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Com h org and dev unit 4

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Community Healt Organization and Development Unit 4 Complete note

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Com h org and dev unit 4

  1. 1. Unit 4: Community Participation (Engagement) in Community Health Service Draft Version 1 (12 hrs) Upendra Raj Dhakal Lecturer: Valley College of Technical Science, Kathmandu
  2. 2. Concept of CP and its form • Participation: Involvement/Engagement ………. • Participation as a mean: Way of using the economic and social resources of community people to achieve predetermined objectives. Government and development agencies see participation as a means of improving the efficiency of their service delivery systems. It is static, passive and ultimately controllable form of participation. It is mostly found in rural development programs. • Participation as an end: Process oriented, confidence and solidarity among community people are built up. It is considered as a permanent and intrinsic feature of community. Development that increases and strengthens the CD program making it sustainable and effective it is associated with development activities outside the formal or government sector and is concerned with building pressure from below for making change. There are three types of participation as the stages the participation reaches as: Marginal Participation, Substantive Participation and Structural Participation. (Source: PH and PHC – Ramjee Pd Pathak & Ratna Kr Giri – pg 129) CHOD Draft Version 1 (Feedback Welcomed) 2
  3. 3. Introduction • A process by which a community mobilizes its resources, initiates and takes responsibility for its own development activities and share in decision making for and implementation of all other development programs for the overall improvement of its health status. • The key to the successful organization of PHC is community participation, through the process, the people gain greater control over the social, political, and economic and environmental factors determining their health. CHOD Draft Version 1 (Feedback Welcomed) 3
  4. 4. Objectives • Awareness to people about the importance of CP and its relation to HFs for change in health. • Involve community people to identify and understand the nature of health related problems. • Create interest within community people to solve or reduce health related problem with great zeal (passion). • Enable community people to overcome hindrance to community participation in health matters and others. • To enable community people to utilize the locally available skills and resource materials. • It enables people to become self – dependent • It develops the capacity to identify and implement the new development activities with great enthusiasm. • To take them aware about the potentiality hidden inside them. CHOD Draft Version 1 (Feedback Welcomed) 4
  5. 5. Importance • It is cost effective method for reaching to health services of the people. • People began to view health more objectively; people are more likely to accept preventive approach in health care. • Greater commitments of people in success of health programs. • Health awareness becomes an integral part of community. • Health workers get greater support from the people for their activities • People become more and more self – reliant (centered) in their ability to prevent diseases and promote positive health. • Community makes additional resources available. • Health services becomes more reliant (focused) to health need of the community. • Less dependence on the government. • Result of health measures are more durable • Health planning is done at most peripheral and grass root level. CHOD Draft Version 1 (Feedback Welcomed) 5
  6. 6. Levels of CP • First Level of Community Participation • Compliance or Force • Collaboration • Local Control (Community Empowerment) • Second Level of Community Participation • Lowest Level: ………. • Mid Level: ……… • Highest Level: ……….. • Other Levels of Community Participation/Defined as forms in later slides • Marginal:……….. • Substantial:……. • Structural: ……… CHOD Draft Version 1 (Feedback Welcomed) 6
  7. 7. First level of community participation a) Compliance or force: Unwilling or unwanted change brought by force. Eg. Enforcement of law, creating the situation of fear, providing incentives and the system of punishment. This sort of participation does not long last and cannot bring sustainable positive results in the field of public health. b) Collaboration: To work with community with good relation with community members. Good coordination and cooperation is essential. c) Local Control (community empowerment): Challenges the existing power structure as well as demands to redistribute power in order to build the minimal, if not equal, economic base for previously excluded group. Local people see all the development activities. CHOD Draft Version 1 (Feedback Welcomed) 7
  8. 8. Contd ….local control (community empowerment) • People exercise all right and duties. • People utilize and mobilize local resources for CD. • Community people, themselves plan, implement, monitor and evaluate the local development program themselves. • It creates sustainable and long lasting results. • Empowerment implies enabling people to understand the reality of their environment, reflect on the factors sharing that environment, and takes steps to effect change to improve the situation. • It is the process that encompasses people deciding where they are now, where they want to go and developing the implementing plans to reach their goals based on self reliance and sharing of power. CHOD Draft Version 1 (Feedback Welcomed) 8
  9. 9. Contd ….local control (community empowerment) Hence, in community empowerment or local control, community people are able to: • Define their needs, problems and issues. • Develop plans and strategies to meet these needs, and • Implement such plans to reap (gain) the benefits and accept the outcomes rationally including hiring – firing and supervision of health post. CHOD Draft Version 1 (Feedback Welcomed) 9
