As we stated, the purpose of this assessment is to
define the movement of the process of participation
in health care programmes. Using the definition of
participation we have earlier suggested and recognising
limitations which may be imposed on participation
by the government [18] a mark will be
placed along the continuum to tell us how wide or
narrow the process is at any given time.
To collect information which will decide where the
point will be plotted, 'action/research' [21] may be
used in which the programme planners, the health
team and the beneficiaries all play a role. Through
'participant/observation', data can be collected. We
have included in the appendix a list of questions
which might be useful to help define each indicator in
a specific health programme (Appendix 1).
Once information is obtained, a decision as to
where to place the mark needs to be made. The
discussions about this decision can be as valuable as
the final decision. It is not crucial to find the precise
point for the mark. Rather the objective is to find a
point which can be used as a point for comparison at
a later time. Once all the marks have been placed,
they can be connected to give a broad picture of the
extent and scope of participation in the programme.
The first phase of the assessment is now completed.
The process indicators for participation provide the
baseline by which future assessments can be made.
These assessments can be carried out by the same
team, by a new team or a new assessor. As a means
of developing participatory evaluation [22], they also
can be carried out by a range of programme participants
to see if the assessment by programme
planners differs from community assessment.
The new assessments will show changes in participation
in the programme or will show areas where
no perceived change has taken place. They will also
show where participation has tended to become more
broad or more narrow. Based on these assessments,
planners and beneficiaries can decide what next programme
steps might be in relation to participation.
They also may reflect on this assessment as a learning
exercise to better understand the process of par