|Training Manual in Combatting Childhood Communicable Diseases Part I (Peace Corps, 1985, 579 pages)|
|Module 4: Health education|
|Session 23: Adult learning and nonformal education techniques|
In recent years there has been a great deal of interest in the use of non-formal techniques of education for training of health and development workers. The term is often ill-defined and misunderstood, but in practice it usually means the use of techniques that encourage active participation of the members of a group in learning through a process of identification of a real problem, examination of the problem as a group and discovery of possible actions the group can take to solve the problem. The "something" being learned is frequently a piece of information or a technical skill, but the non-formal method of problem solving is learned at the same time.
Non-formal education used as a technique to teach more or less technical skills has its applications, but in practice it walks an unsteady line between its origins in philosophies of education as liberation or political consciousness raising, and conventional schooling. The outcome of the use of these techniques depends greatly on the composition of the group, the orientation of the group leader, and the surrounding social-political climate.
The use of non-formal techniques, when they work at all, quickly breaks down the formal teacher-student relationship and establishes a relationship of equality and mutual responsibility for learning. This seems to be an obvious and desirable step, but in the context of political or racial repression it is literally explosive. The simple fact of treating oppressed people with respect, listening, and providing a place where they can work together is a much stronger message than whatever the topic of the class was supposed to be. This is especially true of groups with no schooling.
Groups of unschooled peasants make very little separation between perceiving the solution to a problem and the action to implement the solution. They may be slow to become convinced, but they are very quick to move on to concrete action, and that is where they come into conflict with the constraints of the prevailing social-political system. More sophisticated groups, on the other hand, can work through a non-formal exercise very smoothly and come to all the right conclusions, but they are much less likely to carry their conclusions into action, and so are less likely to come into conflict with the harder realities of their situation.
The group leader who uses non-formal techniques may find that the techniques lead him into territory he hadn't planned to explore or to conclusions that weren't part of his private curriculum. This style of learning is a group process that may be very difficult for the leader to control. The following are a few examples among many from personal experience.
An Indian health promoter was trying out a new teaching aid with a group of Indian women. The material was a set of pictures about prenatal care. She showed the first picture to the group. It was a dull enough picture of a white coated male doctor, talking to a pregnant Indian woman. The promoter asked what the group saw in the picture. The replies came hesitantly at first, then in an angry flood: "He's scolding her., "He says she came too late", "He's telling her she has to go to his private clinic and pay a lot of money", "He doesn't want to touch her", She is sad and wants to go home", "She can't understand his Spanish."
At this point the promoter had a choice between talking about the reality or continuing the fiction of talking about prenatal care which in practice is inaccessible to most people because of inadequate facilities, corruption and racist attitudes.
Another time I was teaching nutrition to a group of health promoters in a part of the country that is notorious for low wages. There were some very poor-looking people in the group including a young man whose skin and hair showed signs of vitamin deficiencies. I used a market game to teach price comparisons and the nutritional value of foods. Each person "buys" the foods he thinks best with the amount of money that he normally has to spend in a day for food. The foods can be real or pictures but they must be common, local and not expensive. The group evaluates each person's buying to decide how well they did with the money they had. The game went well with a lot of good natured joking and a minimum of technical information from me. When we got to the young man he said that he could not buy any of those common foods and in fact had not bought them for years. He was earning $.60 per day for plantation labor and had no other resources. His first two children had died of kwashiorkor and the third was born small and soon died. He said that his wife had stopped menstruating even though she wasn't pregnant and he wanted to know what nutritional advice I could give him for her. I had to say that there was no nutritional advice I could give him but that he and his wife should get away from that plantation and look for something else before they starved to death. Then another young man said the only real answer is to change the system that creates such poverty. I said yes but that was outside the limits of what I could allow the group to discuss in an open public meeting. The class broke up after that: most had learned a little nutrition and all felt bitter and frustrated at the young promoter's situation, and at my refusal to talk about it which they saw as hypocrisy.
In both of these examples the intrinsic power of the educational method combined with the reality of the people had overwhelmed the intended contents or subject matter. Non-formal education cannot be easily separated out into techniques for training on the one hand, and political awareness on the other. This is probably true of education in general but the particular power of non-formal education is that it is a collective process which promotes cohesion and cooperation within a group. The group as a whole discovers their problems, reaches conclusions and desires actions, which have a greater or lesser political impact. The same number of people reaching the same conclusions one at a time in isolation, if that were possible, would not have the impact or visibility of a group, and would not be able to carry their conclusions into action. Because of the things that the group is able to accomplish they become visible and may become targets for political repression.
Successful health education is especially likely to lead to visible action. One of the goals of health education is to get people to give up their magical view of disease causation for an understanding of cause and effect, and the use of non-formal group techniques is quite effective in this respect. However, the fact that most of the people have a magical view of disease is one of the corner-stones of the social-political system as a whole. If through successful health education people come to accept a cause and effect explanation of disease they will start to feel the need for actions that the system is in no way willing to allow, and for services that the system can't or won't provide. In fact the magical view of disease causation can be seen as an adaptation of the culture to a situation of extreme helplessness maintained over a long period of time. It may be the only way for the people to avoid frustrating and dangerous conflict with the system. When a health worker is effective at helping people to discover cause and effect relationships and abandon their magical view of disease he himself becomes identified as a leader and becomes highly visible.
The health or development promoter often uses techniques that he has been taught to use in the relative safety of an officially approved course, given by government workers or foreign volunteers. In this setting he is protected by the status of an institution which has at least tacit support of the authorities; and by the composition of the group which will most likely be made up of schooled people who are used to playing with ideas and will not be inclined to take direct action of any sort. When he uses the same techniques with the illiterate peasants of the village all of these conditions change and he may be put in a very vulnerable position.
When non-formal techniques are used as a political tool, the group leader presumably knows where he is going and how to protect himself, but when they are used for other ends, the leader is often quite naive about the implications of what he is doing. If the attitude of the promoter is at times naive, the attitude of the agencies is more than naive: it is irresponsible. Both government and private agencies set up and finance programs to train promoters with very narrow, short-term goals in mind. Training in non-formal education is a means to the end of having X number of latrines installed within Y number of months, or some percentage increase or decrease in malnutrition.
But the use of non-formal education and the formation of cohesive, active groups in the community will not just go away once the latrines are built. People who learn how to analyze what is wrong with their water system are quite likely to move on next to what is wrong with their political system. And while the agency may have prepared people very well to deal with the water system, they probably did nothing to prepare them to deal with the political system. The agencies and the people who work for them should be willing to admit that their project, whatever it is, exists within an historical context and will inevitably influence that history. In the context of social-political change, there simply are no neutral actions. They should also realize that the people they train will become active participants in historical processes and need preparation for political understanding and action at least as much as they need preparation in technical matters. To fail to do this is irresponsibly and in really bad times comes to resemble a form of human sacrifice.