Rhetoric and Reality of Community Participation in Health Planning, Resource Allocation and Service Delivery: a Review of the Reviews, Primary Publications and Grey Literature

Abstract

Introduction: This paper synthesises reports on community participation (CP) concept and its practicability in countries’ health service systems, much focus being on developing countries.
Methodology: We narratively reviewed the published and grey literature traced from electronic sources and hard copies as much as they could be accessed.
Findings: CP is a concept widely promoted, but few projects/programmes have demonstrated its practicability in different countries. In many countries, communities are partially involved in one or several stages of project cycles - priority setting, resource allocation, service management, project implementation and evaluation. There is tendency of informing communities to implement the decisions that have already been passed by elites or politicians. In most of the project/programmes, professionals dominate the decision making processes by downgrading the non-professionals or non-technical people’s knowledge and skills. CP concept is greatly misinterpreted and sometimes confused with community involvement. In some cases, the community participates in passive manner. There is no common approach to translate CP into practice and this perpetuates debates on how and to what extent to which the community members should participate.
Conclusion: Persistent misconceptions about CP perpetuate inequalities in many countries’ health systems, suggesting more concerted measures towards making a desired difference.