What is perhaps less commonly evaluated is the growth of social empowerment and participation in health actions.

Tools for assessing participation range from survey questionnaires and key informant interview, to specific tools such as the Rifkin diagram, and more participatory methods such as the chapati chart (Schmidt & Rifkin, 1996).

These tools exemplify a range of options for reflecting on the extent to which participation has itself been built through programmes. Sentinel surveillance is one means of monitoring community perceptions of quality of care and community priorities. Measures could also be included in such surveillance to assess access to, use of and participation in health systems.