|Education for Health (WHO, 1988, 274 p.)|
|Chapter 6: Health education with communities|
People do not always understand why they should try to improve their health by their own efforts. They feel sometimes that health care is the responsibility of the government. Of course, the government has a responsibility in this area. And it is clear that the promotion of people's self-reliance should in no way be an excuse for health workers to avoid rendering the services that the community is entitled to receive.
Here is an example of a community-based project where it took a long time to establish a real partnership.
Right from the beginning, the health project workers tried to involve the people in planning and programming. They were careful to ask 'What can we do together about the problem?", and they started defining the issues with the people. The people liked this very much, because they had an input to make. Previously, in another development project in the area, health workers had been conducting surveys without consulting them. The people did not even know what happened to the surveys afterwards. There was no feedback whatsoever. So, this time, they really appreciated being involved and informed.
However, when the point of planning was reached and the health workers asked 'What can you do about your problem?', the people were shocked.
They said 'Why us, why not you? It is your duty.' They had been quite comfortable letting health workers take action in the past. Now they were asked to do something about their problems themselves. The people did not quite understand why it should be that way.
The leader of the project said that one important lesson they learned was that they needed to help people regain confidence in themselves and to reassure them that they could do it. She explained that in the past, health workers had taken away from the people their decision-making power and discouraged them from thinking for themselves. This led to people lacking confidence in their capacity to become active partners.
Partnership, self-reliance and community participation are all easy to discuss in a forum. They are much more difficult to put into practice. As the saying goes, 'it is easier said than done'. Involving the community requires a tremendous investment of human resources, time and effort. No health worker can make an effective investment without commitment and motivation.
What sustained the project workers through the difficult moments at the beginning was a belief in people. The project workers gave the community much more than expertise, and technical knowledge - they were totally committed to making the project work. When the people realized this a positive relationship started to grow.
Now the project is developing very well and the people are very much involved.
Think about your own experience. Have you sometimes found people reluctant to make an effort or to take on certain responsibilities to improve their health? What were the reasons? Did you have the skills necessary to take action? Had you been teaching them these skills?
In what circumstances did you find people most willing to cooperate? What were the factors that created this partnership between you and them?