Community participation is the process by which community members are empowered to take part in problem identification, setting priorities, identifying possible solutions, taking decisions, implementing, monitoring, and evaluating activities for their own health and development.

Following Community Mobilization, participation is the active phase where a community is fully involved. Community participation is not just the utilization of services or being passive users; it requires active engagement and decision-making power.

• Bottom-up approach: Starts from the grassroots level and engages communities in decision-making processes regarding issues that directly affect them. It recognizes that communities have valuable knowledge and perspectives that should shape interventions.
• Democratic process: Ensures that everyone in the community has the opportunity to be involved and consulted. It promotes inclusivity, transparency, and equal participation, allowing members to voice their opinions.
• Enabling environment: Creates a supportive environment that enables communities to develop and advance. It empowers members to take ownership of programs, fostering a sense of responsibility, commitment, and accountability.
• Shifting power dynamics: Shifts traditional power dynamics from external experts to the communities themselves. It recognizes the lived experiences of members and involves them in all stages: needs assessment, priority setting, planning, implementation, and monitoring & evaluation.

Not all participation is equal. The level of true empowerment varies across these different types:

Participation naturally evolves through four progressive levels:

1. Participation in the use of services provided: Actively mobilizing the community to utilize available services (e.g., encouraging mothers to attend an immunization clinic).
2. Participation in pre-planned programs: Program content is developed outside, but community committees are invited to help implement it (e.g., executing a national water source protection drive locally).
3. Community involvement based on local assessment and decision-making: Assisting community groups in developing skills for analysis, priority setting, and action planning. The community is actively engaged in assessing local needs and making decisions.
4. Community empowerment: The highest level. The community becomes sufficiently aware and empowered to assume full control of the development process across all aspects of planning, implementation, and evaluation.

N.B: Progressing from one level to another takes time and requires careful preparation and facilitation.

• They use the services provided.
• They provide resources (labor, materials, money, and spare time) for planned activities.
• They monitor and evaluate programs and planned activities.
• They participate in making decisions and developing plans.
• They share the project benefits.

• The initial step aiming to make the community understand the concept of PHC. It does not end here but continues throughout the whole process.
• Involves making people understand what is happening in their surrounding area and that disease prevention is worthwhile.
• Helps them understand the roles of community health committees, CHWs, and resource persons.
• Develops personal commitment, helping them understand that the responsibility for health is on the community to plan/organize, leading to a sense of ownership.

• Prior to training, sensitization is very important. Training is required at various levels:
  • National: Training of PHC facilitators.
  • District level: Trainers & program leaders.
  • Sub-county level: Training of trainers (TOTs) and health community program leaders.
  • Community level: Training of grassroots resource persons.

• At the district level, identify health community persons with the help of the district health team.
• At the sub-county, continue discussions about problems, raising awareness of PHC concepts and practical activities.
• At the parish level, obtain support of leaders, agree on practical ways to introduce PHC, and identify specific communities interested in development with capable leadership.
• In the community, meet the LC1 to introduce the concept and begin awareness via home visits and small group meetings.

• Continue raising awareness leading to an agreement of partnership between the community & the program.
• Identify main problems and practical things to do.
• Select committee members to lead the PHC project/program.

• Train the health development committee & CORPS/CRPS in participatory research methods.
• Collect information useful for the implementation of the PHC Programme alongside extension workers.

• Make regular follow-up visits to the communities.
• Bring communities together to share experiences & plans.
• Reinforce links with local health units for referral & ongoing refresher training.

• Together with health/development committees, sponsors, and extension workers, assess the level of achievement of the set objectives.

• Based on evaluation findings, develop new strategies and plan for new actions.

How do we know if a community is truly participating? We look for these indicators:

• People working together as a group: Formation and functioning of community groups (youth, women's, CBOs) demonstrating collective action.
• Increased participation of women: Involvement of women in decision-making at household and community levels, reflecting empowerment and recognized voices.
• Community contributions: The extent of contributions in terms of labor, materials, and finances, demonstrating ownership.
• Documentation of activities and accomplishments: Keeping records (minutes of meetings, progress reports) showing engagement in planning and monitoring.
• Utilization of local resources and services: Community members utilizing local resources for their development, reflecting self-reliance.
• Response to community mobilization: The level of interest, engagement, and turnout when mobilized for activities.
• Diversity of roles among community leaders: Decentralized and inclusive distribution of leadership roles and responsibilities.
• Engagement in seeking external support: Proactive efforts by the community to seek technical/material support to complement their own capacities (networking).

• Decision-making authority: Promotes democratic principles, ensuring individuals have the right to shape their own development.
• Increased utilization of services: Involvement fosters a sense of ownership, making members more invested in utilizing available resources.
• Development of responsibility and ownership: Individuals take pride in their contributions and take care of the programs they helped create.
• Enhanced sustainability: With a sense of ownership, members are committed to maintaining projects even after external support diminishes.
• Increased resources: Brings forth additional local resources (labor, materials, finances, volunteered time), leading to better execution.
• Improved planning and implementation: Shared understanding of objectives leads to more efficient planning and smoother execution.
• Confidence and unity building: Witnessing positive outcomes builds confidence, cohesion, and a greater sense of unity.
• Community empowerment and capacity building: Gives members agency and control, leading to the acquisition of valuable skills and knowledge.

When done correctly, the community assumes full responsibility, resulting in:

• Sense of ownership
• Self-reliance
• Acquisition of skills and abilities to sustain the PHC process
• Efficiency & effectiveness in PHC implementation
• Equitable distribution of resources among members

• Good leadership: Builds trust and confidence that resources will be utilized transparently.
• Good planning: Involvement in the planning process gives a sense of ownership and increases commitment.
• Clear understanding of project goals and stakeholders’ roles: Clarity helps individuals see the value of their contributions to the overall success.
• Effective communication: Transparent, consistent communication about purposes, challenges, and benefits.
• Knowledge, attitudes, and skills: Providing training/capacity building ensures individuals feel capable and confident.
• Positive attitudes: A favorable attitude towards working together fosters collaboration.
• Cooperation and collaboration: Building strong relationships ensures collective decision-making.
• Involvement of relevant sectors: Engaging various sectors ensures diverse perspectives are considered.
• Income-generating activities: Economic empowerment motivates active participation and strengthens commitment.