Lessons from community participation in health programmes

Although primary health care emphasizes community participation and many health care programmes attempt to develop participation, good analysis of these developments is still rare. This paper, based on a review of about 200 case studies, examines some of the lessons for planners which are emerging from experiences of the last decade. These lessons focus on the problems of defining the term 'community participation', of gaining and sustaining broad-based community participation, of failing to recognize the political implications of the concept and of attempting to develop a management model of community participation for health. Based on these lessons, a planning framework is suggested that seeks individual programme answers to three questions: 'Why participation?', 'Who participates?', 'How do they participate?'. The answers to these questions will help to define a programme's objectives and to monitor and evaluate its development.