Community involvement in health care interventions in rural Fiji

The thesis aims to identify how community development is supported in health care interventions in rural Fiji, through the assessment of key processes that enable community involvement in health development. To address the aim, two case studies are examined, the Kadavu Rural Health Project (KRHP), and the Taveuni Community Health Project (TCHP). The KRHP facilitated community involvement in health (CIH) as related to the Small Grants Scheme, health promotion activities and the training of community members including Community Health Workers (CHWs). An Evaluation of the project confirmed that community participation had been sustained three years after the project's completion. Utilising the lessons learned from the KRHP, the TCHP is likewise seeking active engagement with CHWs and Village Health Committees, and has recently assisted communities to develop "Community Action Plans" for social mobilisation and community development in health care, in particular, environmental and public health. The case studies point to a multitude of factors supporting CIH, including a conducive national political context, the establishment of village health committees and training of community health workers. Weaknesses were identified in the lack of research into how differing local understandings of health and CIH may influence development processes, and the limited participation of some sectors of the community. Engaging with communities is undoubtedly complex in relation to social, cultural, economic, political and environmental factors that may or may not support health promotive principles. Due to the critical importance of CIH to the success of the project outcomes, the TCHP must employ an adequate, ongoing monitoring system in consultation with communities. Findings of the thesis contribute to the body of knowledge surrounding CIH in the Pacific, and point to methodological issues of engaging CIH