Community Participatory Approaches Research Articles

Progressive Patronage? Municipalities, NGOs, CBOs and the Limits to Slum Dwellers’ Empowerment

ABSTRACTEfforts aimed at urban poverty reduction and service delivery improvement depend critically on slum dwellers’ collective agency. Adding to a long history of community participation approaches, there is a now growing incidence of so‐called ‘partnerships’ between municipal agencies, non‐governmental organizations (NGOs) and slum organizations. Such approaches require a fair representation of a majority of the poor by local community‐based organizations (CBOs), the potential and interest of both poor men and women to organize pro‐actively in collective action, and a CBO leadership that works for the common good. This article puts some key assumptions underlying grassroots‐based strategies under scrutiny. That relations amongst the urban poor are unequal and that they are divided in terms of income, gender and ethnicity has been well documented, but there has been less attention for the fact that the poor, facing conditions of scarcity and competition, rely on vertical relations of patronage and brokerage which may hinder or prevent horizontal mobilization. Rather than being vehicles of empowerment and change, CBOs and their leadership often block progress, controlling or capturing benefits aimed at the poor and misusing them for private (political) interests. Presenting evidence from community‐based projects in the slums of three large Indian cities, the article argues that municipal agencies, donors and NGOs cannot easily escape the logic of patronage and often themselves become part of a system of vertical dependency relations.

Combining community participatory research with a randomized clinical trial: The protecting the hood against tobacco (PHAT) smoking cessation study

This article describes the process and results of a smoking cessation intervention randomized clinical trial (RCT) that was conducted as a community-based participatory research project. This RCT tested whether outcomes are improved by adding social justice and tobacco industry targeting messages to a smoking cessation program conducted among African American adults within a low-income community in San Francisco, California. This study provides lessons for future similar research projects that focus on urban low-income populations. Participants were randomly allocated to receive a smoking-cessation program (control group [CG]) or CG care plus tobacco industry and media (IAM) messages. Primary interventions were behavioral. At intake, participants reporting severe withdrawal or smoking > or = 25 cigarettes daily were offered free nicotine replacement therapy. Baseline data were from an in-person interview. Outcome measures included self-reported smoking status; validation of quitting was by salivary cotinine assays. Of 87 participants providing baseline data, 31% (27) did not join the RCT. Proportions quitting in the CG and IAM group were 11.5% and 13.6% at 6 months and 5.3% and 15.8% at 12 months, respectively. African Americans in underserved inner-city neighborhoods can be recruited into RCTs with community participatory approaches. Differences between the CG and IAM in proportions who quit were 2.1% and 10.5% at 6 and 12 months, respectively. More than 3 years with adequate funding, high staffing ratios, and intense outreach and follow-up schedules are needed to achieve recruitment and study goals.

