Introduction: Accountability through Participation: Developing Workable Partnership Models in the Health Sector

In recent years, and at least partly in response to an emerging crisis in health care provision in many countries, there has been a major shift in attitudes to community involvement. Approaches that saw communities primarily as passive recipients of health care have given way to those which seek to make more of the potential that more active community participation might offer for enhanced accountability and improved responsiveness of Services. With this shift has come a greater emphasis on issues of governance and, within that, on the institutional dimensions of community participation. Recent experience in seeking to develop workable partnership models in the health sector lends a new dimension to debates about community participation in health. It focuses attention beyond the involvement of beneficiaries to relationships at the interface between communities and service providers and managers. Changing emphases, then, give rise to new challenges.