Participation in rural health development : a case study in Kenya
Achieving active participation of community members in community-based health care programmes (CBHC) is a challenging and complex task. It is also a criterion for successful programming and is promoted as a universal truth and requirement for primary health care development. Nevertheless, most CBHC programmes admit that more needs to be done to achieve satisfactory levels of community involvement. Thus, a better understanding is required as to why success in community involvement has been in most part, elusive. The thesis uses a historical perspective to examine the emergence of participation in the period prior to and during the community development era in Africa and the post-independent period in Kenya. The emergence of participation and it's progression as an international health strategy in the 1980's and 1990's within WHO, a leading international organisation promoting community involvement in health is critically examined. At the community level, people's perception and understanding of community participation and an analysis of how they participated in the case study CBHC programme provided an operational assessment of community participation. A particular focus was community contributions as a mechanism of participation. Thus, the primary aim of this thesis was to examine in rural Kenya the socio-economic and institutional support factors which can potentially enhance or limit participation of community members in rural community-based health development programmes. The main socio-economic factors examined were education, income, group membership and domestic factors such as harmony in the household and women's time. The roles of local structures and support personnel such as community health volunteers (CHVs), health committee members (HCMs) and local leaders in promoting participation were also analysed. The method used was interviews with a sample of these respondents. Based on the case study research results, the thesis draws conclusions on the factors that appear to be most significant in relation to community participation. The importance of education, group membership and regular monthly visits by CHVs were identified as particularly significant factors. A more informed understanding of these relationships will enable health planners in designing integrated programme strategies which can help promote broader community participation in health development programmes. An awareness of these factors and their inter-relationships by operational-level health staff will enable them to enhance community participation when developing and implementing community-based health care programmes.