Community participation in health care decisions

Abstract

Community participation is defined as a range of activities which involve people from various communities identifying issues and participating in decisions about planning for management and delivery ofhealth programs or policies. Participation occurs at two levels in health care. Firstly, the participation of individuals in their own health care and treatment, and secondly the involvement of people as community members, participating in decision making and debate concerning health spending priorities. There is a large body of literature that advocates community participation in health care decisions. The strongest arguments claim that involving people in the health system will assist in improving the health of populations. By setting up mechanisms that let people have a say in health care decisions, the health care system will provide more appropriate care to communities. There are a range of approaches to community participation many complex and multifaceted. The key defining characteristics of community participation are joint problem solving, joint decision making, joint responsibility and joint sharing of benefits. Models including: (A) Community Development; (B) Social Action; (C) Action Research; and (D) Participatory Research, are relevant for community participation approaches. These share similar underlying philosophies, although they are not appropriate for implementing in the same situations. Generally, community participation is viewed as positive and desirable for improving quality of health care and the health of populations, although studies show mixed success in these outcomes. Methods and philosophies of community participation models are not aligned with traditional research or health care models. Appropriateness of community participation in all situations is limited due to the nature and requirements for implementation, such as timing, provision of sufficient resources, engaging communities and determining suitable representation is a further issue. Also there are issues for community participation, in terms of implementation, evaluation, and integration with traditional health service models. In general, outcomes of community participation in health care may be discussed in terms of community empowerment and, and improved individual rights, equity, efficiency and effectiveness, accessibility, accountability and quality ofhealth services. It is recommended as a strategy to achieve the above factors as well as for debate in health spending priorities. Moves toward community participation were strengthened through a paradigm shift in ways of thinking in the last few decades, in areas in health care concerned with a population focus, including community health, health promotion and the new public health. The Ottowa Charter was a landmark document of this paradigm shift, and its principles have been internationally accepted. Community participation is a critical focus of the Ottowa Charter. The recent push for cuts in health care expenditure, has resulted in countries internationally concentrating on the need to set priorities in health care. However, techniques for prioritising are very uncertain. There are barriers and issues for community participation in health care decision making, due to the nature in which health care decisions currently take place. One element agreed upon is that priority setting inevitably involves subjective judgments, also that there is a need for development of ethical or public values to influence health decisions.