This was a spontaneous form of community action instigated and driven by the community to influence decision-making. It is a hallmark of our human rights.

These same rights extend to having a voice in decision-making about our healthcare, but are we being heard?

Involving communities in health service planning, implementation and evaluation is a feature of health policy across major Western countries. 

In Australia, community participation is a democratic right embedded in legislative and policy frameworks that govern health services, which are then required to demonstrate how they involve the community in all aspects of health care delivery.

So how does this happen at the local, rural community level?

Traditionally, rural health services are committed to community participation and are supported by their communities where participation can occur spontaneously.  However, in my doctoral research study in rural Victoria, I found that government-mandated community participation policy was not easily enacted in health services or at the community level.

The government expects rural health services to actively involve their community in all aspects of health care delivery, with no clear guidance on how this should occur. In smaller communities, lack of funding and small population size can impact on the way health services engage. 

Community advisory committees are a common strategy in rural settings, but attract only a small number of ‘usual suspects’ in response to attempts at recruiting the ‘right’ type of community member.

In my work, I have found significant barriers to bringing people together, such as no childcare and lack of transport.

Government policy is based on the assumption that communities and health services have the will, capacity and resources to ensure community participation is not tokenistic. Broad assumptions about city-based communities are not easily translated to the rural setting, where, by comparison, services lack resources for training and for employing specialised staff to drive community participation activity. The government position on this situation is that it is a matter for health services and their boards to address.

Health service staff need clear direction about the policy’s purpose and expectations for individual roles. Community advisory committee members need clarity about their role and decision-making processes. Health services need targeted government funding to resource community participation activity.

Barriers faced by rural health services and communities, and their capacity to work together need closer attention from policy makers. At the community level we all could embrace opportunities to support others wishing to have a say, as we all interact with the same health care system.

While the aim is not to reach a five million-strong march, genuine community participation needs funding to support it, people to engage with it, and health services to prioritise it. Meanwhile, it seems our democratic right to be heard relies on a top down, unidirectional and unrealistic policy mechanism. This situation prompts the question whether policy has completely missed the mark.