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What is participation?
Two views have developed about people’s participation in health:*
In the first, more conventional view,
planners see participation as a way to
improve the delivery of standard
services. By getting local people to
carry out pre-defined activities, health
services can be extended further and
will be better accepted.
In the second view, participation is
seen as a process in which the poor
work together to overcome problems
and gain more control over their health
and their lives.
The first view focuses on shared values and cooperation between persons at all
levels of society. It assumes that common interests are the basis of community
dynamics—that if everyone works together and cooperates with the health
authorities, people’s health will improve.
The second view recognizes conflicts of interest both inside and outside the
community. It sees these conflicts as an important influence on people’s health.
It does not deny the value of people organizing and cooperating to solve common
problems. But it realizes that different persons and social groups have different
economic and political positions. Too much emphasis on common interests may
prevent people from recognizing and working to resolve the conflicting interests
underlying the social causes of poor health. This second view would suggest that:
Any community program should start by identifying
the main conflicts of interest within the community.
It is also important to identify conflicts with forces outside the community and look
at the way these relate to conflicts inside the community.
Which view of participation is taken by planners or program leaders will depend
largely on what they believe is the cause of poverty and poor health:
Some believe that poverty results
from the personal shortages or
shortcomings of the poor. Therefore,
their program’s goal is to change
people to function more effectively
in society. They think that if the poor
are provided with more services,
greater benefits, and better habits,
their standard of living will become
healthier. The more the people accept
and participate in this process, the
better.
Others believe that poverty results
from a social and economic system
that favors the strong at the expense
of the weak. Only by gaining political
power can the poor face the wealthy as
equals and act to change the rules that
determine their well-being. Programs
with this view work to change society
to more effectively meet the people’s
needs. For this change to take place,
people’s participation is essential—but
on their terms.
*Many of these ideas are taken from “On the Limitations of Community Health Programmes,” by Marin
das Merces G. Somarriba, reprinted in CONTACT-Special Series #3, Health: The Human Factor, World
Council of Churches, June, 1980. www.oikumene.org