The need to strengthen health systems in developing countries in the drive to reach the United Nations' millennium development goals is under the spotlight.1 But one key component of health systems, the activities that take place in the community that have an impact on health, gets insufficient attention.

The World Health Organization's definition of health systems includes “all the activities whose primary purpose is to promote, restore, or maintain health.”2 Community participation in activities that improve the health of individuals, families, and communities should be an integral part of the health system. Such activities should be at the centre of any concerted action to improve health. Yet the community's role and participation are sidelined in most top-down health programmes—a reason why many international and national programmes fail to deliver.

Engaging local communities to participate in identifying their own health priorities spurs the development of innovatory culturally acceptable solutions with locally available resources. In Bolivia, a study using such participation in planning services for mother and …