IV.

IMPLEMENTING COMMUNITY HEALTH INTERVENTIONS

1. IMPORTANCE OF PARTNERSHIP AND COLLABORATION
 COMMUNITY PARTNERSHIP
 It is a collaborative relationship between willing entities formed to
address shared objectives. 
 Effective partnerships leverage the strengths of each partner and
apply it strategically to the issue at hand. It might take more work,
and it might take longer, but strong partnerships build the
relationships, shared understanding, and collective focus to make
lasting progress on issues related to community and economic
development.
 CHARACTERISTICS OF EFFECTIVE COMMUNITY PARTNERSHIPS

Effective community partnerships rarely emerge overnight. They are

the product of time and thoughtful deliberation.

 Leadership

 Community partnerships are leader’s collectives. “Leadership” is

to communities as chocolate chips are to cookies: the more the
better.” If that’s the case, then partnerships are the batter
holding the chips in place.
 Aligned Vision.
 Each partner must be pursuing the same essential goal. This
does not mean they are committed to the same outcomes,
approach, values systems and the like—in fact, disagreement
about these can be healthy for the group. But it must be moving
in the same general direction.

 Roles, Responsibilities and Accountability.

  Delineating clear roles for participating members and their
responsibilities alleviates confusion and streamlines the group’s
effectiveness. Additionally, clear roles and responsibilities
create channels of accountability. When partners understand
how their contributions add value to the overall effort, and can
see whether others are meeting their roles, it
creates opportunities to provide accountability.

 Framework for Culture and Values.

 Especially important for partnerships tackling a bigger, longer
term issue, developing a framework for, well, how the group
works, is crucial. Roles and responsibilities can be contained
here, but the framework generally covers items like meeting
ground rules, decision-making, behavioral expectations, conflict
resolution, and overall goals and purpose.

 Communication.
 Strong and consistent feedback loops grease the skids of
understanding and progress. It’s also one of the easiest things to
achieve, especially today with the proliferation of smart phones
and social media.

 COLLABORATION
 It is a process of participation through which people, groups, and
organizations work together to achieve desired results.
 Collaborations accomplish shared vision, achieve positive outcomes
for the audiences they serve, and build an interdependent system to
address issues and opportunities. Collaborations also involved the
sharing of resources and responsibilities to jointly plan, implement
and evaluate programs to achieve common goals.
 Members of the collaboration must be willing to share vision,
mission, power, resources and goals.
 The goal of collaborations is to bring individuals, agencies,
organizations and community members themselves together in an
atmosphere of support to systematically solve existing and emerging
problems that could not easily be solved by one group alone.
Collaborations should focus on increasing capacity, communication
and efficiency while improving outcomes.

 PRINCIPLES OF COLLABORATION
 Start with a unifying purpose.
 Create, maintain and revisit Mission and Vision statements. The
vision represents a picture of the future and should be written in the
present tense. The mission describes the purpose of the
collaboration – it is the fundamental reason for the collaboration’s
existence.
 Set measurable goals and objectives.
 Set high expectations – expect the best from the people with
whom you are working.
 As a group, identify leaders for the collaboration who are open
minded, willing to share leadership and empower others.
 Show respect for members of the collaboration (consider people’s
time, transportation, child care needs, access and comfort,
acknowledge the contributions of others, and be flexible.)
 Foster open and honest communication – remember that everyone
needs to be heard.
 Obtain feedback and evaluate the efforts of the collaboration.
 Stick with it, persevere and support each other!
 Celebrate success.
 BENEFITS OF COLLABORATION may be immediate or long term,
direct or indirect. It is important to note that some members of the
collaboration may benefit more than others. Benefits include:
 Improved delivery of programming
 Opportunities for professional development
 Improved communication and enhanced information
 Increased use of programs and resources available in the
community
 Elimination of duplication
  Come in many different shapes, sizes and are of varying duration –
one size does not fit all
 Increased availability of resources
 Improved public image.

