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One of the "seven sins" of development is development without participation: sustained development ultimately depends on strengthening people's ability to improve their lives and take control of their own destiny (UNICEF, World Health of Children, 1989). In 1978, at the International Conference on Primary Health Care in Alma Ata, the importance of decentralization of health care and the development of citizen participation was emphasized. The Ottawa Charter (1986) called for strengthening community action in transforming their health status.The Edinburgh Medical Education Summit in August 1993 called for giving communities an active role in decision-making in the health sector.