Community participation in action: an analysis of the South Australian Health and Social Welfare Councils

This paper presents an analysis of a health department's efforts to introduce a mechanism to increase community participation into a bureaucracy's decision-making, planning and operations. In the 1980s, South Australia adopted a Social Health Policy and a Primary Health Care Policy. These documents were intended as a means of implementing the state's commitment to ‘Health for All by the Year 2000’ and the Ottawa Charter for Health Promotion. A key plank of each of these policy statements is the strategy of involving community people who are not professionally involved in the health sector, in the process of promoting health and tailoring health services to the needs of the local people. In South Australia, one of the means by which participation was encouraged in the health system was through the establishment of four pilot Health and Social Welfare Councils (HSWCs) in 1988. This paper describes and analyses the data that were collected for an external review of the HSWC program, conducted in 1991. Data collection was through telephone and self-completion questionnaires administered to key informants and HSWC members. The evaluation data show that the Councils mobilised people to take action on a range of issues and three key themes related to the HSWCs as models for community participation: the structural preconditions for success; issues of representativeness; and the differing power levels between stakeholders. The study points to some important lessons for a successful model of participation. These include: (i) participation is difficult when organisations are restructuring and frequently changing staff; (ii) the need for community participants to set their own agenda; (iii) the need for resources, support and quality leadership; (iv) recognition of the competing demands of bureaucracy and community; and (v) allowing the voice of the marginalised to be heard is a more valuable objective than accurately representing all views. The paper describes the progress of the Councils since the review and notes that they were defunded in December, 1995. Some members of the Council viewed the defunding as one indicator of their success in challenging bureaucratic practices.