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Community InvolvementSome Lessons from Southern India

Hari and Prem John Deenabandu &

People’s Health Movement India

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Community Health

Community involvement in health or development is not value neutral. It is not a mere methodology to implement a project.

It is an intensely political involvement where one identifies victims and oppressors, takes sides, goes behind the barricades with the people against ruling structures that oppress them.

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“Health is politics on a social scale- Halfdan Mahler

“The Sole purpose of life is to serve humanity”

- Leo Tolstoy

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“and those who were seen dancing were thought to be insane by those who could not hear the music" (Nietzche)

The medical professionals look down upon other medical professionals working at the community level. Call them quacks.

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The Analysis

The very basis of community involvement in health lies in socio-political analysisa Class Analysis and Approach

(Marx). Clearly defined class enemies,

therefore entirely pro-poor

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The Blocks

Ignorance Class, Caste, Ethnicity, Gender, Religion Cultural factors such as dress, food habits Preconceived notions Rigidity Arrogance Haste/Impatience Long history of insensitivity/oppression

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Therefore, the Need

Humility Open mind Ability to transcend class, caste,

education factors Willingness to deschool Willingness to learn Ability to go beyond the boundaries Capacity in integrate into the community

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That would lead to

Participation as an internalised value

Participation as a methodologyWhere the community

participates from the stage of conception to data collection, to collation, analysis, planning, implementation, monitoring, evaluation, course correction

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Community Organisation

Communities divided along any lines (caste, class, ethnicity, religion) cannot work together

Therefore, the necessity for ‘organising’ the community, to build unity (Ivan Illich)

The biggest investment is in terms of time – to bring the community under the same tree for discussions and agreement on joint action

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Methods Used

Participatory Strategic Planning (PSP)

Participatory Action Research (PAR) Participatory Vulnerability Analysis

(PVA) Participatory Training Methodologies

(PTM)

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PSP PSP is a derivative of Strategic Planning. It

comes from the military and corporate sectors and has been specially adapted for communities

The Process affirms the belief that any one, even illiterate, down trodden communities have the capacity to look back, take stock of their present situation and state what they aspire for

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PSP Simply stated, it means:

* What we want to be

* Where we want to be

* What is the path to take

* How do we want to reach there on a specific time frame

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PSP Communities and the organisations

that work with them learn to look at it under three circlesThe Context Circle (Community and

Organisation)The Vision CircleThe Organisation Strengths Circle

(Community and Organisation)

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The Context Circle

The Critical IssuesThe ChallengesOpportunities and ThreatsKey Players

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The Vision Circle

* Vision

* Mission

* Objectives

* Strategies

* Program

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The Third Circle

Strengths Weaknesses Capabalities Potential Resources

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The Three Circles

VisionMission

StrategiesObjectivesPrograms

Role Models

StrengthsWeaknesses Capabilities

Potential Resources

ContextCritical Issues

ChallengesOpportunities

ThreatsKey Players

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The “F I T”

FIT

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The Fit The three circles converge and the area

of convergence is called as the “FIT” The more they converge, the larger is the

fit When the “FIT” keeps getting larger, over

time, then the aspirations and capabilities of the community and the organisation and the goals and objectives of the organisation are congruent

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The Methods The Community uses many

participatory techniques. One of them is Village Mapping The Older people map the village as it

was 10 years ago using available materials

The younger people map it as it is today

The community looks at it and sees what changes have taken place over time

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Then Our role is only facilitatory The community then looks at the

reasons for change We help them to reason out why

these changes have taken place and what can be done about these changes eg water, deforestation

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Changes

The Community looks at: the reasons for change the trends

If trends remain the same what would be the scenario 5 years from now,

if trends become better what would be the scenario and

if the trends worsen, what would be the scenario

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The Probable Scenario

Then they pick from each of the scenarios and come up with a probable scenario, look at what problems would be faced and how the scenario can be improved

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Joint Action The Community then gets to know

what needs to be done, what resources they have, what outside resources are needed, how they can go about it, what the blocks are, who the obstacles are and at what level –

local, national and international, and finally how to overcome those obstacles

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PAR

It is a methodology where the community participates fully in getting to know their situationStrengths and weaknessesResourcesProblemsOpportunitiesThreats

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PAR

Regenerate and build upon existing knowledge

Regenerate and build upon existing skills

Regenerate, refine and build upon existing practices

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From Day One

The community participates fully in: InvestigationAnalysisPlanning Appropriate and Joint Action Implementing the ProgramMonitoring and EvaluationMid-course Corrections

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Goals of PAR

To release To restore To renew To empower and finally Transform

PAR empowers, achieves collective power,

Makes them realize their collective worth and

Builds Self Reliance

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PAR Is committed to the Marginalised and

the Poor. Is biased in favour of the poor.

Believes that everyone has intelligence, create knowledge, the right to make history.

Develops critical understanding Insists on democratic interactions

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PAR Is an Action-Reflection-Action Process and

therefore is basic to community organisation Build inter-personal and intra-community

relationships, bonds Re-energises and fosters social capital such as

trust, confidence, sharing, care of the poor etc., Helps breakdown barriers

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Participatory Vulnerability Analysis (PVA)

PVA is a systematic process that involves communities and other stakeholders in an in-depth examination of their vulnerability, and at the same time empowers or motivates them to take appropriate actions.

The overall aim of PVA is to link disaster preparedness (droughts, floods, state oppression on a large scale) and responses to long-term development.

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PVA-Community Level

PVA enables communities to play a dual role, as informants, but also analysts, by breaking down vulnerability to a point where they can begin to take action to reduce their ownvulnerability. The analysis itself has no value unless it is followed by action: people cantake action themselves

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PVA Means

Community meetings Discussion sessions and analysis Training of local facilitators Participatory and reflection approaches Stakeholders and focal group meetings Local level advocacy and lobbying Documentation and liaison Studies on selected issues

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Participatory Training Methods(PTM)

Is an enabling experience Best method for adult learning Learning by doing No one comes as empty vessels and

that even the illiterate have experiential knowledge

Equality between trainer-trainee

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PTM Treats trainees as adults Shared responsibility for learning Is a confidence-building process Mutually enriching Builds on what they know Respects cultures, values and life

experience Translates scientific knowledge to real life Leads to behavioural changes

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Rights-based Approach Participatory Approaches empower communities

to stand up to ruling structures Communities know what their rights are:

Human rights Women’s rights Peasants’ rights Rights of outcastes, indigenous people Children’s rights

And have the knowledge, skills and capacities to fight their own battles