HEALTH AND DEVELOPMENT WORKSHOP
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HEALTH AND
DEVELOPMENT
WORKSHOP
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HEALTH AND
DEVELOPMENT
WORKSHOP
Manual for Participants
May 3-14, 1992
Winnipeg, Manitoba
Developed by
Canadian University Consortium
for Health in Development
with
H.R. (Eric) Amit R
Elizabeth Hillman
•' Susan Kalma
DRAFT MANUAL
April 1991
Copyright permission
for enclosed readings pending
\jo
’A-
K.A. Wotton
Don Hillman (
Susan Elizabeth Smith CVe<^^)
HEALTH AND DEVELOPMENT WORKSHOP
Page
Table of Contents
Acknowledgements.
i
Table of Contents.
ii
General Comments to the Facilitator.
iv
Reference Materials for the Facilitator.
vi
DAY 1
Introduction and Overview (1.1).
1
Negotiating the Workshop (1.2)
6
Working Together (1.3)
9
DAY 2
What is Development (2.1)
13
Bead Game (2.2)
18
Development Context (2.3)
20
DAY 3
Toward People-centred Development (3.1)
25
Team Building (3.2)
30
Towards Empowering (3.3)
35
DAY 4
Global Health Concerns (4.1)
39
What's Happening in Health? (4.2)
41
ii
DAY 5
Examining Alma Ata (5.1)
44
Community-based vs Community-oriented
Programs (5.2)
50
DAY 6
Optimizing Scarce Resources (6.1)
56
DAY 7
Force Field Analysis (7.1)
63
Making Connections (7.2)
67
DAY 8
Understanding Organization (8.1)
70
Approaches in Planning Changes (8.2).
73
Facilitating Organizational
Change (8.3)
76
DAY 9
Strategies for Community Change (9.1)
79
DAY 10
Planning Community Change (10.1)
83
DAY 11
Evaluation (11.1)
87
Evaluation (11.2)
91
Evaluation (11.3)
93
Closing (11.4)
95
iii
HEALTH AND DEVELOPMENT WORKSHOP
GENERAL COMMENTS TO THE FACILITATOR:
1.
There needs to be emphasis on the subject of women and
development throughout the 11 day workshop. This is not
addressed specifically in ;-ny one session but should be emphasised
at points throughout. The e are resource materials in the workshop
kit that participants should be encouraged to read and refer to.
2.
Cultural sensitivity anc adaptation is not addressed in any particular
session but should be a thread throughout the 11 days. As with
women and development the cross-cultural sensitivity reading and
reference materials are in the workshop kit. Some of the activities in
the evening could address this issue in a participatory fashion.
3.
Emphasis on the environment is not the subject of any one session
but should be addressed in the evening activities. There are
resources and materials in the workshop kit.
4.
A participant's manual is provided for each participant. Each session
is listed and required readings are included in the manual.
5.
The participatory management process should be well utilized to
enable participants to further develop their skills in this area.
Participatory management evolves as the workshop progresses and is
often dependent upon the facilitator's ability to empower others.
The facilitator should model throughout the workshop the
empowerment of others.
6.
Inclusive language should be used, avoid words like manpower human resource is not associated with any one gender.
7.
The workshop kit includes such items as the Bead Game, Tower
Construction supplies, all handouts, reference books, videos etc.
8.
List of games, resources, videos etc. has been developed for the time
in the evenings.Participants are encouraged to take part in these
activities for about one hour each eve/.ing.
iv
9.
Reports back to plenary can be deadly unless there is creativity ie.
written reports to read later individually, reports posted and people
circulate to read, list major points only by nominal group process,
etc. Facilitator can be as creative as necessary.
10.
Lecture should be kept to a minimum. We want to model the
participatory process in the workshop.
11.
Attached in this section are a number of references, activities, and
resources on adult education and facilitation skills. Facilitators may
have additional material and skill from their own past experience.
12.
Each participant has been requested to bring data from their own
country or community. This data should be used whenever possible
in problem identification, problem solving and planning throughout
the workshop. Additional data is furnished in the workshop kit.
v
OVERALL WORKSHOP OBJECTIVES
At the end of the Health and Development workshop participants will be able to:
explain a concept of development which is people-centred, participatory
and sustainable;
critically review their understanding of health and development from a
people-centred perspective;
develop a conceptual framework for negotiating change in health and
health care;
develop skills in working in an interdisciplinary team; and
develop attutides and skills to work with groups of people of different
backgrounds, skills, position and status.
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2
HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
Introduction and Overview (1.1)
DAY
1
TIME:
9:00am - 10:30am
(1 hour 30 min.)
BACKGROUND:
The introductory session will set the tone for the workshop. Participants will need
some time to become acquainted among themselves as well as with the
facilitators. The facilitators should ensure the physical arrangements are conducive
to group process. The agenda is a draft for discussion with the participants.
Overall objectives of the workshop are discussed. An overview of the 11 day
workshop will be provided by the facilitators.
OBJECTIVES:
Participants will begin to develop a learning community.
OUTLINE:
Greeting and Introduction
of CUCHID
15 min.
Ice Breaker - Getting to
Know You
45 min.
Agreements and Housekeeping
15 min.
Expectations for the Workshop
- individual exercise
15 min.
1
RESOURCES:
Name tags, flip chart, newsprint, markers, hand-out readings 1.1a, 1.1b, 1.1c
READINGS:
Required:
Recommended:
1.1a
Bruntland Report "Our Common Future", Oxford 1987. p 123
1.1b
Sharing Our Future, CIDA 1987, p 23-25
1.1c
Participatory Management Process
Rohde,Jon, Assignment Children 1983 When the Other Half Dies,
Vol 61 62 p. 35-65
Comea,A. Adjustment with a Human Face, UNICEF, 1986
Schumaker, EF, Small is Beautiful, London, Sphere Books Ltd. 1979
2
Detailed Notes for the Facilitator
15 min.
Greeting and Introduction of CUCHID
Background of the organization and historical perspective of the workshop explained to
the participants.Reference material included for the facilitator. Specific objectives of this
workshop and draft agenda will be reviewed later.
45 min.
Ice Breaker - Getting to Know You
Several activities can be used at this point. The purpose of the activity is to begin to get
to know the group. Participants can be instructed to choose someone that they do not
know and introduce themselves. They are told they will introduce this person to the rest
of the group. Keep the introductions brief, only mention the key points, 2-3 minutes per
person. The ability to summarize and select material for presentation is also an
important skill participants will develop throughout the workshop.
A few suggestions can be made by the facilitator to guide the discussion, ie. name,
background, job, and most important aspect of health and development. 10 - 15 minutes
can be given for this interaction in pairs. The group is brought back together and each
person introduces their partner.
15 min.
Agreements and Housekeeping
Suggestions are taken from the participants as to the agreements (ground rules) under
which they will operate. Some of these agreements may be fixed i.e. meal times if in
c residence, smoking if in smoke free building, etc. Other items may be negotiated i.e. start
and finish time each day, beginning on time even if not all participants are present,
length of coffee and lunch breaks etc. These can be written up on a flipchart and
referred to throughout the workshop.
15 min.
Expectations of the Workshop
This is an individual exercise. Each participant is asked to write down their own answers
to the following questions:
Why am I attending this workshop?
What do I expect to get from this workshop?
How will I use the workshop learning?
The workshop will be a success if
Participants will share this information with others later in the morning in small
groups.
3
Reference for the Facilitator
INFORMATION ON CUCHID
The Canadian University Consortium for Health and Development (CUCHID) has four
principal goals:
1.
to support collaboration and cooperation rather than competition in
the international health in development capacity of Canadian
Universities.
2.
to focus on priority health problems and themes best carried out by
a consortium or network rather than a single University, and to
establish a world class academic Canadian Consortium in the field
of international health and development.
3.
to undertake mutual capacity-building and to increase health in
development, as a group as well as by individual effort, through
links to developing countries.
4.
to provide a demonstration model of a consortium of Universities
working together for health and development. The strengths and
weaknesses of both the process and output could be critically
evaluated and applied to other University consortia.
CUCHID was initially proposed to the Canadian government for support in 1988 through
their Centre for Excellence Program.
The merit of the CUCHID concept was recognized by IDRC (International
Development Research Centre) who provided a planning grant for two years from
Februaiy 1990.
Collaboration with the Canadian Public Health /Association (CPHA), the Canadian
Society for International Health (CSIH) and the Association of Universities and Colleges
of Canada (AUCC) resulted in a Secretariat being established with a shared office with
CSIH in the CPHA headquarters building. The move to Ottawa will help consolidate and
strengthen mutual efforts in international health and development.
The CUCHID meets twice yearly and presents a day long symposium on international
health issues at the annual meeting of CPHA.
4
CUCHID interest and participation at other recent international health in development
meetings:
«
Canadian Association of African Study (CAAS)
The Summit for Children (UNICEF)
The Commission on International Health Research in Development
and the resulting program on ENHR (Essential National Health
Research)
The Commonwealth of Learning (COL)
Southern Africa Development Coordinating Conference (SADCC)
UGANDA-CANADA Partnership
Delegations from Thailand and USSR
New developments at IDRC
Education for ALL (Thailand March 1990)
Scientific Forum at annual CPHA meeting in toronto June 1990
Global Conference on Environmental Issues in Rio de Janerio June
1992 and the subsequent conference on environmental education
and information follow-up meeting to be held in Toronto October
1992
The workshop in Health and Development will be piloted in
199X
with 30 participants (ten will be students from Third World countries presently in
Canada, ten will be Canadians interested in Health and Development and ten will be
selected Faculty members training as potential facilitators for subsequent courses). It is
expected that this CUCHID course will be used across Canada by different Universities
and ready for international use in 1993.
5
HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
Negotiating the Workshop (1.2)
DAY
1
TIME:
11:00am - 12:30pm (1 hour 30 min.)
BACKGROUND:
A participatory process will be established to set the tone for the workshop.
Objectives, agenda etc. are all subject to negotiation with the participants. An
ongoing evaluation process will be set up via the daily management/ steering
committee. The handout Participatory Process" from the previous session
explains the makeup of this committee. Participants will be involved in the
documentation and evaluation of the workshop.