 COLLABORATIVE PARTNERSHIPS (people and organizations from

multiple sectors working together in common purpose) are a
prominent strategy for community health improvement.
 This review examines evidence about the effects of collaborative
partnerships on
 Community and systems change (environmental changes)
 Community-wide behavior change
 More distant population-level health outcomes.
 We also consider the conditions and factors that may determine
whether collaborative partnerships are effective.
 The review concludes with specific recommendations designed to
enhance research and practice and to set conditions for promoting
community health.
 A collaborative partnership is an alliance among people and
organizations from multiple sectors, such as schools and
businesses, working together to achieve a common purpose.
 In public health, collaborative partnerships attempt to improve
conditions and outcomes related to the health and wellbeing of
entire communities. When the focus is a community, those
affected may include people who share a common place, such as a
rural community or an urban neighborhood, or an experience,
such as being a child or living in poverty.
 Such partnerships are often hybrid strategies that may include
aspects of social planning, community organizing, community
development, policy advocacy, and acting as a catalyst for
community change. As such, they may have both top-down (social
planning led by experts) and bottom-up (grassroots community
organizing) features.
  The distinguishing feature of collaborative partnerships for
community health is broad community engagement in creating and
sustaining conditions that promote and maintain behaviors
associated with widespread health and wellbeing.

2. ACTIVITIES INVOLVED IN COLLABORATION AND ADVOCACY

 Advocacy includes traditional activities such as litigation, lobbying,
and public education. It can also include capacity building,
relationship building, forming networks, and leadership
development.
 Community health advocacy entails advocacy by a community
around issues related to health, however that community is defined
or formed.

 Activities Involved in Collaboration and Advocacy:

 The advocacy approach uses many different methods of reaching
people.
 Inter-personal meetings or face-to-face approaches with the
decision makers are the most effective advocacy approaches for
those people. However, with the limited availability of
advocates in the field, the potential number of people reached
is limited using this form of communication, and further work
like that may be expensive.
 You can also use other channels for reaching the public, for
example newsletters, flyers, booklets, fact sheets, posters,
video, dramas and folk media.
 Some possible advocacy resources for your locality include
the worked Health Office, the nearby health centre, local NGOs
and other governmental sectors such as the Departments of
Agriculture and Education, as well as local women’s associations
and kebele leaders.
 You need support to form an advocacy network because of the
amount of work and the number of activities that may
be involved. You may need help in order to design effective
 messages, to form a task force, to decide the strategy, and for
fundraising, as well as for calculating the cost of the activities.
 You also need to identify potential supporters. This can be
achieved by attending local events, enlisting the support of the
media, holding public meetings, and talking to all the influential
people in your community. To do these things effectively, you
will also need to do a community diagnosis and get to
understand the resources in your community or locality.
 To get good support for advocacy campaigns, you need to form
a cooperative team for your advocacy activities, and you need
to know the stages to go through in order to achieve the best
results.

 Key principles to help you get support for your advocacy activities

Remember to consider the following principles which can help you to

get support for your advocacy activities:
 Use several tools for advocacy to reach a wide audience (for
example, not only the public, but also officials and decision makers),
and be sure to form good relationships with your local media
representatives.
 Have good relations with the private sector and all the NGOs
working in the area around you. Collaborate with them and all the
people who can help your advocacy work.
 Have good strategic planning.
 Use effective monitoring tools.

 As an advocacy coordinator, you will need support and technical

assistance, and possibly extra personnel to carry out your advocacy
activities.
 You may need help in the areas of identifying health issues, planning,
and message or material production.
 Some organizations that can help you carry out an advocacy campaign
will have expertise in conducting advocacy campaigns, or be able to
help you carry out needs assessment and issue identification.
 Other organizations may help with advocacy activities such as message
development and broadcast work. Some will have expertise in audio-
visual and media message production, while others may have expertise
in training field workers for developing their advocacy and networking
skills.

 STAGES OF TEAM GROWTH

It is advisable to implement the following stages to support your team
building, in order to help you in your advocacy activities.
Stage 1 Team forming
 When a team or network is forming, you need to explore the
boundaries of acceptable group behaviour as the people change from
individuals to gain member status. At this stage, the members of the
team may feel excitement, anticipation and optimism, as well
as possibly suspicion, fear and anxiety about the advocacy
activities ahead.
 Members attempt to define the task at hand and decide how it will
be accomplished. They also try to determine acceptable
group behaviour and how to deal with group problems.
Because so much is going on to distract members' attention, the
group may only make a little progress. However, be aware that a
slow start is a perfectly normal phenomenon.
Stage 2  Storming
 At the storming stage, the team members begin to realise that they
do not know the task, or may consider it is more difficult than they
imagined. They may become irritable or blameful, but are still too
inexperienced to know much about decision making.
 Team members argue about what actions they should take, even
when they agree on the issues facing them. Their feelings
 include sharp fluctuations in attitude about the chance of success.
These pressures mean that members have little energy to spend in
meeting common goals, but they are beginning to
understand each other.
Stage 3 Norming
 During the norming stage, members reconcile competing loyalties
and responsibilities. They accept the team ground rules or norms,
their roles, and the individuality of each member. Emotional conflict
is reduced. There is increased friendliness as members begin to
trust one another. As members begin to work out their
differences, they have more time and energy to spend on their
objectives, and to start making significant progress.
Stage 4 Performing
 At the performing stage, members begin diagnosing and solving
problems, and implementing changes. They have accepted each
other’s strengths and weaknesses and learnt their
roles. They become satisfied with the team’s progress and feel a
close attachment to one another. The team or network is now an
effective support, and ready to help you in your health advocacy
work.