Financial health promotion in Japan and Mongolia

Introduction Health promotion is becoming a noticeable policy in both developed and developing countries facing a burden of both communicable and noncommunicable diseases. This paper discusses the focus of health promotion policy, financing arrangements and the perspectives of social health insurance to fund health promotion. The population health status in Japan is among the highest in the world despite an increasing incidence of cancer, heart, cardiovascular diseases and diabetes. Communicable diseases such as HIV/ AIDS and new types of influenza also pose threats to public health. In Mongolia, both communicable and noncommunicable diseases are a serious public health concern. Since 1995, cardiovascular diseases, cancer and injuries have been the leading causes of mortality. Tobacco and alcohol consumption, physical inactivity and unhealthy diet are common risk factors for many chronic diseases. Japan In 2000, Japan announced the National Health Promotion Movement in the 21st century, with the shortened name of Healthy Japan 21. This policy aims to encourage all citizens to be healthy and free of disease. It focuses on healthy dietary habits, promotion of physical activities, diagnostic tests and reduction of tobacco use. Traditionally, health promotion is regarded as a useful means to prevent disease and promote health among different social groups. Municipal governments, health centres and urban communities play a major role in implementing health promotion activities. Health promoting leaders have been identified and nominated by community members and trained to conduct health promoting activities in their communities. These include advocacy of healthy lifestyle, behaviour, attitudes, dietary habits, access to health-related information and improvement of health literacy and education at community level. Studies suggest that a community participation approach suited to the socioeconomic setting has been effective in improving health-related behaviour and promoting health in Japan. (1) Mongolia Since 2000, the government of Mongolia has approved 16 public health programmes with health promotion effects such tobacco control, health education, cancer and injury prevention, nutrition, population fitness activities, child and reproductive health. However, strong evidence is not available yet about whether these programmes have been successful in controlling and reducing risky behaviours among the population. Since 2002, there has been an increase in the reporting of unsafe sex practices. There is an increasing trend in tobacco consumption, especially among young people. It is estimated that about 65% of males and 20% of females consume tobacco, which is higher than the respective averages in developing countries. The 2006 STEP survey on the prevalence of noncommunicable disease risk factors estimated that 9 of every 10 people surveyed had at least one risk factor and I in 5 people had three or more risk factors for developing a disease. (2) Currently, the public health programmes in Mongolia are implemented at population level but other country experiences show that the effects of health promotion can be increased through action at the community and individual level. There is an acute lack of funding support for the public health programmes in Mongolia. Although the central government budget is referred to as the main funding source, no specific budgeting tools and guidelines are provided. The 2005 national health accounts estimated that the level of spending on public health services was less than 5% of total health expenditure. (3) Financing promotion schemes In Japan, local governments assumed the main responsibility for financing health promotion. In practice, the availability of local revenues to implement health promotion activities varied among the country's 47 prefectures. Therefore, the financial adjustment policy was implemented in the form of financial assistance from the national to local governments. …

Mathematics, psychosocial work and human rights: a unique partnership between technical consultants and community organizers in India

Bestpractice inpsychosocialworkwithmarginalized populations emphasizes the importance of community participatory approaches. However, the majority of ¢eld reports on psychosocial support with marginalized children describe donor initiated projects in which the goal is community empowerment, ownership and control, rather than reports about collaboration with activist movements arising from the communities themselves. This paper addresses one recent example of the latter form of collaboration, in which activists of a social movement inTamil Nadu, India requested brief, targeted, external psychosocial assistance, following the tsunami of December 2004. The focus of the assistance, at the community’s request, was to increase cognitive capacity among children and volunteer teachers in a community education program.

Traditional forest knowledge and sustainable forestry: A north-east India perspective

Forests in the Asian context are part of a cultural landscape linked to livelihood concerns of traditional societies particularly those living close to nature and natural resources. From a typical forestry management perspective, timber extraction has always been a priority. However, in the present day context and circumstances, where forest resources are rapidly being degraded in the Asian tropics, the issues involved are more about sustainable forestry for economic benefits (timber and non-timber forest products) to the society, and the conservation of biodiversity through a protected area network. An understanding of the ways in which forest resources are perceived by the forest dwellers on the one hand and by the forest managers on the other is critical for designing strategies for sustainable forestry in the Asian context. There is an increasing realization that today we need to move beyond formal knowledge based on silvicultural issues, and find appropriate linkages with traditional forest knowledge generated over generations by forest dwellers through an experiential process of trial and error. Strengthening linkages between knowledge systems using community participatory management approaches is now seen as critical for sustainable forestry.

Biofortification, biodiversity and diet: A search for complementary applications against poverty and malnutrition

Biofortification, the focus of the HarvestPlus program of the Consultative Group on International Agriculture Research (CGIAR), represents a potentially powerful tool to increase dietary intake of essential nutrients in staple foods. This paper evaluates the compatibility of biofortification with the preferred option of dietary diversification and its potential impacts on the agricultural biodiversity essential for long term sustainability. In poor countries, biofortification requires increasing public investment in agricultural research and infrastructure for success. Rather than cereal commodities, biofortification for developing countries should focus on vegetatively propagated species or in improving quality of coarse cereals, as well as fodders. Community participatory approaches that identify local food resources with nutritional, agronomic and economic advantages to small-scale farmers could complement and set targets for biofortification as one of many approaches to alleviate nutritional deficiencies. Furthermore using agricultural biodiversity to reinforce dietary diversity can help situate biofortification within the larger context of sustainable food-based approaches. In this light, this paper evaluates specific biofortification interventions from environmental, sociocultural, political, economic, ethical, and biomedical perspectives.

