Community Involvement and Participation

Community Involvement and Participation

Terms
     Community: A specific group of people, often living in a defined geographical area, who share a common culture, values and norms, and are arranged in a social structure according to relationships which the group has developed over a period of time.

       Community involvement: The process by which members of the community, either individually or collectively and with varying degrees of commitment, develop the capability to assume great responsibility for assessing the health needs and problems, plan and then act
to implement their solutions, create and maintain organisations in support of these efforts and evaluate the effects and bring about necessary adjustment in goals and programmes on an on-
going basis.

          Involvement is the beginning point of participation.
          For example, involvement means drawing a person, a community or a group of people in to raise awareness about an issue.
          By becoming involved in the issue, people begin to participate in different ways
     Community participation: A process of involving people with similar needs and goals in decisions affecting their lives.
    Participation is basic to community empowerment; it describes the involvement of individual community members in small groups and in larger organizations.

>The term community participation is often applied to programmes where self help labour is used.

Participatory approach: When community involvement and participation are encouraged from the beginning and throughout the life of the project or research.

         Consult with as many people as they can in the community recognizing and bringing the leaders, structures, committees, decision making processes, resources, experience and knowledge that already exist in the process.

         Consultation should begin early and be ongoing.
         Involve the community in making decisions that affect them.

Note: In some cases community participation and community involvement are used interchangeably.

Benefits and Challenges/Barriers of Community Participation

Benefits of Community Participation
       >Achievement of better results because the services are adapted to the local health needs and circumstances
       >Communities make important contributions to the whole process thus, reduced costs of operation
      >Ensures sustainability of the intervention
      > Increases community responsibility and accountability
      >Improves relationship between health care providers and community
      > Enhances community acceptance and ownership of health intervention
      >Builds community capacity
      >Motivates community participation and vice versa, community involvement is motivational
      >Increases resource utilization
      > Attracts support from other stakeholders
      >Allows for re-planning
      >Easier to achieve goals and objectives because of common vision and unity

Challenges/Barriers of Community Participation
    √  Inadequate information, skills and training
   √Weak networks, poor coordination and lack of consistency (e.g. in messages)
  √ Cultural and traditional barriers
  √ Lack of understanding the community and environment
  √Lack of appropriate representation by community groups
√Competition and duplication of efforts
√ Poor governance

Community Involvement/Participatory Strategies, Process and Sustainability
Community Involvement/Participatory
Strategies
           • Participatory baseline surveys
           • Participatory planning
           • Holding community meetings and giving feedback through regular reviews
           • Forming community committees and/or organising community groups
           • Networking with other stakeholders
           • Raising community awareness (advocacy)
           • Educating the community
           • Gaining commitment from nongovernmental organizations (NGO) forums if available at the community
          • Local resource mobilisation
          • Identifying entry points (e.g. gate keepers, influential community leaders)
The process of Community Participation/Involvement
   In the process of doing community participation the following are key steps involved
            o Community entry process
            o Problems identification
            o Problems analysis
            o Problems prioritization
            o Plan for interventions
            o Implementation and
            o Evaluation

Community Entry Process
      Before the community entry process, it is essential that a community assessment is done
     Community entry process involves establishing rapport and build trust and confidence
    The importance of establishing rapport is to create and establish good relationship
    Creating rapport
       o Understand greeting style of the community
       o Know how community members mix and relate in social events
       o Study gender issues
       o Know how the community handles conflicts

Building trust and confidence
        The following is the method of building trust and confidence with community members.
    o Start with the positive attitude towards what people already know and practice
    o Show empathy and concern as appropriate
    o Develop relationship (know the people and appreciate their way of life)
    o Observe and listen to their problems
    o Be consistent with promises and visits
    o Help the people in their efforts to solve existing problems
    o Create awareness and dialogue on their existing problems
    o Be a good role model
It is important to observe this process when entering the community
       o Introduce your ideas to the leaders and ask for their permission to enter the community (do not be arrogant)
       o Identify influential people
       o Identify yourself with the community
       o Take time to learn the community, use acceptable and understandable languages
        o Work with the whole community
Problems Identification
       Problem identification is an initial stage in the process of solving community health problems.
       • There are different approaches of identifying the problems.
        • In one case professionals/healthcare workers may identify the problems for the community.
        This way of identifying the health problem denies the community the right of participating in problem solving process.
          • An ideal way of identifying health problem is by involving community members. This can be simply termed as participatory problem identification.
           • There are different methodologies for participatory identification of health problems.
           • A good methodology for this purpose should encourage active dialogues and joint decision.
            The following methodologies may be used

     o Convening a community meeting and have a dialogue/discussion which will end up with identification of health and health related problems
     o Doing a participatory survey. In this survey, health care provider should let the
community voice be heard (having a say). This process should end up with identification of health and health related problems.
     o During this process a health care provider should only be a facilitator of the process. All decisions should be in the hands of the community.

