Community participation in health activities: some concepts and appraisal criteria.

Despite descriptions of many community participation programs in the literature, few authors have attempted to devise systematic methods by which the nature and extent of community participation can be assessed. The present article, based upon work conducted in Bogota, Colombia, in recent years, presents a method for making an assessment of this kind. This method calls for evaluating community participation in health programs by evaluating the kind of management used, the range and completeness of community participation in program administration, and the community financing and other community support actions performed. For this purpose, management can be classified in general terms as "self-management" (when the community manages the health services on its own), "comanagement" (when the community shares management of the services with a public or private health institution), and "nonmanagement" (when the community makes none of the decisions). Similarly, community support can be categorized as consisting of cash contributions, community labor, or material donations. Administrative participation, carried out through 1 or more "agents", can be relatively complete or incomplete. Regarding administration, various agents of community participation (health promoters, community health committees, other community organizations, and the community as a whole), provide the mechanisms through which community participation can proceed. Therefore, a rough idea of the range of community participation can be gained by determining the number of different kinds of agents present. And a rough idea of the completeness of participation through any 1 type of agent can be obtained by determining which of various possible activities are being performed. By assigning numerical values to these determinations, it is possible to quantify the range and completeness of community participation in the administrative process. This quantified measure, when combined with information about types of management and community support involved, and when supplemented by a general description of the program studied, provides a basis for evaluating community participation in any given program and comparing it to that attained in other cases.