B. D. PATEL.

MBA (HRM), MSW, MA (JMC), PGDPRM, PGDNGOM, PGDHE, MIPHA.

B -704. Mahavir Hills -2, Koba – , Gandhinagar.Pin-382421,
[email protected] (M)6352031885, 9427801698

COMPILATION
Community Participation

“Go in search of people

Begin with what they know
Build on what they have”
-From a Chinese proverb.
Introduction:
Participation means self- motion. It gives the citizen a chance to show his willingness to carryout
constructive public work and to demonstrate his good citizenship by other means that
periodically exercising his right to vote.
It means the full involvement of the community in the planning, implementation and control
of Primary Health care. People’s involvement has to be understood in the following three
senses:-
• Participation and decision–making, such as in the identification, development priorities and
planning of development program, projects and activities;
• Participation in implementation, monitoring and evaluation of development programs and
projects;
• Participation in sharing the benefits of development.
Among the complexity of factors that comprise health care, socio-cultural factors assume as
much critical importance as medical and technological factors. Major community aspects of
rural life include existence of a common set of social standards, beliefs, values and norms of
behavior which are referred to both individuals as well as groups while deciding upon whether
or not to participate in or adopt any community practice, and much less then health aspects
since people need support for their actions in the community and often they tend to believe it
as their social norms. However these aspects are often ignored by outsiders coming in contact
with the villagers who assume that their program aims and means are convergent with those of
the people.
Deducing from the above any health program if it were to succeed in a holistic sense, it should
be ensure on the one hand that while such sensitive aspects of community life are to be kept in
mind modification in community behavior the essence of community participation are sought
and mechanisms for sustained community participation established.
The spirit of self-reliance and self-determination is expected to ensure as a result of the
participation of community in not only by planning health care but by implementing it too
because democratization of community and involvement of people’s institutions are believed to
form the cornerstone of community participation.
Ideally, people should be fully knowledgeable about their health problems and they should
identify the need for its solution or reduction, draw out plans of community health action and
organize community to implement those action plans and closely monitor them and carry out
recycling if there be a need. However, in the present context of socioeconomic conditions it
may be difficult to get peoples voluntary participation but they need to be educated and
mobilized and encouraged to take greater interest and play an active role in improving their
own health and condition of community health. The activist role of Health care worker for IEC/
Advocacy, Communication and Social Mobilization (ACSM) is important.
Concept of community participation: A community may mean a few small clusters of families
which may belong to varied clusters and diverse social backgrounds bounded together,
presumably with common needs and interests, into larger groups joined together by aspects

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like caste, class, religion and occupations etc., in a given geographical area as in a village or
urban neighborhood.
Community participation may mean different things to different people as for example, it may:
be viewed as a ‘means’ to development or may also be visualized as an ‘outcome’ of
development. It is hard to find agreement among the divergent definitions.
Possible definition of community participation could be as under:-
Community participation in an educational empowering process in which the people, in
partnership with those who are able to assist them, seek to instill a sense of belongingness, self-
reliance, confidence, competence to diagnose the problems, priorities the needs and assume
critical responsibilities to manage, control and assess activities that affect them most and take
collective actions that are proved necessary. It is a democracy in action community participation
is of intrinsic value to the population group and ensures the involvement of local population in
the decision making process concerning developmental planning and implementation through
their own efforts with the available local resources.
1. Definition of community participation:
It is a process which enables the community:
• To know its problems,
• To identify its needs,
• To prioritize them,
• To draw action plans,
• To organize resources,
• To implement the programs,
• To monitor and control progress,
• To evaluate results,
• To initiate corrective measures.
2. Purpose community participation:
• Creating will and determination among the members of the community for improvement
in their present and future life.
• Identification and development of the local resources, thereby generating self-reliance
among the community.
• Achieving integrated area coordination among various agencies interested in primary
health care.
• Mobilizing the available manpower for productive and useful activities.
• Keeping the member of the community constantly informed about the developments in
the area.
• Arranging functional literacy programs which can help them in understanding new
technology.
• Organizing and encouraging various clubs of youth, Self Help Group (SHG), Mahila Samiti,
Village Health Sanitation and Nutrition Committee, women to serve as centers of
discussion for involvement in health care.
• Providing an open forum for the community to discuss its problems and find indigenous
solutions which may be efficient and economical.
• To develop local leaders who can further educate and mobilize the people in the area.
• Encouraging the people to adopt modern change which can accelerate their socio-
economic development.
• Arranging extracurricular activities to generate social awareness through well designed
publicity.
• Encouraging the person to develop themselves rather than depend upon the Government
for all activities and thus become self-reliant which is the key to development.
• Resource mobilization from within the community to supplement organized health care
services and keeping social control in the way resources are utilized.
• Encouraging non-governmental and voluntary organization to become active partners in
health care delivery.

