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Community Empowerment in Health: An Exploratory Study in Rural Community of a District of West Bengal

Background: Community empowerment is the process and outcome where community itself is able to identify, prioritize health problems and address them. It has been considered as the key strategy for scalability and sustainability of health services. 
Objectives: To explore the status of community empowerment in health in rural areas in West Bengal, India and the interplay of different stakeholders. 
Methods: A cross-sectional, qualitative study was conducted in 2017 – 2018 among the people residing in rural areas of Birbhum district in West Bengal, India who utilized the public health system (lay informants), formal and informal leaders of the community, community level health workers and peripheral health staff (key informants). Three community blocks, two sub-centers from each block and one village from each sub-center were selected randomly. In-depth interviews were conducted among 36 lay and 36 key informants using Laverack’s nine dimension model of community empowerment. Framework analysis was done to summarize data. 
Results: Participation of people was restricted to awareness and utilization of existing health services. Unmet aspiration for greater participation was noted among a small section of the community. They were mostly fitted to the role of beneficiaries. Functioning of village level organization to promote communitization as envisaged in national health programmes was largely deficient. The community health workers acted as the most peripheral appendages of formal health system rather than the health activists to empower community regarding community’s health. 
Conclusion: Although, every national health programme advocated community empowerment, the current status and the process of empowerment in health is in nascent stage.