Problems With Participation In Primary Health
massey-university
Tue Jan 09 2007 13:00:00 GMT+1300 (New Zealand Daylight Time)
Problems With Participation In Primary Health
Tuesday, 9 January 2007, 2:11 pm
Press Release: Massey University
Problems With Community Participation In Primary Health Services
New research has identified problems with community participation in planning and setting up primary health services in New Zealand.
Management researcher, Jan Lockett-Kay, from Massey University, says community participation is a Government requirement in the development, governnce and monitoring of health services. But her research suggests the traditional model of involving communities is not working.
“Health strategy implementation in New Zealand is prescriptive and centrally driven yet requires community input,” she says. “This should enhance the likelihood of health services reflecting the unique needs of the community it serves. But the challenge for health service planners is to manage the contradictions and tensions which emerge as a result of both centrally determined and community determined expectations.”
Ms Lockett-Kay used as a case study the establishment process for the Horowhenua Primary Health Organisation, which she observed over a nine-month period.
She found the effectiveness of community involvement is diminished by factors that include a power imbalance between the bureaucrats and community representatives, a lack of knowledge and understanding on both sides, and inadequate resourcing.
Her study suggests:
Ø Power imbalances should be addressed: “Bureaucrats, health professionals and other experts must work with and along-side communities.”
Ø All stakeholders (community, health professional and bureaucrat) have valuable knowledge to contribute to the planning process. “The knowledge brought by community representatives is important and legitimate. Experts and community representatives must learn from each other.
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Ø The unique needs of a community must be incorporated in planning, and community representatives are very well positioned to take leadership in this.
Ø Community participants should be involved in all decision-making processes and not excluded at various stages of the planning process simply because they do not have the knowledge and skills.
As just one example of difficulties with communication and resourcing, Ms Lockett- Kay says community participants often have problems receiving and printing out large documents using home computers. Most resource material in the Horowhenua Primary Health Organisation planning was in electronic form.
She also says although the way the experts treated community people was not intended, “it sent a clear signal of disempowerment.”
Ms Lockett-Kay says policy makers are aware that primary health services will not work in the longer term if they do not meet the needs of their communities and are not run in line with the community’s “way of doing.”
She says the issue is important, with health service funders and providers continually looking at ways to make community participation more effective.
“We need a new way of doing things. Community representatives must develop new skills and competencies – and the experts also need new skills to better understand communities and what they need,” she says.
“The traditional community development model, formulated by the World Health Organisation, is often used to involve communities. But this approach will not work in the current New Zealand policy environment where stakeholders with differing access to knowledge and power are required to work together.
Ms Lockett-Kay says the New Zealand primary health care context provides excellent opportunities for experts and grass roots communities to establish strong collaborative approaches to service planning.
“If this is not achieved there is the risk that traditional consultation processes will continue to keep decision-making in the control of the experts and the community’s input as mere tokenism.
“New relationships and partnerships that challenge and modify existing networks are essential”.
ENDS
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