Primary Health Care and Health Promotion

Unit-9: Community Development for Health

Mrs. Niza R.S Belvin

MPH and MBChB PRE-CLINICAL COORDINATOR
Dept of Public Health
Texila American University Zambia
Learning objectives:
• Foundations of Community Development
• A frame work for community and economic development
• Seven theories for seven community developers
• Bases of community development
• Process of community development and its Challenges
9.1 Theoretical foundations of community development
❖Community is defined as People who live within a geographically defined area and who have
social and psychological ties with each other and with the place where they live.
❖It is also defined as a grouping of people who live close to one another and are united by
common interests and mutual aid.
❖A combination of social units and systems which perform the major social functions and the
organization of social activities.
❖Development implies structural changes and improvements within community systems
encompassing both economic change and the functioning of institutions and organizations.
❖Growth focuses on the quantitative aspects of more jobs, facilities construction, and within the
context that is more better.
❖Community Development is an educational process that enable citizens to address problems
by group decision making.
Definition Community Development
❖Community Development is a planned effort to produce assets that increase the
capacity of residents to improve their quality of life.
❖It is also describe as a process to achieve improvement in some aspects of
community life such action thats leads to the strengthening of the community’s
pattern of human and institutional relationships outcome orientation.
❖Community development focus on the process of teaching people on how to
work together to solve common problems.
❖Community development may be defined in terms of actions, results, or
outcomes
Cont...
❖Community development as :
❖A process: developing and enhancing the ability to act collectively
❖An outcome: (1) taking collective action and (2) the result of that action for
improvement in a community in all realms thats is ;
❖ physical, environmental, cultural, social, political, economic, etc.

❖The process of community development starts with capacity building which

leads to social capital. This in turn leads to the outcome of community
development:
❖Capacity building community development process
❖Developing the ability to act as Social capital
❖The ability to act Community
Cont....
❖ The five forms of “Community Capital”
i. Human capital: labor supply, skills, capabilities and experience, etc.
ii. Physical capital: buildings, streets, infrastructure, etc.
iii. Financial capital: community financial institutions, micro loan funds, community
development banks, etc.
iv. Environmental capital: natural resources, weather, recreational opportunities, etc.
v. Social capital: is the extent to which members of a community can work together effectively
to develop and sustain strong relationships to;
▪ solve problems and make group decisions;
▪ collaborate effectively to plan,
▪ set goals, and get things done.
❖Social capital building or capacity building is an ongoing comprehensive effort to strengthen
the norms, supports, and problem-solving resources of the community.
9.1.0 Relationship between community development and economic development
❖Economic development is the process of creating wealth through the
mobilization of human, financial, capital, physical and natural resources to
generate marketable goods and services.
❖The relationship and activity between community development and economic
development includes:
Community Economic Development occurs when people in a community analyze the
economic conditions of the community,
determine its economic needs and unfulfilled opportunities,
decide what can be done to improve economic conditions in that community,
and then move to achieve agreed upon economic goals and objectives.
❖Development Economic development outcome includes;
✓Job creation ,Community improvement, Increase in income and wealth Increase in
standard of living Capacity building .
✓Economic development process Creating and maintaining the programs, Mobilizing
recourses
9.1.1 Community Development Theory
❖Community development theory is the most practical framework,used for seeking
lasting change for individuals and the communities and societies in which they live.
❖It focuses on the centrality of oppressed people in the process of overcoming
externally imposed social problems.
❖Thefore, following are the community development theory:
❖Empowerment Theory
✓Empowerment theory refers to the experience of personal growth and an
improvement in self-definition that occurs as a result of the development of
capabilities and proficiencies.
✓Another definition suggests that empowerment is a combination of personal
strengths, initiative, and natural helping systems to bring about change.
✓This theory can be applied to community development by empowering the people
within the community to develop their own community.it can also be adapt to other
disciplines like Sociology.
Cont...
❖Ecological Systems Theory
❖Ecological Systems Theory is a form of general systems theory in which
there is concren with the relations among "living entities" and
"between entities and other aspects of their enviroment."
❖This theory can be applied to community development by or through
the enviroment.
❖ because the Community worker has to check out the environment and it's
surroundings first in order to build sucessfully health program.
❖ The theory can adapt th other disicplines like Ecological psychology
Cont....