A Model for Defining West Nile Virus Risk Perception Based on Ecology and Proximity

West Nile virus (WNV) has made considerable impact as an emerging infectious disease, spreading from coast to coast across North America since 1999. The disease has exhibited great spatial variability in North America, making an ecosystems approach to understanding the local human and vector ecology critical to prevention and control. This study underscores the importance of employing both personal prevention and community participatory approaches to create messages that have been adapted to the local ecology and are designed to reduce the risk of human infection with this mosquito-borne virus. As the virus spreads into new areas, underlying attitudes toward mosquitoes and the local perception of environment/ecology can affect the success of control and prevention measures. This work presents results from focus group discussions conducted in two Colorado counties in 2003, a year of significant WNV activity in the state. Issues addressed include residents’ assessment of risk and how this perception varied by age group and location, use or nonuse of repellents, and community attitudes toward mosquito control in areas with different ecologies and histories of mosquito-borne disease. The need to address individual components of personal prevention, to target prevention to specific audiences, and to disseminate prevention messages through local channels is discussed. The authors propose including aspects of ecology and disease proximity in understanding risk perception and addressing emerging diseases with a prominent ecological component.

Does farmer participatory research matter for improved soil fertility technology development and dissemination in Southern Africa?

Crop management research is increasingly involving farmers in evaluating new technologies, identifying adoption constraints and opportunities for improving farm performance to produce more sustainable impact. ICRISAT and its partners worked with farmers in Malawi and Zimbabwe during the 1999/2000 and 2000/2001 seasons to evaluate a range of ‘best bet’ soil fertility and water management technologies and evaluate the impact of farmer participatory research. Although there was some variation in methods implemented at different sites, the study found that there is a basis for a comparison of methods. Community entry and participatory approaches that engage farmers in decision making throughout the research-development-diffusion-innovation process have higher setup costs compared to traditional ‘top-down’ approaches. But they improve efficiency, both in technology development and in building farmers' capacity for experimentation and collective learning. This results in the development of more relevant technologies, joint learning among farmers, researchers and extensionists and better impact. To make farmer participatory research projects more sustainable and introduce them on a wide scale, the study recommends that public and NGO investments be targeted to building district and village-level innovation clusters.

Community Asset Management A Good Practice in Participatory Local Governance

This article places the concept of community asset management (CAM), the focus of a DFID Knowledge and Research (KAR) project which has been described elsewhere, in the context of the broader concepts of participatory local governance and good practice, themselves the subjects of other recent KAR projects. It is contended herein that it is imperative to local development, service delivery and poverty reduction that these concepts are fully operationalised by the stakeholders involved in the governance process. The article argues that, not only is CAM as a community participation approach a good practice in good governance ‘in its own right‘, but the very practice of the CAM approach involves the operationalisation of other participatory local governance principles.

Four different approaches to community participation

This paper explores some of the politics of community work by examining four basic community participation approaches. Moving from the right of politics to the left, it overviews some of the different theoretical orientations, goals, processes and recruitment practices that are commonly used but not always recognized to constitute different forms of community participation. Offered primarily to ‘lay’ community members, students and beginning practitioners, the paper is intended to clarify some of the differences that emerge when participation projects are designed, and to stimulate discussion about community participation more generally.

Health promotion and the development worker: A qualitative needs assessment

This qualitative study investigated the experiences of Irish health development workers involved in health-related development or rehabilitation programmes in developing countries, with specific reference to their health promotion involvements. A phenomenological approach involved semi-structured interviews with 12 health professionals who had returned to Ireland less than 12 months prior to the study. Respondents reflected on the support they received from their sending agencies before, during and after their assignment. In the development context the need for hi-tech western expertise is perceived as less relevant than for community participatory approaches to health promotion. Development workers need to be aware of their facilitative role, which aims to enable and empower individuals to help themselves. Expatriate health professionals would benefit from an understanding of health promotion principles and strategies to nurture health promotion within communities in developing countries. Training needs were articulated in relation to all of these considerations. Support from sending agencies for the health of development workers was a further key area of need.