OBJECTIVES:
Participants will negotiate and determine program and process.
Self-governing mechanisms will be established by the participants.
Participatory process will be used for decision making.
OUTLINE:
Small Group Work - look at
objectives, relevance of content
30 min.
Plenary Report and Discussion
30 min.
Comparison to Draft Agenda and Objectives
and Agreement
15 min.
Establish Management Team
10 min.
Summary Remarks
5 min.
6
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1
Detailed Notes for the Facilitator
Small Group Work (objectives, content, evaluation)
30 min.
Randomly formed groups of 5 discuss and answer the following questions:
What do we expect from the workshop? (objectives)
We will use the workshop learning as follows: (relevance of content)
The workshop will be a success if .... (evaluation criteria)
30 min.
Plenaiy Report and Discussion
In plenary the group will tabulate the reports, summarize and negotiate workshop
objectives. There will be a comparison with the draft objectives. Agreement will be
reached on realistic objectives within the given time frame considering overall workshop
purpose and resources available.
15 min.
Comparison to Draft Agenda and Revisions
Discussion on draft agenda as related to revised objectives.
10 min.
Formation of Management Teams
Establishment of the management and evaluation process through management team and
< steering committee.
5 min.
Summary Remarks
Remarks on adult learning theory and process refer to hand-outs provided ie. adults
must have input into the design and control of a program in order to have commitment
to the learning. The facilitators will provide the materials, and opportunities to learn.
8
HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
Working Together (1.3)
DAY
1
TIME:
1:30pm - 3:00pm
3:30pm - 5:00pm
(3 hours)
BACKGROUND:
This session is conducted in plenary and small group activity. The purpose of the
session is to begin the reflection and interaction process of the participants, to
develop a baseline on the participants' understanding of health and development,
and to begin the participatory learning process.
OBJECTIVES:
Participants list work interests and experience of everyone in the group.
Participants indicate their understanding of health and development.
Participants begin working in groups to problem solve.
OUTLINE:
Overview of Session
5 min.
Pretest
25 min.
Sharing Work Experience
60 min.
Break
30 min.
Report to plenary
15 min.
Health and Development
30 min.
Wallo Exercise
45 min.
9
RESOURCES:
Newsprint, markers, flip chart, hand-outs 1.3a, 1.3b, 1.3c
READINGS:
Required:
Recommended:
1.3a
Pre-test
1.3b
Chambers, R. Rural Development: Putting the Last First
Longman, London 1983. Chapter 1
1.3c
Wallo Handbook
Evans, J. Health Care in the Developing World NEJM, Nov.5,1982,
Vol 305, No. 19 p. 1117- 1127
10
Detailed Notes for the Facilitator
5 min.
Overview of Session
Purpose of the session is explained to the participants as stated under objectives.
25 min.
Pretest
Pretest is distributed to each participant for completion individually. When completed
they are returned to the facilitator for analysis later and used in planning with the
steering committee.
60 min.
Sharing Work Experience
This exercise will help the participants become aware of the varied experience and
interests of the group. Common difficulties may also be identified.
Randomly formed groups of 5 are made. Each participant will share his or her area of
work highlighting interests, successes and difficulties. The group will prepare a summary
of the information for presentation to the large group.
15 min.
Report to Plenary
< Each group posts their summary sheet and through plenary discussion pull together some
of the commonalities.
30 min.
Health and Development
Using the same groups as before and given the common problems listed, how do we see
the connection between health and development? What does health and development
mean to us?
After 15 minutes in the discussion groups draw them together for feedback and
discussion. Draw attention to some of the problems identified in the discussion on
sharing work experience and relate this to the development problems of the country.
Also underline some of the value assumptions reflected in the summaries.
11
45 min.
Wallo Exercise Introduced
The Wallo exercise is used to demonstrate planning rural health services in the Third
World. It is introduced at this point in the workshop and participants work on it
throughout in self-directed learning time as well as during the assigned time as noted.
Each participant receives a handbook.
Day 4
Day 9
Day 10
3:30pm - 5:00pm
12:30pm - 5:00pm
12:30pm - 5:00pm
The objectives are:
To identify problems facing those who operate health services in the
Third World.
To develop a plan and practical approach to the problems
identified.
A report is written up by each group. A presentation of 20 minutes for each will be done
on Day 10.
12
HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
What is Development? (2.1)
DAY
2
TIME:
9:00 - 10:30
11:00 - 12:30 (3 hours total)
BACKGROUND:
In the last session on day 1 the participants began to situate their health work in a
broader development context. Our purpose now is to help clarify participants’
understanding of development. Specifically; it is more than economic growth. A
development problem must be precisely defined, and its causative factors and
consequences known before it can be addressed. Desired outcomes must be
specified if they are to be measured.
OBJECTIVES:
Participants restate their understanding of development.
Participants describe precisely a development problem and identify critical
causative factors.
Participants specify desired development outcomes.
OUTLINE:
Defining development
30 min.
Looking at a development problem.
Introduction of a framework
60 min.
Small group work with the framework
30 min.
13
Review reports
15 min.
Desired development outcomes and indicators
30 min.
Share finding and summarize
15 min.
RESOURCES:
Summary of development definitions for the pretest, overheads and overhead
projector newsprint, felt markers, flip chart, hand-outs 2.1a, 2.1b
READINGS:
Required:
Recommended:
2.1a
Cornea, M. ed. Putting People First. Oxford, OUP.
Chapter 1
2.1b
The Food Path
UNDP Human Development Report 1990. Chapter 1.
14
1987.
Detailed Notes for the Facilitator
30 min.
Defining Development
Place before the group the definitions of development taken from the pretest.
Summarize stressing that:
Development is a recent phenomenon in human history - a post 1945
phenomenon
The content of development has changed over the past 40 years. Roughly in the
1950’s it was defined as economic growth. The indicator was the Gross
National Product (GNP).
1960's there was more concern for equal distribution in society. More
social indicators were used.
1970’s an effort was made to combine the two above, i. e. growth with
change
1980's has seen a regression to the dogma of the 50's. Development =
economic growth supported by privatization.
1990's Development may be seen wholistically - with an emphasis on
human development. Development is seen from a people perspective in all
dimensions of human capacity.
The facilitator should stress the concepts of the quality of life and equity etc as a part of
development if these concepts are not brought out by the participants.
60 min.
Looking at a Development Problem
Introduction of a Framework
A problem arises when we are dissatisfied with a situation and see the need to change it
to one which will be better. Our programs and projects are concerned with this effort to
improve a defined situation. This requires that we can:
a)
b)
clearly define the problem
explain why it exists.
15
Participants were requested to bring country or community specific data to use
throughout the workshop to define problems and formulate solutions. This material may
be referred to at this point.
Defining a problem - requires us to specify what it is - what is the evidence for it - to
specify who it effects - in terms of numbers and social dimensions (age, sex, economic
and social position, educational levels, and other criteria); when it occurs (year long,
seasonal); trends (increasing decreasing or constant); consequences, intervention efforts
to address it and the causes.
Ask for an example of a development problem from the group and attempt with the
group to first specify the problem providing the data listed above. Lack of information
from the group will help to underline the need for collecting baseline data.
Any problem exists because of a historical past and a dynamic present. The problem
exists because of deficiencies at personal, collective, structural, cultural and ecological
levels. These are interrelated. In different situations and times different factors assume
key significance.
To get to the root cause, the key task is to ask the question - why does this exist? and to
keep asking until we get to root causes. Examine with the group the causative factors of
problems where dimensions were described above. Construct a web diagram of
interrelated causes.
To assess root causes the questions to be asked are: What are the key causative factors
in the past? today? Assessing root causes eg....
Malnutrition
Participants can specify what is involved in this problem: poor families, seasonal
variation, etc.
Obtain from the participants why this exists eg. lack of land for food production
Why is this a problem? traditional methods, lack of rain, cash crops, etc.
Use the Food Path hand-out as demonstration.
If there is a circular causation, identify and attack the weakest link or base the program
on the organization's strength. (Explain circular causation if necessary)
Facilitator should use a simple example to demonstrate a web diagram as all may not be
familiar with this concept.
16
30 min.
Small Group Work with the Framework
Small buzz groups to use the above framework to:
Choose a problem
Define the problem
Develop a web diagram indicating possible causes. The group then draws a
diagram on a flip chart
15 min.
Review Reports of the Buzz Groups
Be creative.
Desired Development Outcomes and Indicators
30 min.
Explain outcome, i.e., what is the change we wish to bring about and how do we know
we brought about the change.
Obtain a few examples from the participants of desired development outcomes, e.g.,
higher standard of living and indicators to measure these.
Buzz groups suggest development outcomes relevant to their concept of development
and indicators to measure outcomes.
15 min.
<• Share Findings and Summarize
Points to be remembered are:
Are the indicators valid, reliable, sensitive, specific, cost effective, timely?
Development is people not things.
Development changes must be sustainable.
Development is both process and goal.
Who decides the pace and direction of change?
17
HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
The Bead Game* (2.2)
DAY
2
TIME:
13:30 - 15:00 (1 hour 30 minutes)
BACKGROUND:
This is a simulation game not a role play, i.e. people are being themselves in a
simulated situation. The game simulates a class system with subtle rules which are
not defined publicly, a system which isolates the people who work in it and which
works against cooperation among the members of the system.
OBJECTIVES:
To experience, through a simulation activity, a class system in which the wealthy
control the resources, increasingly dominate trade and the distribution of
resources for their own benefit, understand the rules and have the power to
manipulate the rules. The poor, meanwhile, have fewer and fewer resources, do
not have the tools to understand the rules, and have no power until they discover
the power of collective action.
To discover how this affects them.
OUTLINE:
The full details of the game are attached and a kit is required to play the game.
The instructions should be read by the facilitator in advance of the session.
Introduction to the Game
10 min
Playing the Game
30 min
Debriefing
30 min
18
RESOURCES:
Game kit containing beads, string and instructions for playing; newsprint and
markers.
FOLLOWUP:
This game could be followed with an audio-visual or readings on the basic
structures of poverty and injustice.
