After decades of 'participation' in health systems, there are only isolated examples of its success

'Participation' of civic groups and communities has at worst been included to give programmes respectability. Such programmes have continued to use top-down approaches to decision-making, have continued to set up bureaucratic blocks, have failed to invest in the material and institutional conditions to support participation and have continued to marginalize the most vulnerable.

Participation has been weakest in areas of decision-making, such as in resource allocation, which is what people feel most strongly about. As noted later, this is a potential constraint in ensuring that resources reach the intended communities and in mobilizing resources from communities. For both health sector programmes and communities, poor forms of participation lead to poor returns for time and resources spent, and to poor health outcomes.


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Involvement in health

"Community participation"

Financing health systems

Use of resources
Interactive exercise