3. COMMUNITY ORGANIZING AND SOCIAL MOBILIZATION

 COMMUNITY ORGANIZING
 It is the process of building power through involving a constituency
in identifying problems they share and the solutions to those
problems that they desire; identifying the people and structures that
can make those solutions possible; enlisting those targets in the
effort through negotiation and using confrontation and pressure
when needed; and building an institution that is democratically
controlled by that constituency that can develop the capacity to take
on further problems and that embodies the will and the power of
that constituency.
  It is a process of educating the people to let them understand and
develop their critical awareness of existing conditions.
 Community organizing strategies include meeting with corporate or
government decision makers to hold them accountable for their
actions, designing programs for others (not the group) to implement
that meet the needs of the community, and aggressive group action
to block negative developments or behaviors.
 Community organizing, method of engaging and empowering people
with the purpose of increasing the influence of groups historically
underrepresented in policies and decision making that affect their
lives.
 Community organizing is both a tactic to address specific problems
and issues and a longer-term engagement and empowerment
strategy. Longer-term objectives of community organizing are to
develop the internal capabilities and to increase the decision-making
power and influence of underrepresented groups.
 Community organizing is often a place-based activity, used in low-
income and minority neighborhoods. It is also used among common
interest-based “communities” of people, such as new immigrant
groups, who have limited participation and influence in decision
making that affects their lives.
 Organizing and mobilizing a community is oftentimes a cyclical
process that comprises assessment, research, action, and reflection.

 SOCIAL MOBILIZATION
 It is the process of bringing together all societal and personal
influences to raise awareness of and demand for health care, assist in
the delivery of resources and services, and cultivate sustainable
individual and community involvement.
 In order to employ social mobilization, members of institutions,
community partners and organizations, and others collaborate to
reach specific groups of people for intentional dialogue.
 Social mobilization aims to facilitate change through an
interdisciplinary approach.
 Social mobilization and the Sustainable Development Goals
 The Sustainable Development Goals were developed with input
from an unprecedented global conversation involving young
people, women, and people living with disabilities, civil society
leaders and activists. This open and inclusive process was
undertaken in part because of growing recognition that
ownership of Agenda 2030 by civil society is critical to its success.
 To shift our planet onto a sustainable development path this is to
“encourage and promote effective public, public-private and civil
society partnerships, building on the experience and resourcing
strategies of partnerships.”
 Social mobilization is an important means to advance sustainable
development policy by making it more responsive and
accountable to people’s needs and demands. Social movements
often emerge from a sense of shared grievance and injustice, and
“make visible alternative ideas and concepts about the forms
that society (and development) should take.” Influenced in part
by the spread of social media and new information technology,
civil society has gained momentum in advocating change on a
range of topics, from climate change to women’s empowerment,
from social justice to transparent governance.
 The potential to harness the growing power of social mobilization
for health promotion is tremendous, and much has been written
about the role of civil society to advance health and well-being.
Because health touches the lives of everyone, everywhere, and
since health inequities stem from and contribute to other
inequities, integrating health promotion into various efforts for
change can push the SDGs forward. The universal and indivisible
Agenda 2030 offers a powerful stimulus to form alliances across
constituencies that have traditionally worked in parallel, and to
expand the space for all people to participate in meaningful
decision-making.
  Organizing and mobilizing a community is oftentimes a cyclical
process that comprises assessment, research, action, and reflection.

4. CORE PRINCIPLES IN COMMUNITY ORGANIZING

 COMMUNITY ORGANIZING IS PEOPLE-CENTERED
 The basic premise of any community organizing endeavor is that
the people are the means and ends of development and
community empowerment is the process and the outcome.
 It is people centered in the sense that that the process of critical
inquiry is informed by and responds to the experiences and needs
of the marginalized sectors / people.
 The development is concerned with improving the quality of life in
the different dimensions of community – social, political,
environmental, cultural and spiritual.
 Community organizing is a people- centered strategy with
emphasis on the development of human resources necessitating
education.
 The educational processes are interactive empowering both the
learners which is the members of the community and the teacher
which is the nurse. Leading to decision making that plays a part in
human development.
 The people themselves serve as the instruments in their own
development.
 Community organizing is a process that promotes the
development of peoples autonomy and self-reliance leading to
people empowerment
 The organizer serves as a facilitator or mentor who guides the
community through the process.
 The people take the lead, make decisions for themselves and
participate in processes that affect their lives

