|Education for Health (WHO, 1988, 274 p.)|
|Chapter 6: Health education with communities|
People who share common interests and have the feeling that they belong together form a community. In a community people usually share common values, a common history (or background), and accept certain forms of behavior as normal for all community members. People belonging to a certain religion or having the same political beliefs could also be called a community.
A community, then, is not the same thing as an area of land. Community is people, not landbut community members will often be able to point out the boundaries of land that belongs to the community.
We can demonstrate this by taking the example of a small village. The houses and farms of the village may occupy 50 hectares of land. We cannot say, though, that the land with its houses and farms is the community. There are possibly sons and daughters who have moved away to larger towns and cities. They may have their own children and grandchildren there. Yet, they may still feel that they are members of their original village community. Another possibility is that the village land is occupied by groups of people from different backgrounds. In that case, the village may shelter two or more communities. Feeling part of a community is a feeling of belonging that people hold in their minds and hearts. A community cannot be identified simply by looking at the land or lines drawn on maps.
Here is a case study that shows why it is necessary to identify clearly the communities with which we work.
Mr Jola is a health assistant working in a small dispensary that serves ten villages. He would like to involve the people more in providing their own health care. He visits all the villages to see if they would be willing to have a volunteer trained in primary health care. He stops at the first house in each village and asks the people to take him to the village leaders, so far, all have agreed to participate in the programme and to send volunteers for training. Several months later, there is a cholera outbreak in the next district. Mr Jola meets with the volunteer community health workers to discuss what should be done to protect the people. After several suggestions are made, the community health workers go back to work out specific plans in their own villages.
In a few weeks, the cholera has spread to Mr Jola's district. Fortunately, because of the advance planning, most villages were prepared. Few people became sick and none died except in one village, Abedo. There, twenty people, all from the west side of the village, died of cholera. This seemed strange, so Mr Jola went to Abedo to investigate.
On reaching Abedo, Mr Jola met the community health worker and asked to visit the section of the village where the people had died. Mr Jola talked to the families in that section and made an interesting discovery. These people said that they had originally come from a place about 50 kilometres away. Although they now lived in Abedo, they still had their own leaders, celebrations, and customs. They had never worked closely with the people who were native to Abedo, so they had not participated in any of the primary health care activities to prevent disease. Even though the map showed that these people lived in Abedo, they were really a separate community.
How could Mr Jola have avoided this problem in the beginning? What steps are needed to make sure that a community is correctly identified and involved?
A community cannot be found simply by looking at the lines on a map. It is necessary to walk along the streets and talk to residents to discover where they consider the boundaries of their own community to be. The community survey is an educational tool that will help you and the members of the community learn more about who belongs to the community and what are its special needs, resources, and culture.
Mr Jola's problem arose in a rural area. Health workers in towns and cities will find the same type of problem even more often. Towns are made up of many communities. A particular community may live in a certain neighborhood, which may be divided from the next neighborhood by streets or streams, but often is not.
Ask the residents to tell you who are the members of the different communities or neighborhoods, and where they believe the boundary lines are located. Then each neighborhood can be mobilized to identify and solve its own problems. There will be more cooperation and participation if the people feel that they belong together.