Between aspirations and realities of participation: Understanding the meanings of community participation in the context of Family Health Centre policy of Kerala

The Government of Kerala in 2017 launched the Aardram Mission aimed at a complete overhaul of the State’s health system. A crucial component of the Mission was the Family Health Centre (FHC) initiative using Comprehensive Primary Health Care. A core strategy of the FHC initiative was its emphasis on strengthening community participation through decentralization and creating newer ways of engagement. The study aimed to examine the meanings attributed to community participation within policy and functionaries of the health system using qualitative content analysis of the FHC policy and narratives of health functionaries. The policy analysis suggested a genuine commitment to community participation by locating FHCs under the leadership of local self-governments and through newer mechanisms like ‘Arogyasena’ volunteers constituted by community cross-sections. However, the narratives of health functionaries’ points to a reductionist view of community participation that excluded communities from priority setting and decisionmaking. Communities were seen as incapable of planning health activities and, therefore, their participation equated with the idea of expressing their needs. Participation was also seen from the perspective of communities as ‘resources’ for implementing activities and as ‘responsible beneficiaries’ who maintain positive health behaviours. Findings from the study suggest the prevailing conflicts between health functionaries’ reductionist views on communities as compared to policies’ aspirations in achieving a transformative idea of community participation. This demands urgent attention and resolution to enable the successful implementation of the FHC initiative as well as achieve the larger goals of social justice and equity.