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Levels of community involvement


Prof. Brieger differentiates between five levels of community involvement in (health) programs:

(1) Acceptance: Acceptance merely means passive cooperation, such as the use of health services provided by an outside agency. This level of involvement includes no active participation on the side of community members (e.g. putting up a mosquito net offered for free by an NGO).

(2) Mobilization: At the mobilization stage, the program is still run from the outside, but valuable input and ideas are provided by community members (e.g. obstacles with mosquito net use are actively discussed with the outside agency).

(3) Participation: Participation implies, that community members carry out parts of the program themselves and voluntarily contribute to it (e.g. community members with authority make the public case for mosquito net usage and see that nets are distributed within the community).

(4) Involvement/planing: At this stage, the program is not longer run completely from the outside. Community members plan and evaluate measures themselves, the community is given a high level of autonomy (e.g. a community health center is up that actively promotes distributes mosquito nets and has people regularly going from door to door to see if the nets are actually being used).

(5) Control/ownership: At this stage, the program is not longer run from the outside but is in total control of the community. Community members decide not only on the goals, which they are trying to reach, but also on the methods by which these goals should be accomplished. Outside agencies at this point only provided needed resources and outside contacts (e.g. a mosquito net program that is completely run within the community, whith local businesses buying and selling the nets with some help by outside agencies and local health centers advocating and controlling net usage).

When success and failure of a program are not seen as the success and failure of the outside NGO or agency by the community, but as success and failure of the community itself, an optimal level of involvement has been reached. Reaching that goal requires outside agencies to give up control over the program and accept local decisions, even if they are based on beliefs and customs that might not be shared by the respective agency.

These lecture notes were taken during 2012 installment of the MOOC “Community Change in Public Health” taught by Prof. Dr. William R. Brieger of the Johns Hopkins Bloomberg School of Public Health at Coursera.org. Prof. Brieger blogs under www.malariamatters.org and can be found on twitter as @bbbrieger.

Community participation


Community participation in health projects increases community efficacy and usually leads to not only a better use of local resources but also to a higher acceptance of health measures by the local community members. Participation is – in this context – defined as the active involvement of community members in decision making processes as well as in the implementation of solutions. Higher levels of participation benefit the health of the community in various ways: people are more involved in spreading and implementing health solutions, local resources are put to better use, local needs are considered more aptly (no “one size fits all” solutions) and decisions are generally better accepted.

It is important to note, that even good ideas and valuable programs might not be accepted by a community if they are seen by people as being forced upon the community from outside NGOs or government officials. The better strategy often is to educate community health workers and then turn most of the outreach, implementation and evaluation over to them. This principle has been proven true in many primary health projects over more than three decades, ranging from water filtering (for preventing guinea worm desease) to well construction, child inoculation and use of contraception. An effective community health program can, however, still start out as a typical social policy planing effort (being initiated from the outside) and then be slowly turned over to more and more local control.

These lecture notes were taken during 2012 installment of the MOOC “Community Change in Public Health” taught by Prof. Dr. William R. Brieger of the Johns Hopkins Bloomberg School of Public Health at Coursera.org. Prof. Brieger blogs under www.malariamatters.org and can be found on twitter as @bbbrieger.
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