Primary health care : on measuring participation.

This paper examines the problem of finding measurements for the two major principles of primary health care (PHC): equity and participation. However, attention is focused on the assessment of participation. A methodology is presented to define indicators for assessing participation in health care programmes. It sets out to provide a process-oriented framework for those involved in PHC programmes to describe participation in their programme and, upon that basis, to plan their future actions. It is based on premise that broader participation is achieved by developing a wider range of activities. The paper is divided into five parts. The first section reviews past efforts in measuring PHC by frameworks besides those which only examine the improvement in health status and in measuring participation. The second section discusses the conceptual framework for assessing participation, while the next section elaborates on the analytical framework. Part four presents the methodology. The development of process indicators is critical to the understanding of health improvements and community participation. These indicators will help demonstrate whether participation ôhas become narrower, broader, or remained unchangedö, along a continuum that will establish a baseline for comparison. Five factors or indicators said to influence participation are 1) leadership, 2) organisation, 3) resource mobilisation, 4) management, and 5) needs assessment. Part five describes a case study of rural health programmes in Nepal using the analysis. The paper includes an appendix of questions suggesting how indicators might be identified.