• Source: Basics and Tools A Collection of Popular Education Resources and
Activities CUSO, Ottawa 1988
READINGS:
Nil
19
HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
The Development Context (2.3)
DAY
2
TIME:
3:30pm - 5:00pm
(1 hour 30 min.)
BACKGROUND:
The participants can prepare for this session by:
a)
studying the pretest data on national resources and constraints to
development; and
b)
reviewing the statistical data they have brought with them or data
provided in the resource material
The facilitator can prepare by:
a)
reading the extract from the World Development Report
"Concluding Themes". This draws attention to some public sector
resources and constraints within which the development effort is
mounted (one need not agree with all the recommendations or
underlying assumptions.)
The overall purpose of the session is to help participants look at the parameters
within which national development takes place using the data they have available
to them.
The last half hour on country specific data and implications of this data for
development is critical in facilitating collective reflection on development.
20
OBJECTIVES:
Participants list key elements in the development context of their countries and
discuss the positive and negative dimensions of each element.
Participants become familiar with the relevant national statistics and consider
their implications for development.
OUTLINE:
Introduction
10 min.
Small Group Exercise: List key elements,
resources and constraints
30 min.
Synthesis
20 min.
Examining Country Specific Data
30 min.
RESOURCES:
Newsprint, flip chart, country specific data resources in workshop kit, Concluding
Themes, World Development Report 1989.
READINGS:
Recommended:
UNICEF, State of the World’s Children, 1991
World Development Report, 1989
What Now - 1975 Dag Hammarskjold Report - published by Dag
Hammarskjold Foundation Uppsala Sweden 1975
Bryant, E. and White, L.G. Managing Development in the Third
World. Boulder, Co.; Westview. 1982 - Chapter 1
21
Detailed Notes for the Facilitator
Introduce the Topic
10 min.
The facilitator may illustrate resources and constraints from the pretest completed on
Day 1.
Small Group Exercise
30 min.
Task:
1.
Each group lists key elements to be considered on flip chart paper. Under each of
the listed key elements the positive (resource) and negative (constraining)
dimensions are noted.
Element
Resource Aspect
Constraint Aspect
Demography
people as a resource
rate of population
growth/ rate of
urbanization
Foreign
Exchange
external cunency
available for national
development
debt burden - /cost
of servicing loans
Environment
favourable - adequate
supplies of water,
fuel, etc.
harsh /deteriorating
environment
drought, deforestation
2.
Reports posted on the walls and all participants circulate to read the reports.
22
20 min.
Synthesis
Facilitator develops a synthesis, drawing from the reports and introducing aspects that
may not be mentioned. The following elements are suggested to be included. Draw on
suggestions from participants for other elements.
Key Elements
Resource Aspect
Constraint Aspect
Demographic
Foreign exchange
aid
as in table above
as in table above
Human resources
high rate of literacy
Gender - united
nation
low rate of literacy
Gender - divided
nation -ethnic split
minority problems
generous aid
available on
favourable terms
declining
declining aid
flow
Cultural
strong cultural
identity, open
to change
weak cultural
identity
Institutional
educational, legal
health systems well
developed
poorly developed
mainly the
privileged benefit
Government
decentralized
efficient
committed to
grassroots improvement
centralized
inefficient
Political
stable
unstable
Development
paradigm
favours people,
agriculture and
rural development
capital intensive
industrial
urban export
orientated
Economic
Aid
Foreign
exchange
earnings
etc.
23
growing
30 min.
Examining Country Specific Data
Participants extract data of their country or community that they have brought to the
workshop.
The facilitator may now examine selected data with the group. Raise the following
points:
How reliable is the data?
Implications of the data
e.g., Total population - some may question the figures - reliability depends on the
accuracy of the census
Data on women, e.g., literacy rates and difference between the sexes. What are the
implications on development?
Population as a resource - what does this mean for expenditure on health, education, etc.
Debt servicing - the strain this places on any development exercise. IMF adjustment
process has meant cuts in expenditure on social services, etc., which largely affects
adversely the poor.
The development model implicit in the statistics is capital intensive, urban/industrial,
export-oriented. What are the implications of this? What are the positive and negative
aspects?
24
HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
Toward People-Centred Development PCD (3.1)
DAY
3
TIME:
9:00am - 10:30am
11:00am - 12:30pm (total 3 hours)
BACKGROUND:
The presentation will be greatly facilitated by the preparation of overheads or flip
charts summarizing the main points. Avoid lecturing.
This session will help participants appreciate Primary Health Care (PHC) in a
developmental setting. Accordingly, the presentation will introduce participants to
three different development perspectives and focus on the evolving PCD
perspective. The three supporting references provide ample material for the
elaboration of this theme.
Present the four elements - people, participation, self-reliance and sustainability.
People
Who are they? They are the majority population in the third
world countries; the poor; the marginalized and the weak.
Focus on women as a special group.
Participation -
This means participation in decision making not only
implementation. People are empowered to effect change.
Self-reliance
Focus on being in control; psychologically, managerially and
financially.
Sustainability -
Focuses on the future.Changes in culture may be necessary to
ensure changes endure. Organizations may need to be
developed to provide a forum for involvement in future
decision-making affecting the community i.e. planning
structural change. Efforts are needed to develop the
environment rather than despoil it.
25
OBJECTIVES:
Participants list and explain:
- the main perspectives of development
- the emerging PCD perspective and its key elements
- focus the poor and powerless, especially women
- participation
- self-reliance
- sustainability
OUTLINE:
Review Day 2
5 min.
Alternative Approaches
30 min.
Relevant Home Experience
25 min.
Reports and Synthesis
20 min.
Break
30 min.
People-Centred Development
30 min.
What and How
30 min.
Clarifying Concerns
20 min.
Reports and summary
10 min.
RESOURCES:
Flip chart, newsprint, markers, overhead projector, overheads,’hand outs 3.1a, 3.1b
READINGS:
Required:
3.1a
Participation and Social/Gender Analysis, A Handbook For
Social/Gender Analysis, Coady Institute, 1989, p. 16-20.
26
3.1b
Recommended:
Towards Understanding Development, Coady Institute
Newsletter, Vol. 6, No. 1, 1986, p 7-10.
Seers,D. The Meaning of Development in Lehman,D. ed.
Development Theory. London: Frank Cass. 1979.
UNDP - Human Development Report 1990 Oxford. OUP 1990 p. 983
27
Detailed Notes for the Facilitator
5 min.
Review Day 2
Review the learning from the previous day - Bead Game.
30 min.
Alternative Approaches
The three main approaches to development - economic, dependency, and humanistic.
See hand out 3.1b.
25 min.
Relevance to Home Experience
Each group is to review the presentation answering the following questions:
a)
1In the context
\ of your country
/ or region, to what extent do you agree with
the problem diagnosis of each perspective - and with the proposed
solutions?
b)
How does your country/region’s development fit into the three
perspectives?
<0
Summarize findings on flip charts.
20 min.
Reports and Synthesis
All groups read reports and commonalities and differences are noted.
c Break
30 min.
What is People-Centred Development?
20 min.
Key elements:
The population - Who are the People, poor and marginalized should be the focus
of development. Note here to underline the gender issue and the position of
women.
The participation - What does participation mean?? Who participates? On whose
terms, for whose benefit? See hand out 5.1.
Self-reliance - focuses on our ability to control our own initiatives. People take
primary' responsibility to find the resources. Set expectations within resource
constraints.
28
Sustainability - people have a say in decision making. Ensure that development
benefits endure.
30 min.
How of PCD
Helping the people to take charge: animation, organization, action, evaluation,
Education is an ongoing process helping people to understand and act. Leaders must be
available accountable and have the ability to move the process forward.
There may be a need for a mediating organization to facilitate the action.
The political climate must favour these activities.
20 min.
Clarifying Concerns
As time is limited suggest that three groups be formed and each group examine a
different question.
Group 1
Group 2
Group 3
Why PCD - Is this relevant to Third World needs?
Implications of PCD to bureaucracy - Do we agree with its problem
diagnosis and prescription?
List concerns we have with PCD
Comments are written up for the other groups to view.
10 min.
Reports and Summaiy
Points to bring out of reports:
have there been substantial improvements in the lives of the poor?
how do we reach the poor?
how do we motivate and train the poor to become part of the bureaucracy?
what is our development role facilitator rather than doer?
listening and helping them to do things for themselves
list of concerns can be referred to at future points in the workshop.
29
HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
Team Building (3.2)
DAY
3
TIME:
1:30pm - 3:30pm
(1 hour 30 min.)
BACKGROUND:
The group will be given the materials and rules to construct a tower. Specific
instructions to the group are on the attached pages. Instructions should be
reviewed by the facilitator. Observers need to be briefed by themselves before the
exercise.
OBJECTIVES:
Participants begin to internalize the meaning of a participatory approach.
Participants list practical blocks to participation and relate it to work experience
OUTLINE:
Introduce the exercise and^rules
e^teawd. Groups are divided
into equal size, and materials
are distributed
15 min.
Tower Building
45 min.
Debriefing - ask for:
45 min.
Observers comments, participants
comments and feelings.
How did the group work together?
What was the planning process?
30
Was lime budgeted?
Discuss application to work
situations.
*
Source: Adapted from Pfeiffer and Jones, A Handbook of Structured Exercises
for Human Relations Training. La Jolla, California. University Associates. 1974.
Vol.II No. 32
RESOURCES:
Tower Building outline for the facilitator, observation sheets, materials for each
group as listed.
31
~T ia
O
36°i3
Detailed notes for the Facilitator
15 min.
Method
Divide into groups of equal size of about 8 per group. One person in each group is an
observer. The observer is selected by the group. The facilitator will brief the observers
on their task as outlined in Instructions to the Observer. The purpose of the observer is
to observe and report on group dynamics as on the next page (Instructions to Observer).
Observer does not take part but makes silent notes. Groups are informed about this
process during the briefing. Observer also ensures the rules are observed. Preferably
groups would work in separate rooms.
The exercise does not commence until the observer rejoins the group.
Following the tower building all groups meet in one room bringing with them their tower
and any remaining materials. Discussion and debriefing will take place.
This is a participator}', fun, learning activity.
Rules
Participants may use only the materials provided.
Participants can do anything with the materials.
