Community participation in a rural community health trust: the case of Lawrence, New Zealand.
Since the mid-1980s, the New Zealand health sector has been in a state of continual change. The most radical changes were in the early-1990s, with the creation of an internal market system for public health care delivery. Rural health services, seen to be unviable, were given the option of establishing themselves as 'community trusts', owning and running their own services. Community trusts have since become a feature of rural health care in New Zealand. An expectation was that community trusts would facilitate community participation. This article reports on a study of participation in a rural community health trust. The 'pentagram model' of Rifkin and coworkers, with its five dimensions of participation-needs assessment, leadership, resource mobilization, management and organization-was applied. High levels of participation were found across each of these dimensions. The research revealed additional dimensions that could be added to the framework, including 'sustainability of participation', 'equity in participation' and 'the dynamic socio-political context'. In this regard, it supports recent theoretical work by Laverack (2001) and Laverack and Wallerstein (2001). Finally, the article comments on the future of rural health trusts in the current round of health sector restructuring.
Eyre
Rachel
R
Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand. r.gauld@otago.ac.nz
Gauld
Robin
R
D002391:Catchment Area, Health; D018672:Community Health Planning / Q000458:organization & administration*; D003256:Community Participation / Q000379:methods*; D015276:Health Care Rationing / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D017146:Models, Organizational; D009520:New Zealand; D019982:Organizational Case Studies; D011320:Primary Health Care / Q000458:organization & administration; D011635:Public Health Administration; D019035:Rural Health Services / Q000458:organization & administration*