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 • The health care services providers and voluntary agencies should not behave as providers
rather they should consciously make effort to be viewed as agents of change enabling the
community to use its own resources, improve skills to improve its own health.
• Recognizing the need to develop inter-sectoral coordination and multiple support linkage
with health and health-related sectors of development to provide for the interest of varied
sections of the community to avoid segmentation.
• Motivate and strengthen the skill of grass root level workers to improve their credibility in
the community.
• Catalyst for further development.
• Generate kinetic energy for health development.
• Making people aware of their health needs
• Higher achievement at a lower cost.
3. Essential of community participation:
• Full involvement at all levels, i.e. policy- making and planning.
• Framing/ developing program.
• Implementation of program.
• Evaluation of program.
• Empowerment of powerless through giving weightage to them.
• Control over process and monitoring to ensure benefits.
• Keeping people well informed at all stages.
• According due recognition to people’s contribution.
• Sincerity of government functionaries in enlisting people’s support.
• Harnessing physical/ economic/social resources of individual.
• Designing innovative plans for people’s involvement in community.
• Empowered relationships.
• Voluntary contribution to programs.
• Inculcating responsibility among the people for all development activities in the
community.
• Ensuring that the people benefit from all development activities of the community.
• Selfless desire to work for the community.
• Respect faith in people’s capacity and value the opinions and experience of the people.
• Develop on the basis of equal partnership.
4. Types of community participation:
Participation could mean associating oneself, individually or collectively with a definite
objective, be if a program, scheme, and activity or a movement, with an appreciable degree
of adaptive, emotional, expressive or instrumental involvement including those which may
appear to have even negative connotation.
The adaptive, emotional, expressive and instrumental involvement referred to as above can
also be conceptualized as:
• Cognitive-participation means identifying oneself with the concept, idea or task but not
necessarily participating in it physically. For example, Old people may participate not by
doing manual labor, but by encouraging able bodied persons to participate in preventive
health care by sharing the wisdom of their knowledge about indigenous drugs
community practice and community fears and threats. It would provide inputs to decision
process.
• Process-participation would involve participating in processes which lead to better
decision making. For example, involvement of articulate community groups/ leaders in
deciding about the rehabilitation of villagers who might be displaced because of an
expected evaluation of parts of villages or due to accessibility for isolation/quarantine
purposes.
• Interactive participation connotes educating, motivation, organizing, guiding and
preparing people for a task. The activities of the preparatory and planning phases, and

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 those related to leader-follower relationship during implementation may call under this
category.
• Material-participation would individual contribution by way of time, money, labor or
other resources necessary for achieving the goals and is not necessarily restricted to
activities like digging soak pits or sanitation related activities. People giving their barren
land for creation of health centers, growth of trees, or making available their private
water sources for drinking purpose or giving donations are some examples of material-
participation.
5. Stages of community participation:
• Cooperation based on the assumption that people will cooperate willingly to utilize the
facilities being created for them.
• Participation based on the assumption that people will participate in developmental
process provide they share the decision making process and governments ideological and
financial support is forthcoming.
• Involvement based on the assumption that people have a sense of belongingness as to
own the project and they have become self-directed and may not require any external
assistance for its sustenance and continuance.
6. Obstacles to community participation:-
• Absence of confidence and ability of people in the machinery of health administration.
• Unequal domination of power relations in favor of rich and to the disadvantage of the
poorer sections of the society.
• Inaccessible services in tight quantity and quality.
• Rigid bureaucratic setup impeding the people to participate.
• Inadequate understanding of local talent, abilities and resources: professional experts
underestimate people's knowledge and ability to handle local problems.
• Absence of identity with the community among people.
• People's dependence on Government and not in their own self.
• Heterogeneity of Interests.
• Resistance to empower people.
• Health system not oriented to Primary Health Care approach.
• Resistance on the part of certain segments of population to participate.
• Health workers indifferent attitude.
• Sustained efforts missing or Luke warm attitude.
7. Promoting effective community participation in health care:
Community involvement could be effectively promoted in following ways:
• Improve the community awareness and understanding of the health problems in the
community by effective disseminations of health and health related information and
mobil-
ize them to seek and utilize the available services and facilitates created for them.
• Identify and encourage enlighten leaders/satisfied service utilizes/health
promoters/health guides/progressive women leaders to participate and enlist
participation of others in identifying health needs, setting goals, implementing health
action, monitoring and exercising control and even evaluating the outcome.
• Resource mobilizations from within the community to supplement organized health care
services and keeping social control on the way resources are utilized.
• Encouraging non- governmental and voluntary organizations to become active partners
in health care delivery.
• Activating village health committees, panchayats, mahila mantillas and youth clubs
involvement in health care.
• The health care service providers and voluntary agencies should not behave as providers
rather they should consciously make efforts to be viewed as agents of change enabling the
community to use its own resources, improve skills to improve its own health.
• Encouraging willing participation by allowing people to shape in decision making and
ensuring that benefits accruing from the program will reach all those who need it. It

