The role of the public in the planning, management and evaluation of health activities and programmes, including self-care

Over the past two decades, with increasing evidence that medical science and technology alone has made little impact on dramatically improving the health of the majority of the world's population, interest and enthusiasm has focused on the idea that much greater gains might be made by involving the public in its own health care. Although advocates of this concept are increasingly winning converts, the umbrella of public participation hides many differences in approaches which are not often explicit. In order to begin to dissect this concept, it is suggested that four approaches to this topic might be made. These approaches are based on views about three issues: (1) the involvement of laymen in the highly specialized field of medicine, (2) the organization of this involvement, and (3) mobilization and motivation for public participation.

The four approaches are (1) the public health approach, which gives the reason for public participation as necessary to assist in the eradication, or at least control of communicable disease, (2) the health planning approach, which sees public involvement as a means to create additional health resources in a terms of manpower, money and materials and to gain public support for both better utilization and development of health services; (3) the community development approach, which argues public participation is necessary to correct the imbalance in health resources distribution and to have people, especially the poor and underprivileged, become active in decisions which affect their own daily lives; and (4) the self-care approach, which sees public involvement as the way in which people can meet their health needs because medical professionals are both unwilling and unable to meet them. These approaches reflect views about the role of the public in planning, managing and evaluating health activities. It is argued that different attitudes and expectations about public involvement must be carefully examined in both theoretical and practical terms in order to ensure a place for the layman in a field traditionally preserved for the medical professional.