Sharing knowhow and joining forces towards Health for All
The Experience of SRC in Community Empowerment and Action for Health

When Beneficiaries Become Agents

When Beneficiaries Become Agents

"This issue paper presents some of the experiences of the Swiss Red Cross in supporting community-based health care (CBHC) systems in line with the principles of the Alma Ata Declaration and the Ottawa Charter. Based on case studies from Ecuador, Eritrea, India and Kyrgyzstan, it assesses these experiences and defines the lessons learned using a number of key questions regarding general strategies, approaches and practices in community-based health and in particular in the area of community empowerment. This assessment will inform policy and practice in SRC. At the same time the intention is to contribute to filling the information gap that exists in this area and to open up further debate within the international development community.

The SRC experience confirms that the country context and level of development of health care systems influence the approaches and strategies employed in CBHC interventions. A favourable policy framework and an appropriate institutional set up create a supportive environment for the implementation of CBHC but are not the only factors required for its success. Although the projects presented in this paper used different «entry points» for empowering communities to act on health and for building the capacity of the health care system to provide better services at the local level, they all demonstrated the importance of working at both the community and institutional levels as well as the need to bridge the gap between the two. However, national and local ownership linked to the role of the MoH, district health authorities and local government are crucial for the continuation of new patterns of community engagement in health.

Improving both the «demand» and «supply» side of service provision is a key precondition for the sustainability of CBHC. Building community capacity refers to improving people’s awareness of their entitlements and the mechanisms for claiming these, as well as developing self-mobilization and organizational skills to draw on the available local resource base. Strengthening service providers includes increasing access to basic health care infrastructure and essential drugs, investing in human resources and developing the ability of health workers to interact constructively with communities and traditional health care systems.

The organizational forms of community engagement in health can vary depending on the context of the intervention. Different organizational forms can be successful as long as they provide the basis for a productive interface between community actors, health service providers and local authorities, build on existing structures and are culturally and socially appropriate, legitimate and accountable. Institutionalized links between communities, health care and local governance systems are instrumental for enabling greater community influence in decision-making and public budget allocation in the long run. Yet, the formalization of these relations and networks has to take place at the most appropriate level in order to secure operational efficiency, effectiveness and leverage.

The factors for success in putting into practice the concepts of community empowerment and community capacity building include the need for conceptual clarity in defining community empowerment interventions and actions combined with flexibility and long-term commitment. The latter is necessary for a better understanding of the intervention context as well as for building trust, strengthening social networks and generating sustainable voluntarism in communities. Understanding local power dynamics also requires time and true empowerment depends on success in changing existing political, economic and social power relations which is especially critical for producing an impact on the most vulnerable. For a more meaningful empowerment process and a better targeted building of community capacity in health, it is of paramount importance that government policies recognize CBHC and facilitate its inclusion in policy dialogue.

There are several aspects that are critical with regard to strengthening the link between empowerment and improvements in health outcomes at the local level. Along with narrowing the gap between communities and health providers, central concerns also involve mainstreaming health promotion, maintaining a focus on the determinants of health and the availability of health information management systems.

The paper concludes that the principles and approaches enshrined in the Alma Ata Declaration and the Ottawa Charter still provide a highly valid base for developing CBHC and can be put into practice by comprehensive health care interventions. It also calls for a more systematic assessment and exchange of experience in the area of community action in health."

When Beneficiaries Become Agents: The Experience of SRC in Community Empowerment and Action for Health. Sharing Experiences in International Cooperation, Swiss Red Cross Issue Paper on Health Series, No. 1, © Swiss Red Cross 2008, available as PDF

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