Paradigms Lost: Toward a new understanding of community participation in health programmes

Susan B. Rifkin

Research output: Contribution to journalArticlepeer-review

164 Scopus citations


Community participation has been a critical part of health programmes, particularly since the acceptance of primary health care as the health policy of the member states of the World Health Organisation. However, it has rarely met the expectations of health planners/professionals. This paper argues that the reason for this failure is that community participation has been conceived in a paradigm which views community participation as a magic bullet to solve problems rooted both in health and political power. For this reason, it is necessary to use a different paradigm which views community participation as an iterative learning process allowing for a more eclectic approach to be taken. Viewing community participation in this way will enable more realistic expectations to be made. Community participation in disease control programmes focusing on community health workers is used as an example to show the limitations of the old paradigm. Participatory rapid appraisal is used to illustrate the new.

Original languageEnglish (US)
Pages (from-to)79-92
Number of pages14
JournalActa Tropica
Issue number2
StatePublished - Apr 1996
Externally publishedYes


  • Community health workers
  • Community participation
  • Paradigm shift
  • Rapid appraisal

ASJC Scopus subject areas

  • Parasitology
  • veterinary (miscalleneous)
  • Insect Science
  • Infectious Diseases


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