I recently attended a conference on “community participation” hosted by the European Commission in Brussels. The European Union and its member states provide over half of global aid, much of it through the European Commission, and the Commission wanted to understand how it might use this influence to help communities in developing countries have more of a say in the decisions that affect them. It invited NGOs, donors and academics to discuss ways in which it might achieve this objective in the field of health.
In developing countries, many people are unable to access health services provided in facilities like health centres and hospitals. There are several reasons for this – the cost of health services for example, or not knowing that they’re entitled to use these services, or living too far from the nearest health facility.
Encouraging communities to get involved in activities and decisions affecting their health care can help to overcome some of these barriers. This is particularly important for maternal and child health, which is a focus of Save the Children’s work as well as Millennium Development Goals 4 (a reduction in maternal mortality) and 5 (a reduction in child mortality). Participation can take different forms: village health committees can be given responsibility for overseeing public health services; community volunteers can be mobilised to make sure people are aware of simple measures to prevent illness (e.g. hand washing with soap) and know how to access health services if they do fall ill; and community health workers can provide some health services at the level of the community rather than in hard-to-reach health facilities, thereby making these services much more accessible.
These are just some of the ways that community participation can be made real. During a recent visit to Save the Children’s health programme in India, I saw evidence of how promising this approach can be. I was in Purulia, a rural district in West Bengal state about six hours drive from Calcutta. Save the Children is supporting a local organisation working with community groups and village health committees. I met a group of women who had become inspired by the idea that they had a right to health care. They described how a few days before my visit a group of local politicians had passed through their village on a pre-election campaign. The politicians were taken aback when the women stopped them and engaged them in a heated discussion, insisting that they do more to improve the availability and quality of local health services. The politicians left humbled, promising to take these issues seriously – a good example of a mobilised community!
Back in Brussels, the conference was less inspiring than my encounter with the women’s group, though there were some interesting discussions. We did come up with recommendations for the Commission on how to ensure more effective community participation in the decisions which affect their health. But of course the true test will be whether the talk can turned into significant and sustained action in the villages and districts of the developing world where too many communities remain unable to access the health care which is their right.