Front-3
In spite of the failure of most large, centrally controlled programs to achieve
effective community participation, in many countries there are outstanding
examples of enthusiastic community involvement in health. This is especially true
in small, non-government programs that take what we call a people-centered or
community-strengthening approach to health care.
Within these community-based programs, there is a wealth of variety in terms
of innovation and adaptation to local conditions. But at the same time, there is a
striking similarity in their social and political objectives in many parts of the world—
Pakistan, India, Mozambique, the Philippines, Mexico, Nicaragua, Honduras, El
Salvador, and Guatemala.
In these community-based programs, a new kind of health worker has begun to
play a leading role. These health workers speak out for the ‘voiceless’ poor. Their
goal is health for all—but health that is founded on human dignity, loving care, and
fairer distribution of land, wealth, and power.
To us, one of the most exciting aspects of this new world-wide community-
based movement, decentralized and uncoordinated as it may be, is that it goes
far beyond any rigid religious or political doctrine. Most of the leaders in these
programs recognize the dangers to ordinary people in any large, centrally controlled
system, be it capitalist or communist. They have far greater faith in small, self-
directed groups of working people. Rather than accept any established dogma, they
are asking searching questions. They welcome criticism, and encourage others to
observe for themselves and form their own conclusions. They believe in helping
the powerless to gain strength through a greater understanding of the factors that
shape their health and their lives.
Around this practical human vision has gradually grown a whole new approach
to the training, role, and responsibilities of community health workers. Ideas and
methods are being shared and further developed through a series of informal
networks around the world.
Many of the ideas in this book have been gathered from these networks of
community-based health programs, and especially from Project Piaxtla, a small,
villager-run program based in Ajoya, Sinaloa, Mexico.