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Primary Health Care: On Measuring Participation

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Abstract

This paper considers the problems of finding measurements for the two major principles of primary health care (PHC), equity and participation. Although both are of equal importance, the authors concentrate on the assessment of participation. A methodology is put forward to define indicators for participation in health care programmes as how wide participation is on a continuum developed for each of the five factors which influence community participation. These factors are: needs assessment leadership, organisation, resource mobilisation and management. By plotting a mark on a continuum which is defined as wide and narrow at the extremes and is connected with all other marks in a spoke arrangement, it is possible to describe a baseline for participation in any specific health programme. This baseline can be used to compare the same programme at a different point in time, to compare observations by different evaluators, and/or to compare perceptions of different participants in the same programmes. A case study provides an example of how the indicators might be used. These indicators focus on the breadth of participation and not its potential social impact, an area which is recognised to be critical for future research.
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... Several authors argue that any evaluation of participation levels and quality should itself be participatory (Blauert and Qunintanar in Estrella et al. 2000), so another question to add is who should measure changes in participation. Rifkin et al. (1988) discuss the problematic nature of evaluating health outcomes in a linear fashion to determine direct causal relationships. The inadequacies of such traditional evaluation methods are particularly true when measuring participation. ...
... They identify the characteristics of social audit as a process that draws on many perspectives, reflects local circumstances, encourages enquiry and leaming, is peer driven rather than top-down and can be qualitative rather than just quantitative (Bums and Taylor, 2000). Rifkin et al. (1988) have, after assessing over 100 case studies, developed 6 factors which influence participation: needs assessment, leadership, organisation, resource mobilisation, management and a focus on the poor. These factors then form the basis of a diagram where each of the arms provides a scale on which to measure the extent of participation within each factor. ...
... The design developed by Rifkin, Muller & Bichman's (1988) and the characteristics of social audit identified by Bums and Taylor (2000) formed the basis of an exercise for measuring participation. This experience of doing this in practice and a reflection of its value is given in the following Chapter. ...
Thesis
p>There is a strong belief among practitioners and some evidence in the literature of the benefits of community participation; particularly its ability to improve the effectiveness and sustainability of health programmes as well as the health and well-being of those participating. However, when attempting to develop a programme to effectively encourage participation within all aspects of the design and delivery of its services, there is much less evidence to guide the practitioner or policy maker. This study aims to identify factors which enable and constraints which restrict community participation within a health programme in a regeneration area in the South of England. The study used an action research approach, with seven co-researchers of different seniority levels and a community member. Three main areas of findings emerge from the study data: firstly, the interpretations and motivations for participation from community members and public and voluntary sector staff led to the development of a new dynamic definition of participation as a journey. Secondly, the findings on the success, or otherwise, of interventions to encourage participation have led to the conceptualisation of participation as a system in which all components must be developed in order to progress towards a fully participatory programme. Finally, the longitudinal and in-depth nature of the action research process allowed the mergence of findings on the factors which encourage and conversely, discourage the development of a participatory programme. In particular these focus on the nature of the regeneration area, the level of influence of front-line staff within the organisation, the levels of empathy and professionalism among those working with communities and the extent of organisational commitment to participation.</p
... Implementation analyses were conducted in about a third of the included studies. Two of these studies measured the participation of community partners using Rifkin's spidergram, a semi-quantitative framework based on monitoring five factors that influence community participation (needs assessment, leadership, organization, resource mobilization and management) [64]. ...
... It aims to assess the process of participation rather than its impact. It is based on the evaluation of five factors (needs assessment, leadership, organization, resource mobilization and management) and can be used to compare the same program at different points in time, observations by different evaluators, or perceptions of different participants in the same programmes [64]. Only the NEOH framework aims to address the complex prism of an integrated approach since it specifically targets OH initiatives. ...
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... The aim henceforth should be to consistently and actively contribute to emancipation and participation in whatever way possible. One way of doing this is through the adoption of participatory (action) research methods, while bearing in mind that participation has long been a contentious issue 29 and it is important to actively revert from tokenism or instrumentalization of local stakeholders. 30 Photovoice (see Mukumbang et al. 20 ) and the Community Lab of Ideas for Health (see Masunaga et al. 31 ) are just two such promising methods. ...
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... The needs identified were clearly within a disease framework and paid little attention to socio-environmental or equity issues. The Healthy Cities, primary health care and other 'new public health' movements in developed and developing countries has resulted in criticisms of these limited approaches to community needs assessment [56][57][58][59]. The critics have gone on to call for and conduct research that is methodologically eclectic and more participatory than the earlier work. ...
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... Η κοινοτική συμμετοχή (community participation) έχει οριστεί από τους Rifkin et al, 10 καθώς και από τους Bermejo & Bekuit, 11 ως η διαδικασία με την οποία συγκεκριμένες πληθυσμιακές ομάδες με κοινές ανάγκες, που διαμένουν σε καθορισμένη γεωγραφική περιοχή και με έντονο το στοιχείο της μεταξύ τους αλληλεπίδρασης, μετέχουν ενεργά στον προσδιορισμό των αναγκών τους και στη διαδικασία λήψης απόφασης για την ικανοποίησή τους. Οι Bracht & Gleason 12 έχουν προσθέσει ότι η διαδικασία αυτή μπορεί να λειτουργεί σε εθελοντική βάση και να αποτελεί επίσημη ή ανεπίσημη δραστηριότητα. ...
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