Connecting local responses around the world
I need your help:
October 21-23 I'll participate in a Conference in Dakar which will take stock of the the Harare declaration, 25 years after its publication gave impetus to the health district.
Please visit this blog and bring your contribution to the debate!
J'ai besoin de votre aide!
Du 21 au 23 octobre, je me rendrai à Dakar pour participer à la Conference sur la décentralisation des soins de santé, 25 ans après la déclaration de Harare qui établit les districts sanitaires.
Svp, rendez-visite à ce blog, et apportez votre contribution!
Response from Chris Burman, South Africa (via email)
I’m not sure how useful my comments will be. However, I have gone through the blog quickly and I tend to agree with the general thrust of it. My observations from a small area of South Africa are:
1. There is a mixed perception of health in our rural places;
2. Very little idea about chronic illness;
3. Traditional values [witchcraft / trad healers very important / significant to health decision making];
4. Medical services operative in silos from the community context;
5. Medics tend to view themselves as being aloof to non-professionals / lay-people;
6. People are dependent on medical expertise [there is no genuine relationship between community / health care services, except with few unique NGOs];
7. There is no real dialogue between people and government health services;
8. The community in generally not trusted to manage its own health [even though they are managing it in ways that make sense to them, given the constraints they live with];
Which makes the situation very complicated. My bias is towards a form of community empowerment that provides them the options to be active managers of their own health [which is why I like the approach of the Competence group].
I would lobby Jean Louis to throw a challenge out to the international community to identify a few case study sites and actually go for an international action research project that focuses on bringing people into the picture as health care providers rather than being the ‘problem’.
You never know – a simple challenge like that might work and it could be a nice way to begin to undo the preference towards a technical, elitist style of health care management?? I could find you a few sites to consider in South Africa if it is of interest.
Thank you vey much Jean for always being there to support our (talking as African who benefited from your initiative) communities to tackle the challenges of their concerns in all levels (included this international politics).
Having gone through the blog and comment from Rituu I feel that is an opportunity for us to launch a proposal to the world of experts to go for a more Human Rights Based Approach (like the Community Competence) that considers at first participative planning. Let us understand participation in all levels: 1) identifying the concern - communities must understand what affect their health and demonstrate will to act towards a change, including if needed to be them requesting experts collaboration instead of imposing agendas on basis of big and un-understandable studies; 2) plan and act - within their internal resource they plan and implement responses. It is our communities who must decide on external experts intervention in responding to their health concerns and not the inverse; and 3) evaluate and celebrate - communities are the beneficiaries of the response to their own concerns. Evaluating health programmes in communities must at first plan be the concern of communities, monitoring and evaluation mechanisms and tools must capture from the will of communities and not experts. Experts have to learn to go to communities hands free (of tools) and collect from experience of how communities celebrate success and failure of their programs.
There are several advantages in moving towards a such inclusive and owned approach. In Africa rural communities, the scarcity of resources (human, materials, etc.) is most evident. Even if there was an acceptance from communities in adhering to the health programs promoted by the so-called experts, there would not be enough capacity. In many rural communities of Mozambique people have to walk more that 40km to access a very basic health post (where there is only a nurse who can only provide very basic primary care, including giving a birth). This calls to the need of using local available resources without looking them from top to down, but working together in the benefit of already set life systems of communities. Handicap International in Mozambique has an experience of working with communities in understanding their concerns with Orphans and Other Vulnerable Children which resulted in extending the hand of the state in rural settings to the very remote areas in Monitoring and responding to challenges raised in and by communities.
Is it said everywhere that Prevention should be the priority, however the type of response developed and provided by experts is administrative and expensive. We totally left aside the aspect of behaviour change as the most important step for prevention and prioritized expensive materials (such as condoms, vaccines, pills, among others). As an example, less than 20% of resources planned to the response to AIDS in Mozambique were effectively managed by community organizations, including Faith Based Organizations. Behaviour change is only possible when communities identify it from within them and not as a recommendation from an outsider who knows nothing about the community structural organization and functions.
Many thanks Chris and Joao! Here is my presentation for tomorrow. I'll keep you posted on the proceedings/ More inputs are welcome!