❖Communication Theory
❖Communication Theory examines how a person behaves in response
to information about himself and his environment.
❖when peolpe exchange information , they influence each other.
❖This theory can be applied to comunnity develpoment by the fact that
the Community worker has to communicate with the peolpe within the
community to gain an understanding of what the people need or want
to be developed.
❖This theory adapts not only to social work and communicaton but it
exists not only as a single entity but as a series of interrelated areas of
study.
Cont...
❖Positivism
❖It is the basis of sociology's claim to a scientific paradigm which measures human behavior in a
decontextualized way and with little concern for the more intangible intuitive, emotional or feeling
aspects of being human.
❖This theory has basis in dichotomous thought as well as bourgeouis philosophy which looks to empirical
science to be the true source of knowledge.
❖A community development situation exemplifying this theory to be where the organizer is looking at
the community not as individuals, but as objects needing to be dealed with as a part of the problem
solving.
❖There is no idea to how the community members may be feeling about the issue at hand and how they
may be affected by the potential changes.
❖If the issue is at the interpersonal level, the practitioner simply looks at the person, decides what they
need to solve their problem and does not discuss with them how they might or might not want that
change.
❖This can be adapted to be more intuitive to community concerns and desires by looking at scientific
research or surveys and considering how change based on that information may effect the people.
Cont...
• Naive Consciousness
❖A concept for partial empowerment which relates to the symptoms of oppression,
engaging with single issues rather than the underlying roots of injustice.
❖Naive consciousness can be seen in a community situation where the people are
dealing with an issue such as poverty, and in the process overlooking the root of the
problem and not resolving the issue where it starts.
❖i.e. A person is homeless, and the social worker works to take care of that aspect of their lives while ignoring
the issue of that person not having stable income or competitive job skills needed in order to more
permanently out of that homeless situation.
9.2 Determinants of health, public policy and community development
❖Social Determinants of Health represent non-medical factors that affect both the average and
distribution of health within populations.
❖These determinants include the distal political, legal, institutional, and cultural factors, and the
more proximate elements of socioeconomic status, physical environment, living and working
conditions, family and social network, lifestyle or behavior, and demographics.
❖Social determinants of health refer to access to power, money, and resources and the
conditions of daily life that affect health and well being for groups of people.
❖These conditions support or limit the health of a community or a population.
❖Health disparities or inequalities occur when there are differences in conditions where people
are born, live, work, and play across different groups
❖Public Policy encompasses the intentional actions or inactions by government to address a
problem affecting the public.e.g
❖Properly construed, laws and regulations could have positive impacts on population health.
9.2.1 WHY DEVELOP A SOCIAL DETERMINANTS OF HEALTH INITIATIVE IN COMMUNITY?
▪ Such initiatives use a participatory process that involves all sectors of the
community. Involvement by individuals, groups, and organizations from all
backgrounds and sectors of the community leads to community ownership.
▪ When affected groups are involved in the planning, implementation, and evaluation,
the effort can best meet the needs of the community.
▪ Aiming at social determinants gets at the root causes of inequity,such as income
inequality, underlie many different problems in health and development.
▪ A social determinants effort addresses social change through the development of
greater equity,
▪ This lead to longer life expectancy for everyone,peace and stability by lessening
resentment and strengthening social ties.
▪ It helps create community partnerships that can endure, and be directed to other
issues as well.
9.3 Community development strategies to improve health
❖There are 5 Strategies for Community Development
❖Food security :This could be agriculture related projects that help people produce food, store food, use food more
economically, or grow/produce marketable products.
❖These generate income that can be applied to purchasing food.
❖Food security could also be job skills training or small business startups to help increase overall individual and
family income.
❖Health care :We mainly use health care in the form of health care education, health extension work, and
development of local health care capacities.
❖A community development framework is utilized to gather and engage communities and individuals in topics and
issues of health care particular to their situation.e.g mother/child health classes, nutrition education, community
level first aid, or wellness/sickness recognition programs.
❖Water and sanitation :A common development-oriented project is helping people with clean water. This can be
done through the development of local sources such as gravity-fed spring systems, well drilling, rainwater
harvesting, etc.
❖However, water development projects can manifest themselves in other types of projects such as water for
agricultural use (irrigation/food production) or sanitation/hygiene needs (hand washing stations, water sealed
sanitary toilets, etc.).
