This brief article describes some of the problems the authors encountered conducting pile sorting and free listing with women in a slum area. It emerged that these women did not view their health problems in "lists" but rather as part of the socio-cultural context of their lives. The authors discover a more effective way of involving participants is to organise group meetings on specific topics.
This article consists of observations arising from the author's visits to several NGOs on the Indian sub-continent. Four main suggestions are made: conduct limited direct observations; use pile sorting techniques with key informants; experiment by modifying the pile sort technique; conduct key informant interviews on issues relating to the context of women's health.
PRA in Malda District, West Bengal: Report of a Training Workshop for ActionAid India and Tagore Society for Rural Development
A detailed account of a five day training course in PRA for NGO staff working on a project in West Bengal. After a day's introduction to PRA techniques, the field work in Kharamdanga village began: descriptions of each day's activities are given, with methodology used and findings. Time line, social map, transect and resource map are illustrated visually. The report concludes with a list of PRA methods found useful to the NGOs involved.
The Ogaden Needs Assessment Study was undertaken as a joint exercise between SCF(UK) and the Pastoral Surveillance Team of the RRC Early Warning and Planning Services. The trigger for the study was the influx into the Ogaden of thousands of returnees from Somalia and concern about capacity of the region to support the growing population. A rural sample survey was carried out using two helicopters. The objective was to establish the nutritional status of children and also to get data on grain production, consumption, sale and exchange, and the prospects of the food economy. The health data was obtained using standard anthropometric procedures, while socio-economic data was gathered by the use of questionnaires on key informants. The survey showed that the combined effects of the collapse of the livestock/grain trade and the continuing burden of the returnee population could result in a food crisis during the following dry season.
In Tanzania, a participatory approach was used to increase community capability to identify poor households and arrange assistance based on community resources. Community-based nutritional status data was used to identify households with severely malnourished children, and community leaders were used to identify poor households. Strengths and weaknesses of participatory methods are discussed with a proposition that their purpose should be community-enabling, rather than only to extract information from communities. The Triple-A cycle developed by UNICEF (Assessment, Analysis and Action) to improve conditions of women and children is adapted to include community assessment, analysis and action. Some case studies from Tanzania are presented with examples from conventional as well as participatory studies.
A topical PRA on health was held in South India for 23 participants belonging to 11 NGO groups. Activities were conducted separately by the NGO group and women's group : their different perceptions of health problems are compared on a table. Information on the reproductive cycle was also produced by the women's group. Some general observations made about women's participation include : "women have come out with seasonal calendar of 10 months" and "women have triangulated only amongst themselves and never wanted to present in the larger forum."
The author briefly describes the origins of RRA, the evolution of Rapid Assessment procedures and the development of PRA. PRA has demonstrated that rural people have a strong capacity to map, model, quantify, rank, score, diagram and analyse. The potential of PRA in the field of health and nutrition includes participatory social, demographic and health mapping of villages, seasonal analysis of deprivation and disease incidence, ranking wealth and wellbeing, matrix ranking, time lines and trend analysis. PRA can be used with direct relevance to health issues.
Participative rural appraisal: potential applications in family planning, health and nutrition programmes
The paper is divided into three sections: I) origins of PRA - its advantages and disadvantages; II) the potential applications of PRA in family planning, health and nutrition. This is discussed with specific reference to India and three stages of PRA development are envisaged i) techniques which are simple enough to be applied on a routine basis with local health workers acting as facilitators (verbal feedback on healthcare performance, recording of seasonal trends, village mapping and verbal autopsies). ii) techniques in category i) which work well might then be applied on a continuous basis to monitor and manage service performance iii) PRA is then used in a more formal way to facilitate research and development. III) suggestions are made on how PRA might be institutionalised, again using the Indian example. NGOs are considered to be vital to institutionalize the PRA process. The speed at which governments are able to absorb PRA techniques will be determined by the rate at which suitable NGO support for the process can be made available.
In an area of El Salvador where dengue fever was endemic four anthropologists, one entomologist and one epidemiologist collected data from women for one week. Participants were given nine different insects in mounted boxes which included malarial mosquitos and were then asked to group insects with common characteristics. The results were processed on computer using a package called (ANTHROPAC). "These data concerning the insect vectors , together with other data from respondents identifying symptoms of dengue, malaria, and other illnesses, provide the necessary background of information for developing appropriate messages in the campaign against dengue fever." (Reprinted from Cultural Anthropology Methods Newsletter, May 1990)
Save the Children Fund and the Ministry of Health in Somalia used focus group discussions, key informant interviews and observation to identify factors influencing the acceptance of immunisation. Focus groups consisted of mothers of different ages, Mother and Child Health staff and Traditional Birth Attendants. Three researchers lived with families in the community for 12 weeks. The team found that there were widespread misconceptions regarding the Expanded Programme on Immunisation (EPI). All health campaigns were regarded with suspision by the community because of the sensitive political situation. Suggestions are made for adapting future health messages to take into account local perceptions of disease.
Rapid Anthropological Assessment Procedures (RAP): Applications to the Measurement of Maternal and Child Mortality, Morbidity and Health Care
Rapid anthropological assessment procedures (RAP) have evolved as a form of shortcut anthropological techniques which complement quantitative data. RAP is suited for social scientists spending approximately six weeks in the field. The core of the RAP approach is guidelines or "shopping lists" which form the basis for both data collection and analysis. Data are collected through several techniques; formal interviewing, informal interviewing, conversations, observations, participant observations, focus groups, secondary data sources. The advantages and disadvantages of each technique are discussed. Comments are made on the complementarity of qualitative versus quantitative information. Constraints to the RAP approach are acknowledged and analysis is made of the use of RAP for understanding maternal and child mortality.
This report outlines a four day workshop conducted by the Indian NGO SPEECH in Manavarayanenthal, Tamil Nadu. The primary purpose of the exercise was to introduce 23 NGO participants to PRA principles and to evolve new stategies in planning specific health projects. Training took place through a mixture of lectures and activities, which included social mapping (by mixed groups and women only), health mapping, time lines, historical transects, seasonality diagrams, venn diagrams, disease ranking, focus groups with women on the reproductive cycle and a problem linkage exercise. The report includes feedback on the lessons participants learned and some of the illustrations generated by the village participants.
This report discusses appropriate mechanisms for community involvement in different social, economic, and political contexts and identifies the corresponding requirements for training health personnel and strengthening communities. Participatory methods are suggested for training health workers. It is suggested that monitoring and evaluation involves a mixture of quantitative and qualitative techniques.
This report describes the technique of body mapping - a crucial innovation for anyone working with women (and possibly men?), on issues of reproductive health, health generally and sex education. The article begins with a description of the author's observation that traditional concepts and language about the body were being used to communicate contraceptive methods. Body mapping was developed from there. In the case study presented the technique was used to bridge the gap between western and traditional knowledge, though importantly, not to replace western knowledge with traditional knowledge. Method is described in detail. There is an important behaviour and attitudes point - that for trainers and community workers to take people's own ideas about their bodies seriously, requires a major shift in attitudes about traditional vs "western" knowledge.
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.