|Community Monitoring in Health Resources for the Practitioner|
Addressing Issues of Inclusion, Representation and Validity of information
The evidence generated from the community monitoring process is forms the basis for evidence-based advocacy and one of the first tests that such evidence has to pass is the test of adequately representing the collective community reality, and not being anecdotal or a one-off experience. In formal research this issue is dealt in adopting an appropriate sampling methodology which allows some degree of representativeness in the findings.
In community monitoring the issue of validity and representativeness is approached taking these points into consideration:
1. Community monitoring does not aim at universal representativeness and it is a methodology for representing the experience of the marginalised or socially excluded communities. It is useful to mention and keep in mind this ‘specific’ interest from the beginning, and be careful to identify and include the experience of the socially excluded within the overall exercise.
2. Community monitoring is a multi-method exercise and thus it aims to represent the community reality by including different points of view. In such an exercise the validity of the findings is not necessarily maintained through a representative sample but through a process of triangulation which allows different actors/stakeholders to contribute to developing the picture. Triangulation means asking the same question from multiple sources, to verify the answer and determine any differences in perspectives. For example, an idea of quality of care of services can be obtained from the service provider, the service recipient as well as observing the service delivery environment (without compromising confidentiality and privacy associated with service delivery).
3. Another issue that needs to be kept in mind is that Community Monitoring tries to collect a variety of experiences and even though it presents the final report card as a single numeric or traffic light rating, this indicator is backed by a detailed narrative explanation which provides stories or community experiences. The narrative portion justifies the rating and explains any variations in experience and perspective that were obtained during the enquiry process. Examples of more complicated justifications include:
4. When gathering information from more than one point of view, there may be differences of opinion. In such cases it is useful to keep in mind one question while deciding how much importance to give to a particular piece of information and this is– does this information come from ‘direct’ community experience. The source which relates to direct community experience should be give greater value. The process is explained later. There are also certain issues which are simply ‘unacceptable’ from a human rights perspective – for example a death of a child following immunization, or refusal to provide ambulance to a woman in labor. These incidents are important in themselves and such experiences do not require any statistical justification and should be recorded in detail as case studies and reported.
In community monitoring adequate variety of sources of information and sufficient information about the experience of the socially excluded/marginalized provides the key justification about sample variety and size. (See box given below)