ABSTRACT
This article describes community participation in a comprehensive eight-year health program at Porto Nacional, a town in Brazils Amazon region. The authors discuss various techniques employed to encourage community participation, indicate methods used to resolve low-key conflicts in a positive manner, describe the major contributions made by community participation in this program, and present a number of conclusions considered applicable to other communities in this part of Brazil.
PIP: Community participation was found to be an important resource for ascertaining and achieving the project health goals of a multiprofessional health team in Porto Nacional, an Amazon community in Brazil's interior. The project was established in 1968 to provide comprehensive, integrated medical care. The health team consisted of 6 physicians (1 sanitarian, 2 surgeons, 2 internists, and 1 pediatrician), 2 social workers, 1 nurse, and 1 educator. The team assumed operating responsibility for the area's health unit and 50 bed hospital, and worked closely with other local health agencies and providers. To attract financial and technical resources, the team founded a non-profit agency, COMSAUDE, to promote health and educational activities. The area's health problems consisted of a predominance of waterborne and foodborne diseases, an infant mortality rate of approximately 70 deaths/1000 live births, high malaria morbidity, tuberculosis, leprosy, cutaneous leishmaniasis, a moderate incidence of Chagas' disease, and extensive infestation of vermin. The local health unit was well-known and accepted in the community which facilitated the team's activities. At the time of the team's arrival, the vermin problem was causing public concern. Work on controlling this problem appeared an appropriate vehicle to achieve the dual objectives of promoting sanitation activities and becoming familiar with and accepted by the community. A combination of home visits and general meetings with institutional and local leaders mobilized a significant segment of the population. Increased cesspool construction resulted. Among the poorest neighborhoods, residents developed an organization to finance the cost of construction materials. Technical assistance from sanitation aides was provided to rural communities. Municipal health boards were organized to assure maximum utilization of visiting physicians, to conduct health surveys, and to oversee the implementation of recommended preventive health measures. A health board of volunteers was initiated in Porto Nacional to identify health related problems and propose solutions within the scope of the local government. The board was responsible for improvements in sanitation at the market place and the organization of trash collection. Health surveys were conducted utilizing students from local schools as interviewers. The surveys increased community awareness of health problems in addition to providing health data. A center for malnourished children was established which served as a recuperation facility for the children and a nutrition and hygiene education center for mothers. A cooperative housing improvement program was initiated. Residents worked Saturdays gathering construction materials and working on neighbors' houses. The sanitation aides assisted in drawing plans and selecting building, cesspool, and well sites. The team participated in educational activities at the schools, including a controversial sex education/marriage preparation course that was ultimately limited to prospective newlyweds. Based on 8 years of program operation, the authors conclude that community participation is an important development resource and that the process of working together is as important as the results achieved.
