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Working with communities to

improve health
Liliane Luwaga

Introduction
What is a community?
A group of people that may or may not be
spatially connected, but who share common
interests, concerns or identities.
Communities may be local, national or
international or even global in nature and may
have either specific or broad interests
(Laverack, 2007)

Community participation
A process that increases a communitys
capacity to identify and solve problems. Such
participation can lead to equitable and
sustainable improvements in health.
Active involvement in planning,
implementation, monitoring, evaluation and
decision making on matters related to their
health and development

Community participation
Change from Top down planning approaches
expert makes the decisions (indoctrination the
process of telling people what to do)
Community participation: Bottom up approach
members of the community make the decisions
Self help programs e.g. Community contributing
labour
Calling people for a community meeting does not
mean that community participation has taken
place!

Elements of Community Participation


The Community Possesses:
Health Knowledgebasic technical information
on causes, prevention, and treatment of health
problems.
Planning and Management Skillsanalysis of
assets and problems, understanding views of
different community groups, gender analysis,
problem solving, action planning, coordination,
evaluation, information access, and resource
mobilization.

Facilitative Leadership and Communication


Skillsresponsive leadership, representation
of diverse interests, equitable approaches to
including disenfranchised groups, group
facilitation, conflict resolution, and
participatory learning methods.
A Commitment to Collaborationadvocacy,
negotiation, partnership cultivation, and
journalist/media relations.

Health Workers Possess:


Health Knowledgecredibility as a provider
of advice and service.
Knowledge of the Community
understanding community perspectives on
health, and identification of community
resources and strengths; and respecting
community members regardless of wealth
and/or education.

Planning, Communication, and Collaboration


Skillsdialogue facilitation, participatory
analysis and planning, mutual respect and
learning, cultural competence, consensusbuilding, problem solving, advocacy, and crosssector collaboration.
Facilitation and Mentoring Skillsworking in
partnership, acting as a catalyst by stimulating
analysis of assumptions held in the community.

Desired outcomes

Responsibility sharing
A sense of ownership
Self reliance
Acquisition of skills and competences
Efficiency and effectiveness in implementation
Equitable distribution of resources

Levels of Community Participation


Participation in use of services provided
Community involvement in a pre planned
programme
Community involvement based on local needs
assessment and decision of community
Community empowerment to increase control
over events that determine their lives

Constraints to CP
Inappropriate attitudes and beliefs
Focus of training institutions on curative
services with little emphasis on preventive
and promotive services
Inadequate communication and feedback
between health structures and communities

Steps to facilitate CP

Baseline survey
Awareness creation
Training
Facilitate the community to start own
initiative
Monitoring
Evaluation
Re-planning

Overlapping Concepts
Community Participation- actively and genuinely
involved in the process e.g. defining issues of
concern to them, making decisions, planning, etc
Community Involvement being included as a
necessary part of something
Community empowerment control, (gain
confidence, self esteem, understanding and
power necessary to articulate their concerns,
ensue that action is taken to address them)

Thank you