Mediators of physical activity behavior change among women with young children

Background: Women with children are less likely to engage in adequate physical activity (PA) than women without children. This study aimed to evaluate the efficacy of two strategies for promoting increased PA among mothers of preschool-aged children, and to explore the mediators of any resulting change in PA behavior. Design: Controlled intervention trial incorporating repeated data collection from 554 women, randomized to one of three experimental conditions. Intervention Group 1 served as a control, while women in Groups 2 and 3 were given print information about overcoming PA barriers. Women in Group 3 were also invited to discuss the development of local strategies for the promotion of PA among mothers of young children. The primary strategies included increasing partner support, social advocacy, and capacity building, and were implemented through collaboration among participants, researchers, and community organizations. Main Outcome Measures: Adequate physical activity (PA), self-efficacy (SE) and partner support (PS). Results: Following the intervention, women in Group 3 were significantly more likely to meet guidelines for PA than controls (odds ratio [OR]=1.71, confidence interval [CI]=1.05–2.77)] after controlling for age and PA at baseline. After controlling for baseline PA, residualized change in SE (OR=1.86, CI=1.17–2.94) and PS (OR=2.29, CI=1.46–3.58) significantly predicted meeting guidelines. After controlling for residual change in PS and SE, the significant intervention effect was attenuated (Group 3 OR=1.40, CI=0.76–2.36), indicating that partner support and self-efficacy may be mediators of physical activity behavior change. Conclusions: The findings indicate that community participation approaches that facilitate increased self-efficacy and partner support can be effective in increasing PA among mothers of young children.

Urban Residential Satisfaction and the Planning Implications in a Developing World Context: The Example of Benin City, Nigeria

As urban expansion continues into the 21st century, one of the daunting challenges facing many developing countries is the planning and the management of cities in such a way as to meet a planning reformist role of promoting equitable, efficient and sustainable urban settlements. In the face of mounting criticisms of technocratic top-down approaches to housing and infrastructure development, there is a need for studies on the interface of satisfaction assessments and planning on the one hand and the social and cultural implications for urban management on the other. This is particularly so in the context of developing cities that are often characterized by dwindling public finances, urban poverty, spatial variations in housing and services, and poor socioeconomic conditions, as well as top-down approaches to urban management. A systematic spatial assessment of urban satisfaction is presented using Benin, a traditional West African city, as a case study. The significance of the satisfaction approach for planning, social and equity concerns is identified, and it is argued that we should look beyond it and incorporate community participatory approaches in the urban development process.

Community Participatory Approaches to Dengue Prevention in Sarawak, Malaysia

This paper covers preliminary findings from a participatory action research (PAR) project into dengue prevention in Sarawak, Malaysia, which formed one part of a national, multisite study. The objectives of the project in Sarawak were to reduce a high Aedes mosquito index and associated risk of dengue in two coastal Malay villages, using behavior modification strategies through a community participatory approach. The approach has achieved a reduced Aedes index as well as both material and nontangible benefits for the communities under study. These benefits may be calculated in terms of reduction of identified health risks and physical well-being of the community as well as in terms of more effective networking and self-advocacy with government agencies and the wider community.

Effectiveness of a community leaders' programme to promote healthy lifestyles in Tokyo, Japan.