Cont....
❖Education and literacy;For children and youth, education can include child
sponsorship projects, accrual of necessary materials for attending school (books,
supplies, uniforms, etc.), or even simple things such as healthy school lunches.
For adults, this is often seen in adult literacy and training programs.
❖Microenterprise/Microfinance :This is a growing strategy for many development
organizations, seen by some as the “silver bullet” to all the development issues of
a community.
9.4 Community mobilization
❖Community mobilization is a process that aims to engage all sectors of the
community to prompt individual, family and community action.
❖It uses a variety of community engagement approaches to raise awareness and
empower individuals and groups toward those actions, creating an enabling
environment and effecting positive change.
❖Community mobilization can include
✓activities such as door-to-door outreach,
✓ public meetings,
✓ health fairs,
participatory theatre and other activities.
❖Mobilization efforts are community driven, and community members are active
participants in defining the problem, generating solutions and evaluating the
outcomes of those solutions.
9.4.1 Important of Community Mobilization
▪ To increases the capacity of a community to identify and address its own needs
while generating local solutions to problems.
▪ Strengthens and enhances the ability of a community to work together towards a
common goal.
▪ It also contributes to the sustainability of any given action.
▪ Understanding how communities perceive and comprehend a problem
❖Working with localized community groups,
❖E.g. In Sierra Leone, during the Ebola response, emergency communication teams worked with the
Village Development Committee, Family Member Committees and many youth groups
9.5 Community advocacy and action for health
❖Advocacy is the act of “taking a position on an issue, and initiating actions in a deliberate attempt
to influence private and public policy choices.
❖The approaches of advocacy includes “Grassroots” or “bottom‐up” approaches are based on the
identification of needs and goals by community members themselves.
❖In contrast, top‐down models emphasise on the identification of needs or goals by experts outside
of the community or by the community leaders.
❖ These advocates may be professional staff of non‐profit organisations, such as national or international professional health
organisations.

❖Organising the successfull advocacy both bottom‐up or top‐down approach can be used depends
on the situation.
❖Successful advocacy campaigns are modeled around the following 5 characteristics :
✓ A final goal.
✓ An intended target of the advocacy.
✓ A core team of supporters and influencers.
✓ A well-defined message.
✓ A specific timeline for implementation.
9.5.1 Examples of Advacocy activities
❖ Targeted Messages— Targeted messages encourage your supporters to send messages to policymakers through the webforms on your site.
You can target individual legislators or simultaneously target multiple legislators at the same time. This allows all your supporters to take the
same action with a consistent theme and message.
❖ Online Petitions — A petition is a special type of advocacy that includes a statement or belief on a topic or issue and a form where your
supporters express their agreement. When the form is filled, you get the signer’s contact information so that you can market opportunities to
them later.
❖ Social Advocacy — This involves using social media to spread awareness for your advocacy campaign through text, links, videos, graphics, GIFs,
and more.
❖ Click to Call — This is a tool on your website or advocacy campaign pages that supporters click to automatically connect with their elected
representatives. You provide a script and actions you want the supporter to take, and they can follow those directions when on the phone with
their legislator.
❖ Legislator Lookups — This tool enables supporters to type in their addresses. Then, they’re given contact information for the elected officials
who represent their districts. This is the first step in helping supporters select the right advocacy target before they send the messages you
want them to send.
❖ Action Alerts — These are emails that get sent to your supporters with important updates. The intention here is to inspire them to take a
specific action.
❖ Event Registration — Creating events in support of your advocacy efforts is a great way to bring new supporters into the fold and to educate
them on the actions you want them to take for your advocacy campaign. This can be training, in-person or online events, conference calls or
webinars, and so on.
❖ Online Fundraising — Use fundraising forms on your website where supporters and advocates can donate to the cause, directly furthering
your advocacy efforts.
❖ Texting — Use text messaging, SMS, and MMS to get the word out, send links to supporters, and even fundraise via special shortcodes and
online forms.
❖ Facebook Lead Ads — This is a special type of ad used in Facebook feeds that, when clicked on, allows visitors to submit their information. The
information is then downloadable or synced to your CRM automatically.
9.5.4 Step for advocacy campaign
• Step 1. Set a Goal.
• You can’t succeed unless you define what success means to your advocacy campaign. To create an achievable and
aspirational objective, you’ll want to follow the renowned SMART framework.
