Community Ownership in Primary Health Care—Managing the Intangible

Although enduringly intangible, community ownership is foundational to primary health care. This intangibility is a reminder of what programs can and should do (create space for dialogue, question their own choices, expand diversity in stakeholder voices making sense of program-induced changes, including through evaluation) and what they cannot do (manage someone else’s ownership). The concept of community ownership in primary health care has a long history but remains challenged in terms of definition, measurement, and differences of perspective from practitioners on a gradient between utilitarianism and empowerment. It continues to be somewhat intangible. Although a universal definition across time and contexts may be illusory, contextual appreciation of its dynamic evolution under programmatic influences—for different stakeholders with diverse agendas—is accessible to evaluation and learning. No one can “manage” someone else’s ownership, but programs can reject hubris and tokenism by intentionally questioning their unavoidable impact on community ownership and whether they foster it through meaningful dialogue and “sense-making” with local stakeholders.