The aim of this study was to evaluate a community-based health promotion programme in terms of changing: (i) attitudes with respect to a healthy lifestyle; (ii) behaviour with respect to access to health-related information; and (iii) attitudes and health literacy regardless of socio-economic status. In this programme, 20 people are selected every 2 years in each municipality from the lay people of the community, and they are designated as members of a 'community leaders' committee' by the Mayor. They, as a group, have opportunities to gain knowledge about and skills in healthy lifestyles, and undertake voluntary activities to serve the community. A programme intervention sample (INT group) was selected from programme participants from 13 municipalities in the greater Tokyo area. A questionnaire survey was carried out with the INT group and a general population group (REF group). The data obtained for female respondents, aged 30-59 years, in the two sample populations (n = 662 and 1361, respectively) were analysed using the chi(2) test, the Kruskal-Wallis test and multivariate log-linear methods. Another questionnaire was given to female programme participants (n = 200) to identify any changes since the start of their participation. The results showed that the people in the INT group were pursuing healthier lifestyles than those in the REF group; current non-smokers who performed physical exercise and who ate meals regularly paid more attention to a healthy lifestyle and were more interested in the relationship between food and health. From the INT and REF groups, 22 and 4% of people, respectively, frequently obtained information from health professionals, and 29.8 and 10.8%, respectively, were satisfied with their access to health-related information. Results of multivariate log-linear analysis showed that significantly more people in the INT group were doing exercise, eating meals regularly, paying attention to nutritional balance and to food additives, were interested in health, and were satisfied with access to health information, after excluding the effects of age and socio-economic factors (p < 0.05). The results also showed positive changes after the implementation of the programme. These findings indicated that the people in the INT group were significantly more likely to pursue a healthier lifestyle and to have greater health literacy than those in the REF group, regardless of socio-economic status. In conclusion, this community participation approach, employing a committee style, was effective in improving health-related behaviour and in promoting health literacy while overcoming socio-economic variation.

The Impact and Sustainability of Community Water Supply and Sanitation Programmes in Developing Countries

ABSTRACTSound strategies for community water supply and sanitation programmes in developing countries should be based on (i) a clear understanding of the existing problems, (ii) the beneficial impacts achievable, and (iii) the factors which determine sustainability. The impacts of many water and sanitation programmes are limited, and many systems break down and are abandoned prematurely; only limited impacts are achievable in the short term without greatly increased investment. Sustainability, in the sense of continued delivery and uptake of services, is threatened by numerous attitudinal, institutional and economic factors, and community participation approaches alone are no guarantee of success. The key to sustainability is that all stakeholders involved in consumption/use, maintenance, cost recovery, and continuing support, perceive it in their best interests to deliver high‐quality services.This paper, based upon the authors' experiences in Africa and Asia, proposes new sets of programme aims and objectives in relation to impact and sustainability, which can be used in programme design, monitoring and evaluation. It also makes longer‐term recommendations to external support agencies.

Minority ethnic community participation in needs assessment and service development in primary care: perceptions of Pakistani and Bangladeshi people about psychological distress.

OBJECTIVES: To promote community participation in exploring perceptions of psychological distress amongst Pakistani and Bangladeshi people, in order to develop appropriate services. DESIGN: Training and facilitation of resident community members (as community project workers), to define and conduct qualitative research involving semistructured interviews in their own communities, informing primary care led commissioning and service decision making. Setting A socio-economically disadvantaged inner-city locality in the UK. Participants One-hundred and four South Asian people (49 of Pakistani and 55 of Bangladeshi origin), interviewed by 13 resident community members. RESULTS: All community project workers completed training leading to a National Vocational Qualification, and successfully executed the research. Most study respondents located their main sources of stress within pervasive experience of racism and socio-economic disadvantage. They were positive about 'talking' and neutral listening as helpful, but sought strategies beyond non-directive counselling services that embraced practical welfare advice and social support. The roles of primary health care professionals were believed to be restricted to physical ill health rather than personal distress. The importance of professionals' sex, age, ethnicity and social status were emphasized as affecting open communication. Practical recommendations for the re-orientation and provision of services were generated and implemented in response to the findings, through dialogue with a primary care commissioning group, Health and Local Authority, and voluntary agencies. CONCLUSIONS: The work illustrates the feasibility and value of a community participation approach to research and service development in addressing a challenging and neglected area of minority ethnic health need. It offers one model for generating responsive service change in the context of current health policy in the UK, whilst also imparting skills and empowering community members. The study findings emphasize the need to recognize the social contexts in which distress is experienced and have implications for effective responses.

