COMMUNITY PARTICIPATION IN ACTION - AN ANALYSIS OF THE SOUTH AUSTRALIAN HEALTH-AND-SOCIAL-WELFARE-COUNCILS

This paper presents an analysis of a health department's efforts to in troduce a mechanism to increase community participation into a bureauc racy's decision-making, planning and operations. In the 1980s, South A ustralia adopted a Social Health Policy and a Primary Health Care Poli cy. These documents were intended as a means of implementing the slate 's commitment to 'Health for All by the Year 2000' and the Ottawa Char ter for Health Promotion. A key plank of each of these policy statemen ts is the strategy of involving community people who are not professio nally involved in the health sector, in the process of promoting healt h and tailoring health services to the needs of the local people. In S outh Australia, one of the means by which participation was encouraged in the health system was through the establishment of four pilot Heal th and Social Welfare Councils (HSWCs) in 1988. This paper describes a nd analyses the data that were collected for an external review of the HSWC program, conducted in 1991. Data collection was through telephon e and self-completion questionnaires administered to key informants an d HSWC members. The evaluation data show that the Councils mobilised p eople to take action on a range of issues and three key themes related to the HSWCs as models for community participation: the structural pr econditions for success, issues of representativeness; and the differi ng power levels between stakeholders. The study points to some importa nt lessons for a successful model of participation. These include: (i) participation is difficult when organisations are restructuring and f requently changing staff;. (ii) the need for community participants to set their own agenda; (iii) the need for resources, support and quali ty leadership; (iv) recognition of the competing demands of bureaucrac y and community; and (v) allowing the voice of the marginalised to be heard is a more valuable objective than accurately representing all vi ews. The paper describes the progress of the Councils since the review and notes that they were defunded in December, 1995. Some members of the Council viewed the defunding as one indicator of their success in challenging bureaucratic practices.