Community participation in health care is important because of the recognized value of locally tailored approaches, as well as the need for increased community financing to supplement government expenditures. For example, the Alma Ata Declaration of 1978 focused on primary health care as the best way to achieve healthy communities, and the deployment of community health workers was viewed as a key component in that strategy. More recently, the concept of community case management has evolved to respond to international recommendations to deliver community-level treatment for common, serious childhood infections. Many activities of questionable value, however, carry the label of "community participation," which can reflect negatively on the whole field. This chapter summarizes the essential elements of a successful community participation program, with a focus on pharmaceutical management.
Community participation may involve -
- Contributing-community members contribute money, labor, or materials.
- Consulting-members are asked for their views and are informed of project plans.
- Managing-members actively participate in making decisions and in controlling resources.
When all three levels of participation are present, communities are full partners in providing services.
Full partnership in decision making means that health development is defined in terms of people’s real needs and priorities; community economic, human, and organizational resources are mobilized; and mechanisms are created to increase people’s access to information, knowledge, and skills and to help them make their goals and priorities known.
Community participation can improve pharmaceutical management through-
- Advocating for access to health care
- Promoting preventive health care
- Improving the availability of medicines and supplies
- Managing outreach services
- Managing facility-based health services
- Promoting appropriate medicine use
Formal health care professionals play a key role in facilitating community participation. They act as motivators; as supporters to the community in establishing strong organizations for community-based activities; as resource persons by establishing links between the community, government agencies, and other organizations; and as trainers and supervisors, building capacity within the community.
Community participation rarely emerges on its own. It succeeds best within an enabling environment, which includes-
- Political commitment to the concept of participation
- Interest in decentralization of health services
- Existence of a health structure
- Commitment to developing people’s managerial capabilities