A Community Participation Approach to Farm Health and Safety

This article describes a community participation approach to farm health and safety concerns raised by rural residents of the Regina Health District. The Agricultural Health and Safety Action Committee was formed with representatives from each rural municipality in the Health District. The committee used a group planning process to set priorities, establish target goals, select strategies, and develop work plans. A need for more information was identified early in the process. This need was met through data collection, participation in a national surveillance project, and by conducting research. Activities in the first year focused on three priorities: chemical hazards, children, and respiratory hazards. The committee raised awareness of chemical hazards by airing two radio spots a total of 110 times on a local radio station. Activities focusing on children included: 10 educational sessions reaching over 625 students, a slogan contest that received 638 entries, and farm safety field trips reaching 112 students. Respiratory hazards were addressed through a display about Hantavirus and respiratory protection that reached at least 1,037 people at a variety of farm shows. An analysis of community participation shows the approach has broad participation measured by five indicators: needs assessment, leadership, organization, resource mobilization, and management. The approach combined community participation and a strong evidence-base, two elements that are necessary for an effective program.

Community participation in Landcare policy in Australia: The Victorian experience with regional Landcare plans

An estimated 30% of the Australian farming community is currently participating in the on‐ground work of more than 1,900 landcare groups. The landcare program is grounded in the community participation approach to rural development and has renewed optimism about reversing land and water degradation in rural Australia. Until recently, landcare groups had not participated in any real sense in landcare policy development, and it is in this context that we discuss recent experience in the state of Victoria where more than 130 community representatives contributed to the development of nine regional landcare plans. These plans will form the basis of Victoria's response to the commonwealth landcare initiative. Indeed, much of the forthcoming legislation for integrated catchment management in Victoria is based on the regional landcare action plan (RLAP) experience. Analysis of participant observation and survey responses revealed a generally positive view of agency/community relationships, that landcare groups w...

La lutte communautaire contre une endémie tropicale: Croyances surnaturelles et pièges à tsétsé au Congo

Community participation in the control of tropical diseases is of major importance nowadays, particularly for sleeping sickness (Gambian trypanosomiasis). Indeed, the authoritarian measures used with success to control this disease during the colonial period are difficult to apply now. Moreover, in the Congo, cultural and financial restrictions are such that patients sometimes refuse treatment. Thus, it has become highly desirable for vector control to be carried out at the same time as the treatment of patients. Trapping tsetse flies (or Glossina) is an ingenious and effective anti-vectorial method which has been tested in 55 villages of the Congo. The blue-black pyramid trap used does not require insecticide impregnation, and is hung in the branches by means of a capture-bag containing diesel oil. These trials, conducted in the sleeping sickness focus of the Niari river, have demonstrated the feasibility of local communities taking over the responsibility for the traps, while at the same time revealing certain obstacles. Indeed, the efficacy of this method depends on the optimization of trapping. This involves the determination of strategic capture sites by periodically harvesting the flies and moving the traps in order to catch the maximum number of flies. It also involves regular maintenance of the traps (i.e. repairs, checking the capture bag, clearing vegetation...). However, although these activities would appear to be feasible at community level, they are not always carried out satisfactorily. This results in the insufficient viability of the traps and finally to the reinvasion of the treated area by the tsetse. This study presents aspects of the present-day Congolese socio-cultural environment characterized by the revitalization of traditional Bantou mysticism and religious worship. The possessors of the 'Vital Force' or Kundu (sorcerers and healers) are confronted at night in an 'over-reality' consisting of the visible reality together with innumberable beings and objects existing specifically in the invisible state. This nocturnal confrontation may modify the local balance of power and relationships, and is also thought to cause certain symptoms of sleeping sickness and other diseases. During the colonial period, Kundu was prohibited. Under the influence of the Christian church, and because of the progress of modern medicine, the power of the sorcerers and healers gradually decreased. Then, in the 1960s, the eruption of Marxism as an anti-religious theory, modified the balance of power once more.(ABSTRACT TRUNCATED AT 400 WORDS)