Health Promotion International, Vol. 18, No. 2, 99-106,
June 2003
© Oxford University Press 2003
Building capable communities: experiences in a rural Fijian context
Health Promotion Specialist, York, UK
Address for correspondence: Glenn Laverack, 41 Algarth Road, Pocklington, York YO42 2HW, UK, E-mail: grlavera{at}hotmail.com
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SUMMARY |
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This paper discusses the design of a methodology for ‘building capable communities’ in a health promotion programme context. The design of the methodology builds upon previous work and offers a new approach, through the use of nine ‘operational domains’, for the assessment and strategic planning of community empowerment. The purpose is to go beyond the rhetoric of participation and empowerment, and to provide a better understanding of how community empowerment goals can be made to be operational in a health promotion programme context. The experiences of implementing the methodology in two rural Fijian communities are discussed briefly. The common themes for the successful application of the methodology have been identified. The paper will be of interest to the planners and evaluators of health promotion programmes that aim to build community capacity and promote empowerment.
Key words: community empowerment; Fiji; health promotion
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INTRODUCTION |
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TOPSUMMARYINTRODUCTIONMETHODSEXPERIENCES OF IMPLEMENTING THE...CONCLUSIONSREFERENCES |
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Community empowerment is central to health promotion and yet making this concept operational in a programme context has proven to be difficult. This paper builds upon previous work by the author (Laverack, 1998
; Laverack, 1999; Laverack and Labonte, 2000; Laverack, 2001; Laverack and Wallerstein, 2001) by discussing the design of a methodology that uses nine ‘operational domains’ for the assessment and strategic planning of community empowerment. The operational domains are the organizational influences of community empowerment, which provide a link between the inter-personal elements such as individual control, social capital and community cohesiveness, and the contextual elements such as the political, socio-cultural and economic circumstances of a programme. They represent those aspects of the process of community empowerment that allow individuals and groups to organize and mobilize themselves toward social and political change. I believe that the operational domains are a robust measure of a ‘capable community’, for example the existence of functional leadership, supported by established organizational structures with the participation of its members who have demonstrated the ability to mobilize resources, would indicate a community with organizational empowerment.
The operational domains were identified from a review of the relevant literature, with particular reference to the fields of health, social sciences and education, to provide an in-depth understanding of programmes that sought to achieve the same goals: to bring about social and political change. The domains were categorized from a textual analysis of the literature and the validity of this data was cross-checked by two other researchers using a confusion matrix approach as discussed by Robson (Robson, 1993). These domains were later checked against the historic literature on community development, and the emerging literature on community capacity building to ensure their face validity (Labonte and Laverack, 2001). A summary of each domain is provided in Table 1 and a detailed interpretation is provided by Laverack (Laverack, 2001).
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There is a considerable body of literature on the theoretical and philosophical issues of empowerment (Rappaport, 1987
; Zimmerman and Rappaport, 1988; Zimmerman and Zahniser, 1991; Rissel et al., 1996) but, with the exception of Fetterman et al. (Fetterman et al., 1996), there is little discussion in regard to the practical evaluation of community empowerment. There is also a broad body of literature concerning the assessment of concepts that overlap with community empowerment in their aim to redress inequalities in society (Rifkin et al., 1988; Jackson et al., 1989; Bjaras et al., 1991; Minkler, 1992; Eng and Parker, 1994; Goodman et al., 1998), however this discussion usually stops at assessment. What is new about the methodology discussed in this paper is that it goes beyond assessment to offer a means by which to transform the information collected into action and future planning. This is achieved through using the nine operational ‘domains’ as a focus for strategic planning such that the programme:
- improves stakeholder participation;
- increases problem assessment capacities;
- develops local leadership;
- builds empowering organizational structures;
- improves resource mobilization;
- strengthens links to other organizations and people;
- enhances stakeholder ability to ‘ask why’;
- increases stakeholder control over programme management; and
- creates an equitable relationship with outside agents.
The methodology does not therefore start with a blank slate onto which participants can inscribe their own problems or needs, but provides a pre-determined focus through the operational domains.
The design of the methodology is based on the understanding that the concept of ‘community’ may be interpreted as heterogeneous individuals and groups who share common interests and needs, and who are able to mobilize and organize themselves toward social and political change.
It is the interpretation of community empowerment as a process progressing along a dynamic continuum (individual empowerment, small groups, community organization, partnerships and political action) that provides most insight into the measurement of the competencies and capacities developed toward social and political change within programmes. The process of community empowerment is influenced by both social and organizational areas of influence.
