Participation

WHO Definition of Participation

WHO Human Rights and Gender Equality in Health Sector[1]

Meaningful participation requires that individuals are entitled to participate in the decisions that directly affect them, including in the design, implementation, and monitoring of health interventions. In practice, meaningful participation may take on a number of different forms, including informing people with balanced, objective information, consulting the community to gain feedback from the affected population, involving or working directly with communities, collaborating by partnering with affected communities in each aspect of decision making including the development of alternatives and identification of solutions, and empowering communities to retain ultimate control over the key decisions that affect their wellbeing.

WHO Handbook on Social Participation for Universal Health Coverage [2]

Participation is often used in relation to democratic ideals as well as empowerment [3](63). Public participation in (health) policy is viewed as a process by which the government actively seeks out the public’s views and inputs with regard to a decision or a way of civil society to influence the political agenda. It can range from being passive in nature, where inputs are sought, to a more active involvement of citizens in decision-making [4,5](66, 67). The main objective of participation for civil society seems to be to hold the government accountable for their obligations towards the population, while for governments the objective is to increase stakeholders’ ownerships and to improve responsiveness and uptake of policies [5,6,7](45, 64, 67). Another important aspect of participation as highlighted in the literature is the focus on marginalized and minority groups, as it allows the population that has been excluded from political processes to be included in planning, research and action in the health sector [3] (63). Participation therefore often also has a component of empowerment, as it weighs the input from members of the public equally with expert inputs [3](63).

Other Definitions of Participation

PubMed Medical Subject Headings (MeSH)

A process between an entity and those groups or individuals potentially or actually impacted by the actions of that entity over a range of activities and approaches.

Year introduced: 2018

Note: See also Social Participation, Patient Participation, and Community Participation

Eldis Key Issue Guide[8]

At the most basic level, participation means people being involved in decisions that affect their lives. Through participation, people can identify opportunities and strategies for action, and build solidarity to effect change

UNDP [9]

Involvement of stakeholders through analyses, information-sharing, public awareness campaigns and educational initiatives, dialogue and networking for consultation, oversight, audits and issue-mapping by citizens, community advocacy groups or partnerships through collaboration in public policy forums where stakeholder preferences are represented.  

Additional Notes on Participation

Citizen Participation [2]

The term citizen participation seems to be used particularly in countries which are on their way to increased democracy, where citizen participation is the next step after citizen movements where the latter’s purpose is principally to challenge the status quo and make way for reform [10,11] (48, 62). There may be a slight connotation of confrontation [3] (63), thereby distinguishing it from community participation.

Community engagement, community participation [2]

The literature describes community engagement broadly as involving communities in decision making and planning [12,13](59, 68). Examples include needs assessment, community development, planning, design, development, delivery and evaluation [14](58). Some authors go a step further by using the terms collaboration, partnership and power sharing [15,16](60, 69). According to Williams [13](68), community engagement has become synonymous with legitimate governance. The WHO makes a clear difference between community engagement and community mobilization and considers community engagement as the process of developing relationships, which then allow for working together [17](57). While most of the sources use the two terms community engagement and community participation interchangeably, some authors, such as Paul [18](47), distinguish between engagement as being initiated by the government or policy-maker, and participation which is initiated by the beneficiary or client group with a view of enhancing their well-being. Similarly, Robertson and Minkler [19](70) describe community participation as groups identifying their needs and establishing mechanisms to meet these needs. Overall, community engagement is seen positively as a powerful tool for bringing about improvements in the public services [15](60).

Participatory Approach [20]

Participatory Approach: An approach to development and/or government in which key stakeholders (and especially the proposed beneficiaries) of a policy or intervention are closely involved in the process of identifying problems and priorities and have considerable control over analysis and the planning, implementation and monitoring of solutions.

Social participation [2]

Social participation may be the most encompassing term of any form of participation, which, at the same time, does not seem to be widely used in the literature reviewed. According to Chan [21] (55), social participation means that social actors group their collective potential to achieve a collective good. Boje in contrast uses the term more broadly for social activities in everyday life, ranging from labour market involvement, family matters, community networks to advocating for democratic rights, indicating that it can refer to informal relations as well as active or passive membership in formal organizations [22] (73).

