World health report

Chapter 3

Community participation in public health

WHO’s Constitution of 1948 states that “Informed opinion and active co-operation on the part of the public are of the utmost importance” in improving health, but it was in the 1960s and early 1970s that the practical benefits of community participation in, and ownership of, health projects began to attract increasing attention. Projects in areas of Guatemala, Niger and the United Republic of Tanzania demonstrated that population health gains could be made as a result of increased community involvement. In these projects, community input helped shape programme priorities and community health workers took on significant responsibilities (1). In 1978, the full participation of the community in the multidimensional work of health improvement became one of the pillars of the Health for All movement. In 1986, the Ottawa Charter, signed at the First International Conference on Health Promotion, identified strengthening community action as one of five key priorities for proactive health creation (2).

Since then, there have been both successes and setbacks. The actual capacity of communities to participate in defining and implementing health agendas has been limited by resource constraints, entrenched professional and social hierarchies, and public health models focused on individual behaviours and curative biomedical interventions. Gender, race and class discrimination also play a role. Nevertheless, communities have taken part in many successful public health projects, including sanitation, nutrition, vaccination and disease control programmes (3). Recent reviews of primary health care have continued to find strong support for community participation and there is evidence that such involvement has led to significant health gains (4).

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