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 requires basic changes in the project organization, work attitude, work patter and social
skill of the workers of the health care organization and willing acceptance on their part to
subordinate to social control. A system agreed upon so that social benefits do not have
limited to any specific group or individuals but flew to all segments.
• Recognizing the need to develop intra-sectoral coordination and multiple support linkage
with health and health related sector of development to provide for the interest of varied
sections of the community to avoid segmentation.
• Motivate and strengthen the skill of grassroots level workers to improve their credibility in
the community.
• Community is educated to identify its health status based upon few clear cut
Indicators which may also be used to monitor the service programs and performance of the
workers.
8. Development a partnership with people: People do not always understand why they
should try to improve their health by their own efforts. They feel sometimes that health
care is the responsibility of the government. Of course, the government has a responsibility
in this area. And it is clear that the promotion of people’s self-reliance should in no way be
an excuse for health workers to avoid rendering the services that the community is entitled
to receive.
Here is an example of community-based project where it took a long time to establish a real
partnership.
9. Advantages of community participation:
• Higher achievement at a lower cost.
• Catalyst for further development.
• Develop a sense of responsibility in the community to meet a felt need.
• Permits use indigenous expertise and development self-reliance.
• Offers starting point, for conscientiousness.
People’s Management:
• Try to remember the names of peoples.
• Be first to tell ‘Good Morning or Hello’.
• Do not judge people, from their faces.
• Have respect and courtesy for all.
• Do not indulge in arguments.
• Friction or conflict arises because of Ego problems.
• Do not criticize anybody when he or she is absent.
• Appreciate in public and criticize in private.
• Think twice before you speak.
• Listen to people with Empathy.
• Keep cool. Do not be angry.
• Use words telegraphically.
• Be sincere about your commitments.
• Do not give false promises.
• Leave a lasting impression with positive manners.
• Shake hands confidently.
• Love every one.
Beautiful advised of Late Dr. Y. C. James Yen:
Go to the people;
Live among the people;
Learn from the people;
Plan with the people;
Work with the people;
Start with what the people know;
Build on what the people have;
Teach by showing, learn by doing;
Not a showcase, but a pattern;

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 Not odds and ends, but a system;
Out piecemeal, but an integrated approach;
Not to conform, but to transform;
Not relief, but release.
For
In every developing community there are Civic-minded leaders who want to help their People,
give them a handle and they will seize it and March like an army with a banner.
"To involve people and to enable them to formulate their own healthcare objectives, the health
care providers will have to:
• Provide opportunities for people to learn how to identify and analyses health and health-
related problems and how to set their own targets;
• Make health and health-related information easily accessible to the community, including
information on practical, effective, safe and economical ways of attaining good health and of
coping with disease and disability;
• Indicate to the people alternative solutions for solving the health and health-related problems
they have identified.
• Create awareness of the importance of effective communication in fostering mutual
understanding and support between the people and the health care providers;
• Translate the targets set by the people into simple, understandable, realistic and acceptable
goals which the communities can then monitor; and
• Help people to learn how to set priorities among the different health problems they have
identified and to understand the need to refer to relevant policies in doing so, e.g. that
priority should be given to the deprived sections of the community and to certain diseases on
the basis of the degree of their contagiousness, susceptibility to treatment etc."
It is essential that communities have a clear understanding of their role in the implementation
of strategies for solving health problems. Here, health education should facilitate the dialogue
with the people through culturally and socially acceptable forms of communication.
-WHO Expert Committee on New Approaches to Health Education in Primary Health Care.