Community participation in primary health care in rural Haiti: An ecological approach

Date of Completion

January 1993


Anthropology, Cultural|Health Sciences, Public Health




This study describes patterns and variations in community participation in a primary health care (PHC) project in rural Haiti. The factors that mediate variations in participation at both macro and micro levels were examined from theoretical and applied perspectives.^ "Community participation" was defined as, "The process of active involvement of local individuals and groups in the design, implementation, maintenance and/or evaluation of a community-based primary health care system" (Rifkin, 1980).^ The research was conducted from September, 1987 through December, 1990 utilizing data from 27 communities. The extent to which acceptance and utilization of PHC was effected by community participation, and by ecological features of the communities was described. Differences in local peoples' use of selected preventive health services were analyzed.^ The major hypothesis tested was that greater participation by Health Committees is predictive of greater acceptance and utilization of health programs. Other specific hypotheses tested concerned factors that affect participation, e.g., geographic isolation, worker characteristics, involvement of mothers, herbalists and traditional birth attendants, past development efforts, and demographic characteristics. Data were collected through structured interviews, participant observation, key informant interviewing, health records, vaccine cards and meeting reports.^ A key finding was that the involvement of folk healers and women on Health Committees had a strong positive relationship with the strength of the Committee, and with utilization of immunization services. Their influence was strongest in the first year of the program. Other independent factors predictive of high immunization status in the first two years of the program included: distance and isolation from the town (+), presence of stable market, presence of Protestant Church, experience with other development efforts, and more mature village health worker.^ Differences were found between predictors of women's vaccine rates and children's vaccine rates. Over the 15-month period of the study (May, 1989 through August, 1990) there was a 50% improvement in the immunization rates of both women and children. ^