|Oral Rehydration Therapy and the Control of Diarrheal Diseases (Peace Corps, 1985, 566 pages)|
|Module Five: Working with the community|
|Session 14 - Working with the community to prevent and control diarrheal diseases|
Now that you have some basic information about the community, the next step is to broaden your contact with the leaders of the community. Involve the local leaders as soon as possible in the project. Who are the leaders? Why are they important? How do you find them? What can they do to help?
Who are the leaders?
Anyone in the community may be a leader. A person is a leader when his or her ideas or actions influence others or he/she helps to get things done that the people want done. He/she is accepted by the people as a person of wisdom and sound judgement and one whose advice has been valuable in the past. He/she might be wealthy and powerful, or a person known to be very religious. Different people may be leaders in different areas such as agriculture, religion, politics or health. The leaders you are interested in should have some influence over people's actions which are related to their health.
Why are leaders important?
Community leaders usually make decisions that result in success or failure of a project. They are trusted and the people of the community will work with them more quickly than with you. If this is to be the community's program you must count on community leaders to take some responsibility for its success. You are the spark plug and the source of assistance. You can help bring together the other resources needed for improved community health. But the project will not be a success unless members of the community participate; their participation is usually decided by community leaders. The people to work with are those respected by the community and who are willing to learn and work.
Two kinds of local leaders
1. Formal leaders: Are generally paid for what they do. Projects sometimes fail or move slowly because these people were overlooked during the planning stage. Consult them often and request their advice and assistance. Gain their cooperation. Examples of formal leaders are:
- Political appointees (mayor, party representatives)
- Government officials (police, national guard)
- Village chief
- Religious leaders
- School teachers
- Heads of organizations
2. Informal leaden: May receive no money for what they do and have no official authority. They come from the local community and often have more influence than formal leaders. They are not necessarily the person' with the best houses or the best pieces of land, but they are liked, trusted and respected by their neighbors and are willing to help. A woman may be a leader in respect to the need for a better water supply while her neighbor may mainly influence vegetable gardening.
How do you discover the informal leaders?
The first step is to consider the responses you received when asking villagers "Where would you go for help if you have a health problem?" Other questions you might use are:
"Who are the important people in the community?"
"Whose opinion do you respect?"
"Whose advice do you follow?"
"Who is wise?"
"Who settles arguments within or between families?"
"Whom do you think people would go to for advice when their children have fever? To organize a special trip or event?"
You will probably find that the people named are those with leadership qualities and that the named will differ according to the problem to be solved.
However, leaders may not be the persons who show the greatest interest at the beginning of a project.
You may not uncover obvious enthusiasm to help others, but people who express interest, friendliness, and willingness to work, or people whose name was mentioned often by neighbors, may be your key to potential leaders. In your quest to discover local leaders, do not bypass those who appear to be against your work. Give them special attention and try to win their support and cooperation.
Example of a local leader: the birth attendant
Birth attendants are the most widely distributed of any category of health-related person. The reason for this is that women usually wish some assistance at the time of delivery and they are unable to travel far or to wait long for some one to reach them when they go into labor. The birth attendant is also working at a time which is especially appropriate for maternal and child health education. Unfortunately, birth attendants are often untrained, but they are often very influential with mothers.
Identifying and working with local birth attendants can be very effective in health education. In fact, in some poor communities the entire standard of health, sanitation, infant and childhood death rates and family planning have been revolutionized primarily through the work of birth attendants.
What can leaders do for the community?
If an effort is made to give leaders a thorough understanding of how health problems affect community well-being and how these problem. can be solved, they can contribute immeasurably to better understanding among the people. They can also become a powerful motivating force for community unity and action. Through their own acceptance of improved health methods and practices, they become a motivating force for change.
But, care must be used when deciding which leaders are the influential ones related to the specific community problem. In Tonga, an environmental sanitation project was initiated after preliminary planning with the community leaders. In Tongan society the women rank higher than the men according to traditional Tongan Kinship systems; the men however, are the heads of the households. The organization of the project was based on the men's support, and, at the request of the men, the women were not involved in the planning. The health workers left the decisions about methods of work to the male leaders but conducted the evaluation themselves. The project failed.
When a second project was planned in another Tongan community, an analysis was made of why the first one failed. The conclusion was that both the male and female leaders should have been involved. Both groups were given full control of the activities under guidance of the health worker. The villagers were left to themselves to make the decisions and suggestions supported by the majority were encouraged and used. Evaluation of the second project showed that every goal was achieved.1
1Fanamanu, Joe and Tupou, Vaipulu. "Working through the Community Leaders, An Experience in Tonga." International Journal of Health Education. July-September, 1966.
Project success can be achieved through the efforts of the villagers themselves, providing the right approach is used in promoting the active participation of the most influential community groups and leaders.
