Community Monitoring in Health Resources for the Practitioner |
Building Block Two: Community Mobilization and Health Entitlement
Awareness
Community mobilization and participation is a key component of community monitoring. While mobilization of disadvantaged communities provides them with increased capacity to bargain and negotiate, it also provides a platform for increased entitlement awareness, sharing of local resources, and collective planning and working together for change. Together these activities bring about a greater sense of ownership in the community about the public facility or service they are engaged in monitoring. The village or urban neighbourhood is the main focus for the community monitoring activities and mobilisation of the residents of the village or neighbourhood is an important part of the community monitoring process.
Objectives of Community Mobilisation:
Steps towards Community Mobilisation – Urbanisation and increased mobility for purposes of work are increasingly fragmenting modern societies. However, marginalised communities continue to live either in rural areas, and in somewhat compact urban neighbourhoods and also have a sense of collective identity. This sense of collective identity is an advantage in terms of community mobilization and may make the first step of familiarization and rapport building easier. The broad steps for community mobilization are as follows:
Step 1 : Familiarisation and rapport building – For the purposes of this manual it is being assumed that the process of community monitoring, including the process of community mobilization is being facilitated by an external civil society organization. It is necessary that this external agency is familiar with the community and some of the members of the community are also familiar with members of the organization. This can be done through informal meetings with key people (leaders of community, church leaders, any active women from the community, village head if there is one). Once one is familiar with a number of the community it may be a good idea to take a walk through the village to get an idea about;
Step 2 – Group building – Once members of the community are familiar with the members of the facilitating organization, its workers and purpose, it is important to move towards developing a formally shared objective with the community and also facilitate the formation of a collective or group which will represent community interests. In some cases there may be a pre-existing group which may have been formed for a different purpose. This group may choose to reorient its purpose for the current set of objectives and also include new members, or a new group may also emerge with some members from the earlier group and some new members. During group/collective formation process it is important to understand pre-existing groups and relationships and to build upon those. Some old groups may have lost energy but their leadership may be accommodated as mentors for youth who are willing to work for change. It is important the members of the group realize that their involvement in the social change process – in this case improvement in health service delivery through community monitoring, has to be through volunteer effort. In exchange for their volunteer efforts, the facilitating organisation choose to provide some equipment for a youth club, books for a community library and so on. This kind of contribution may assist the process of group building. But Community Facilitators have to be conscious that they do not do anything which may undermine community identity, local leadership or promote personal interest over group interest.
Some of the practical steps towards group building could be to announce a meeting in the community around the issue of health. Pamphlets can be distributed to literate people and posters put up in the common meeting places of the people (e.g. near Church, wells, market place, playing area etc.), announcing purpose and time of the meeting and inviting all to attend. During this meeting it is a good idea to ask a person from the community to introduce the facilitating organization, and then the facilitating organization can introduce its purpose etc. The community has to be introduced to the general outlines of the health entitlements that it has and how gaps in the entitlements or in the way the services are being provided can affect their ability to access health services. At this meeting the contours of the new group is established.
Step 3 - Building capacity in the group – Once a group has been formed and its membership identified, it is necessary to build capacity in the group. Some of the essential elements of this capacity building process will be to develop their knowledge about the health entitlements, the key health problems faced by the community, the key determinants of health, the way the health system functions and so on. In addition the group members will also need to be trained on ways to effectively communicate in the village, how they can support other members in the community to facilitate access to health services. It may be a good idea to arrange a field visit to a hospital or doctors chambers to understand how the public health system actually works. Once the group members are sufficiently knowledgeable about the health system functioning and health entitlements, it will be their responsibility to spearhead an entitlement awareness process in their community. The group is also trained and encouraged to prepare a village health profile which can serve as the baseline to understand that changes that take place as a result of community monitoring. Once the entitlement process in the community is over the group is trained for conducting community monitoring exercise.
Step 4 – Entitlement Awareness in the Community – Entitlement awareness is a crucial component of rights education. Marginalised communities are ignorant about and suspicious of public systems. They may have history of being discriminated and having faced abuse in the hands of public officials. In such situation it is important that the communities understand that the historical situation has changed and they are now citizens of the country and are entitled to some basic citizenship services. In many cases the entire gamut of citizenship services available to the majority community may not be available to those who are marginalised, but without a sense of entitlement they will not be able to raise a demand. The following activities may be conducted as part of entitlement awareness in the community:
Time Line: Community mobilisation and entitlement awareness is an intensive process and it may require multiple visits for familiarisation , developing rapport and group building. Once the group building process is over the capacity building of the group should take place soon so that they momentum is maintained. After the capacity building process the group can be expected to take more responsibilities.
Community mobilization and participation is a key component of community monitoring. While mobilization of disadvantaged communities provides them with increased capacity to bargain and negotiate, it also provides a platform for increased entitlement awareness, sharing of local resources, and collective planning and working together for change. Together these activities bring about a greater sense of ownership in the community about the public facility or service they are engaged in monitoring. The village or urban neighbourhood is the main focus for the community monitoring activities and mobilisation of the residents of the village or neighbourhood is an important part of the community monitoring process.