Unused materials must be displayed with the finished product.
Work commences only after the observer rejoins the group.
* Facilitator will signal the commencement of the work and give warning before time given
has elapsed.
Materials
Each group is provided the same materials.
1 sheet of bristol board (standard size of flip chart paper
small piece of twine
one broad tipped felt marker
a blade or knife
10 paper clips
a ruler
paste or glue
(preferably things that can be readily assembled and are available. The whole idea is to
get the group to be creative with limited resources.)
32
45 min.
Tower Building
Groups work on building their tower according to the rules.
45 min.
Debriefing
Focus on the following during the debriefing:
1.
Examination of resources. The main largest resource was the creative imagination
of each participant. Did the process mobilize this? When working with others how
do we mobilize imagination to solve community problems which they identify?
Was the time seen as a resource? Were the resources themselves used
imaginatively?
2.
Examine process aspects. How well did they plan? Was anyone in the group
excluded? Did anyone exclude themselves? This can lead to:
ways of participation - active, passive
role of women in the group - did the women conform to traditional
roles? Does this happen in reality?
how did the leadership move? what caused the changes? - were
there changes in behaviour under the pressure of time? What
happened when there were only 5 minutes left? Did task
accomplishment take over and process get ignored?
3.
Reflect back to working in community/groups. Do any of the reactions and
problems occur in reality? Why?
33
TOWER BUILDING EXERCISE
Instructions to Observer:
Please make notes on both the task and the process using the following guidelines.
PROCESS ASPECTS
TASK ASPECTS
1.
Time taken to examine problem to assess resources
1.
Was there a pooling of ideas?
Was everyone brought in?
2.
Time taken to think about
alternative ideas - examine choose
2.
Did leadership evolve in the
group? How?
3.
Did the group have a clear idea
of how to proceed when they
started work? Was there a plan or
did they muddle along?
3.
Were ideas shared? Did everyone
know what they were planning to
build? What kind of a tower was
actually decided on?
4.
Was time seen as a resource?
Time budgeted for specific
activities e.g. to plan the whole
exercise, get ideas, etc.?
4.
Was everyone involved? What
was the degree of involvement?
What evidence was there of non
involvement? Did marginalization
occur? How?
r.
decide
General Comment:
co^Aucr- woufk £‘'crj
Was there a good balance maintained between Task Aspects and Group Process needs?
imhur-
Cu34
HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
Towards Empowering (3.3)
DAY
3
TIME:
3:30pm - 4:15pm
(45 min.)
BACKGROUND:
The main difficulty here will be in the first 15 minutes. Will the participants have
sufficient experience to share? If not there perhaps move to describe the top
down planning style and its weakness. Use handout 3.3a as a lead off on different
perceptions of the same problem. Use the table attached 3.3b to lead off
discussion on blue print vs. participatory planning approaches.
OBJECTIVES:
Participants can critically review their planning experiences:
discuss strengths and weaknesses of top-down vs. bottom-up planning; blue
print vs. process planning
establish a rationale for a more participatory approach to planning.
OUTLINE:
Plenary discussion on planning
15 min.
Discussion on top-down vs.bottom-up planning
15 min.
The participatory approach emphasised
15 min.
35
RESOURCES:
Felt markers, newsprint, tape, hand outs 3.3a, 3.3b, 3.3c
READINGS:
Required:
3.3a
Perception picture
3.3b
Hedenquist, Popular Partidpation in Rural Development,
Maasa Project in Zimbabwe, University of Stockholm,
Department of Anthropology, 1989
3.3c
Korten and Garner. Planning Framework for People-centred
Development and Korten and Klaus, "People-Centred
Development". Conn. Kumarian Press, 1989. p. 201.
36
Detailed Notes for the Facilitator
15 min.
Plenary Discussion on Planning
Given the perspectives on development discussed in the morning, the question arises how
to bring development about. A powerful tool used in this process is planning.
Discussion on:
What is planning:
obtain participants feedback and underline problem
definition, objective, resources, steps, time frame, and
inevitably choices.
Obtain feedback on participants' experience (may be top-down planning for
most).
Discussion on Top-down vs. Bottom-up Planning
15 min.
Use the information in the previous discussion to lead into discussion of top-down vs.
bottom-up planning; strengths and weaknesses of each approach. Distinguish between
blue print planning and process planning. (Use overhead of 33b)
15 min.
Participatory Approach Emphasised
' Summarize and establish the case for a participatory approach as follows:
a)
People's perception of problems and priorities may be quite different than our
own. Use handout 3.3a to have participants reflect on the different perceptions of
the same reality. The question could be What do you see in the picture? After
several answers have been discussed (and old lady and young lady) move on to a
discussion how different people perceive the same reality (based on values,
culture, beliefs, etc.). How a problem is defined will indicate how it will be
addressed or solved. Hence the need for people's input into problem definition.
b)
Involvement of people from the start will help them identify with the project. It
becomes their project. Motivation and commitment will occur to bring about the
desired changes that the project or program addresses.
c)
Minimally participants will enable us to tap local knowledge and local resource^.
37
d)
Our scarce resources include lack of trained human resources. We do not have
the resources to expand our bureaucracy to do all the development tasks. These
tasks must be shared with the people. This frees the bureaucracy to attend to
other tasks. Progressively tasks are handed over to the people so that more and
more tasks are managed locally. Why do something at a higher level when it can
be done equally well at a local level - with local people trained and helped to do
the job without compromising quality.
The role of the development worker shifts to facilitator of learning rather than an
implementor of projects. The people define, implement and benefit from the
development exercise.
e)
Implicit in any planning is the question of choice - and values. The participatory
approach ensures that the people have a real say in the process.
38
HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
Global Health Concerns (4.1)
DAY
4
TIME:
9:00 - 10:30
(1 hour 30 minutes)
BACKGROUND:
The participants will want to read and be familiar with the background material.
Examples from their own experience could be used. The multiplicity of factors
facing global health in the next decade and century will be mentioned with three
or four examples discussed in detail. The possible factors to be considered
include: population, nutrition, sustainable development, nuclear energy, military
proliferation, new viruses ie AIDS, and corporate behaviour ie drugs, alcohol,
bottle milk, tobacco.
The implications for global health of both people and the planet will be discussed.
Several examples of indications that awareness is increasing and concern is having
some affect on the situation will be given eg. Brundtland Commission on the
Environment and Development, UNICEF speaking out on structural adjustment.
The fact that change is happening and when it does it can happen much more
quickly than anticipated will be backed up with examples such as the Nestle’s
boycott, and the ongoing process of the G.E. boycott, polio eradication campaign
and the response to AIDS.
OBJECTIVES:
To describe three major threats to global health.
To identify current trends in health related issues.
To list four examples of success in dealing with global threats.
To increase awareness that the old ways of dealing with health issues have not
worked and new ways are important.
39
OUTLINE:
Plenary discussion
(based on the hand outs and
participants experience)
30 min.
Small Group Discussion:
50 min.
Which of the threats is perceived as a
priority in your country?
How do these problems affect health
in the community?
What can be done within the health
sector about such global
threats?
Plenary Reporting: Brief (2 min)
report will be made by each group
10 min.
RESOURCES:
Overhead projector, prepared overheads, newsprint and markers, video "Eyes See,
Ears Hear", hand outs 4.1a, 4.1b, 4.1c, 4.1d
READINGS:
Required:
4.1a
Public Health and the Global Environment, CJPH, vol 81.
Jan/Feb 1990
4.1b
Nelson, M. A Global Challenge: health promotion for people
and the planet, Health Promotion Fall 1989 p. 2-7
4.1c
Greiser, M. Yes, but Nothing will Happen Without
Regulation, Development Communication Report no.71 p. 16
4.Id
Ling, J. Communicating Disease through Words and Images,
Development Communication Report no.71
40
HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
What's Happening in Health? (4.2)
DAY
4
TIME:
11:00am - 12:30pm
(3 hours total)
1:30pm - 3:00pm
BACKGROUND:
The preparation for this session includes:
a)
examination of the answers to the pretest to determine participants
understanding of health systems and to determine groups. Participants will
divide themselves into regional or country specific groups.
b)
review of available statistical data on health indicators, GNP, etc. Any
sources of data may be provided by the participants and the facilitator.
Several examples are UNICEF, State of the World’s Children, World
Development Report etc.
c)
familiarization with the questionnaire for Health Assessment (hand out
4.2c).
An initial explanation of the framework provides an overview to participants and
prepares them for the group work session.
The concluding synthesis will pull together causative factors of the present health
care system.
The process should ensure that participants:
relate features of the health system as cause and effect;
become aware of various sources of data for their national health
system;
examine the reasons for differential access to national health
systems by rural/urban; rich/poor groups.
41
OBJECTIVES:
To develop skill in analysis of health care systems. This analysis will assess the
adequacy of a national health system to serve the health needs of citizens of
various socio-economic classes.
To enable participants to develop and discuss reasons to support their findings.
OUTLINE:
Introduction to the framework for analysis.
20 min.
Group work focusing on various national health
systems using health statistics, key
informants,etc.
60 min.
Guidelines for report writing. (This intervention
can be at any stage during the group work
refer to 4.2d)
10 min.
Presentation of work group reports.
60 min.
Synthesis Focusing on the distribution of health
care system benefits by socio-economic
class within society and the reasons.
30 min.
RESOURCES:
Pretest analysis, newsprint, markers, hand outs 4.2a, 4.2b, 4.2c, 4.2d
READINGS:
Required:
4.2a
Health and Development Chapter 1 of Health Research:
Essential Link to Equity in Development - Commission on
Health Research for Development. New York, OUP. 1990.
4.2b
Health Assessment Framework
4.2c
Health Assessment Questionnaire
4.2d
Guidelines for Report Writing
42
Detailed Notes for the Facilitator
Some Analytical Questions:
1.
List your key concerns in data arising from Section I. Why do these
situations exist? Lack of resources, problem not understood, problem
given low priority, poor management? What are the underlying causes root causes of the response to the question?
2.
Examine section III part 1 - Health services - Is there a disproportionate
use of health resources in urban vs. rural areas? What are the root causes
of this situation? Lack of resources, a paradigm that does not recognize
the morbidity realities or resource constraints, staff reluctance to serve in
rural areas, cultural problems? Who really benefits from the Health
budget?
