Handout 17A: Defining the health problem

The first requirement in banging about change is for people to agree that there is a problem and that something should be done about it. The challenge is to avoid simply looking for things which the people do which are unhealthful. Search for the meaning of existing practices. For example, you may find that the community women use the banks of the river or pond for toilets and you may try to convince the community to build and use household privies. This effort could easily fail if a new means is not provided for the women to meet and chat each morning, such as at a protected well site.

To say that there is a health problem is a very general statement which covers many specific situations. In order to plan your work, to set goals and to go into action, you must be able to define the specific problem on which you wish to work.

To help you define it and involve the community in doing so, talk with the local leaders and villagers. Use a questioning approach in an attempt to find out how they view the health situation. Start from the general and work down to the specific problems you have in mind. For example, if you found a very unsanitary environment in your survey of the community you might contact the leaders and proceed as follows:

1. "What kinds of things need to be done in this village?"

2. "What are the illnesses most common in this village?"

3. "What do people die of, mainly?" "Are there many children under 5 years old dying? it so, what from?"

4. "Do they have diarrhea, dysentery, cholera, typhoid, worms in this village?" "What causes these illnesses?"

5. "Are there any latrines in the village?" "What do people use?"

6. "Has any thought been given to building latrines?"

7. "Why would some people refuse to use them?"

8. "If these diseases could largely be stopped if the people themselves decided they wanted to, would people in the village want to plan together to do away with diarrhea, dysentery, cholera, worms, etc.?"

The problems you have already uncovered in the forma village survey can be compared with the views expressed informally through this type of questioning. In fact, much of the essential information may have already been gathered while you were first getting acquainted with the community.

The place for further problem identification and definition is with the Health Committee. Here are a few steps to help the Committee define specific health problems.

· What is the nature of the problem? What is the problem situation, behavior or condition?

· What is the extent of the problem? How bad is the situation? How significant is the problem in terms of the community?

· Whom does the problem affect? What groups or individuals are affected?

· What are the size, the characteristics and the nature of the "target" group?

· Where does the problem occur? What geographic area is affected? What is its size and nature?

· How long has the problem existed? is it improving or not?

· How much would people be willing to contribute in work, money, land for a well, sand for concrete, labor, etc.?

(Community Health Education in Developing Countries. pp. 19-29.)