Understanding community participation: a health programme in the Philippines

The principle of community participation is so well recognizedin international health circles that no declaration about primaryhealth care is made without it.1 Yet in actually planning andimplementing programmes it is very difficult to find clear waysof following this principle. This paper analyses the concreteaspects of community participation in the Munoz-community basedhealth programme, a small nongovernment health programme fundedby Missionary Medical Actions (MEMISA - the Netherlands) andestablished in Munoz, Nueva Ecija, the Philippines. The programme started as a parish based charity clinic witha policy of free consultations and medicines but underwent agradual evolution towards a mother and child health (MCH) programme,with a growing emphasis on the participation of the (pregnant)mothers and community health workers (CHWs) in the villages.The sponsoring agency, staff members and CHWs agreed to strivefor financial independence by the year 1990-91. This would requirea better cooperation with the Rural Health Unit (the governmentpublic health sector) at the programme level, and a higher degreeof community participation at the level of the community ifthe MCH-programme was to be maintained after the discontinuationof external financial support. An intensive debate among staff members and CHWs revealed alack of clear understanding of the concept of community participation.Specifically, the absence of an instrument to assess the processof community participation resulted in a vague and unsatisfactoryanalysis of the situation. Recently, an analytical frameworkfor such an analysis has been developed2 which focuses on participationas a process, enabling an assessment of participation to gobeyond the limits of a merely quantitative analysis. It appearsto be a useful instrument for analysing community participation,describing what has been achieved and identifying some of theelements that influenced this process. We have applied thisframework retrospectively to our programme as described here.