3.
Examine Section III part 2 - Health System Decision-Making - What are
the reasons for lack of local input into decision making at the local level?
Is this lack of input a causative factor in some of the unsatisfactory features
of statistics in section I?
43
HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
Examining Alma Ata (5.1)
DAY
5
TIME:
9:00am - 10:30am
11:00am - 12:30pm
(3 hours total)
BACKGROUND:
During this session participants will review the Declaration of Alma Ata to
understand the 10 components including the 8 elements of Primary Health Care
(PHC) and discuss how PHC can be applied to achieve Health for All by the year
2000 (HFA 2000).
Aspects to be emphasised are:
acceptance of PHC by all health workers with integration of health
promotion, disease prevention, and treatment;
implications of applying the principles and elements of PHC at the
community, district and national level; and
development of a PHC approach to health problems including
understanding the priority health problem approach and the
meaning of essential national health research.
From the analysis of the strengths and weakness of the existing health system, the
demands and effects of the adoption of the PHC concept will be appreciated.
Consider how the training of health workers must be changed and community
participation and a district focus of health services achieved.
44
OBJECTIVES:
To understand the components and basic elements of the Declaration of Alma
Ata and progress made in implementing "Health For All" during the past 12 years.
To list four priority health problems from your country/district or community and
outline a PHC approach for each problem.
To describe the concept of essential health research.
OUTLINE:
Presentation in plenary of the 10
statements of the Declaration
of Alma Ata (see outline)
30 min
Discussion and questions
15 min.
Small groups using a case study
to examine the progress towards
Health for All by the year 2000
45 min.
Break
30 min.
Presentation in plenary of
prioritizing health problems and
initiating essential health research
as a means to monitor and support
PHC and HFA 2000
30 min.
Small groups work to apply PHC
strategies to selected priority
health problems
45 min.
Presentation of reports by
groups to plenary
15 min.
45
RESOURCES:
Newsprint, markers, hand outs 5.1a, 5.1b, 5.1c,
Report of WHO-UNICEF Conference Alma-Ata 1978 (Declaration),
Warren, KS, The Alma Ata Declaration Brittanica, 1990 supplement p 21-30,
Global Strategy for HFA 2000 - WHO 1981 Health for All Series # 3,
Ottawa Charter for Health Promotion - WHO/H&W Canada/CPHA 1986.
READINGS:
Required:
Recommended:
5.1a
Survey of Primary Health Care
5.1b
10 Components Alma Ata
5.1c
Evans, J., Community-based Health Care in Kenya, NEJM,
1990
Bryant, J.H., Commentary, APHA 74: p 714-919, 1984.
Hamburg, D.A., University’s Role in HFA - Development Forum,
Nov. Dec 1984, p3.
Canadian Task Force on Periodic Health Examination Parts I, II,
CMAJ:141, 1989, p 205-207, 209-211.
WHO March 1988, Alma Ata Reaffirmed at Riga, from Alma Ata
to the Year 2000, A Midpoint Perspective, 1989.
Cornea, A., Adjustment with a Human Face, UNICEF, 1990
46
Detailed notes for the Facilitator
30 min.
Alma Ata Presentation
In presenting Alma Ata to the group the hand out "PHC Survey" may be of help in the
discussion of:
Why a broader definition of health was developed.
Why it was felt the existing health services were failing and some of the solutions
proposed.
How the proposed PHC differs from primary medical care, firs aid, family
medicine, community medicine etc.
Are most of the problems presented in PHC socio-economic?
Although WHO and UNICEF jointly organized and sponsored Alma Ata consider
the major differences in approach ie. WHO-Horizontal program looking at
disease origins and working with the Ministry of Health, UNICEF-Vertical
programs with cost effective interventions, working regionally and often with the
head of state.
Consider the effects of the IMFs structural adjustment policies.
Why was such stress placed on the expanded program of immunization?
Consider some of the specific strategies eg. Bamako Initiative, Essential Drug
Program, Child Survival and Development Revolution, and Safe Motherhood.
Recognize the disastrous impact of the world recession on developing countries,
social plans and likewise the added insult of militarism and consider management
strategies is Adjustment with a Human Face.
How could you introduce the 8 elements of PHC at a district or community level?
Hand out 5.1b Ten Components of Alma Ata is referred to.
Discussion and Questions
15 min.
Small Group Work
45 min.
From the "Community-Based Health Care in Kenya" case study consider the CBHC
initiatives undertaken and the problems encountered. What would you recommend to
overcome these problems and how could you monitor progress towards HFA 2000. Some
of the possible approaches are indicated on the section title of Toward a Framework for
Action - developed at a WHO meeting in Harare in 1987.
The group might start by considering each of the CBHC experiences and discussion
action plans.
eg. Sensitization - social mobilization action - Community meetings with identification of
leaders and specific plans to fully inform leaders, develop a school program, initiate a
small inexpensive community project that will be rapidly completed and show results eg.
47
Community Nutrition garden, Ventilative Impaired Latrine at the school, Tree Planting
etc.
Break
30 min.
Essential Health Research
30 min.
Essential National Health Research (ENHR) supports the Alma Ata Declaration.
ENHR is an operational strategy aimed at accelerating action to improve the health of
people in developing countries. This strategy was recommended by the Commission on
Health Research for Development, a group of 12 experts from around the world who,
after a through two year study of the strengths and weaknesses of research on the health
problems of developing countries published their report. Health Research - Essential
Link to Equity in Development (Oxford University Press 1990).
The establishment of ENHR, a major recommendation of the Commission^ requires that
the developing country identify the country specific major health problems and design,
implement and evaluate action plans to deal with these problems.
Finding and sharing new knowledge, methods and techniques to address global health
problems should be a commitment of all investigators.
To establish ENHR, each developing country must make long term commitments to
health research in the amount of at least 2% of total national health expenditure and
establish financially sound and attractive career paths for their national researchers.
< Collaborative international research networks should be promoted to attack the common
problems of developing countries and international support systems strengthened to
facilitate expansion of research capacity and action.
International efforts should be made to mobilize research funds focused in an integrated
fashion on the priority health problems of developing countries. The commission
recommends the establishment of an international mechanism or agency to promote the
work of countries undertaking ENHR.
The Commission was supported and sponsored by many of the major international
donors, WHO, UN agencies, several Governments and Universities.
Already several developing countries have organized and initiated ENHR efforts.
National and international workshops have been held in various parts of the world and
an international task force and Geneva-based secretariat have ben established.
48
Concern has been expressed that some of the PHC strategies developed in the past with
major international organizations have resulted in too many workshops and task forces
and too little action in the developing country.
University faculty and students are key players in ENHR. For both students and faculty
it will strengthen the links between medical education and the general health needs of
society and could provide the medical teacher-scientist with an academically rewarding
and financially attractive career path. Major university commitments would facilitate the
rapid implementation and guarantee the sustainability of ENHR.
45 min.
Small Group Work Applying PHC
Small groups apply PHC strategies to selected priority health problems in their region or
country. Report should be summarized for brief presentation.
15 min.
Reports
Each group presents a brief report of their discussion.
49
HEALTH AND DEVELOPMENT WORKSHOP
EL
SESSION:
Community-Oriented vs. Community-Based Health Care
(5.2)
DAY
5
TIME:
1:30pm - 3:00pm and
3:30pm - 5:00pm
(total 3 hours)
BACKGROUND:
This session will examine the differences between community-oriented and
community-based health care, using short case studies,a mime and two quotations
for discussion. It will build on the principles of Primary Health Care outlined in
the previous session.
OBJECTIVES:
Participants will identify differences between community-oriented and community
based health care
Participants will begin to apply principles of primary health care to selected case
studies
Participants will outline a personal framework for working with communities
OUTLINE:
’’Crossing the River"
Starter Mime
20 min.
Review Principles of Primary
Health Care
10 min.
Analysis of 2 Case Studies
60 min.
50
Break
30 min.
Analysis of Video:
"Valleys in Transition"
60 min.
Plenary Discussion and Summary
30 min.
RESOURCES:
Newsprint, markers, case studies, quotes on change on flip chart, mime starter,
video and equipment, hand outs 5.2a, 5.2b, 5.2c, 5.2d
READINGS:
Required:
Recommended:
5.2a
Boyd, D., & Williams, D. (1989, March) Manual on Primary
Health Care, Prepared for the World YWCA. Oxford, UK:
Nuffield Press Ltd., p. 61-68
5.2b
Hilton, D. (1988, Dec.) Community-based or communityoriented: The vital difference, Contact No. 106, p. 1-4
5.2c
Mburu, F.M., (1989) Whither community-based health care?,
Social Science and Medicine. 20(3) p. 1073-1079
5.2d
Taylor, C. & Jolly, R., (1988) The straw men of primary
health care. Social Science and Medicine, 26(9), p. 971-977
Chandran, John,H. & Chandran, John, P. (1984, Dec.) We learn
through our failures: The evolution of a community-based
programme in Deenabandu. Contact, No. 82, Christian Medical
Commission, World Council of Churches, 150 route de Ferney, 1211
Geneva 20, Switzerland.
Hope, A., & Timmel, S. (1978) Training for transformation (volume
1) Zimbabwe: Mambo Press
Smith, S, Carpio, B, Hillman, E et al (1990) Women and Health:
Leadership Training for Health and Development Manual,
McMaster University
■
O (
(
,
1 -<
nOCU™’1-
.
A N Q AtO
'
.Jr
/i
Stark, R., (1985) Lay workers in primary health care: Victims in the
process of social transformation. Social Sciences and Medicine,
20(3), p. 269-275
Werner, D. (1980 August) Health care and human dignity - a
subjective look at community-based rural health programmes in
Latin America. Contact. No. 57, p. 2-15
52
Detailed Notes for the Facilitator
20 min.
"Crossing the River" Starter Mime
Select three participants prior to the session to do the mime. Ask them to practice the
mime and then perform it in front of the large group.
