Rifkin S B
Human Nutrition Unit, London School of Hygiene and Tropical Medicine, UK.
Acta Trop. 1996 Apr;61(2):79-92. doi: 10.1016/0001-706x(95)00105-n.
Community participation has been a critical part of health programmes, particularly since the acceptance of primary health care as the health policy of the member states of the World Health Organisation. However, it has rarely met the expectations of health planners/professionals. This paper argues that the reason for this failure is that community participation has been conceived in a paradigm which views community participation as a magic bullet to solve problems rooted both in health and political power. For this reason, it is necessary to use a different paradigm which views community participation as an iterative learning process allowing for a more eclectic approach to be taken. Viewing community participation in this way will enable more realistic expectations to be made. Community participation in disease control programmes focusing on community health workers is used as an example to show the limitations of the old paradigm. Participatory rapid appraisal is used to illustrate the new.
社区参与一直是卫生项目的关键部分，尤其是自初级卫生保健被世界卫生组织成员国接受为卫生政策以来。然而，它很少能达到卫生规划者/专业人员的期望。本文认为，这种失败的原因在于，社区参与一直是在一种范式中被构想出来的，这种范式将社区参与视为解决源于卫生和政治权力两方面问题的万灵药。因此，有必要采用一种不同的范式，将社区参与视为一个迭代学习过程，从而能够采取一种更加兼收并蓄的方法。以这种方式看待社区参与将使人们能够产生更现实的期望。以社区卫生工作者为重点的疾病控制项目中的社区参与被用作一个例子，以展示旧范式的局限性。参与式快速评估则被用来说明新范式。