Problems Analysis
     At this stage the community members should be fully involved in discussing each problem in order to establish causes of it.
   The causes of health problems include behaviors, environmental and social aspects. In the problem analysis various causes are discussed.

The analysis may involve
       o Investigating the attitudes, behaviors and knowledge of health problems in a community.
       o Collecting data that might be used to propose theories or hypotheses about the nature and
causes of illness, as well as utilization rates for services.
       o To establish the attitudes, opinions or beliefs of people concerning health related issues.
       o The data collection techniques often include questionnaires, interviews and focus group
discussions.
      behaviors related to the problem.
      o Identify the predisposing/reinforcing factors to the behaviors.
      o Identify the short and long term consequences of the behaviors.
      o Describe the cultural practices and values.
   Prioritization
         A process of ranking the health problems/needs in a given community according to relevancy, urgency of required solution, political acceptability, feasibility of intervention, ethical acceptability, and if there is no duplication of efforts.
     After identification of health and health related problems, next step is prioritization of those problems.
       Problems are prioritized because there are not enough resources (finance, materials, time and human) for addressing all problems in a time.
        In doing prioritization defined criteria are used like, magnitude, severity, urgency of required solution, vulnerability, cost of intervention and political acceptability.
     o Magnitude in terms of the proportion affected such as women, school children, pre-school children and the elderly. This basically describes how big the problem is.
      o Severity to the individual and the community. How serious is the condition. Does it threaten life, cause major suffering, and decrease the ability to read a normal life, or reduce productivity.
       o Vulnerability to intervention (feasibility) if a problem is not vulnerable to the intervention, then it makes no sense to include in the list of those targeted for action.
      o Cost of intervention is expressed in terms of cost effectiveness. This criterion should answer the question whether the problem, if addressed, is worth the financial costs involved.

    o Political acceptability even if the problem fulfills all of the above criteria, if it is not recognized/accepted by the central authority, it is very difficult to include it among the high priority list.

Prioritization of Community Problems and Needs.
Plan for Interventions
      How to get from your starting point to your end point and what you want to achieve, it entails
     o An assessment of need
     o Setting aims/goals, what the target group intend to achieve
     o Setting objectives and precise outcomes. Objectives should specific, measurable, achievable, realistic, time bound
      o Deciding which methods or strategies will achieve your objectives
      o Develop a work plan
      o Develop monitoring and evaluation plan

Implementation
   Is a process of interpreting a plan into active actions.
    Entails performance of intervention in form of a number of related activities (main and sub activities).

Evaluation
  Evaluation is a systematic assessment of action in order improves implementation of current and future activities.
Evaluation is done to:
     o Decide whether an activity is worth doing
     o Determine whether the objectives set were achieved ether activities should be continued or not
      o Determine whether activities should be continued.
   Note: In all steps records should be kept by both health care providers and community leadership

Summary of the Community Participation/Involvement Process
1.Community entry process
2.Evaluating together Problem Identification,
3.Analysis and setting priorities
together
4.Community action Planning for intervention
(Implementation) together

Strategies for Sustainability of Programmes
• > Information sharing/reports
• >Establishment of strong networks
• > Regular reviews and feedbacks
• >Joint plans
• >Make use of locally available resources
• > Ensure close and participatory monitoring process
• >Accountability and transparency of implementers to beneficiaries, e.g. village government.
• >Involve the community from the beginning
• >Be honest and realistic with the community about what may be achieved

Report Writing
• >Important aspects/requirement to reflect progress, performance and resource use.
• >In this context all the activities, resources and results involved in community participation
need to be documented.

The following is a format that can be used in writing a report:
> Report title
> Name of the authority/or memo of transmittal (which will include the recipient and sending authority)
> Table of contents
>Procedure/Methodology
>Findings
> Conclusion/recommendations
>Appendices/annexes

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