BMC Public Health 2004, 4 http://www.biomedcentral.com/1471-2458/4/11 are yet to exert their right over their bodies in doctor- patient interaction. The philosophy and practice of SC are still in infancy in these countries. Partnership between lay person and professionals Partnership between lay persons and professionals is essential for promoting SC. In practice, roles of lay per- sons and professionals in such partnership vary widely. At one end in many SC activities, such as the Women's Health Movement in the US, the role of professionals is quite limited. In many other SC activities, input from the professionals is substantial. In some studies, it is observed that presence of receptive professionals is a precondition for development of SC [36]. A survey of SC education pro- grammes in the US revealed that, despite SC being branded by the American media as a popular social move- ment, more than half of such programmes were funded by health service delivery organizations and were run by pro- fessionals such as registered nurses, health educators, phy- sicians as instructors rather than lay persons [37]. In Canada, Health Canada initiated a number of activities for increasing the support of SC by health professionals. One such initiative, SC project, developed a framework for registered nurses and physicians for supporting SC in 1994. This study identified three categories of pro- grammes (integrated education and support programmes, self-help groups and support groups) and four categories of tools (print and audiovisual tools, telephone help lines, computer based tools and self-monitoring tools) as useful adjuncts for professional support of SC [38]. Community participation or community involvement in health development (CIH) Origin of the idea of CP or CIH Growing disillusionment with prevailing development strategies for the failure to improve the lives of the major- ity of people in developing countries led to a re-thinking of the entire development process in the 1970s, which ultimately led to the emergence of the idea of CP [39]. It was pointed out that most of the earlier strategies were planned for the people by outsiders, where people were considered as mere recipients and the transfer of technol- ogy was thought to be adequate for their development. Emphasis was laid on the active participation of people and there was a general concern to make development strategies more people-centred, based on their own aspi- rations and ideas. Since then the idea of CP emerged as a fundamental component of any development strategy, at least in theory, including health development. Different interpretations of CP and role of information and education in promoting CP Since its inception, CP has been interpreted differently. According to one school, communities can be mobilised to participate in the development process merely by increasing their knowledge and awareness about develop- ment projects and programmes, lack of which is perceived as the main reason behind their non-participation. The other school advocates a radical change in the prevailing development process. Participation, in this sense, is viewed as "empowerment", where people exercise more control over the decision-making process and participate from the planning stage itself [6]. Participation has also been viewed as a ladder with different levels. Information, consultation and placation are at the lower levels, which represent only tokenism for participation, whereas dele- gated power and citizen control at the upper levels repre- sent citizen empowerment [40]. Still another view is that it is a continuum with different inter-related, overlapping stages; with information and consultation with communi- ties by professionals at one end, to the collaboration and assuming of full responsibility by communities at the other [41]. The WHO study group on CIH suggested two broad ways of promoting CIH: a) through awareness and understand- ing of health and health problems and b) through access to information and knowledge about health service pro- grammes and projects [42]. Partnership between professionals and people in generat- ing health information through participatory planning is crucial for CP. The involvement of people in generating information leads to the ownership and utilization of the knowledge that has been generated [41]. Rapid development of theory and practice of CP and universal acceptance of CP as a strategy for HP Gradually the idea of CP gained wide acceptance as a strat- egy for HP. Activities implemented to promote CP range from projects in small geographic areas to national verti- cal programmes for addressing a particular health issue, to overall primary health care (PHC) at the national level. On the theoretical side, frameworks for the monitoring and evaluation of participation in disease control pro- grammes were developed [43,44]. A conceptual frame- work was also developed for measuring participation in PHC [45]. Many disease control programmes, ranging from guinea worm eradication to malaria control, were implemented in participatory ways [46,47]. In the US, a national HIV control programme was implemented with a major planning exercise involving thousands of com- munity residents and professionals in all the states [48]. Efforts were made to improve consumer participation in the national health services in Australia [49]. There are numerous examples of successful CP in small-scale projects, often managed by non-governmental organiza- tions (NGOs), but they are never replicated on a much larger scale [50]. Success stories include community ori- ented primary care, which originated in rural pre-apart- Page 5 of 12 (page number not for citation purposes)