Community-based participatory development empowers villagers to develop community cohesion and confidence, increase their ability to identify, analyze, and priorize their own needs, and organize the resources to meet these needs. An important first step in the process involves establishing a cohesive and functional community group. The authors believe that this is best accomplished through villagers' critical examination of their experiences with development including their understanding of reasons for success or failure, and the gradual emergence of a model of working together that acknowledges and builds on participation and collective expertise. This approach to development is demonstrating encouraging results in a rural area of western Nepal in a university affiliated Canadian/Nepali Health Development Project. This paper describes two mini-projects to illustrate the evolution of group formation through reflection, analysis, and action, and identifies outcomes that could serve as indicators of community empowerment. The paper also presents a generic model of empowerment, and offers lessons learned by the project through the application of the empowerment process to sustainable health development.
PIP: The Nepal Health Development Project's promotion of empowerment through analysis and action has led to a strong sense of community identity, an open decision-making structure, sensitivity to gender and social inequality, skill dissemination, and two-way interaction with resource agencies. The community-based participatory development method is elucidated through the description of two mini-projects: a market garden and reservoir scheme among households who share a water source for irrigation and the introduction by women of smokeless stoves. Outcomes common to both projects included an end to the monopolization by some castes of group leadership roles, leader accountability for their actions, pressure on elected village leaders to act on the community's behalf, increases in women's participation to over 50% of organized groups, and a widened social network. The Project has delineated a dynamic model of the empowerment process that includes the steps of group analysis, community action, reflection, and sustainable health development. The Nepal experience suggests that health programs are rarely cited as a community priority; required first are community readiness to engage in an interactive dialogue with health system agents and a willingness on the part of the external agents to respect newly acquired community competencies.