 COMMUNITY ORGANIZING IS PARTICIPATIVE

  The participation of the community in the entire process of
assessment, planning, implementation and evaluation should be
ensured.
 The community is consider as the prime mover and determinant,
rather than beneficiaries and recipients of development efforts
including health care.
 The organizer must bear in mind that the community is an active
participant, learning more from what they do and experience
rather than from what is said to them.
 For people empowerment, community participation is a critical
condition for success.
 Community participation is evident in the involvement of many in
the community activities. The people are well informed about
community activities and are aware of their potential
contributions to the common good.
 Decision making and responsibility are in the hands of ordinary
people not just the elite. Distinctions is not among different
groups and different personalities.

 COMMUNITY ORGANIZING IS DEMOCRATIC

 Community organizing should empower the disadvantaged
population.
 It is a process that allows the majority of people to recognize and
critically analyze their difficulties and articulate their aspirations.
 The decisions must reflect the will of the whole more so the will of
the common people than that of the leaders and the elite.
 Conflicts are inevitable in group dynamics and they are to be
expected in organizing work
 The organizer and the community leaders require skills to
effectively process and manage their conflicts. Effort must be
exerted to achieve a consensus. This requires participative and
consultative approach.

 COMMUNITY ORGANIZING IS DEVELOPMENTAL

  Community organizing should be directed towards changing
current undesirable conditions
 The organizer desires changes for the betterment of the
community and believes that the community shares these
aspirations and that these changes can be achieved
 Community organizing affords empowerment of the marginalized
people
 The community gains insights, hones their capacities and develops
their confidence in themselves and in each other that will allow
them to take the lead in the holistic improvement of their
community
 Beyond health or economic improvement, it seeks authentic
human development.

 COMMUNITY ORGANIZING IS PROCESS-ORIENTED

 The community organizing goals of empowerment and
development are achieved through a process of change. The
organizers needs to diligently and patiently follow the community
organizing process to achieve its goals and allowing the
community to internalize and embrace the process requires time.
 Community organizing is dynamic. With the evolving community
situation, monitoring and periodic review of plans is necessary.
 The community may initially face barangay problems, resolution of
this problems through the effort of community members develops
confidence to identify and deal with other problems.
 This leads to sustenance of the community organizing efforts.

5. GOALS OF COMMUNITY ORGANIZING

 A core goal of community organizing is to generate durable power
for an organization representing the community, allowing it to
influence key decision- makers on a range of issues over time. In the
ideal, for example, this can get community organizing groups a place
at the table before important decisions are made.
 PEOPLES EMPOWERMENT
  Community organizing is aimed at achieving effective power of
the people. The people learn to overcome their powerlessness
and develop their capacity to maximize their control over the
situation and start to place the future in their own hands.
 It is their progressive realization of the power that they possess
and the ability to influence the course of history that dramatically
erodes the dehumanizing effects of powerlessness.

 BUILDING RELATIVELY PERMANENT STRUCTURES AND PEOPLES

ORGANIZATIONS
 Community organizing aims to establish and sustain relatively
permanent organizational structures that best serve the needs
and aspirations of the people
 This structure ensure peoples maximum participation at the same
time they provide the venue through which the people’s
organizations can link up with other groups and sectors.
 It is also an alternative ways of doing things can be tested and a
new system of values can be internalized, so that localized
experiences become the building blocks upon which the blueprint
of a more desirable future is based.

 IMPROVED QUALITY OF LIFE

 Community organizing seeks to secure short and long term
improvements in the quality life of the people
 The process of mobilization can gain concessions for fulfilling
basic needs for food, clothing, shelter, education and health.
 In the long term, it must create a conducive environment for the
development of human creativity and solidarity through
equitable distribution of power and resources.
 THE TEN RULES OF COMMUNITY ORGANIZING
1. Nobody's going to come to the meeting unless
they've got a reason to come to the meeting.
2. Nobody's going to come to a meeting unless they
know about it.
3. If an organization doesn't grow, it will die.
4. Anyone can be a leader.
5. The most important victory is the group itself.
6. Sometimes winning is losing.
7. Sometimes winning is winning.
8. If you're not fighting for what you want, you don't
want enough.
9. Celebrate!
10. Have fun!