• Step 2. Identify the Target.
• Before you can affect change, you need to identify the people who are in a position to make that change. The target of
your advocacy campaign will be the person or people who are most likely able to bring about the change defined in your
campaign goal.
• Step 3. Build Your Team.
• Your advocacy campaign team is going to be composed of the people who will have the most influence on your intended
target. They’re also going to help you create the messaging that will spur the most supporters to action.
• Each advocacy campaign team should have the following team members:
• Campaign Admin :This is someone who is responsible for making sure the rest of the team is performing their duties on
schedule and who can serve as the main point of contact for questions.
• Campaign Marketer : This individual creates the messaging with input from other team members. They might also
create graphics, videos, place ads, and website pages. They’ll also likely work with the advocacy software.
• Volunteer Coordinator : This person interacts with the campaign supporters and volunteers, helps train them on the
actions they need to perform, makes sure they understand the campaign messaging, and encourages them to share the
campaign messaging with friends and family.
Cont...
• Step 4. Define Your Message.
• Once your advocacy campaign team is in place, you can begin working on the messages that will be
used to engage your supporters and ultimately reach the campaign target.
• This is the time to be a storyteller. Go beyond just the facts and work in a dramatic narrative to engage
as many people as possible.
• The more your audience can relate to your message the more likely they are to take action.
• A complete campaign message has two parts a defined problem and a proposed solution.
• Step 5. Map Out A Timeline.
• Like your SMART goals, your overall advocacy campaign will also have its own timeline during which you
expect it to reach completion.
• You also need to be mindful of the time it takes your team to create the required messaging to move
people to action. You can’t launch and complete your advocacy campaign in 30 days if it’s going to take
90 days to create the video that explains how your campaign works.
• Bring together details from all of the previous planning steps and discuss with your team the most
appropriate timeline. Leave room for changes, edits, discussions, and questions from supporters.
9.6 Using participatory theatre and performative art to advocate and promote health
❖The use of various creative art forms in the research process is reflective towards
interpretative practices.
❖Theatre has the capacity to convey meanings that pertain to the flow of social
relationships.
❖ The arts create a more highly skilled workforce:
❖A broader arts education, through school or the community, can foster critical
thinking, social skills and motivation to learn so students are better equipped to
enter the workforce.
❖A more highly skilled workforce is consistently associated with improved economic
outcomes.
❖Using theatre as a way of reinforcing Behavior Change Communication (BCC)
messages that are currently being delivered by field personnel to ensure that
agriculture delivers positive nutrition and health outcomes.
Cont...
❖Advocating through the media
❖Media advocacy, one of the most common advocacy strategies used to advocate on health
related issues.
❖It requires the identification of issues and concerns related to the community wellbeing, an
emphasis on the broader context of those concerns,
❖ the maintenance of media attention to those concerns, and the provision of
“entertainment” to the audience hearing of those concerns.
❖ Examples of successful media advocacy used the media to raise public awareness
regarding the lack of access to adequate care for HIV infected people in that country,
❖Each of these media campaign undertaken increase public awareness, to enlist public
sentiment to support a desired change, and to pressure the target of the campaign to
modify its actions in a certain direction.
❖The issues that provide the focus of the media advocacy must be appropriately framed
using sound bites, which are brief, quotable statements; visual images; and social math.
Cont....
▪ Using the courts
▪ The courts system provides another avenue for advocacy efforts.
▪ Legislative and regulatory advocacy
▪ Regulatory and legislative advocacy are strategies that are often used by
organisations seeking to have their voices heard.
▪ Using coalitions
▪ Coalition may play a critical role to the success of the advocacy,Coalitions are
groups of groups with a shared goal and awareness such as ‘united we stand,
divided we fall.
Conclusion
❖It is also defined as a grouping of people who live close to one another and are
united by common interests and mutual aid.
❖Community development may be defined in terms of actions, results, or
outcomes,also as local decision making and program development resulting in a
better place to live and work
❖Community development can also be defined as a process i.e developing and
enhancing the ability to act collectively, and An outcome as taking collective
action and the result of that action for improvement in a community in all realms
thats is physical, environmental, cultural, social, political, economic, etc.
❖Community Health workers go above and beyond in their craft, performing the
duties of a half dozen different healthcare workers.
THANK YOU