How do health workers see community participation

A questionnaire was distributed to the 30 health centers of the Butare Health Region in southern Rwanda in a study exploring health workers perceptions about community participation. 29 replies were received covering 23% of staff at the peripheral level. Asked to categorize various aspects of community participation on the basis of their importance the workers gave the following order of priorities: identifying ones own problems paying for drugs community management of the ambulance choosing basic health workers suggesting a health program and helping to evaluate results working on the environment helping to manage the community health center maintaining the health center and suggesting better hours for consultations. 83% of health workers responded that communities should not take the initiative in health promotion activities. Poverty and a lack of financial resources for drugs treatment and environmental improvement; ignorance about the value of participation and of health care in general; and taboos customs and traditions producing resistance to change were cited by almost all of the health workers as potential and actual obstacles to community participation. It was suggested that people who can not pay for treatment be helped by the community or through credit. Moreover almost all respondents endorsed continuing education for all people through discussions and home visits. Overall survey findings suggest that the respondents are rather opposed to the involvement of laypeople in promoting and implementing primary care programs. There was confusion about the notion of community with the health workers tending to underestimate peoples potential for action and reaction and to insist upon the need for a hierarchical structure. No concrete picture emerged as to what should be done.