The design of a methodology should be participatory and have clear roles and responsibilities for all participants. Development approaches are sometimes criticized for only using the rhetoric of participation, which can lead to the unjust and illegitimate exercise of power (Cooke and Kothari, 2001). In practical terms, participation allows the different stakeholders of a programme to express their views, share their experiences and to challenge existing knowledge claims and paradigms. Different participants may have different opinions, and the methodology allows individuals to participate with an equal relationship between all parties and facilitates the involvement of each member through their discussion and interaction with each other.
The methodology should be an empowering experience and provide a means to translate the information gained into action through strategic planning. The process of community empowerment promotes the capacity building of heterogeneous individuals who have shared interests and concerns. It engages them in small group activities, organizational structures and links with others towards an increased awareness of the broader social and political causes of their circumstances. The methodology allows the participants to focus on the organizational aspects of this process and provides opportunities for them to strengthen the capacity of their community in each area through assessment and strategic planning. (Laverack and Wallerstein, 2001).
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METHODS |
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The methodology employs a participatory approach in four phases (see Figure 1
), as outlined below.
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- Preparation (including the development of a working definition for empowerment).
- Assessment of each operational domain.
- Strategic planning for each operational domain.
- Follow-up (re-assessment and comparison of progress).
This series of steps is not a new element of the design and is purposefully similar to the logical process used in other approaches such as the Precede model (Green and Kreuter, 1991). The methodology also uses a simplified version of the logical framework system of project planning to provide a 6 x 10 matrix as a summary of the assessment and strategic plan for the nine operational domains.
Phase 1: preparation prior to implementation of the methodology
A period of observation and discussion prior to the assessment of community empowerment is important to adapt the methodology to the social and cultural requirements of the programme participants. The use of a working definition of community empowerment is important to provide all participants with a more mutual understanding of the programme in which they are involved and toward which they are expected to contribute (Laverack, 1998).
Phase 2: assessment
Activity 1: an assessment of each operational domain
The participants first make an assessment of each domain. To do this they are provided with five statements for each operational domain, each written on a separate sheet. The five statements represent a description of the various levels of empowerment related to that domain. Taking one domain at a time the participants are asked to select the statement that describes most closely the present situation in their community. The statements are not numbered or marked in any way and each is read out loud by the participants to encourage group discussion. The descriptions may be amended by the participants or a new description may be provided to describe the situation for a particular domain. In this way the participants make their own assessment for each domain by comparing their experiences and opinions. This is placed in column 3 of Table 2.
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Activity 2: recording the reasons for the assessment
It is important that the participants record the reasons justifying the assessment for each selected domain. First, it assists other people who make the re-assessment and who need to take the previous record into account. Secondly, it provides some defensible or empirically observable criteria for the selection. This overcomes one of the weaknesses in the use of qualitative statements or ‘mini-stories’, that of reliability over time or across different participants making the assessment (Uphoff, 1991
). The justification needs to include verifiable examples of the actual experiences of the participants taken from their community to illustrate in more detail the reasoning behind the selection of the statement.
Phase 3: developing a strategic plan for community empowerment
The assessment in phase 2 is in itself insufficient to empower the participants who must also have the ability to transform this information into action, with respect to decisions that influence their lives. This is achieved through strategic planning for positive changes in each of the nine operational domains, as discussed earlier in this paper, using three simple steps: (i) a discussion on how to improve the present situation; (ii) the development of a strategy to improve upon the present situation; and (iii) the identification of any necessary resources.
Activity 3: a discussion on how to improve the present situation
Following the assessment of the domain, participants are asked to decide as a group how this situation can be improved in their community. If more than one statement is selected, the participants should consider how to improve each situation. The purpose is to identify the broader approaches that will improve the present situation and provide a lead into a more detailed strategy. If the participants decide that the present situation does not require any improvement, no strategy will be developed for that particular domain.
Activity 4: developing a strategy to improve the present situation
The participants are next asked to consider how, in practice, the present assessment can be improved. The participants develop a more detailed strategy based on the broader approaches that have already been identified in column 4 of Table 2
by:
- identifying specific activities;
- sequencing activities into the correct order to make an improvement;
- setting a realistic time frame including any significant benchmarks or targets; and
- assigning responsibilities to complete each activity within the time frame.
Activity 5: assessing resources
The participants assess the internal and external resources that are necessary and available to improve the present situation, for example technical assistance, equipment, land, finance or training. This includes a review of locally available resources and resources provided by an outside agent.
