Is it consumer or community participation? Examining the links between 'community' and 'participation'.

ABSTRACT

In writing about community participation in health, the term 'community' is used loosely and ambiguously. On analysis, it appears that there is a conceptual shift in health policy to thinking about involvement of consumers in health planning and programs rather than communities. This shift is consistent with a managerialist approach to planning health service delivery. Participative processes are perceived as being initiated and directed by health administrators. Participants in the processes are to be 'representative' of health service consumers, rather than whole communities. However, in many Australian rural communities, there are enduring traditions of community participation in providing governance for local hospitals, developing infrastructure for general practice services, and providing in-kind support. Participation in health services is embedded in the way the community functions. Acknowledging and understanding the ways in which 'community participation' and 'consumer participation' are different may result in more effective participative processes.

KEY WORDS

community participation; consumer participation; rural community; health; sociology

Current understandings of community participation

 
   ... community participation has captured the 
   attention of health planners, policy makers 
   and administrators and has become well 
   entrenched in mainstream health discourse. 
   The analytical complexities, definitional 
   disputes, and operational challenges [of 
   community participation] have been 
   thoroughly, (even exhaustively) discussed and 
   illustrated through case studies (Morgan 
   2001:221). 

The idea of community participation continues to have currency in health planning, and in health program and service development in Australia and internationally. It is widely accepted that community participation in health activities facilitates both health and social benefits for participants (World Health Organisation 2000). Community participation in primary health care (Asvall 2000) and in rural health (Walker 2002) is strongly promoted because it is seen as an essential component of effective, efficient, and locally owned health care. The notion of community participation as ordinary people involving themselves in raising funds for equipment (Short 1989), helping identify health needs (Dunne et al 1994), and voluntarily helping to organise health services (Zakus 1998) continues to make pragmatic sense. It attracts the attention of health administrators and policy makers almost a quarter of a century after it was formally introduced to health planning and delivery at the Alma-Ata Conference in 1978 (Morgan 2001:222).