One of the main goals of global health is the establishment of human-centred health services, i.e. services based on the needs and preferences of users, not on diseases.25 The participation of service users in planning, 11,24-26 The World Health Organization recommends community participation in processes to improve the quality of maternity services and in the programming and implementation of programmes to improve the health of mothers and newborns24. 27 To achieve social change, participatory approaches to health must co-exist at different levels. We identify three areas of action: (i) individual and community skills to participate; (ii) man-centred health services; and iii) social responsibility. These areas are consistent with existing frameworks, such as capacity approach15 and health promotion charters16, which emphasize the need to address factors outside the traditional health services sector, including the role of different participants in health production. Community participation is encouraged in the global dialogue as an essential part of a human rights-based approach to health. This means not only ensuring the provision of health services and their use by the public, but also addressing the underlying social determinants of health.2 While proven interventions in clinical and health services could save many lives by 2030 if made available to all, the poorest people are often not affected.3 ,4 Many factors: prosperity – environment, gender, education, geography, culture and other structural determinants – directly influence health outcomes through the acceptance of health services and indirectly through relationships and behaviours outside the clinical environment5,6 Community participation, which includes underserved groups and is context-appropriate, is a fundamental principle of a fair primary health care system and an opportunity to optimize measures to improve Health.
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