Participation - A way to better health outcomes?

The term 'participation' appears frequently in both international health do cuments and the national and local health documents of China. However, in a ll these documents there have rarely been concrete explanations of what par ticipation is, how it will happen and what advantages it will bring. Based on six years experience in applying PRA in the health field in China, this article describes two cases in which participatory approaches were employed to conduct health projects, in order to try to explore answers to these is sues, It concludes that participation means the involvement of all stakehol ders at an early stage, and the sharing of responsibilities and power openl y among stakeholders through a process of communicating and negotiating. Th e article raises some key issues that emerge in the process of participatio n, such as where views of stakeholders differ strongly, whose voice is stro ngest and who makes the final decision. Is participation always appropriate ? Finally the article discusses the feasibility of participation and explor es constraints and prospects for participation in the current context of Ch ina.