Strategies to Build Relationship

It is important for the community to note that all the levels are inter-related and the levels of power and authority are different.  In practical terms very less authority, power, resources and very high burden of work is at the lowest level where the contact and expectations of the community is highest. At the higher levels authority and policy making decisions are taken but the engagement of the community is very less.

It is crucial for the community to understand this power dynamics between the health functionaries at different levels. While for the proper dispensation of medicines which are supplied, the community has to engage at the primary care level. However, for policy decisions such as increasing the supply of medicines, increasing budget, supplying adequate and appropriate medicines as per the local need, engagement has to continue at the higher levels. Hence, relationship building at all levels, critical engagement at all levels and differential engagement at different levels is very essential.It is important to note that whatever change occurs at the lower most level, it is often the outcome of the critical and strategic engagement at various levels.


The various strategies:

• Identifying entry points and areas of collaboration for relationship building - for personal meeting and discussions (e.g. visiting the health centres, participating in the community immunisation programmes, Inviting the health functionaries for community programmes or meetings etc.)
• Community representation at the health facility level : community can make a committee representing organised groups (women’s groups, youth groups, People living with HIV/AIDS, People with disability etc.
• Using the statutory or recognised local committees – Local Health Committees at the village level, committees at the local governance level and health institutional level
• Identify  strategic health functionaries, allies and friends in the system: 
• Positive, collaborative and non-antagonistic relationship with the local health functionaries / providers as the community has to deal with them in an ongoing manner
• Confrontation should be avoided when the community is vulnerable - Identify moments of strategic silence: e.g. difficult delivery of a woman is not the occasion to confront and antagonise health functionaries.
• Identifying Target functionaries with policy and decision making power, generally at the middle or higher level of the health system. These should be made the target points for pressure building and answerability. 
• Using documentary evidence, photographs, memoranda, signatures while dealing with the higher level
• Ensuring continuity of relationship with health providers through a follow up, repeating representation, using media positively. 
• Using the elected representatives, legislators or the other human rights or rights bodies to keep engaging with the health functionaries through the medium of discussions, seminars, conferences, writing in the media etc.  Very often the elected representatives head the local health committees or hospital boards etc.

Levels of Community Engagement  for
Feedback & Action 

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