A mime is a play with no spoken words. Two lines approximately 5 feet apart are made
on the floor using string, chalk or masking tape. Pieces of paper are used to represent
stepping stones across the river. Another piece of paper represents an island in the
middle of the river. Arrange the rest of the participants so they will be able to see the
mime.
Perform the mime.
Questions for discussion:
- What happened in the role play?
- What different approaches were used to help people cross the river?
- Who could these people represent in real life?
- What could each side of the river represent?
- How could the role play be used by health care workers?
Be sure to cover the following points:
1.
2.
3.
distinguish between building dependence versus independence
identify self-reliance as a PHC principle
identify personal definitions of self-reliance (on a personal level, on a
community level). Identify what shared meanings exist in the group
10 min.
Review of Principles of PHC
In the large group, participants recall principles of PHC and list then on flipchart paper.
(This is a recall from the morning session and will assist the facilitator in assessing if
participants understood the terms used)
The list should include:
affordable, accessible, appropriate health services and technology
building of self-reliance
building of equity
multisectoral action
53
community participation
health as a fundamental human right and social goal
60 min.
Analysis of Case Studies
Divide into four groups. All groups will do both case studies, one at a time.
The small group will read the case study within their group. Decide which principles of
PHC the case supports. Make a distinction between those principles that are strongly
supported and those not supported. Discuss the reasons for the distinctions.
In the large group, report on the group’s decisions regarding support for PHC principles.
Read and review the second case study in the same way. Discuss in the large group.
Outline the process for decision-making that was used in each case study. Identify a
continuum with community-based at one end and community-oriented at the other. Ask
participants to give examples of programmes from home and identify where they fall on
the continuum. Discuss advantages and disadvantages of different types of programmes.
Break
30 min.
Analysis of the video ’"Valleys in Transition"
60 min.
Watch the video in the large group. Prior to the showing, ask the group to note the
following questions "What happened in the video?", "What were the actual steps taken in
the development of the programme?", "What was the impact on the community?", "How
were women involved?", "Who were the leaders?", "What principles of PHC were
< supported?".
Following the video, small groups meet to discuss the debriefing questions. As a large
group, outline on the flipchart paper the actual "unfolding" of the programme step by
step.
30 min.
Plenary Discussion and Wrapup
Two quotes are posted on flipchart paper and discussed by participants, giving examples
from their own situations.
"Health of the people is far more influenced by politics and power groups, by distribution
of land and wealth than it is by treatment or prevention of disease" (D. Werner)
"The fatal...error is to throw answers, like stones, at the heads of those who have not yet
asked the questions" (P. Tillich)
54
"Only when people themselves become actively responsible for their own and their
community's health, can important changes take place” (D. Werner)
"Community development workers who merely help people to become 'comfortable', who
simply do things for people - identifying and analyzing their problems for them, and
'doling out' answers, are part of the problem, not part of the long term answer." (Lik Lik
Book, Papua New Guinea quoted in Working Together - A Manual for Developing
Cooperative Work Skills in a New Culture, by S. Percival (1983) CUSO, p. 6)
55
HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
Optimizing Scarce Resources (6.1)
DAY
6
TIME:
9:00am - 10:30am
(1 hour and 30 minutes)
BACKGROUND:
The overall purpose of the session will be to describe the roles and
responsibilities of members of the health care team needed to optimize the scarce
resourcesand to describe changes in training necessary to meet these new roles
and responsibilities.
In order to achieve Health for All (HFA), the training and education of all health
workers must become more relevant to community needs. An appreciation of the
needs of community-based health is best achieved by early and extended training
in the communities to be served.
Aspects to be emphasised are:
Relevant training for all health workers emphasizing problem-based
learning
The importance of the team approach
Community-based learning
Life-long learning
Acceptance of the role of traditional healers etc.
OBJECTIVES:
Participants will be able to:
list categories of health workers in their country including the
approximate numbers of each and define their roles; this includes
herbalists, TBA's, CHW’s, traditional healers etc.
describe existing training for these health workers
56
discuss relevancy of this training to the priority health problems of
your country/ district/ community
describe modifications in training which are taking place in order to
achieve HFA (see Edinburgh declaration attached)
describe the health team concept, the District focus and community
involvement in participatory health care
given limited resources for health care, identify at risk population
describe methods to improve the imbalance of health care workers
in relation to areas of greatest need.
OUTLINE:
Introduction:
selection, education, utilization
and maintenance of competence
of providers of health care
discussion re changes to
present education of health
personnel
30 min.
Role play identifying functions
and roles of health workers
30 min.
Discussion of role play
15 min.
Summary
15 min.
RESOURCES:
Video: Eyes See, Ears Hear (Memorial U.) C.H.W. (IDRC) and Dominga
(CIDA), VCR equipment and monitor, District Health Manager - Case Study Ethiopia, hand outs 6.1a, 6.1b, 6.1c
57
READINGS:
Required:
Recommended:
6.1a
Evans, J. Health Care in the Developing WorldiProblems of
Scarcity and Choice, NEJM, 1981 vol 305 p. 1117-27
6.1b
The Edinburgh Declaration Lancet Aug. 20 p. 462 & 464
1988.
6.1c
The Risk Approach, WHO Forum, 1981, p. 413-422
Health Personnel for Health for All: progress or stagnation?
TAMAS FULOP WHO Chronic;e 40 (5) 194 - 199, 1986.
PHC:HFA and the Role of Doctors, H. Mahler, Tropical Doctor
1983, 13, 146-148.
International Consultation on Health Manpower - WHO ICP/HMD
157, 28 January 90.
King, M.(ed) Medical Care in Developing Countries, OUP 1966.
Berman, PB, 1987, Community-based Health Workers: Head Start
of False Start Toward Health for All; Soc.Sci.Med vol 25 pp 413-459
58
Detailed Notes for the Facilitator
30 min.
Introduction
With the community served, define the health care tasks and priorities.
Encourage empowerment of individuals to take responsibility for their own health and
the health of their families.
Find out from whom community members seek health care: traditional healers,
herbalists, relatives, TBA’s, CHWs, pharmacists, clinical officers, nurses, private
practioners, etc. whoever provides this care, and where it is provided. Who is available to
carry out health care - number, skills training, availability, etc.
Could any of the health care providers listed above benefit from further training? What
kind of training? By whom?
List the members of the basic health care team at the district level. Define their roles
and responsibilities and training needs. Can anyone with less training carry out any of
their duties effectively?
Who will evaluate success of health care provided? What indicators will you use to assess
this?
Discuss the population "at risk" and the "risk approach" as a means of optimizing scarce
resources.
< Remind participants that many people can often provide health care with minimal
training eg. parents, teachers, senior students, religious leaders, traditional healers, ... and
have the participants suggest others.
Identifying Functions and Roles of Health Workers
30 min.
This could be done through a role play, as attached, looking at who does what best.
(Competency based learning)
15 min.
Discussion of Role Play
As noted on the role play
59
15 min.
Summary
Points to remember are:
Worldwide shortage; in industrialized countries in the north and rural areas; in
developing countries everywhere except in urban centres and even there in urban
slums.
Why this maldistribution?
- selection, motivation
- training cost and content
- salaries/incentives
Recognition of changing role of health personnel to meet community needs
Development of new cadres: traditional birth attendant (TEA), community health
worker (CHW) and District Health Managers and their need for supervision and
integration into the health care system
Need for management skills, training and understanding of the team concept
Recognition of the community and personal responsibility for health
60
ROLE PLAY
You are a new nurse (doctor, administrator which ever you prefer) who has just
completed your training in the capital city. You have been assigned to work in a busy
African district hospital. You have just arrived and the nurse in Charge, who has worked
in the hospital for several years, and who comes from the district, tells you she has been
waiting for your arrival because there are 58 patients waiting for you in the clinic and a
woman in "obstructed labour" in the delivery room. She also says the hospital vehicle has
broken down in the health centre 6 km. away where it was sent to pick up a badly
burned child.
You meet to discuss management of the immediate situation now.
Later you and the senior nurse meet again with community leaders and health committee
members to discuss how the problems described above could be prevented in the future.
Participants should be allowed to role play either situation or develop their own
scenario.
INSTRUCTIONS TO PLAYERS:
NURSE: who has been in the hospital a long time resents new people and resists change
but knows the community well.
NEW HEALTH PROFESSIONAL: recognises problem and wants to make changes
< quickly but is unfamiliar with resources in the hospital and community.
COMMUNITY LEADER: accepts the problems of the hospital but does not see them as
a priority as s/he has many problems to deal with.
HEALTH COMMITTEE: are concerned but have not been involved in the hospital and
are more involved in the health centres.
61
DIRECTIONS FOR OBSERVERS:
This role play provides an opportunity to analyze the roles and responsibilities of health
workers and their ability to work together with the community they serve.
Was there an attempt to create an atmosphere or comradeship?
Could everyone see and hear the players?
Was the subject presented clearly?
Was everyone allowed to give an opinion?
How did the workshop participants react to the presentation?
Did the "new health professional" accept ideas from others?
Did s/he listen?
Was everyone given an opportunity to reply to the ideas of others?
62
HEALTH AND DEVELOPMENT WORKSHOP
sai
SESSION;
Force Field Analysis (7.1)
DAY
7
TIME:
11:00am - 12:30pm
(total 3 hours)
1:30pm - 3:00pm
BACKGROUND:
Any change effort must be preceded by a careful evaluation of the forces against
change; whether they could be overcome and if so, how. The technique of force
field analysis will provide participants with a tool to identify these forces.
This session will prepare the participants for the sessions on facilitating change.
It is suggested that the same groups that are formed in this session work together
through days 8 and 9.
OBJECTIVES:
Participants will become familiar with the technique of force field analysis.
Participants will identify forces that will restrain or support a thrust towards Alma
Ata. These forces are identified at personal, organizational and community levels.
OUTLINE:
Orientation to Force Field Analysis
30 min.
Force Field Analysis
75 min.
Reports to Plenary
45 min.
Summary
30 min.
63
RESOURCES:
Newsprint, flip charts, felt markers. Hand out 7.1a
READINGS:
Force Field Analysis
Required:
7.1a
Recommended:
Rifkins. Health Planning and community Participation. London
Croom Helm. 1985
64
Detailed Notes for the Facilitator
30 min.