Objectives of Community Mobilisation:
- To have a shared understanding of the health issues of the community/ neighbourhood.
- To make the communities aware of their health related entitlements.
- To facilitate the formation of the village/ neighbourhood group / team
- To prepare village/neighbourhood health services profile
- To develop awareness about determinants of health.
- To jointly conduct the enquiry for community monitoring
- To facilitate public sharing of the findings of the enquiry and prepare a joint action plan
- Build ownership about public health service.
Steps towards Community Mobilisation – Urbanisation and increased mobility for purposes of work are increasingly fragmenting modern societies. However, marginalised communities continue to live either in rural areas, and in somewhat compact urban neighbourhoods and also have a sense of collective identity. This sense of collective identity is an advantage in terms of community mobilization and may make the first step of familiarization and rapport building easier. The broad steps for community mobilization are as follows:
Step 1 : Familiarisation and rapport building – For the purposes of this manual it is being assumed that the process of community monitoring, including the process of community mobilization is being facilitated by an external civil society organization. It is necessary that this external agency is familiar with the community and some of the members of the community are also familiar with members of the organization. This can be done through informal meetings with key people (leaders of community, church leaders, any active women from the community, village head if there is one). Once one is familiar with a number of the community it may be a good idea to take a walk through the village to get an idea about;
- General layout of the village.
- Different social groups in the village and where they stay.
- Service delivery points in the village
- Members of the community with specific or important health problems and so on.
- Pre existing social groups in the village/ neighbourhood
- During the familiarisation process it is important to also important to share information about one’s own organization and its activities and the why the organisation has chosen to work with the community. It is important to develop a common sense of purpose with some key members in the community.
Step 2 – Group building – Once members of the community are familiar with the members of the facilitating organization, its workers and purpose, it is important to move towards developing a formally shared objective with the community and also facilitate the formation of a collective or group which will represent community interests. In some cases there may be a pre-existing group which may have been formed for a different purpose. This group may choose to reorient its purpose for the current set of objectives and also include new members, or a new group may also emerge with some members from the earlier group and some new members. During group/collective formation process it is important to understand pre-existing groups and relationships and to build upon those. Some old groups may have lost energy but their leadership may be accommodated as mentors for youth who are willing to work for change. It is important the members of the group realize that their involvement in the social change process – in this case improvement in health service delivery through community monitoring, has to be through volunteer effort. In exchange for their volunteer efforts, the facilitating organisation choose to provide some equipment for a youth club, books for a community library and so on. This kind of contribution may assist the process of group building. But Community Facilitators have to be conscious that they do not do anything which may undermine community identity, local leadership or promote personal interest over group interest.
Some of the practical steps towards group building could be to announce a meeting in the community around the issue of health. Pamphlets can be distributed to literate people and posters put up in the common meeting places of the people (e.g. near Church, wells, market place, playing area etc.), announcing purpose and time of the meeting and inviting all to attend. During this meeting it is a good idea to ask a person from the community to introduce the facilitating organization, and then the facilitating organization can introduce its purpose etc. The community has to be introduced to the general outlines of the health entitlements that it has and how gaps in the entitlements or in the way the services are being provided can affect their ability to access health services. At this meeting the contours of the new group is established.
Step 3 - Building capacity in the group – Once a group has been formed and its membership identified, it is necessary to build capacity in the group. Some of the essential elements of this capacity building process will be to develop their knowledge about the health entitlements, the key health problems faced by the community, the key determinants of health, the way the health system functions and so on. In addition the group members will also need to be trained on ways to effectively communicate in the village, how they can support other members in the community to facilitate access to health services. It may be a good idea to arrange a field visit to a hospital or doctors chambers to understand how the public health system actually works. Once the group members are sufficiently knowledgeable about the health system functioning and health entitlements, it will be their responsibility to spearhead an entitlement awareness process in their community. The group is also trained and encouraged to prepare a village health profile which can serve as the baseline to understand that changes that take place as a result of community monitoring. Once the entitlement process in the community is over the group is trained for conducting community monitoring exercise.
Step 4 – Entitlement Awareness in the Community – Entitlement awareness is a crucial component of rights education. Marginalised communities are ignorant about and suspicious of public systems. They may have history of being discriminated and having faced abuse in the hands of public officials. In such situation it is important that the communities understand that the historical situation has changed and they are now citizens of the country and are entitled to some basic citizenship services. In many cases the entire gamut of citizenship services available to the majority community may not be available to those who are marginalised, but without a sense of entitlement they will not be able to raise a demand. The following activities may be conducted as part of entitlement awareness in the community:
- Distributing pamphlets and FAQ’s about the key entitlements and processes and complaint and grievance redressal mechanisms
- Posters with same information
- Small informal meeting conducted by members of the group
- Skits and plays
Time Line: Community mobilisation and entitlement awareness is an intensive process and it may require multiple visits for familiarisation , developing rapport and group building. Once the group building process is over the capacity building of the group should take place soon so that they momentum is maintained. After the capacity building process the group can be expected to take more responsibilities.