Participation and Practice Glenn Laverack

Community participation is a broad based concept by which people become more actively involved in a range of common concerns or needs (Rifkin, 1990).

Single mother and activist in Nova Scotia, Canada. "I wanted to go out and change the world". "But I couldn’t find a babysitter". (Travers, K. D. (1997) Reducing inequities through participatory research and community empowerment. Health Education and Behaviour, 24, ).

Aboriginal organizer, Lily Walker ‘If you are here to help me, then you are wasting your time. But if you come because your liberation is bound up in mine, then let us begin.’ Valvarde, C. (1991) Critical theory in health education. Montreal. Montreal DSC.

Participation Can help to promote involvement in public health programmes. Does not commit either the outside agency or the participants to take further action. Has methods for implementation. Has indicators for measurement.

Participation It is generally agreed that participation alone: does not lead to action or empowerment. does not lead to improved health outcomes. does not lead to improved health care. does not lead to improved access to health care. Rifkin, S. (2011) Chasing the dragon: developing indicators for the assessment of community participation in health programmes. Workshop presentation. Vienna 5/5/2011. Ludwig Boltmann Institute for Health Promotion, Vienna, Austria.

Neonatal and maternal mortality in Nepal The women in the intervention clusters participated in antenatal care, institutional delivery, trained birth attendance and more hygienic practices, which led to an improvement in birth outcomes. By participating in the groups they were better able to decide on, and through the support of others, voice and act on their concerns regarding childbirth. The participation strengthened social networks and improved social support between women and between women and the providers of health-services delivery (Manandhar et al, 2004).

Tostan: Empowering communities to abandon Female Genital Cutting

Tostan: empowering communities A Senegalese based NGO working in 10 African countries (4000 villages alone in Senegal). The program targets both social (normative behaviour) and political (policy) change. A cluster of 7-10 communities linked by social networks. Regular `learner centred` classes by a facilitator (social, health, problem solving ) & (literacy & economic). Sets up a community management committee. Gives materials, funds and ideas for income generation. Enrolment through àdopt another learner`.

Empowering communities to abandon FGC Evaluation in 4 regions in Senegal between 1997 and 2000 found: oprevalence of FGC dropped by approximately 70% compared to 40% in control villages. oprevalence of FGC dropped by approximately 40% compared to control villages in the Gambia ( ). oAmong women with uncut girls, the rate of women reporting they did not have the intention to cut their daughter was three times higher than in control villages (studies show that the desire to change FGC was much higher than the actual rate of change). oIncreased the level of knowledge, attitudes and behavior in support of abandoning FGC in participating communities. oLaw against FGC as a practice passed in Senegal in oFormulation of the second national action plan for the total abandonment of FGC in Senegal by 2015.

The Safer Parks Scheme New Zealand Started by the City Council following complaints about crime in public parks – low patronage. Employed park wardens and honorary rangers to patrol the areas and installed exercise equipment. In collaboration with the DoC it encouraged public participation through its ‘adopt a park’ initiative. Volunteers helped to raise money and to report any problems that they encountered to the park rangers. As a result park patronage and exercise levels greatly increased-leading to improved health.

Participation in Sri Lanka The funding agency held meetings with the community to discuss their health. The people responded by saying that poor health was because of the ‘spirits’ coming from the cemetery. The agency set their own agenda with a water and sanitation project. The community participated in the project by providing voluntary labour. The outside agent provided the funds to purchase the building materials. The result was that the community saw this as an outside project. 2 years later the community continued to blame their ill health on the ‘spirits’. Most wells and latrines fell into disrepair, were never used or for other purposes. We must be prepared to listen to what the community wants. You may not necessarily like what you hear, but you must be committed to moving forward and building upon these issues.

2 Case studies of Participation