The Paradox of Community Participation in Primary Health Care in Zaire

Abstract

Dr. Ngo Bebe, author of the preceding article, considers that the difficulty in achieving true community participation remains one of the main impediments to success in primary health care programmes (PHC).

The classic approach fails from the very beginning when District Medical Officers and other health professionals are chosen to manage primary health care programmes. Their attempts to convince the communities of the necessity of following their advice are often far too overbearing, and thus reinforce the «expert to ignorant» situation to a point where maintaining a true partnership becomes difficult, even impossible. It often happens as well that the community representatives in PHC programmes adopt aspects of the overbearing, «expert-like» behaviour. When this happens, they alienate themselves from the community or, in the least, lose any influence toward initiating action. As for the health professionals, they most likely direct any influence they may have towards clinically-oriented health measures. The preceding tendencies result in programmes which are quite far from the community's true concerns for achieving well-being and development. The PHC's problems such as lack of medicine and care facilities are generally overtaken by the more pressing priorities such as lack of good roads, energy, safe water, diminishing crops, etc.

Dr. Ngo Bebe's article describes an initiative wherein the traditional primary health care approach is replaced by an integrated, community - centered programme. The health center remains the physical point for coordination, and its personnel participates in a variety of activities already taking place in the community. A health aspect is included, but does not overpower the activity which was formerly underway. A community development worker is integrated into the health center team. This provides the opportunity for growth and exchange, thus rendering the various activities truly interdisciplinary.

Although this community mobilisation process has been underway in certain villages in Zaire for the past two years, and seems to have a positive impact on community development and the health status of the villagers, it is still early to proclaim the initiative an entire success. Only an assessment of the long term benefits will indicate the strengths and weaknesses of the project.