Community participation in family planning: some suggestions for organisation development and management change.

Community participation in a family planning program implies a partnership between the people served and the family planning association (FPA). That partnership requires the people themselves to participate in identifying their needs as well as assuming responsibility for planning managing and controlling the actions to meet those needs. The FPA is particularly well suited to manage a community participation program because the FPA is concerned with the problems of individuals works routinely at the community level and is organized to serve small communities. If an FPA is to manage a community participation program it must itself be organized as a hybrid structure somewhere between a centralized hierarchical "mechanistic" structure and a decentralized flexible "organic" structure. At the local level the structure is organic and must include a team from the communitys organizational structure a team from the FPA which includes the community Worker and a team responsible for seeing that the needs assessed by the community team are met by the resources of the FPA. At the central level the FPA must retain a hierarchical mechanistic structure but it should be oriented toward serving the needs of the local units rather than determining how they operate. The local and central levels can be linked by a "linking-pin" arrangement in which at every level from the community organization through the community development workers the block supervisors the field supervisors and the project manager there is 1 person from the next lower level. The management style appropriate to management of a community participation project may be described as "humanistic-democratic-participative" (HDP). Decisions are made by consensus; information flows evenly up and down; and staff activities are coordinated by teamwork. Overall responsibility for the project rests with the project manager who must be a flexible creative leader willing to make mistakes and learn from them. In some cases where the manager has been trained in standard hierarchical management technics it is necessary to "convert" him to HDP-type philosophy by a process known as "organization development." In the HDP philosophy of management supervision is achieved by the use of "socialized power" where the manager exchanges his trust in the staff for their acceptance of his authority. In addition to participatory supervision the project manager must be able to think "synthetically" i.e. to improvise and innovate and be able to confront uncertainty and solve problems as they arise. The field staff whatever else their duties may be must function as an interface between the community and the FPA. They are an integral element in the support system provided by the FPA to the community in that they function as a supervisory system for coordinating the work of the community level teams and as a supply system for providing resources and technical assistance. They must have the responsibility for making decisions and their personality and attitude is at least as important as their technical skills. The community workers form the front line of primary health care. Their work includes service delivery referral education community organization resource procurement record keeping and data collection and demonstrating innovations. They may be full or part-time paid or voluntary although a joint payment from the community and the FPA would seem to be best in terms of community respect. The training of the community worker is one of the most tangible ways of empowering the community by giving it a participatory role in the program.