[Date Prev][Date Next][Thread Prev][Thread Next][Date Index][Thread Index]
AFRO-NETS> The Drum Beat - 42 - Approaches and Tools for CHANGE
The Drum Beat - 42 - Approaches and Tools for CHANGE
----------------------------------------------------
The CHANGE Project - Approaches and Tools for CHANGE
The email and web network from THE COMMUNICATION INITIATIVE partner-
ship - The Rockefeller Foundation, UNICEF, USAID, CHANGE, WHO, BBC
World Service, CIDA, Johns Hopkins University Center for Communica-
tion Programs, The European Union, Soul City, The Panos Institute,
UNAIDS. Information, ideas, linkages and dialogue on communication,
development and change.
Web Site: http://www.comminit.com
Director: Warren Feek
mailto:[email protected]
The CHANGE Project is seeking to identify the major behavioural is-
sues and develop and test solutions to crucial challenges in the ar-
eas of child health, maternal health and nutrition. CHANGE has com-
piled into a matrix of brief descriptions of new approaches and tools
addressing gaps in the current array of methods for positive, health-
related changes at the individual, household, community, institu-
tional and policy levels. Some of those identified are highlighted
below. CHANGE is seeking to expand the range of approaches and tools
for possible inclusion in this matrix. Your suggestions would be most
helpful.
Please send to Mike Favin
mailto:[email protected]
KINDS OF TOOLS
a. Innovative new approaches to changing health behaviour
b. New methodological tools [such as research instruments]
c. Approaches and tools that need further development and then test-
ing
d. Approaches and tools implemented with apparent success but that
need to be evaluated
EXAMPLES OF APPROACHES AND TOOLS BEING CONSIDERED
1. Community input on community health
Introduction: Changing the paradigm of the health facility from a
technical service to a health/social resource that is shared by the
MOH (or other provider) and the community.
Example: MotherCare in Cochambamba tried to mesh medical and commu-
nity perceptions of quality pregnancy, delivery, and postpartum care.
The project and its local partners undertook a major training / sen-
sitizing exercise for teams of providers; made a number of physical
modifications in services (e.g., drapes for privacy, new hospital
wear for mothers and providers); and implemented a major communica-
tion activities to try to reduce the gap in perceptions.
2. "Champion communities"
Introduction: "Champion communities" are those that have had success-
ful experiences in participating in a health/development project and
have learned to implement and maintain collective actions and suppor-
tive environments for behavior change. These communities participate
in exchange programs with other communities, either acting as hosts
to visiting members of other communities, or sending delegations /
representatives to other areas to explain how their community suc-
ceeded.
Example: Africare and the UNDP have developed a detailed project pro-
posal describing the transformation of the district of Dioro, Mali,
home of the successful DIORO Approach used by its Child Survival Pro-
ject, into the "Ripple (Replicating Innovative Practices, Programs
and Leadership Experiences) Center". Also used in Vietnam.
3. Community radio and program archives
Introduction: Community radio is used for health development. In many
settings illiteracy is high so radio is the only affordable medium
that can reach large numbers of the population. Community radio is
characterized by good access, public participation in production and
decision making, and by listener financing.
Example: Radio Douentza is a community radio station that serves the
community of the Douentza area in Northern Mali, a semi-arid region
of subsistence agriculture - most of the population are farmers or
herders. This radio station addresses many issues, including health.
4. Building community self-efficacy
Introduction: Facilitates community planning and implementing of com-
munity health actions, such as a health fair, in order to learn plan-
ning and management skills as well as gain self-confidence. Process
and product-oriented. Involves a variety of community members (indi-
viduals and groups), NGO's, government agencies and donors in step-
by-step preparations for something that the community has agreed is
worthwhile.
Example: The Dioro Child Survival Project in Mali has a large commu-
nity health fair that integrates change communication into all enter-
tainment - theater, demonstrations, speeches, group discussions, con-
test, games, dances, songs, video showings, parades, exhibit rooms,
information diffusion kiosks and health volunteer awards ceremonies.
Health services are alos available - vaccinations, growth monitoring,
prenatal care consultations, counseling services for family planning,
HIV/AIDS, and other interventions.