Orientation to Force Field Analysis
Explain the basic ideas in force field analysis as below.
i)
Present the following proposition to the group -
Proposition - When planning a change program we concentrate mainly on the
technicalities of the change, on resources, budget, logistics, etc. and do not pay
much attention to how we might overcome opposition by the social forces that
amy be opposed to the change. These forces can undermine the change effort, e.g.
a food nutrition education program that does not address the cultural taboos; a
community health program that ignores possible opposition from traditional
health practitioners.
- Do participants agree with this?
- Call for examples from participant's experience and have them explain.
ii)
Force Field Analysis is a technique that helps us to identify the supporting and
restraining social forces vis a vis a proposed change. An integral part of the
change strategy will be how we will neutralize the restraining forces. Can they be
neutralized? If they cannot be neutralized and if they are a significant block to
change, should we pursue the proposed change? This raises the question of risks.
Who derides whether the risk should be taken? The external change agent or the
people who have to live with the change?
The focus is on social forces; on the social environment of change. The forces
occur at individual, organizational and community levels. This technique does not
consider factors like resource constraints, foreign exchange problems, physical
environment, etc.
iii)
The technique explain procedure as attached
reinforce understanding by haring participants examine a common
problem, e.g. forces for and against their efforts to study in Canada
list the restraining and supporting forces
assess the main impediments
examine how the restraining forces were neutralized
65
75 min.
Force Field Analysis
Randomly formed groups to identify the forces which will restrain or support and
movement to implement Alma Ata.
List forces at personal, organizational and collective levels.
examine the forces listed and identify three critical restraining and
supporting forces.
assess the reasons for opposition for each of the three critical restraining
forces
indicate how they may be addressed. Indicate the role if any of the three
supporting forces in reducing the opposition to change
This activity is done in small groups that will continue to work together during day 8 and
9.
45 min.
Reports to Plenary Session
Each group to present the three most important restraining and supporting forces.
indicate why they give these forces priority
indicate how they propose to address the restraining forces
indicate in their judgement whether the restraining forces can be
successfully overcome
Allow for clarification and discussion. If there is repetition focus clarification and
< discussion on forces not addressed in earlier reports.
30 min.
Summary
Examine whether the discussions have sufficiently highlighted opposition from:
"conventional" medical establishment
teaching schools
bureaucracy - accountability to the community
participants -look at themselves at the personal level, collective level with
peers and community level.
66
HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
Making Connections (7.2)
DAY
7
TIME:
3:30pm - 5:00pm
(1 hour 30 min.)
BACKGROUND:
The posters from all the sessions of day 4, 5 and 6 should be collected and
displayed on the walls. Some selection may be necessary if there are too many, to
ensure that key issues are included. Some process observation, particularly
humorous, could be included.
OBJECTIVES:
Participants will be able to:
describe the connections between global threats to health and health
priorities in their own count
summarize cunent trends in health and development.
OUTLINE:
Instructions for the session
5 min.
Preparation of a summary
40 min.
Presentations
20 min.
Summary by facilitator
30 min.
67
RESOURCES:
Posters from the sessions, newsprint, felt markers
READINGS:
Nil
68
Detailed Notes for the Facilitator
5 min.
Instructions
Participants are asked to summarize what has been learned during days 4, 5 and 6 to
compare it to the objectives. They should prepare a short summary for presentation in
plenary.
40 min.
Preparation of a Summary
Small group work with the facilitator providing direction and assistance when requested.
20 min.
Presentations
One or two groups are asked to present their summary.
30 min.
Summary
The facilitator walks through what has been cover in the past three days summarizing the
information and the learnings. Learnings are then compared to the objectives.
Participants comment on how well the objectives have been met. All groups should hand
in their summary to the steering/management committee.
69
HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
Understanding Organizations (8.1)
DAY
8
TIME:
9:00am - 10:30am
(1 hour 30 min.)
BACKGROUND:
The objective is to provide the participants with a conceptual framework for
understanding orgamzations.
Esman's framework of internal organizational variables will be presented. Four
approaches to analyze an organization will be presented. These are: the structural
approach, the human resource approach, the power or political approach and the
symbolic approach (see Bolman and Deal in bibliography). Against this
background a few of the participant’s organizations will be described and analyzed
with data provided by them.
OBJECTIVES:
Participants will be able to describe an organization in terms of structure and
linkage.
Participants will be able to analyze an/ organization from four approaches:
structural, human resources, power and symbolism.
OUTLINE:
Overview
15 min.
Esman’s Institution Building Model
30 min.
Organizational Analysis
30 min.
Discussion
15 min.
70
RESOURCES:
Overhead projector, overheads of hand out 8.1a newsprint, felt markers, flip chart,
hand outs 8.1a, S.lb^Sric?-
READINGS:
Required:
8.1a
The Institution Building Model
8.1b
Alternative Conceptual Frameworks for Organizational
Analysis _
/vs. cfl-
A-
r~8.1c
__
Recommended:
■
Bolman & Deal. Modem Approaches to Understanding - I
Managing Organizations. San Francisco, California. Jossey
Bass Inc. 1984
J
Esman, MJ. Elements of Institute Building in J.W. Eaton (Ed.)
Institution Building and Development. Beverley Hills, Sage. 1972. p.
19-40
71
Detailed Notes for the Facilitator
15 min.
Overview
An overview of the day will be presented with content area and rationale. Brief
discussion on participants’ experience on facilitating change with an organization and in
the community.
30 min.
Esman’s Institution Building Model
Presentation on Esman’s model (see attached).
Stress the internal variables - especially leadership - who are they - their role in
determining organizational doctrine (vision, mission, policy and strategy).
Discussion on vision, mission statement, key policies and strategy of participant s
organization.
Examine linkage aspects - what are the main linkages of the participant s organization.
Implications for programs. Internal, e.g. Ministry of Finance; External, e.g. WHO, World
Bank; donors.
30 min.
Organizational Analysis
* Approaches to organizational analysis will be outlined and discussed using the handout
as a basis. Four approaches will be outlined: structural, human resources, power and
symbolism.
Current Wisdom - Use all approaches as relevant - situationally appropriate.
15 min.
Discussion
This will be a general discussion about the points in the session.
What do participants feel is the most useful approach to analyze their organizations?
Structural - human resources, power and symbolism.
All organizations involved in improving the life in communities have to be judged by how
well they facilitate change. The question is whether the organization can effectively bring
about the change or is the organization itself a block to change? If so, why?
72
HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
Approaches in Planning Change (8.2)
DAY
8
TIME:
11:00am - 12:30pm (1 hour 30 min.)
BACKGROUND:
Participants will be introduced to the steps in planning a change and to the three
main approaches to change in an organization - mandated change (top down);
participative change (negotiated) and organizational change resulting from the
orchestration of external pressure.
OBJECTIVES:
Participants will specify the steps to plan an organizational change and indicate
the approach proposed - top-down; participatory; orchestrating external pressure.
' OUTLINE:
Steps in Planning Organizational
Change
45 min.
Approaches to Planning
Change
45 min.
RESOURCES:
Flip chart, newsprint, felt markers, hand out 8.2a, overhead: Hierarchy of Program
Objectives in an Organization
73
READINGS:
Required:
8.2a , Planning and Implementing Change
Recommended:
Bennis, W.G. ed. The Planning of Change. New York. Holt
Reinhart and Winston. 1976
Hax, A.C. Planning Strategies that Work. (Sloan Management
Revised). New York. OUP. 1987.
74
Detailed Notes for the Facilitator
Steps in Planning Organizational Change
45 min.
Whatever the change proposed it is suggested that a planned approach to bring about
the change will be an effective way to proceed. This plannned approach progresses
through the stepss outlined as attached. The change will always be within the framework
of organization purpose. See the overhead on the Hierarchy of Program Objectives.
Focus attention on the need to be clear on the problem before we attempt change. Refer
back to earlier sessions on perception. The point to emphasize is whether the "target
population" have a key role in defining and priprizing the problem.
Assessing the possibility of success or failure - integrate the social forces exercise.
Clarity of objectives - stated as an outcome that can be evaluated.
The need to examine options for action - do not implement the first solution that
comes to mind.
The action plan including monitoring, evaluation and budget - stress monitoring.
45 min.
Approaches to Planning Change
Outline what each approach is and each step: top-down, participatory, community
organization pressure. Discussion on the advantages and disadvantages of each. See notes
entitled "Approaches to Planned Change Within ai^f Organization" attached.
75
HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
Facilitating Organizational Change (8.3)
DAY
8
TIME:
1:30pm - 3:00pm
3:30pm - 5:00pm
(total 3 hours)
BACKGROUND:
The small group sessions and general discussions will enable skill development in
planning organizational change using the material covered in the morning
sessions. The small groups will work on manageable organizational problems
which hinder adaptation of participatory programs identified on day 7.
OBJECTIVES:
Participants will develop a greater understanding of how organizational change is
planned.
Participants will use a planning framework to map out a change program.
Participants will use specified strategies to facilitate change in an organization.
OUTLINE:
Plenary
- select different factors
5 min.
Analysis and Planning
85 min.
Presentation and Discussion
60 min.
Summary Comments
30 min.
76
RESOURCES:
Newsprint, flip chart, felt markers
READINGS:
*
Nil
77
Detailed Notes for the Facilitator
90 min.
Analysis and Planning
The Same groups as force field analysis will be used.
Each group selects one organizational factor that has to be addressed if it is to move
towards promoting Alma Ata - select one from the outputs of day 7 session of force field
analysis.
Use the outputs developed in the presentation on organizational change to plan changing
the organizational factor selected.Specify the problem clearly; indicate objectives as
outcomes you can evaluate and have a well thought out action plan.
Select a relatively simple problem because of the time constraint of the exercise, e.g.
staff reorientation to favour Alma Ata. Suggest That group be creative in presenting
their reports, e.g., they might role play the problem definition and aspects of solution.
They might represent these pictorially or in mime.
60 min.
Presentation and Discussion
The groups will present their report in the plenary session. Each group will have 15
minutes. Suggest creative ways to present the information eg. role play, mime, discussion,
etc.
30 min.
