Community participation in health: Perpetual allure, persistent challenge

The concept of community participation continues to capture the attention o f international health policymakers and analysts nearly a quarter of a cent ury after it was formally introduced at the Alma Ata Conference. This paper reviews trends in the participation literature of the 1990s, drawing examp les primarily from Latin America. The following topics are discussed: susta inability, new methods for operationalizing and evaluating participation, t he significance of local and cultural variability in determining outcomes, participatory self-determination as raised in the social movements literatu re, the increasing importance of intersectoral linkages, and continuing imp ediments posed by biomedical ideologies and systems. While the rhetoric and practice of participation have become fully integrated into mainstream hea lth and development discourses, the paper concludes that ideological and po litical disagreements continue to divide pragmatists, who favour utilitaria n models of participation, from activists, who prefer empowerment models.