Phase 4: follow-up and re-assessments
It is the responsibility of the facilitator to provide a copy of the completed matrix to the other workshop participants. The matrix is the basis for further discussion, planning and action by the participants, who must meet every 3–6 months to review the assessment and strategic plan that they have developed.
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EXPERIENCES OF IMPLEMENTING THE METHODOLOGY IN A RURAL FIJIAN CONTEXT |
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The methodology was implemented in two rural Fijian ‘tikinas’ on the main island of Viti Levu. Fijian villages provide a geographical boundary for the community and these are grouped into districts (tikinas). The districts are grouped into 14 provinces, and the provinces make up four administrative divisions. The tikina typically represents three or four communities who share the same needs and interests, a cluster concept similar to that developed by Korsching and Borich (Korsching and Borich, 1997
). The Tikina Health Committees (THC) of Nasikawa (17 people) and Bemana (14 people) each participated in the implementation of the methodology described in this paper.
The study was carried out with the support of the AusAID, Fiji Trilateral Health Promotion Project, between July 1997 and August 1998. A focus of the project was ‘developing knowledge bases for health promotion ... including best practice and ensuring that this was available and accessible to all health promotion practitioners’ (National Centre for Health Promotion, 1997). The study had ethical approval from Deakin University in Melbourne. The consent of the participants involved in the study was based on information provided in a plain language statement. After reading or listening to a translation of the statement, each participant was required to sign a consent form. The statement and consent form were provided separately so that the participant could keep a copy of the statement and return the signed form to the interviewer. For the purpose of confidentiality, pseudonyms have been given to the interviewees.
The following is a brief account of the follow-up interviews that were made with workshop participants in July 1998 to evaluate the usefulness of the methodology.
The Nasikawa Tikina Health Committee: a ‘kick start’ response
Nasikawa is a 2-hour drive along a dirt track from the South West coastal town of Sigatoka. At the time of the follow-up visit, only one former workshop participant was available for interview, Mr Tuiono. The interview was held on the veranda of the village school, seated around a small table on a hot and humid day.
Mr Tuiono remembered that immediately after the workshop, a meeting had been convened to discuss the content of the matrix. Another meeting was organized 2 weeks later to discuss how the participants were going to put the strategic plan into practice.
Mr Tuiono felt that the workshop had provided a ‘kick start’ for subsequent community activities, e.g. during the workshop the participants had developed a checklist of indicators for a safe and hygienic community based upon their discussion of the domain ‘organizational structures’. The THC members now periodically visited other communities to check for health and safety standards according to the checklist, and directed remedial work to clean the environment and to repair water and sanitation facilities.
The methodology had engaged the participants in a process of logical thinking and critical self-assessment. Murray and Graham describe a similar phenomena in Scottish communities where a participatory process was observed to facilitate changes and action after identifying needs and resources to address concerns about local transport and the security of children’s play areas (Murray and Graham, 1995). The methodology in Fiji had acted as a ‘trigger’ for further action involving individuals in small group meetings, establishing links between communities and raising resources to carry out the remedial work. This is a process of capacity building along a dynamic continuum as described by Jackson et al., Labonte and Rissel (Jackson et al., 1989; Labonte, 1990; Rissel, 1994).
The Bemana Tikina Health Committee: positive action
Bemana is a neighbouring tikina to Nasikawa, and at the time of the visit two members of the workshop were available for interview, Mr Tupou and Mr Veramu. The interview was held in an open-sided meeting hall, with a floor covered with rush matting, that was provided for informal gatherings in the village.
A copy of the matrix had been recorded by one of the participants on a blackboard during the workshop. This had remained in the community hall where the THC had held subsequent meetings. The THC had used the content of the matrix to discuss various issues, e.g. Mr Veramu commented that:
Strengthening traditional leadership was a subject for discussion and this had been taken from the blackboard. Traditional leaders are not performing (in our community) and a resolution was made to request them to attend meetings regarding decision making. (Interviewee B, Bemana THC.)
The THC was willing to identify openly that leadership was weak and that this was mainly due to poor capacity, support and communication between the leaders, the community and organizations outside the tikina. The participants were able to identify a number of realistic solutions to these weaknesses (see the assessment and strategic plan by the Bemana THC for the domain ‘leadership’ in Table 2).
Following the workshop, and at the request of the THC, a Fijian non-government organization had organized leadership training to address the issue of conflict resolution between clan leaders. The methodology had assisted in strengthening leadership, building links in the community, promoting participation and gaining support from an outside agency. These are examples of the operational domains, discussed earlier in this paper, that can strengthen the process of capacity building.