‘ Summary
Comments and summation will highlight the problems arising in the group report. Pay
attention to the following:
problem definition is not clear - have all relevant factors been taken into
consideration?
change objective not specific and measurable
monitoring not clear
overambitious plan - time factor not sufficient; dependence on external
resources
non involvement of those affected in design and monitoring, women not
thoroughly involved although they may be affected.
78
HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
Strategies for Community Change (9.1)
DAY
9
TIME:
9:00am - 10:30am
11:00am - 12:30pm (total 3 hours)
BACKGROUND:
The purpose of this session is to enable participants to develop a better
understanding of the community in which they have or will be working.
Some of the internal dynamics and differences within a community which could
mitigate against efforts of community change will be examined.
OBJECTIVES:
Participants specify their understanding of community in a given situation.
Participants indicate several differences that may exist in a given community.
Participants discuss the implications these differences have on implemention of a
proposed community change.
Participants specify key strategies that may be used to facilitate community
change.
OUTLINE:
What Is a Community?
30 min.
Implications of Differences with a
Community for a Proposed Change
30 min.
79
Strategies - Overview
30 min.
Group Exercise
45 min.
Reports and Summation
45 min.
RESOURCES:
Flip chart paper, felt markers, tape, hand out 9.1a
READINGS:
McDonald: Strategies for Community Change, extract from
Strategies of Planned Change, Antigonish, CII, 1985
Required:
9.1a
Recommended:
Chambers: Rural Development: Putting the Last First. Chapters
2,3,6,7 and 8. London. Longmans 1983
80
Detailed Notes for the Facilitator
30 min.
What is a Community?
In buzz groups have the participants share their idea of community and follow with
discussion. In what sense is a village a community? What is a community in an urban
setting? Community may be a geographic/administrative concept or a concept of
interrelationships - bonds, culture, etc.
30 min.
Implications of Differences for Change
In any group of people there are differences of wealth, status, position, education, sex,
etc. Differences mean that the interests of all are not identical, e.g., understanding,
priority and approach to the same problem may differ based on whether one is male or
female.
There is a need for the participants to be clear about who is the target community.
Differences exist within the group and vis-a-vis the larger community within which the
target group lives. Generate discussion (buzz groups) on:
implication of difference for change
get examples from the participants
30 min.
Change Strategies - Overview
Proposition - There is no one method to bring about change in a community. Invite the
group to share experiences indicating the problems addressed and strategy used. Lead
< discussion into problems encountered in using the strategy. Move to a discussion of
advantage and disadvantage of each strategy. Perhaps summarize in a matrix as follows.
Strategy
Difficulties
Experienced
Advantage
Disadvantage
Force/
coercion
popular
resentment
quick
result
will change
endure when
pressure is
removed
Inducement
eg baby bonus
Legislating
change eg.
food standards
good PR
good response
resentment, people uniform
do not understand; standards
expensive
feel imposed on
81
?
policing
essential
Move discussion to be aware of a range of strategies and choose on or a combination
appropriate to the situation, (hand out 9.1a)
Provide a quick overview of the strategies.
45 min.
Small Group Exercise
Each group will review two assigned strategies. They will assess the relevance to local
needs and situations. What will be the difficulties implementing the strategy? Examine
the steps to ensure you know how to use the strategy. Summery report on flip chart and
posted for others to read.
45 min.
Reports and Summation
15 minutes is given for the participants to read others reports. Each group will be
allowed to clarify their report to the large group.
Facilitator may help the group to determine the strategies they are most likely to use and
reasons.
82
HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
Planning Community Change (10.1)
DAY
10
TIME:
9:00am - 10:30am
11:00am - 12:30pm (total 3 hours)
BACKGROUND:
The purpose of this session is to provide participants with an opportunity to
acquire insight and skills in the use of change strategies. The same groups who
did the force field analysis to a) identify a common restraining force to the
introduction of community health programs; b) to use one or more of the change
strategies to deal with the restraining force. Planning must be as realistic as
possible within the resources normally available at the community level.
OBJECTIVES:
Participants will plan a program for successfully implementing a proposed change.
OUTLINE:
Planning for Community Change
90 min.
Break
30 min.
Group reports
60 min.
Summary
30 min.
RESOURCES:
Flip chart, newsprint, felt markers
83
READINGS:
Nil
84
Detailed Notes for the Facilitator
Study the outputs of the force field analysis of day 7 to identify suitable themes for the
group exercise. If no suitable themes are available, prepare a few as suggested below for
consideration by the participants.
90 min.
Planning for Community Change
Small groups will work on planning a community change for a problem identified in the
force field analysis. If no suitable case each group may specify a problem from their
experience, e.g., planning mass immunization in a village where immunization is new;
setting up a village health committee; retraining TBA's; introduction of family planning;
addressing the problem of alcohol and drugs.
Suggested time breakdown:
Selection and specification of topic and change objective (20 min.)
Examine the strategy options (15 min)
Elaborate the plan of action (45 min)
Prepare report (10 min)
Note Assume no additional resources are available. You have only those that are
normally available.
Break
30 min.
Group Reports
60 min.
Groups reports to consider the plans generated.
Consider:
- how realistic are the plans
- how achievable are the plans
- clarity of objectives/measurability
- monitoring plans
- cost effectiveness
- the participatory dimension
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30 min.
Summary
Highlight the advantage of the participatory approach for:
- local insights in problem definition
- involvement of local people in setting objectives, providing resources, monitoring
- reducing costs - especially financial and trained human resources
- aspect of continuity
- role of people in decision making
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HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
Evaluation
DAY
11
TIME:
9:00am - 10:30am
(1L1)
(1 hour 30 min.)
BACKGROUND:
The purpose of the session is to provide an overview of the need for evaluation
and basic steps in evaluation.
Material to be covered will be dependent upon the group's familiarity with
evaluation and evaluative methodology. Daily evaluation will also help determine
what needs to be covered here.
OBJECTIVES:
Participants indicate the need for and the main steps in evaluation.
Participants discuss a variety of methods for evaluation.
OUTLINE:
Review of Daily Evaluations
15 min.
Overview of Evaluation
30 min.
Discuss Main Steps in Evaluation
45 min.
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RESOURCES:
Overheads, overhead projector, hand outs 11.1a, 11.1b
READINGS:
Required:
11.la Evaluation overview
11.1b Evaluation, Continuing the education of Health Workers, A
Workshop Manual, Abbatt WHO 1988 p. 80-88, 145-149
Recommended:
Feurestein, Marie, Thene, Partners in Evaluation, London,
Macmillan. 1986
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Detailed Notes for the Facilitator
15 min.
Review of Daily Evaluations
Review the daily evaluation experience focusing on objective, method and findings.
These are the three main elements in any evaluation.
15 min.
Overview of Evaluation
Participants in triads develop answers to the following questions:
what is evaluation?
why evaluate?
when to evaluate?
how to evaluate?
list the main steps in evaluation
Have prepared answers to these questions to summarize the points.
60 min.
Steps in Evaluation
Participants post their findings and comparisons are made to the facilitators prepared
materials.
Clarify the main steps in evaluation:
purpose
objectives
deciding on data requirements/sources/methodology/ resource constraints
developing the "instrument" - pretesting
preparing the community for the exercise
preparing the data gatherers
collecting the data
analyzing the data
preparing the report
presenting the report
the participatory dimension
clarifying any concerns
Given the time available perhaps focus on the following points:
clarity of objectives
method to be used
monitoring
presenting findings to the audience concerned in a useful manner
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the participatory dimension focuses on how to involve the community in
the process. There is a need to demystify evaluation as something only
experts can do.
90
HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
Evaluation Instrument (11.2)
DAY
11
TIME:
11:00am - 12:30 pm (1 hour 30 minutes)
BACKGROUND:
During this session the group will develop a participatory evaluative method and
tool to evaluate the Health and Development workshop.
OBJECTIVES:
Participants develop a plan and method for participatory evaluation of the
workshop.
OUTLINE:
Introduction
15 min.
Small group work
45 min.
Final design
30 min.
RESOURCES:
Felt markers, newsprint, paper, copies of pre-test
READINGS:
nil
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Ke*
Detailed Notes for the Facilitator
15 min.
Introduction
Briefing on the exercise. The evaluation design will be developed in small groups and
negotiated and finalized in plenary.
The task is for each group to develop a plan to evaluate the 11 day workshop with
regard to:
- workshop objectives
- personal objectives
- methodology
- process
Each group will develop objectives for the evaluation, methodology to be used and
instrument to be administered.
45 min.
Small Group Work
Small groups will work on the above tasks.
15 min.
Final Design
< Each group reports to plenary and the final design is negotiated.
The following dimensions should be included:
- relevance of content
- time devoted to themes
- logic of sessions
- methodology
- resource persons
- readings and handouts
- preparation arrangements
- physical facilities
- facilitators
- improvements suggested
- need for similar workshops
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HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
Evaluation (11.3)
DAY
11
TIME:
1:30pm - 3:00pm (1 hour 30 min.)
BACKGROUND:
The participants will use the agreed upon tool, individually, to evaluate the
workshop.
OBJECTIVES:
Participants evaluate the workshop.
OUTLINE:
Small Group Work
45 min.
Presentations to Plenary
30 min.
Post-test
15 min.
RESOURCES:
Evaluation tool, paper, post test
READINGS:
nil
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w
Detailed Notes for the Facilitator
Small Group Work
45 min.
Workshop will be evaluated by using the agreed upon design. Summary reports will be
prepared for presentation in plenary.
Presentations in Plenary
30 min.
Summary reports will be presented and questions for clarification. Main concerns will be
identified and recommendations developed for program improvement.
Post-test
15 min.
Participants will complete the post-test individually.
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HEALTH AND DEVELOPMENT WORKSHOP
SESSION:
Closing (11.4)
DAY
11
TIME:
3:00pm- 3:30pm
(30 min.)
BACKGROUND:
The closing will provide an opportunity for the participants and facilitators to
formall close the workshop. It is important for all people to know when it is
officially over. People will be given an opportunity to speak with each other, say
farewell after an intensive 11 days together.
OBJECTIVE:
Participants formally close the workshop.
This activity will be planned by the particpants and the management committee.
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