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Ideological dimensions of community participation in Latin American health programs.

Ugalde A
Social Science and Medicine. 1985; 21(1):41-53.

This paper explores the emergence of an international fad aiding and monitoring community participation efforts and projects its future outcome based on lessons from previous experiences in other than the health sector. The analysis suggests that the promotion of community participation was based in all cases on 2 false assumptions. 1) The value system of the peasantry and of the poor urban dwellers had been misunderstood by academicians and experts, particularly by US social scientists, who believed that the traditional values of the poor were the main obstacle for social development and for health improvement. However, the precolumbian forms of organization that traditional societies had been able to maintain throughout the centuries were not only compatible with development but had many of the characteristics of modernity: the tequio guelagetza minga and even the cargo system stress collective work, cooperation, communal land ownership and egalitarianism. 2) Another misjudgement was the claim that the peasantry was disorganized and incapable of effective collective action. In Latin America historical facts do not support this contention. A few examples from more recent history show the responsiveness and organizational capabilities of rural populations. The Peasant Leagues in Northeastern Brazil under the leadership of Juliao is perhaps 1 of the best known example. The question is thus raised as to why international and foreign assistance continues to pressure and finance programs for community organization and/or participation. It is suggested that the experience in Latin America (except perhaps Cuba and Nicaragua) indicates that community participation has produced additional exploitation of the poor by extracting free labor, that it has contributed to the cultural deprivation of the poor, and has contributed to political violence by the ousting and suppression of leaders and the destruction of grassroots organizations. Information presented on community participation in health programs in Latin America illustrates that they have followed closely the ideology and steps of community participation in other sectors. A country by country examination indicates that health participation programs in Latin America in spite of promotional efforts by international agencies, have not succeeded. The real international motivation for participation programs was the need to legitimeize political systems compatible with US political values. Through symbolic participation, international agencies had in mind the legitimation of low quality care for the poor, also known as primary health care and the generation of much needed support from the masses for the liberal democracies and authoritatrian regimes of the region. Primary health care delivery can be successful without community participation, in contradiction to what international agencies and governments maintain.

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