This guide from the Lessons From the Field series outlines two training workshops held in Nepal in 1997-98 to help NGO staff understand health from a gender sensitive point of view, analyze current reproductive health (RH) activities, use participatory tools, and develop realistic action plans. The training programme was based on a community-based needs assessment in the Ramechhap, Sindhupalchowk and Kavre districts, aimed at gaining knowledge of some of the RH and gender issues and concerns of women in the communities. Among the service-related reproductive health issues the following stood out: women were not accessing prenatal care and assisted delivery leading to increased maternal and infant morbidity and mortality; women wished to limit family size; unsafe abortion methods; prolapse was a common health problem in all communities visited along with reproductive and urinary tract infections; HIV a growing concern. This was all seen in a gender perspective and it was found that women had low status and constrained gender roles, there were problems with domestic violence and trafficking of girls and women. In order to address outcomes of the assessment the organisation World Neighbors developed a program strategy for training and supporting a team of experienced health workers. The aim of the programme was to enable participants understanding and discussion of RH from a gender perspective; describe and analyze their current activities in terms of a RH/gender approach and identify possible strategies; gain skills in the use of participatory tools and analysis; and develop an action plan. The guide goes through all the methods used in the training workshops in an easy-access manner and includes 15 practical exercises.
A workshop was held in India to "adapt some of the participatory methods developed within agriculture for conducting PRA exercises on women's health". A "body mapping" exercise was conducted with a group of traditional birth attendants to discuss their concepts of reproduction, contraception and nutrition. A village mapping exercise led later to construction of "pregnancy time lines" and information on family planning acceptors. The article briefly mentions constraints, such as how to deal with sensitive issues like abortion.
This article traces the experiences of CARE in using a participatory approach to assessing the sexual health needs of young men and women in Cambodia's garment factories. Detailed information is given on the initiative including the process of contacting and identifying research partners in garment factories and the methods used to get information on sexual health. The research findings are also discussed.
Turning the Tide: The role of collective action for addressing structural and gender-based violence in South Africa
The case study discussed in this Evidence Report explores the value and limitations of collective action in challenging the community, political, social and economic institutions that reinforce harmful masculinities and gender norms related to sexual and gender based violence (SGBV). As such, the concept of structural violence is used to locate SGBV in a social, economic and political context that draws histories of entrenched inequalities in South Africa into the present. The research findings reinforce a relational and constructed understanding of gender emphasising that gender norms can be reconfigured and positively transformed. It is argued that this transformation can be catalysed through networked and multidimensional strategies of collective action that engage the personal agency of men and women and their interpersonal relationships at multiple levels and across boundaries of social class, race and gender. This collectivity needs to be conscious of and engaged with the structural inequalities that deeply influence trajectories of change. Citizens and civil society must work with the institutions – political, religious, social and economic – that reinforce structural violence in order to ensure their accountability in ending SGBV.
The benefits of participatory methodologies to develop effective community dialogue in the context of a microbicide trial feasibility study in Mwanza, Tanzania
During a microbicide trial feasibility study among women at high-risk of HIV and sexually transmitted infections in Mwanza, northern Tanzania we used participatory research tools to facilitate open dialogue and partnership between researchers and study participants.
A community-based sexual and reproductive health service was established in ten city wards. Wards were divided into seventy-eight geographical clusters, representatives at cluster and ward level elected and a city-level Community Advisory Committee (CAC) with representatives from each ward established. Workshops and community meetings at ward and city-level were conducted to explore project-related concerns using tools adapted from participatory learning and action techniques such as listing, scoring, ranking, chapatti diagrams and pair-wise matrices.
Key issues identified included beliefs that blood specimens were being sold for witchcraft purposes; worries about specula not being clean; inadequacy of transport allowances; and delays in reporting laboratory test results to participants. To date, the project has responded by inviting members of the CAC to visit the laboratory to observe how blood and genital specimens are prepared; demonstrated the use of the autoclave to community representatives; raised reimbursement levels; introduced HIV rapid testing in the clinic; and streamlined laboratory reporting procedures.
Participatory techniques were instrumental in promoting meaningful dialogue between the research team, study participants and community representatives in Mwanza, allowing researchers and community representatives to gain a shared understanding of project-related priority areas for intervention.
"We are Healthy, Why Change?" Perspectives, Observations, Experiences of People Living in Poverty on Their Hygiene and Nutrition
The Reality Check Approach is an internationally recognised qualitative research approach that requires the study team to live with people in poverty in their own homes for a period of time and to use this opportunity to have many informal conversations and interactions with all the members of the household, their neighbours and with the service providers with whom they interact.
This study was jointly commissioned by a group of stakeholders including the World Bank, KOMPAK and the Knowledge Sector Initiative. It was designed to understand the nuances of hygiene and nutrition behaviour from the perspective of families living in poverty.
The study was undertaken in three provinces across Indonesia (Central Kalimantan, Maluku, and North Sulawesi), the same districts as those chosen for the Frontline Service Providers RCA study to enable further examination and triangulation of the dynamics between the community and frontline service providers.