Health Systems Strengthening

Whose Reality is it?

Posted On
Monday, February 25, 2019

Author

Siddhi Mankad

Learning and Comm. Catalyst

 

An oft made fallacy in development interventions is the conviction that we have ‘engaged’ with communities and ‘understand’ their needs.

No!

This does not imply that we are purporting a falsehood, rather that our ‘engagement’ and ‘understanding’ could be coloured by our meanings, definitions, experiences—leaving a gap between what we think is, and what really is!

Robert Chambers, the father of participatory methodologies, points out that in many countries, urban and rural people alike have shown an astonishing ability to express and analyse their local, complex and diverse realities which are often at odds with the top-down realities imposed by professionals.

Social development interventions are recognizing this truth and making strides towards involving communities in planning interventions.

The Centre for Catalyzing Change (C3), engaged 150 thousand women across the country in a study quality of maternity care. Their findings gave them much to consider and reflect. They learned that their assumption that women had access to maternity care and improving the quality of care was wrong when majority of women spoke of access while sharing what matters to them in quality of maternity care. While the health fraternity had moved on to quality, large swathes of women still struggled with access.

On respectful care, clinician and policy maker’s point of view was divergent to women’s perspectives, the latter describing disrespect as having to share a bed or stretcher, or being abandoned during labour; things that were not on the mind of the former.

Swasti Health Catalyst, while drawing up its project Pragati on empowerment of women in sex work learned that fear of contracting HIV was rather low in women’s priority when they discussed safe sex. Their concerns were more related to financial insecurity, exploitation by families, partners, police, and difficulties in securing entitlements. These insights meant that the agenda — to reduce the prevalence of HIV — would not be successful unless the gamut of issues that women faced in ensuring safe sex were also addressed; issues that went well beyond provision of health products and services. Swasti engaged with multiple partners to address these varied needs and built health services — of awareness generation, STI and HIV testing, condom provision — as components within a much larger empowerment initiative, rather than its central focus.

 

These examples underscore the necessity to unshackle the perspectives of development service providers and align it with the self-articulated need of the communities. It is clear that involving communities in research or design involves a certain depth of engagement that requires us, as planners, to:
  • First and foremost, recognize our own biases that could result in misinterpretation of our understanding of the issue; or emanate cues that prevent communities from being open in their interaction.
  • Understand that our agenda may be just that — ours! If vulnerabilities faced by the communities we wish to work with are not addressed we may not reach the desired outcomes. This requires strong partnerships.
  • Listen keenly to what communities are saying and probe to understand the meanings behind their words. Asking communities to share stories is a good way to build clarity on experiences and contexts, that may otherwise be lost to planners.
  • Be alert and observant during interactions to notice any reluctance or discomfort, which would mean that the issue may not be properly examined and may require different ways of investigation.
  • Ensure follow-up of the initial engagements with action to earn communities’ trust.

More by this Author

Gaming the Wait

Queuing for health services is a bane to healthcare-seekers. Can we add worth to the wait?

Whose Reality is it?

  An oft made fallacy in development interventions is the conviction that we have ‘engaged’ with communities and ‘understand’ their needs. No! This does not imply that we are purporting a falsehood, rather that our ‘engagement’ and ‘understanding’ could be coloured by our meanings, definitions, experiences—leaving a gap between what we think is, and what…

Age and Agency

Adolescent health programmes try to raise age at marriage. But are they missing the woods for the trees?

Hunger and a woman’s right to health: A Gordian Knot

  An oft made fallacy in development interventions is the conviction that we have ‘engaged’ with communities and ‘understand’ their needs. No! This does not imply that we are purporting a falsehood, rather that our ‘engagement’ and ‘understanding’ could be coloured by our meanings, definitions, experiences—leaving a gap between what we think is, and what…