As the 30th anniversary of the 1978 WHO-UNICEF Alma-Ata Declaration approaches, Dave Hilton, a tireless promoter of community health and empowerment, recently wrote this inspiring note about community empowerment and health.
We have admired Dave’s work, including editing Contact magazine, a publication of the World Council of Churches, for many years. We were honored to have Dave participate at the Course for Health Activists held at the US Social Forum in Atlanta.
“How to truly 'empower'
There is a vital difference between community-based and community-oriented primary health care. Terminologies have changed—community determined, community initiated—but true empowerment means approaching a community with no agenda except to facilitate that community to identify its own agenda and mobilize its resources to address it, as was done in Jamkhed, Chimaltenango, and Garkida. [Pictured below is a community meeting at Jamked, India]
The traditional (community-oriented) approach to health development has been to give things to, do things for, or "educate" communities. Unfortunately, after spending billions on this, little has changed. "Empowering" people to get immunizations, use condoms, or whatever, may help for a time but history reveals that when the project funding ends the community reverts to its original situation. This approach leads to dependence and status quo. This kind of help is not helpful.
The difference between a truly empowering community-based, community determined and community initiated approach and a community-oriented approach is just as relevant now as it was in 1988 when the Contact 106 debated it. In spite of excellent models, most of what is being called community based PHC is really community-oriented PHC that gives things to, does things for, or "educates" communities. Community-oriented PHC is not bad, but it has proved to be as unsustainable as Ministry of Health-oriented PHC.
So how does one do empowerment?
True empowerment begins with listening. Listening is both a set of skills and an attitude. True listening, not with clip board and questions in hand, but with an open mind in the tradition of Paulo Freire, facilitates thinking, speaking, and acting and mobilizes individual and community resources. A facilitator does not give people power, she helps them mobilize the power that they innately have but do not know how to use.
I am convinced that this is the process that will make health—well being—a reality for all…"