN HEALTH
CARE
GNU 407

2. Objectives
• Define the terms; community, participation
involvement, empowerment, mobilization
• Discuss aim of community participation
• Types of community participation
• Determine community participation process
• Identify factors influencing community
participation

3. Introduction:
• Community participation is one of the key
ingredients of empowered community
• Based on the Alma Ata Declaration on PHC,
Community participation is one among the
principles of PHC
• In Health for All, community participation is a
global strategy for health development
advocated by WHO
– People have the right to be involved in decision
making that affect their lives

4. Introduction…
• The community is a social interaction/
grouping of people who share a common
values, purpose, interest or needs and who
can express their relationship through face to
face communication

5. Successful Communities:
• Build on the strengths/ potentials of local individuals,
associations and institutions
• Focus on specific actions and measurable results to
improve community life through bottom-up strategies
• Promote participation by people of all races, genders,
cultures and age groups (Community inclusion)
• Ensure local decision making and ownership

6. SUCCESSFUL COMMUNITIES:
• Bridge all sectors to
develop healthy
children, families
and communities

7. Introduction…
• No single operational definition has been used to define
community participation
• No consensus on the precise meaning of term and its
practical implications for program implementation
• Different interpretations are linked to different
development paradigms
• Key words in community participation are
– Identify needs
– Decision making
– Planning, Implementation and evaluation

8. Definition-1
Community Participation
A process by which people are enabled to
become actively involved
– In defining issues concern to them
– In making decision about factors that affects their
lives
– In formulating and implementing policies
– In developing and delivering services and taking
action to achieve change

9. Definition-2
Community Participation
• Is a social process whereby specific groups
with shared needs living in a defined
geographical area actively pursue
identification of their needs, take decision and
establish mechanisms to meet their needs

10. Definition-3
Community Participation
• Is an educational and empowering process in
which people, in partnership with those able to
assist them
– Identify problems and needs and assume
responsibility to plan, manage, control and
assess the collective actions that are proved
necessary

11. Definition-4
Community Participation
• Is a process by which a community mobilizes its
resources, initiates and take responsibility for its own
development activities and share decision making for and
implementation of all other development programmes
for overall improvement of its health status
• Community participation, as a key principle of PHC help
people gain grater control over the social, political, and
economic and environment factors determining their
health

12. Definition-5
Community Participation
• Is the process whereby individuals, families,
communities are totally involved as actors
from decision making, planning, management
and evaluation of an activity targeted to them
for their complete well being

13. Community Empowerment
• Refers to the process of enabling communities to
increase control over their lives.
• This helps people to gain control over the factors and
decisions that shape their lives.
• Empowerment increase capacity over their assets/
potentials and attributes that build abilities to gain
access, partners, networks and/or a voice, in order to
gain control

14. Community Involvement
• Connecting people who live together in social
organization and cohesion in the planning, operation
and control of primary health care, using local, national
and other resources
• In community involvement, individuals and families
assume responsibility for their and their communities
health and welfare, and develop the capacity to
contribute to their communities development

15. Community Mobilization
• Is a process of bringing together or engaging
communities to identify community priorities,
resources, needs and solutions that promote
representative participation, good governance,
accountability and peaceful change
• Is an attempt to bring both human and non-human
resources together to undertake developmental
activities in order to achieve sustainable
development

16. Elements: Community Participation
People themselves -
• Identify problems,
• Prioritize their problems
• Developing solutions,
• Make decisions in
– Planning and
– Implementation
– Management,
– Evaluation and
– Ownership of the program
• Sharing of power and resources,
• Deliberate efforts by social groups to control their lives

17. Aim of community participation
• The community develops self-reliance
– Community increase control over, and to improve
their health
• The community develops critical awareness
• The community develops problem solving
skills

18. Outcome of community participation
• Increased self-awareness amongst individual, family
and communities for greater health action
• Increased effectiveness and efficiency in use of
health services
• Increased value of health as evidenced by improved
health behavior
• Improved quality of life through enhanced individual
and family resourcefulness in health care
• Significantly reduced or abated common health
problems such as common preventable diseases,
malnutrition, sanitation/environmental pollution,
poverty , health illiteracy

19. Types of community participation
1. Manipulative participation (Co-option):
Community participation is simply by chosen people
who are representatives on official boards but
they don’t have any inputs or power.
2. Passive Participation (compliance): People
participate by being told what is going to happen
or has already happened , Task are assigned to
people with incentives. Outsiders decide agenda
and implement the project

20. Types of community participation…
3. Participation by Consultation: People participate
by being consulted, and outsiders listen to their views
and modify these in the light of people’s responses
but do not involve them in decision-making.
4. Participation for Material Incentives: People
participate by providing resources, for example
labour, cash, or other material incentives, yet people
have no stake in prolonging activities when the
incentives end.

21. Types of community participation…
5. Participation in Information Giving: People
participate by answering questions posted by
researchers using questionnaire surveys or similar
approaches and do not have the opportunity to
influence proceedings.
6. Functional Participation(cooperation): People
work together with outsiders to determine objectives
and priorities. Decision making remains for outsiders

22. Types of community participation…
7. Interactive /Active Participation (Co
learning): People and outsiders share their
knowledge to create new understanding
Participate in joint analysis, decision making,
development of action plans, and formation or
strengthening of local institutions with outsiders
facilitation.

