Title: Concepts of community participation
Course: Level 3 - Health Education and Promotion > Section: Community participation

In the past, while we discuss approaches health education follows, you have learned persuasion approach which force behavior change among individuals or community and contemporary an informed decision-making approach emphasizes on community participation. A community's members are a rich source of knowledge about their community and of energy and commitment to that community. When health extension workers plan a program to address health issues in a particular community, working with community is an essential issue.

When the idea of primary health care was launched, community participation was one of the important principles identified for its implementation. Although everyone talks about it, real community participation is rarely practiced.

The concept of community participation involves individuals or a community has taking part in decisions which affect them or their community's health status. It aims at encouraging people to work actively with health extension workers and others in identifying their own health problems and also in developing solution and plans to work them out.The health of the community will improve only if the people themselves become involved in planning, implementing, and having a say about their own health and health care programs.

Community could be defined as organized groups of people who share a sense of belonging, beliefs, norms, and leadership and who usually interact within a defined geographical area. For example people living in a "Kebele" or "Woreda"

Community involvement in health basically means that communities take responsibility for their own health through: adoption of behavior to prevent and treat diseases; effective participation in disease control activities; contribution to the design, implementation and monitoring of health programmes; provision of resources for health.

In health education, we are concerned about how people actually feel about their problem, not how we think they should feel. We are interested in how people look at their own problems develop confidence and skills to help themselves. The concept of community participation encompasses the process by which individuals and families assume responsibility for the community and develop the capacity to contribute to their health and the community's development. It is a means by which the emphasis is on strengthening the capacity of communities to determine their own needs and take appropriate action. Communities should not be passive recipients of services.

Health extension workers should consider the community participation while the want to deliver any health education /health promotion program. To work with community they will be able to listen to their concerns, to learn from them what they feel is important, to share with them appropriate information, to encourage and support them. It should be clear involvement not asking for approval. It is must to involve the community it not an optional.

- Selamawit is a Health Extension Practitioner in a kebelewhere the birth rate is very high. She plan for the next year includes increasing the number of couples who are using contraception. She decides to call some community members and local leaders to approve the plan and they attend her, the meeting was ended. Is community participation taking in this program?
- Your answer should be NO. The community is called not to give an input for identified problem but only to approve her plan. In this case we cannot say there is effective community participation.

Community participation is defined as "Members of a community taking part in determining, planning, developing, implementing and evaluating programs and actions which affect their lives and the life of their community"

We may say communities are participating when they are actively involved in:

- The assessment of the situation/needs
- Problem identification
- Priority setting and making decisions
- Sharing responsibility in the planning, implementing, monitoring and evaluation

The role of health extension workers should be limited to helping them identify their problems and to point out methods for dealing with the problems. Community participation is very important in many projects including sanitation, child survival, family planning, HIV/AIDS prevention, clean water and health infrastructure.

Fig 4.1 women's health development leaders at health post briefing performance, (photo: Mohammed Hussein, 2012)

For success in community participation health extension workers should know their community structures and patterns well, both community and religious leaders and existing local community organizations well.