The second community level actor identified as relevant for health promotion activity is the local level of public administration.
A major limitation of this study is that, rather than looking first hand at implementation of HFA and how community-level actors are involved in a particular context, we draw our data only from the text of the frameworks and from what has already been written about the participation of communities in HFA implementation.
Whatever the cause, given widespread recognition of the importance of local knowledge and participation and growing recognition of the importance of intra-community differences in vulnerability, it suggests the need for reconsideration of both the discourse and the practice of involving community-level actors in DRR planning and implementation.
However, in order to examine health outcomes at the community level, other actors and systems will have to be taken into account.
Models of producing and sharing electricity at a community level are emerging, and might be stymied by traditional actors.
Chronic disease prevention at community level should ideally encompass activities of the following key actors: primary health care services, voluntary organizations, the food industry and supermarkets, work sites, schools and the local media.
Furthermore, network members in Nepal recognised the need to associate with actors outside their system working at the community level to increase coverage of services.
In Lusaka, the team also met with national level actors such as the Ministry of Education (MOE), the Zambian Community Schools Secretariat (ZCSS), and various donors.
While decentralized, in practice the Ministry of Health continues to play a central administrative role although the provincial and district departments of health level are key actors in service delivery at health facilities and community level [ 8].
3. Work on community level care and referrals, delivered by families and other non-state actors, should continue to merit attention since whilst state systems strive to scale up, the day to day survival of children is underpinned by voluntary commitment at community level.
