Communitization

The term ‘community participation’ was included in the Alma Ata declaration of 1978¹ as one of the key principles of the Health For All movement which it sought to promote at all levels. The declaration mentions that primary health care ‘requires and promotes maximum community and individual self reliance and participation in the planning, organization, cooperation and control of primary health care, making fullest use of local, national and other available resources and to this end develops through appropriate education the ability of communities to participate’. Over the years civil society, and some governments efforts at primary health care all over the world have experimented and studied the phenomena of community involvement and participation in various ways. More recently this whole process of community involvement which now involves participation at all level, processes and stages – from planning, managing, monitoring and evaluating is becoming formalized in some primary health care strategy and public health systems. In the National Rural Health Mission of India, one of the world largest primary health care programmes, initiated in 2005 the new term ‘Communitization’ to describe the institutionalizing and scaling up of community led action for health has been a major gain due to civil society pressure and NGO and state level experimentation.²

Communitization now includes the village Health and Sanitation Committees, the selection and training of social health activists, the involvement of local self government and community based organizations, the availability of funds at community level to be utilized by local community discretion, a formalized method of community monitoring and planning for action in health and even a system of periodic peoples hearings (Jan Sunwai or Jan Samvad) at various levels to empower community members to engage in giving direct feedback and suggestions for improvement of public health services. It is now urgent to bring health systems research efforts to focus on this newest element of public health systems and promote more focused action research/participatory research at this inter face between the community and health systems.³⁴

Since 2007 the SOCHARA team in Tamil Nadu CEU had facilitated the Community Action for Health (CAH) process with Government of Tamil Nadu under National Rural Health Mission (NRHM) till 2012. The first phase started as a pilot in 6 districts covering 14 blocks and 125 panchayats followed by a Phase 2 of implementation which fully covered the same blocks reaching 446 panchayats.

Recently a global network of Community of Practice on Accountability and Social Action in Health (COPASAH) has emerged bringing communitization enthusiasts, innovators and researchers from many countries including India, Kenya, Zimbawe, Peru, Guatemala and others together to share experience and build effort into sustained community health and policy action. The SOCHARA Tamil Nadu team is actively involved with this network.

1. Alma Ata declaration, 1978, WHO World Health Organization. Alma Ata 1978 Primary Health Care, the report of the international conference on primary health care, Alma Ata 6-12 1978.Health for all Series No 1. Switzerland: World Health Organization; 1978 ↩︎
2. Ministry of Health and Family Welfare, GOI, National Rural Health Mission – Meeting people’s health needs in rural areas, Framework for Implementation 2005 – 2012, NRHM, MOHFW, India ↩︎
3. Sudarshan. H, et al, Community Planning and Monitoring of Health Services , Karnataka Experience, State mentoring and monitoring group and state nodal ngo, Karuna Trust, 2009. ↩︎
4. Institute Of Population Health, University Of Ottawa Revitalizing Health For All: Learning From Comprehensive Primary Health Care Experiences. ↩︎