Community participation: the maasai health services project, Tanzania

The Maasai Health Services Project in northern Tanzania is a primary health care undertaking in which individuals chosen by their communities are trained as providers of selected preventive and curative services, including family planning, and as facilitators of change in their areas. The communities, through the selection, support, and supervision of these community health workers (CHWs), are actively involved in every stage of project activities. This article examines in detail the process through which community management of the project is promoted. Important elements within this process include: 1) holding several unhurried meetings with community members and leaders to discuss health problems and solutions fully; 2) cultivating leadership and management from within the community while providing technical assistance from the outside; 3) working with CHWs who are selected by their communities; 4) conducting the training of CHWs in their own communities instead of at a distant site; and 5) integrating community organization skills and activities into CHW training. Some of the lessons learned are that 1) project staff must resist the role of expert and maintain that of facilitator; 2) the pace of the project must be in step with the communities' understanding and readiness to accept it; 3) the role of the CHW must respond to the urgently felt need for curative services; the real need for preventive services, such as family planning; and the long-range need for social change; and 4) the project must respect the traditional social structure of the Maasai and Waarusha groups served and must also recognize and adapt to the differences between them.