Public Participation in Health Systems (2)
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Dear All,
and Dear Claudio,
The problematic you rise here is also of my (and, I suppose, many of
us) concern.
Public participation, from my short but experience, relies on what
the French call "sensibilisation", the concept of which looks quite
different from what one may conceptualise from the word "Education".
Then;
Continuing from this poem, let us examine what it means "not to
force yourself on them.
I think you know about it all; you are 28 years, assigned or be vol-
unteer to "improve the health status of a village population" some-
place. You have a (right or wrong) feeling you have every right an-
swer.
Then, say, in a matter of 3, 5, 10, or 20 years, you come to realise
your conviction, be it scientific or sociologic, or, you name it,
was, has been, had been, WRONG.
The only way we, so-called "SPECIALIST" are left to do is to "Think
it over and come back next year", if we have enough means to do so.
The questions I leave you with are: Can we relinquish our experts
role and become facilitators of the community's vision? Do we trust
the people enough to enter their communities with no agenda such
that they build their own agenda?
No.
Yet....
We are supposed to give clue to a given problem that is supposed to
be in our realm of speciality. Do we have to give it or not? I am
still wondering about this point. Had I a confirmed Anthropologist,
Epidemiologist and Health Demographer to collaborate with on a
"Medic" project, it would have been Heaven to me. Tough, most of us
are confined to work with "peers" and suffering from the Peer Pres-
sure.
Yes, Claudio, the "Medic World" all by itself won't be able to claim
itself as the saviour.
Do we have the patience to be engaged in a participatory process
that is time consuming and on going? Can we truly include soccer
fields and day care and literacy as part of the WHO definition of
health? Can we redefine our results and find new ways to assess
them? And finally, do we have any other choice in the face of the
multiple failures of the status quo of traditional health education?
Suppose YES. How about thinking positive, even if "you may obtain
much lesser fund" for a project....?
The time factor is but a problem, especially for a "W*O-funded pro-
ject". It seems now that W*O is curative-pointed whereas the
Eu**Co*** is turning Prevention in their "pertage des taches". As for
the education we are (first) to be able to perceive the numerous
drawbacks to implement "Standard" measures/projects.
Working NGO? Working NPO?
In both cases, you'll be dealing with the local politics.
So, what could we do?
Takashi Suzuki, MD., PhD., DSc.
Medical Director
Expert & Consultant
JBFA Europe
23, rue St Hippolyte
75013, Paris, France
Tel+Fax: +33-1-4331-4988
mailto:suzuki.jbfa@online.fr
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