Common themes for successful implementation
The common themes for the successful implementation of the methodology were identified as: (i) a free flow of information between participants (access to the matrix, sharing of information between the participants and with other communities, and clear expectations); and (ii) the need for follow-up and support (from the facilitator and from outside agents).
A free flow of information: sharing ideas and visions
The need for dialogue, the free flow of information and open communication between the participants is essential for effective implementation. To avoid misunderstandings the expectations of using the matrix must be clearly defined by the participants and a consensus reached at the time of the workshop. The expectations must be documented and a copy should be sent to the participants along with the completed matrix.
The need for the free flow of information has also been identified as an important element in the process of community empowerment in the context of development programmes by other authors. MaCallan and Narayan identified active inter-agency collaboration and effective communication as important elements (MaCallan and Narayan, 1994). Speer and Hughey identified dialogue between the community organization and the individual as being the most important action towards community empowerment (Speer and Hughey, 1995).
The sharing of information from one person to others, even when everyone had an equal sense of ownership, did present a challenge during the implementation. Traditional protocol was offered by the participants as one of the main reasons behind the failure to communicate information. Traditional protocol is followed when the approval of the village chief is obtained to hold a meeting, prior to the agreement of the THC. This alone may have been reason enough to dissuade the person receiving the matrix from organizing a meeting:
Holding a meeting may be discouraged by the traditional protocol and may not be seen as important because the person may have other more pressing issues. (Interviewee A, Nadi.)
A chief is always accorded the outward signs of respect and thus he is seen to be the leader. Matters of tradition or culture are his concern and this would include holding meetings with the other village leaders. Even though a person may gain prominence, respect and authority within the community because of his/her personal qualities or through the acquisition of wealth, he/ she would have to defer to the chief on matters of tradition and culture. Individuals may be reluctant to defer to the chief to ask for a particular favour, such as organizing a meeting, if he/she lacks respect for the chief or if he/she is not on good terms with the chief at the time.
The need for follow-up: fostering encouragement and support
Leonard and Leonard point out that many years of training experience in Fiji has identified the need for follow-up by someone who has an understanding of the purpose and function of the workshop (Leonard and Leonard, 1991). They stress that this is particularly important at the village and tikina levels and suggest that follow-up should take the form of regular meetings to help people identify and solve issues that may be hindering progress.
The person(s) designated to follow-up may be an outside agent or community member/ facilitator. The purpose of the follow-up meetings is to provide advice and encouragement and to resolve barriers to the successful implementation of the matrix. Framework systems have been successfully employed as a part of training in Fiji at the community level (Leonard and Leonard, 1991), and support to the Bemana THC by an outside agent was greatly assisted by the matrix, which provided a concise summary of planned future action in the community.
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CONCLUSIONS |
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TOPSUMMARYINTRODUCTIONMETHODSEXPERIENCES OF IMPLEMENTING THE...CONCLUSIONSREFERENCES |
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The use of the methodology described here in Fiji has demonstrated the following.
- That implementation differs according to the level of communication, support and follow-up between participants.
- Participants are able to complete each phase as a sequence: preparation; assessment; strategic planning; and follow-up. This was found to be an indication of a high degree of logical thinking and of organizational skills of the participants.
- The development of a strategic plan for community empowerment can be achieved in a 1- or 2-day participatory workshop setting.
- The completed matrices presented achievable, realistic and often innovative outcomes towards community empowerment.
Experiences in rural Fijian communities also demonstrated the need for cultural considerations to be taken into account during the implementation of the methodology. For example, the design has to be flexible enough to accommodate variable time frames, different patterns of participation, perceptions of time and specific cultural protocol.
The Ottawa Charter (World Health Organization, 1986) defines health promotion in terms of ‘enabling people to increase control over, and to improve, their health’. Collectively, this is the process of community empowerment. By using approaches (such as those outlined in this paper) that promote community empowerment to build capable communities as a part of health promotion programmes, we can enable people to gain a better understanding of the problems that influence their health and their lives, and find solutions to those problems.
It is hoped that this paper will provide greater clarity with respect to the processes involved in building capable communities in the context of a health promotion programme.
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ACKNOWLEDGEMENTS |
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In memory of Erberhart Wenzel who gave me the idea for this paper. Thanks also to Dr Kevin Brown, Prof. Ron Labonte and Dr Pat Pridmore for their insightful comments, and to the Fiji Trilateral Health Promotion Project and AusAID for their support during the study.
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