[1] WHO, Human Rights and Gender Equality in Health Sector Strategies: How to Assess Policy Coherence; WHO, Social Participation/. https://www.who.int/gender-equity-rights/understanding/participation-definition/en/

[2] Voice, agency, empowerment - handbook on social participation for universal health coverage. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.

[3] Blacksher E. Participatory and deliberative practices in health: meanings, distinctions, and implications for health equity. Journal of Public Deliberation. 2013;9(1):6.

[4] Abelson J, Gauvin F-P. Engaging citizens: one route to health care accountability: Citeseer; 2004.

[5] Abelson J, Eyles J. Public participation and citizen governance in the Canadian health system. In: Forest P-G, Marchildon GP, McIntosh T, editors. The Roman Papers: Volume II: Changing health care in Canada. Toronto, Buffalo, London: University of Toronto Press; 2002.

[6] Rodrigo D, Amo PA. Background document on public consultation. Organization for Economic Cooperation and Development (OECD); 2006.

[7] Rowe G, Frewer LJ. A typology of public engagement mechanisms. Science, Technology, & Human Values. 2005;30(2):251-90.

[8]https://www.eldis.org/keyissues/what-participation

[9] Lister S. 2010. Fostering Social Accountability: from principle to practice. UNDP Guidance Note.  http://www.undp.org/content/undp/en/home/librarypage/democraticgovernance/oslo_governance_centre/analysis_and_learning/fostering_socialaccountabilityfromprincipletopractice/

[10] Tsujinaka Y. Civil society and social capital in Japan. In: Anheier HK, Toepler S, editors. International Encyclopedia of Civil Society. London: Springer Science; 2010.

[11] Natal A, Cadena-Roa J, Gordon S. Civil Society and Social Capital in Mexico and Central America. In: Anheier HK, Toepler S, editors. International Encyclopedia of Civil Society. London: Springer Science; 2010. 

[12] O’Mara-Eves A, Brunton G, McDaid G, Oliver S, Kavanagh J, Jamal F, et al. Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis. Public Health Research. 2013;1(4).

[13] Williams JJ. The politics of social change and the transition to democratic governance: community participation in post-apartheid South Africa. In: Pretorius J, editor. African Politics: Beyond the Third Wave of Democratisation. Cape Town: Juta; 2008. 

[14] National Institute for Health Care Excellence (NICE). Community engagement: improving health and wellbeing and reducing health inequalities. London: National Institute for Health and Care Excellence (NICE); 2016.  

[15] McCloskey DJ, McDonald MA, Cook J. Community engagement: definitions and organizing concepts from the literature. 2013.

[16] Fawcett SB, Paine-Andrews A, Francisco VT, Schultz JA, Richter KP, Lewis RK, et al. Using empowerment theory in collaborative partnerships for community health and development. American Journal of Community Psychology. 1995;23(5):677-97.

[17] World Health Organization (WHO). 7th Global Conference on Health Promotion: Track 1: Community empowerment
[Available from: https://www.who.int/teams/health-promotion/ enhanced-wellbeing/seventh-global-conference/ community-empowerment ]. 

[18] Paul S. Community participation in development projects. Washington: World Bank; 1987. 

[19] Robertson A, Minkler M. New health promotion movement: a critical examination. Health Education Quarterly. 1994;21(3):295-312. 

[20] Glossary. Handbook for Planning and Implementing Development Assistance for Refugees (DAR) Programmes. UNHCR

[21] Chan K-M. Civil society and social capital in China. In: Anheier HK, Toepler S, editors. International Encyclopedia of Civil Society. London: Springer Science; 2010.

[22] Boje TP. Civil society and social capital in the European tradition. In: Anheier HK, Toepler S, editors. International Encyclopedia of Civil Society. London: Springer Science; 2010.