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Health Policy and Planning; 4(3): 251-256
© 1989

review-article

Understanding community participation: a health programme in the Philippines

Geert Laleman1 and Sam Annys

Institute of Tropical Medicine, Antwerp, Belgium

1Correspondence: Dr Geert Laleman, Department of Microbiology, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerpen, Belgium.

The principle of community participation is so well recognized in international health circles that no declaration about primary health care is made without it.1 Yet in actually planning and implementing programmes it is very difficult to find clear ways of following this principle. This paper analyses the concrete aspects of community participation in the Munoz-community based health programme, a small nongovernment health programme funded by Missionary Medical Actions (MEMISA - the Netherlands) and established in Munoz, Nueva Ecija, the Philippines.

The programme started as a parish based charity clinic with a policy of free consultations and medicines but underwent a gradual 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 strive for financial independence by the year 1990-91. This would require a better cooperation with the Rural Health Unit (the government public health sector) at the programme level, and a higher degree of community participation at the level of the community if the MCH-programme was to be maintained after the discontinuation of external financial support.

An intensive debate among staff members and CHWs revealed a lack of clear understanding of the concept of community participation. Specifically, the absence of an instrument to assess the process of community participation resulted in a vague and unsatisfactory analysis of the situation. Recently, an analytical framework for such an analysis has been developed2 which focuses on participation as a process, enabling an assessment of participation to go beyond the limits of a merely quantitative analysis. It appears to be a useful instrument for analysing community participation, describing what has been achieved and identifying some of the elements that influenced this process. We have applied this framework retrospectively to our programme as described here.


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