Here are some other ways leaders can contribute to the success of a project:
1. Bring people to meetings.
2. Arrange for and meeting places.
3. Help reach more people by telling others.
4. Help people in the community know you and gain confidence in you.
5. Give general information about the program and help interpret it to the people.
6. Help identify problems and resources in the community.
7. Help plan and organize programs and community activities.
8. Help plan and organize any services which might be provided.
9. Give simple demonstrations.
10. Conduct meeting.
11. Lead youth groups and various individual projects.
12. Interest others in becoming leaders.
13. Help neighbors learn skills
14. Share information with neighbors.
15. Serve as an officer in an organization or chairman of a committee. 1
1 Homemaking Handbook for Village Workers in Many Countries. Agency for International Development, Washington, D.C., March 1971, pages 196-197
How can these potential resources of the community be mobilized? In discussions with leaders, what have you discovered that is important to them? Maybe it is the protection of children's health. Maybe it is convenience, privacy, or cleanliness? Maybe they are moved by competition - "Other communities are solving their health problems." They might express pride in their community "We have done so many other things in this village, but this problem remains." Capitalize on these motivations. Use them to guide you towards a better understanding of the people of the community.
The Health Committee
A health program must have some kind of organized group to make it work. The family, the church and the school all have primary purposes other than health. They can take part in the health program, but their separate efforts probably will not be able to make it work. Often, a health committee is organized which involves community leaders and other representatives of community life.
There are many ways to form a committee. Remember the reactions of the people you have talked to in the community. Who was interested in the health situation? Who was hopeful? Which people were recommended as leaders? Talk with these people. Suggest a meeting of the group of them.
In the meeting, discuss the purpose of organizing a committee; let them decide to make an organized attempt to solve community health problems.
In a small village in Nigeria, after a preliminary survey of the community, the village chief was approached and the suggestion for the formation of a health committee was made to him. He liked the idea and was requested to invite other influential members of the community, including women.
The chief requested that the objective of the meeting be presented by the health worker. The worker invited the members to go out on an inspection tour so that all would have a part in determining what their needs and problems were. This they did and it served as a starting point for the meeting. Both male and female members desired urgent solutions to the problems they discovered during the tour. The chief was elected chairman for a village health committee and a teacher was chosen as secretary. Decisions were made in that meeting about plans for solving some of the problems found.1
1"Health Education: The Development of Local or Village Health Committees in Eastern Nigeria." Anonymous. Supplied by Action Library, Washington, D.C.
The community members must become involved from the beginning in the decision-making and planning for the community. To make changes, they must commit themselves. They may need to see health improvement projects of other communities. Suggest a field trip (or this purpose. They learn as they go along and will be better able to manage their own projects.
A separate health committee may not be the best choice for some communities. If an existing local committee or other structure appears to be an effective means for improving community health, then perhaps this group could add health to its other concerns.
Purposes of a health committee
A health committee can serve several purposes:
1. To discuss health problems and discover felt needs.
2. To plan ways to reach goals and objectives that promote new, sound health practices and attitudes.
3. To implement plans and organize projects.
4. To receive and consider new information about health and development of possible interest, and convey this to the community.
5. To encourage all members to gain skills and confidence in working in a group so that the work in the community will not depend on any one person.
For suggestions on planning and conducting a meeting, see Chapter V. Records of proceedings at each meeting should be kept and read at succeeding meetings and matters arising from them should be discussed. These records can always be referred to by any new member so that he/she can acquaint him/herself with the progress and history of the committee's work.
Members of the committee are usually elected, but its formal make-up will differ from one country to another, often from one village to another. The important thing is that you keep abreast of the committee's work and progress. Usually you will be invited to attend the meetings, and may even be chosen as a member. Because your position in the village is temporary, it may be best to decline any offer to be an officer. You are a resource person - one who assists and supplies information and guidance. Participate, hut do not become totally responsible.
After the creation of a Health Committee, initial projects should be simple in nature and should not demand a long period of time. Refer to the next chapter for further discussion of this point. The building of a latrine for a dispensary or school could be completed after only a few work days and would impress upon the Committee - and the community - what they are capable of doing. If a complicated project such as a water system or construction of a health post were chosen first, the problems of materials, technical assistance and the duration of the project would probably discourage the people and have a crippling effect on the Health Committee. More difficult projects can be attempted after the Committee has had some success with simpler projects.
Once a health committee or committees exist and have begun their work, they should always have a problem that they are currently working on. If committees remain stagnant for a period of time, they become ineffective and will cease to exist other than in name. There should also be lines of communication between the local health centers and the Health Committee to ensure recognition and cooperation between the two.
In summary, health committees can accomplish many things to improve community health if they represent key groups in the community, communicate and cooperate with other community workers, committees and institutions, are well-organized, and if they plan projects based on community needs and interests. Your role is to assist the committees in doing these things. The next two chapters will discuss steps in planning, implementing and evaluating a community health project.