5. Counselling as negotiation
Introduction: Interaction between health worker and mother (or other
patient) is still typically a one-way conversation, with the provider
transmitting information and the mother listening and maybe giving
brief answers to one or two questions. Training and job aids are of-
ten part of the solution as well. Improving this interaction requires
system changes that encourage and reward real conversation. The best
counselling cards are designed so that the health worker can tailor
the information provided to the specific needs of the client. The
best counselling cards also facilitate negotiation, serving as a
guide to a conversation.
Example: Counselling cards (or flip charts) are job aids for facility
or community-based health workers to ensure that priority, essential
information is covered. Usually, the cards have photos or drawings on
one side, for the mother or caretaker to see, and words, phrases or
sentences on the other for the health worker to see. Now exploring a
process in which there are more equal relationships such as side-by-
side cards for more equal power between health worker and client.
6. Cultural reminders
Introduction: Reminders may be for individuals, families and or for
communities. These may be (and usually are) a sheet of paper or some
other material, but they may also be reminder visits, phone calls, e-
mails, or, for example giving the husband or mother-in-law responsi-
bility for reminding the mother to do something such as take her iron
tablet daily.
Example: In the Weaning Project in Indonesia (beginning in 1986)
mothers received a large sheet of paper with feeding recommendations,
expressed graphically, for each month of the child's first two years
of life. Some reminder materials are produced in the form of pre-
scription pads. They are used for counselling during a clinic or home
visit (sometimes with a counsellor marking the advice relevant to the
particular mother), and then the mothers takes home the sheet to help
her remember the advice.
7. Cyber-Baobab: Telecommunication tools
Introduction: Provide cellular phones and other telecommunications
technology in rural and urban areas that have no or limited phone ac-
cess. Phones would be provided as an income-generating activity ei-
ther through a health institution or an individual entrepreneur. The
phones serve as public pay phones, allowing all people in the commu-
nity to call out and receive calls for a small price. The cell-phones
could be used for various health-related activities, such as emer-
gency-transport systems.
Example: The Grameen Bank in Bangladesh has a goal of putting at
least one cellular telephone in every one of Bangladesh's 65,000 vil-
lages by the year 2003 to improve the lives of people living in poor
communities with no telephone service. People pay to send and receive
messages at these small public telephones. Grameen's pilot program in
150 villages confirmed that the village phone concept is economically
viable.
8. Networking Marketing
Introduction: Applying the "tupperware approach" to disseminating ba-
sic health consumables and information for their appropriate use in
low and middle-income countries. The basic idea is that individuals
market a small number of health products to their neighbours and sup-
port their neighbours' appropriate use of those products. Those prod-
ucts could be slightly more attractive that those available at gov-
ernment facilities [e.g., flavoured ORS, coated vitamins].
Example: The concept derives from the experience of companies such as
Tupperware, Amway, Mary Kay and Avon, which use typical community
members to sell good quality products to neighbours, with instruction
on how to use them.
9. First Households (Hearth Model)
Introduction: The Hearth Model is a community-based, "positive devi-
ant" approach to reducing malnutrition. Identifies "positive deviant"
mothers whom, while typically poor, are atypically feeding, caring
for, and appropriately seeking health care for their children in bet-
ter ways than the majority of mothers. The program links these moth-
ers to mothers of poorly nourished children. The model mothers
(and/or minimally compensated program workers) might go to the homes
of malnourished children and jointly prepare meals with their moth-
ers. Over time, the children's mothers thus gain knowledge, skills,
and confidence that, without spending a lot of money, they can pre-
pare nutritious meals that will make their child visibly healthier.
Example: Save the Children's programme in Vietnam reduced second and
third degree malnutrition by 80 percent among tens of thousands of
children under three years of age. Caretakers were able to sustain
the enhanced nutritional status of these children as long as two
years beyond their participation in the program. Younger siblings in
the community, born after the program ended, enjoyed the same enhance
nutritional status.
10. YOUR SUGGESTIONS
Please mailto:[email protected] and briefly describe tools and
approaches that you would recommend using the format below:
[i] Brief description:
[ii] Origins and field experience
[iii] Contact person and e-mail
--
Please send items for The Drum Beat to:
The Editor
Deborah Heimann
mailto:[email protected]
--
Send mail for the `AFRO-NETS' conference to `[email protected]'.
Mail administrative requests to `[email protected]'.
For additional assistance, send mail to: `[email protected]'.