This book reviews contemporary campaigns for community participation and empowerment with examples from all over the world. It critically assesses developments in the 'mixed economy of welfare' in terms of their relevance for self-help and community participation. It also considers the concept of empowerment and its relation to public policy and development within social movements.
Exploring the potential for primary environmental care: rapid appraisal in squatter communities in Salvador da Bahia, Brazil
This paper discusses the methods of collecting information in a field study carried out in Salvador da Bahia (Brazil) a suburb of Salvador. The study was part of a training exercise for students of the "International Course for Primary Health Care Managers at District Level in Developing Countries" based in Italy. The study also aimed to explore the potential for Primary Environmental Care and identify ways by which the local health district could support squatter communities. A rapid appraisal was carried out in three squatter communities. Secondary data was analysed, life history interviews were conducted, a "risk map" was drawn in which local participants geographically located problems, focus groups and ranking, key informant interviews, ten institutions with an interest in environmental issues were interviewed, and a feed-back meeting was held for all community members. It is concluded that RRA is well suited to study fast-changing environments, a potential danger of the exercise is taken to be undue expectation-raising of the local community. Finally "microplans" are introduced as a possible means of making RRA action oriented. Five pages are devoted to illustrations arising from the exercises.
A Discussion of the Reliability of Measures of Hygiene Behaviours: The Case of the Health Behaviour Intervention Project, Lima, Peru
This paper discusses the use of qualitative and quantitative methods to eliminate systematic sources of error in quantitative measurement of hygiene behaviours in the Health Behaviour Intervention project in Lima, Peru. The authors argue that the combination of methodologies can give public health better data for the design and implementation of interventions to prevent disease. In relation to qualitative methods, the paper discusses the reliability of structured observation data for health intervention studies. It presents background on structured observation in Lima, reliability of measure across observers and over time, and preliminary significant associations between behaviours and diarrhoeal disease.
The Centre for Tropical Disease Research Medical School at the University of Guerrero, Mexico has been developing the Sentinel Survey process since 1985. Community-based Sentinel Surveys are a tool for developing dialogue among families, local leaders, district health services and regional and national level health planners about health risks (00). They are based on the premise that through careful, inexpensive measurement, dialogue and using the perspective of the family health possibilities can be changed (02). The video focuses on a village survey (one of 43 sentinel sites in Guerrero) which investigated family practices that might increase the risk of parasites and diarrhoea (10). All households in the village were surveyed by local health workers. Blood, faeces and saliva tests were processed quickly and the data fed back to the community (14). A preliminary risk analysis of common practices such as using contaminated water to wash vegetables or keeping pigs in the yard was also carried out by health staff in the field using laptop computers (15). The results were distributed to the community the next day and demonstrated to the community that by changing certain practices their families' health could be improved (15.30). The information gathered can be shared with other district health authorities, as well as with regional and national level bodies. It can also be used as the basis for dialogue with relevant sectors such as the water or education authorities (23).
Rapid Assessment Procedures (RAP) is a data collection tool which takes standard anthropological techniques and adapts them for use with health programmes. It provides a systematic methodology for conducting rapid qualitative assessments of local conditions and needs, knowledge, attitudes and practices. The methods used include formal and informal interviews, conversations, observation, participant observation and focus groups (01). RAP can be used with other techniques to make quick assessments for planning or evaluation (02). The video documents a RAP survey carried out by Foster Parents Plan International in Guatemala. RAP was used to assemble data for programme planning with the aim of understanding people's attitudes towards vaccination. By comparing their views with the programme's objectives the two could be merged to optimise access to primary health care (03). The various techniques used during the survey included formal and informal interviews (05), conversation (06), observation (06.30), participant observation (07) and focus group discussions (07.30). The survey also investigated existing health services such as the pharmacy and local healers to provide a total analysis of the health needs of the community (08). The different methods and sources used in the survey provided triangulation and increased the accuracy of the information (09). RAP can be used at different stages of the project cycle, for project planning as well as process and concluding evaluations (011). It is a flexible tool which can be adapted to fit different areas, situations and populations (14).