19.6.1 An example of community mobilisation:
Step 1 Identify a significant health problem, for example female circumcision.
Step 2 Plan and select a strategy to solve the problem (for example, conduct a workshop for influential people in the community for sensitisation on the issue).
Step 3 Identify key actors and stakeholders (village chief, Imam, heads of families, etc.)
Step 4 Mobilise these key actors and stakeholders for action (discussions and agreement on what to do).
Step 5 Implement activities to work towards a solution (capitalise on the sensitisation of the people created by the workshop and intensify this through various follow-up activities).
Step 6 Assess the results of the activities carried out to solve the problem.
Step 7 Improve activities, based on the findings of the assessment.
The Health Extension Practitioner, Halima Gebre works in Gorbessa kebele. The village is located in a very remote area where there is no access to any kind of transportation. Most pregnant women from the village have no access to transport even if difficult situations arise during their delivery. There is no track or road for cars to travel between the village and the nearby district where the hospital is situated. This year four pregnant women with obstructed labour have died. Most of the community members would not be able to carry a stretcher as far as the hospital.
If you were a Level IV Health Extension Practitioner in this community, what action would you take to help these kinds of mothers? How would you mobilise the community to solve these problems? Obviously this is a big problem and would take a lot of detailed working out. However look again at the steps in the cycle (Figure 19.8), to see if you can begin to map out some of the principles you might use.
Halima has already identified a significant health problem (Step 1). Remember that to mobilise the community for a health action, such as getting better transport facilities in case of medical emergencies, Halima will have to do other things as well:
- She needs to work out a solution and get the support of influential people in the community (opinion leaders) (Steps 2 and 3).
- After these initial stages, she needs to use these key people. Perhaps the kebele administrator could be asked to talk to local government officials.
Of course we don’t know the later stages of Halima’s work, but you can see the way the initial stages are performed.
Halima will also need to be sure that all the people of the community are informed about the problem, and then get the maximum number of people involved. This will not only mean that people ‘own’ this problem, but hopefully the community will also strengthen its capacity to do things for any health issues that arise in the future. Box 19.3 summarises the key messages about community participation.
Box 19.3 Active community participation
- Know your community well, and understand their problems and their needs.
- Be aware of existing health beliefs and practices that exist in the community.
- Always listen to community members carefully.
- Do not rapidly introduce new interventions that are different from existing practices and beliefs. Take gradual steps to introduce such practices.
- Try to analyse community dynamics and adjust to each situation.
- Involve the entire community in the programme right from the beginning.
- Give respect and importance to negative experiences of the community, if any, and try to minimise the negative feelings verbally and in your actions.
19.6 The action cycle of community mobilisation