23. Types of community participation…
8.Self-mobilisation (Collective action): People
participate by taking their own initiatives,
independent of external institutions to change
their life or systems.
They develop contacts with external institutions
for resources and the technical advice they need,
but retain control over how resources are used

25. Community Participation
1
2
3
4

26. Approaches of community
participation
• Community participation can be done in two ways/
approach
• Top- down approach
• Bottom- up approach
• Top-down: few people/ seniors/ experts make
decision, planning, implement programmes while
the community remains as spectators
– Most of the time the programme fails

27. Approaches of community
participation…
• Bottom-up: in this approach members of the
community are involved in any stage of the
programme implementation
• They decision making, planning, implementation,
evaluation together
• This create ownership and sustainability of the
programme

28. Factors Influencing Community
Participation
1. Relevance, accountability and commitment
2. Education status of community
3. Community infrastructure( including communication
network)
4. Socio-economic factors
5. Socio-cultural factors
6. Level of intersectroral collaboration
7. Political stability
8. Leadership
9. Readiness of community

29. Principles of community participation
1. Community empowerment:
• Community must be informed
• Power sharing in decision-making and
management
• Communities are led to plan jointly with
experts or change agents
• Implementation is also evaluated as a joint
effort in order to arrive to intended goals

30. Principles of Community Participation…
2. Self-efficacy relates to individual's self-
perceptions of their competence at
performing particular activities
• That they have ability to accomplish task given
• The sense of self efficacy play a major role in
approaches goals, tasks, and challenges

31. Principles of Community Participation…
3. Effective communication:
• Message should be clear, complete and
understandable by the intended beneficiaries
• Listening to and respecting the opinions of
community members provide positive healthy
working relationships and facilitating effective
communication

32. Principles of Community Participation…
4. Building trust and confidence
• Respect what people know and build ideas from their
base, is one of culturally sound ways to establish
relationship
• Do not generalize that local people are not
knowledgeable about health matters
• Respect what they customs let them show their
potentials and ability
• People willingness to be involved in a program activity is
a function of the degree of trust and confidence between
health promoter and beneficiaries

33. Methods of conducting community
participation
• There are main two participatory appraisal techniques
– Participatory Rural Appraisal (PRA) and
– Rapid Rural Appraisal (RRA)
• RRA is a method used by outsiders to acquire quick
information ( set of issues) about a community
• PRA is methodology aimed gather information from the
community for the purpose of strengthening the community
to plan and make decision on their matters

34. Approaches…
• PRA enable local people to express, share,
enhance and analyze their knowledge of life
and conditions to plan and act
• It shifts the initiative from outsiders to
villagers
• It seeks to empower the weak, powerless and
marginalized by enabling them to analyze,
discuss their conditions
• Believes in flexibility in choosing methods

35. Approaches…
• Four PRA tool and techniques used in PRA
– Mapping
– Diagraming
– Matrix scoring and Ranking (problem analysis)
– Daily activity chart
• All of these are undertaken by local people in
collaboration with outsiders/facilitator

36. PRA
Mapping
•Using local tool to gather community
background and physical features
•Mapping shows physical structure like water
bodies, farms, houses, hosp, schools, land
patterns, distribution of various recourses
•This is done by walking around

37. PRA…
Diagramming
•Diagrams, charts and cards are used to illustrate
relationships concerning people, resources or
time
•Charts /diagrams shows
– Resource use or
– traditional leadership trees.
– Recording seasonal trends relating to hygiene
behaviour and health
– Identifying and prioritizing needs and actions.

38. PRA…
Matrix scoring and Ranking
• Community members are asked to list their
priorities of their perceived needs
• The group facilitator should guide the group in
considering what facilities or activities may be
appropriate but ideas should come primarily from
the participants
• They formulate objectives, and set plans of action

39. Matrix Score And Ranking
Needs Scores Ranking
Water supply 140 1
Malaria 90 3
Building latrines 80 4
Building schools 120 2
Diarrhea 65 5
Environmental sanitation 55 6
Total 550

40. PRA…
Daily activity chart
• This illustrates activities carried out in daily
bases
• Shows time schedules for insisting time
management
• Income / finance generation , productive
work, community work
• By who, how, why

41. PRA…
Evaluation process is the final activities in community
participation
•Outsider and villagers have to evaluate any
implementation put forward
•Evaluate input process
•Evaluate output, outcome and impact process
•See whether they are in the right track (use indicators
if available)
•Correct any mistakes and find a way forward

42. Obstacles To Community
Participation
• Absence of confidence and ability of people in the
machinery of health administration
• Unequal domination of power, wealth
• Inaccessible services in the right time, quantity and
quality
• Rigid bureaucratic set up impending the people to
participate
• Inadequate understanding of local talents, ability and
resources
• People dependence on donors, government

43. Home work : Community Based
Heath Care Programs (CBHC)
• The concept of community participation gave
rise to CBHC
– What is CBHC?
– Common elements of CBHC
– CBHC Strategies
– Major phases in CBHC programs
– Advantage of CBHC
– Your expereince of community participation in
Tanzania

44. Community participation

45. Community participation and
involvement in water supply project

46. Community involvement

47. Community Control