participatory community health development
DESCRIPTION
Dr. Julius Kavuludi, in country director of MAP interiational, delivers this message at the Faith Hope and Charity Dinner of Genesis World Mission in Garden City Idaho, March 6, 2011.TRANSCRIPT
ENGAGING COMMUNITIES IN
WHOLISTIC HEALTH DEVELOPMENT:
THE ‘THV MODEL’
INTRODUCTION
PURPOSE To collectively contribute to the improvement in the
quality of health care and life of the people of Burangi area in Malindi /Magharini district along the Kenyan coast by engaging active community participation in its own development in a model we call “Total Health Village.”
THE MAP/GENESIS PARTNERSHIP
WHY? “We are attracted and bound by absolute like
mindedness in
VISIONMISSION
AND CORE VALUES
THE MAP/GENESIS PARTNERSHIP
SIMILAR CORE VALUES• We are Christian with mirror visions and missions• We are driven by a holistic participatory approach
to health development emphasizing local sustainability
• We specialise in human health care• We prioritise reaching to the poorest, the
marginalised, and underprivileged in society
SIMILAR CORE VALUES• Our philosophy is anchored on realistic
empowerment of communities and individuals• Our inputs are low but our expected outputs are
high.....hence we support cost effective interventions
• Commitment to transparency and good stewardship of resources
SOME FEW HEALTH SECTOR INDICES FROM KENYA
• 5000 health facilities in Kenya• 4500 doctors; 1000 in public service. 50%
concentrated in Nairobi: Ratio 1 physician to 10,000 citizens (compared to 26:10,000 in US)
• 47,000 Nurses & other cadres of medical personnel (10:10,000)
• 4.6% GDP towards health financing ($29 USD per capita) far below the minimum $34 recommended for Africa by WHO. 40% of financing comes from Kenyan Government; 15% donors, rest by private sector
SOME FEW HEALTH SECTOR INDICES FROM KENYA
• 58% of health services run by private sector which caters to high income clientele
• 90% resources devoted to curative a service that only 10% of the population accesses.
• 90% of morbidity (and mortality) is caused by preventable infective diseases (and poverty)
Kenya HDI (Human Development Index) #147 (0.541)
(ranked out of 182 countries)Literacy Rate
(age 15 and over that can read and write) #107
73.6%
Infant Mortality Rate
(per 1,000 live births)
54.7 deaths/M
(2009 est.)
Life expectancy at birth
#152
53.6 years
Combined primary, secondary and tertiary gross enrollment ratio #138
59.6%
GDP per capita
#149
$1,542 USD Per Capita(2009 est.)
THE BURANGI PROJECT is a total health village (THV)
program
• The THV is a ‘low-input($15 pp/py), high-impact strategy for achieving the ‘Millennium Development Goals.’
• It is a cost effective community development strategy that is expected lead to Total Well Being by impacting a whole village of close to a thousand people through a facilitative and low input cost strategy.
• It is a completely participatory strategy where communities analyze their situation, and plan a response strategy, and implement it using Community’s Own Resources/Persons and engaging External partners only in a facilitative role where they have no capacity in solving their own problems.
WHAT IS A THV?
PARTICIPATORY METHODOLOGIES
How?
We have devised simple methods that can apply to any community (in any country).
Is the rallying point that initiates, stimulates and sustains
enthusiasm in participation.
THE TEN SEED (OR EQUIVALENT) TECHNIQUE
Why TST?•Win trust•Ice breaker•Neutralises threats of inferiority•Neutralises the threat of illiteracy•Stimulates thinking and visualisation (perception)•Is the tool for data collection
EXAMPLE OF A TST ANALYSIS OF PROBLEMS IN THE BURANGI COMMUNITY
OVERALL PROBLEMS MAJOR PROBLEMS
•Rampant diseases•Poor health care•No access roads•Drought•Poverty•High illiteracy•Lack of technology/communication•Floods•Wild animals•Poor leadership
Inadequate health Facilities
30%
Diseases 20%
Communications/Access Roads
5%
Floods 5%
Illiteracy 10%
Poverty and hunger 30%
• A ‘SWOT’ analysis
that uses information gathered through the TST.
