Community participation in health programs : experiences from the Maasai health services project, Tanzania

The communities, through the selection, support and supervision of these community health workers (CHW"s), are actively involved in every stage of the project activities. This paper examines in detail the process through which community management of the project is promoted. Important elements within this process include: (l) holding several unhurried meetings with community members and leaders to discuss health problems and solutions fully; (2) cultivating leadership and management from within the community while providing TA from the outside; (3) working with CHW"s who are selected by their communities; (4) conducting the training of CHW"s in their own communities instead of at a distant site; and (5) integrating community organization skills and activities into CHW training. Four key lessons were learned. (l) Project staff must resist the role of expert and maintain that of facilitator. (2) The pace of the project must be in step with the communities" understanding and readiness to accept it. (3) The role of the CHW must respond to the urgently felt need for curative services, the real need for preventive services (e.g., family planning), and the long- range need for social change. (4) The project must respect the traditional social structure of the Maasai and Waarusha groups served and must also recognize and adapt to the differences between them. (Author abstract)