Participate effectively : who, how and why? : a study of people's participation for health development
Peoples' participation and empowerment are widely considered as key elements if not pre-requisites for successful and sustainable health development outcomes. To date there is no conclusive and widely accepted definition of participation and no standard tools for its assessment. What does people's participation in health development mean to the stakeholders from the community to the national and international level? Can it be assessed? What is the effectiveness in terms of health development? and what are the factors that can influence the outcomes of a participatory process? An answer to these questions is sought in the case study from the Community Based Nutrition Programme in Kenya. Using a mixed methods design and innovative tools developed and tested in a pilot community, this field study tries to answer these questions. There is no conclusive and congruent definition of participation to be drawn either from the literature or from the field research. The health impact and process can be measured in qualitative and quantitative terms. However, firm inferences on the effect of health outcomes could not be drawn due to a "non-fit" in the two tested communities. Social cohesion leading to community homogeneity, and the role of gatekeepers in both, horizontal and vertical structures, are the factors that appear to mostly influencing health development outcomes. Health managers when planning interventions in any given community need to acquire in depth knowledge of all participating stakeholders, including diversities within and between them, and adopt democratic processes at all stages. 11 The analytical framework used in this study could stimulate further development of effective tools and methods for assessing participation, thereby contributing to the current policy dialogue on health development and poverty reduction. The results will therefore be disseminated to relevant stakeholders at national and international levels, as well as to the academic and donor community.