• Analyses 3 components simultaneously
1. Problems2. Means of earning
livelihood3. Uncertainties
(W)HOLISTIC WORLD VIEW ANALYSIS:W(H)WVA
WWVA Explanation
Community Strengths
Community Weakness
Community Vulnerabilities
Lack
of H
ealth
Fa
ciliti
es
Outbreak of deseases
e.g Cholera
Prob
lems
Ram
pant
Dise
ases
Poor Roads
Wild Animals
Floods Tapping
(Traditional Licker
Farming
Empl
oym
ent
Cano
e Ro
win
g
Lack of
Education
Small Scale Businesse
s
Poverty
From: Uncertainty Analysis
From: Livelihood Analysis
From: Problem Analysis
Color code
PRIORITY SETTING
• There is a significant margin of statistical error being higher for quantitative data than for qualitative data compared to conventional statistical methods
• It has been tested that the perception results derived are reasonable enough to enable communities to analyse themselves and make informed plans that they can sustain
SHORTCOMINGS OF THE TST
POINT OF ENTRY THEMATIC AREAS FOR BURANGI THV
• HEALTH– Access to quality medical care through mobile and static
health clinics– Access to quality drinking water– Improved community, domestic and personal sanitation
• SUSTAINABLE DAILY LIVELIHOOD– Improved food security– Improved income generation
• Environmental preservation – Through tree planting and use of alternative renewable
sources of energy and others
EXPECTED IMPACT
• THE GOAL: Improved quality of life as measured by positive
changes in the human development index
• EXPECTED MAIN OUTCOME: A community empowered to take charge of its own
destiny
RESOURCES ALLOCATION
THE 50 | 40 | 10® PRINCIPLE• 50% TOWARDS PROMOTION.
– INVEST IN PEOPLE
• 40% TOWARDS PREVENTION. – INVEST IN SYSTEMS/STRATEGIES
• 10% TOWARDS PROVISION:– INVEST IN CONSUMABLES
WHAT ABOUT SUSTAINABILITY?• Involve the people right from the beginning
– Teach them to ‘learn how to learn“– To ‘learn how to dream constructively”– Elevation of self esteem and self confidence– “Doing with” rather than “doing for”
• Weigh when to give what…don’t interfere with their strength.
• Support their vulnerabilities and their weakness. Don’t do what they do well.
• Emphasize transferable skills and locally sustainable technology
WWVA Explanation
Community Strengths
Community Weakness
Community Vulnerabilities
WHAT ABOUT SUSTAINABILITY?• Involve local leadership from the start• Involve women and school children who provide
great potential as change agents• Understand and respect their culture and social
values; handle what you might think is retrogressive culture with tact.
• Don’t aim to make them a mirror image of your self. Let them discover their inherent ability.
• Enthusiasm is the driver of sustainability.
WHAT ABOUT SUSTAINABILITY?• Think “small,” think real, build on what they
know/have. Avoid ‘elephants with strange colors’
SIGNIFICANT PROGRESSTO DATE IN BURANGI
• Conducted Medical camps (April/August ’10/Feb ‘11)– 3800 people served with combination of US & Kenyan
medical professionals and community members
SIGNIFICANT PROGRESSTO DATE IN BURANGI
• Done a WWVA together that generated great understanding of group dynamics (August 2010)
• Construction of an access road though high level advocacy and community involvement
SIGNIFICANT PROGRESSTO DATE IN BURANGI
• Conducted a surgical camp in which 2 individuals with severe filarial morbidity
SOME OF OUR CURRENT WORK
PROVIDED NEEDY SURGICAL SERVICES
BURANGI CHALLENGES
The greatest challenge is adequate resources to facilitate this worthy cause
– Financial…extreme poverty (1/3 of average Kenyan daily earnings)
– Human….not labor but knowledge– Material…….technology
ACKNOWLEDGEMENT
• Tracy Haworth – Genesis Project Director• Dave Hall – Genesis Board Member
• Medical teams, background teams, donors and well wishers
OPEN INVITATION
– All of you– Health care professionals (and students)– Technical people in other areas– Any person with a heart for sharing or witness.– Any person who can donate a dollar or two (or
more) or any other gifts in-kind towards this mission
ABUNDANT BLESSINGS
THANK YOU