differences in health status among socio-economic groups reflect inequalities in access to informati on, facilities that provide decent standards of living and means to pay for ~ood c11re. Specific harriers lo quality care include: ( t} lack of voice or sense of empowerment which delay decision-making 10 address health needs/ problems; (2) unresponsive set"\;ce pro,;ders who nealc a social tl. islance which discriminate ag:iinst the p0<)1·,md the mal'ginali,. ed: (3) inaccessible or poor quality service!; and prohibitive cost of health care especial ly for treatment or major illnesses and injuries (Ashford, 2006; 'Norld Bank Report, 2006). OPTIONS FOR CHANGE Wlrnt are possible areas for analyses Lt) understand the current scenario? Based on outcomes and barriers explicated in the Ashfon. l and \Nodd 13ank reports, it seems that the fnll participa tion or Lhe key players of primary hcaltl1 care, Lhc imlividuals and families in the community. nrc not quite in t J1c working. irc11a 10 achieve the go. ii of health for all. \-Vhy have we missed the full parlicipntion of the key players'? On review, of document:,; and c.,perknccs or t~u·ct dcc. idt'S, there are nt least three areas lo analyze. First, the report of a \>Vl-l O Expert Committee 011 education and tr. iining of nurse teachers and mauagcrl. ' \,;t J1 special rcgnrcl to PHC (1984), emphasized managerial and supcrviso1-y roles with competencies of 11un<ill'1, personnel ;11 the periphcrnl level geared towards direct care to the community. training of community health workers and improving 01· cxtcnding the knowledge and sldlls t1flraditiurml hcnlth prm:titioners. The rule uf nursing personn el on cnmmuni ty parlicipat ion inclndcs :u·ousiug the interest of the cc;mmrnn:ity in the benefits of a posith·e health approach and collaboraling in identifying health nncl related prnhlc!1ls and priorities for action. In nursing practice, nurses often realize that ccillahnrati()n wilh lhc comnnmit)' in identjfying problems and priorltie:; for action is not quite a reality in many villages hl!cm1sc identified locnl leaders and volunteers Lack prnblem solving l'lnd leadership skills and competencies for collective action. Local and internationa l evaluative studies ( Constantino-David, 199s; Laverack, 2001) provide evidence that this compcte11ey limitation among leaders and volunteers is a barrier to i11ili,1l attempts at involving the community in developme nt effo1·ts. Within this contexi:, unresponsiveness of ser,..icc providers can be analyzed as a consequen ce of inadequacy in educational preparation to address the challenges of installing the participatory framework as rcqt1isite of communi ty self-rcliunce andself­ determination. Second, autborit:V-dr ive1i practice as a consequence of socialization into 011. e·s profession, c,111. control and predict client-pai·tners· perspective of health and human reality. Combined with inadequate I mining on tl1e particip::ilory approach, the arrogancl. ! of "knowing it all'" sustains an autocratic behavio r which can create social distance between service providers and clients. This nurtures lack of voice ilmong clients causing frustration, pessimis m, a. pathy or their derivatives. ln any case, tl1e cycle causes delay in decision-making to address health needs and problems and the economicnlly disadvantaged groups struggle \,ith dysfunctional health services. A third area for analysis is the possibility that nurses do not quite understand how to address human response lo inequities in resource allocation and barriers to "health for all", such as poverty and related bu. man responses Uke hopelessness, hardiness and apathy. The current scenario will be perpeh1ated by both nurses and client partners if they do not realize that there is a 11eed to c:t·eate a i:e;ility where both perform the best orchestra tion, rhythm and pattern wl1ich p1·oducethe harmony required for unleashin g the empowering potentia l for health and healing. The participatory approach creates the working arena for client-partne rs and nurses to change the current reality as a new one is envisioned and unfolds. It gnide·s the partners to move in the same rhythm, creatin. g a pattern together and being invisibly nou1ished by it. Both _partner-cli ents 111 