  10. 10. Levels of Public Participation (Read it by your own) – not in syllabus • Manipulation: It is aka “Non participation”. Public and observers are manipulated into thinking that public participation is in progress. This is often used when a certain organization has to prove that “real people” are involved in a project which is not even discussed with these people. • Therapy: This is many times referred as “both dishonest and arrogant”. People without power are shushed, and many time treated as mentally ill. It is called therapy because, citizens are put together to make change themselves rather than guiding a procedure. Eg. Hospital recommending for home therapy ….. CHOD Draft Version 1 (Feedback Welcomed) 10
  11. 11. Contd …. • Informing: Creating awareness by informing. It is a two way process: not only citizens learn about coastal issues, officials can also learn from citizens. Also, one way communication are frequently used to inform community. Publics are informed at earlier stage for preparedness. Drawback: low quality of information provided with superficial information. If citizens are not properly informed, they cannot truly participate. • Consultation: It is “inviting citizens” opinions in decision making or planning process. It is valid way of informing and participating. i.e. consulting. There is no guarantee that citizens concerns and ideas will be taken into account. CHOD Draft Version 1 (Feedback Welcomed) 11
  12. 12. Contd … • Placation: it is done after informing and consultation. Citizens get to advise and even plan a great deal but it is the power holder that finally gets to decide whether to even take these ideas into account or not. The level to which citizens are placated depends on 2 things: “the quality of technical assistance they have in articulating their priorities; and the extent to which the community has been organized to press for those priorities”. • Partnership: In a partnership, the power is shared by “negotiation between citizens and stakeholders”. Planning and decision making tasks are carried out through bodies like “joint policy boards”, “planning committees” and other mechanisms that might enforce such a partnership. They work best with an “organized power base” in the region or community where meetings can be held, finances can be taken care off and where the group can do business with its employees (lawyers, technicians etc..). CHOD Draft Version 1 (Feedback Welcomed) 12
  13. 13. Contd … • Delegate Power: the public has the dominant decision making authority in a plan or program. This happens on not very many occasions and requires a number of very dedicated citizens. It can also be that there are two groups, one power- holder group and one public group. When decisions cannot be made through negotiations between the groups, the citizens often hold the right to veto. • Citizen Control: this is the highest form of authority that citizens may achieve and it means that they are in full charge of a policy or plan and that they are “able to negotiate the conditions under which ‘outsiders’ may change them.” There are several drawbacks to full citizen control: it might support separatism and hostility against public services, it costs more money and is usually less efficient and it might enable the wrong people to have too much power. Besides all those arguments, citizen control is not a professional way of dealing with things but in some cases it might work and it is the only way to give full power to the “powerless”. CHOD Draft Version 1 (Feedback Welcomed) 13
  14. 14. Models of CP • Contributory: Some sort of resource is shared/given voluntarily. • Collaborative: A type of partnership. Two or more parties (of similar status) working together. • Co – creative: Bringing different parties (different status – like company and group of customers) together to produce valuable outcome. • Hosted: Receiving and entertaining people (examples in next two slides) CHOD Draft Version 1 (Feedback Welcomed) 14
  15. 15. Categories Contributory Collaborative Co – Creative Hosted Kind of commitment We are committed to help our visitors and members and feel like participating in the institution We are committed to deep partnerships with some targets in communities We are committed to support the needs to target communities with goals align with the institutional mission We are committed to invite community members to feel comfortable while using institutions for their own purpose. How much control? we want participants to follow our rules and engagement and give us what we request Staff will control the process, but participants actions will steer the direction and content of the final product Some participants goals and preferred working styles are just as important as those of the staff. Not much – as long as participants follow out rules, they can produce what they want How do you see? The institutions requests content and the participants supply it, subject to institutional rules. The institution sets the project concept and plan, and than staff members work closely with participants to make it happen. The institution gives participants the tools to lead the project and than supports their activities and helps them move forward successfully. The institution gives the participants rules and resources and then lets the participants do their own thing Who are the participants/what kind of commitments we seek from participants? We want to engage as many visitors as possible, engaging them briefly in the context of a museum or online visit We expect some people will optional in casualty, but most will come with the explicit intention to participate. We seek participants who are intentionally engaged and are dedicated to seeing the project all the way through. We would like to empower people who are ready to manage and implement their project of their own. 15
  16. 16. Categories Contributory Collaborative Co – Creative Hosted How will you manage? We can manage it lightly, the way we would maintain an interactive exhibit, but we ideally want to set it up and let it run. We will manage the process, but we are going to set the rules of engagement based on our goal and capacity. We will give much time as it takes to make sure participants are able to accomplish their goals As little as possible – we want to set it up and let it run on its own. What kind of skill do you want? Creation of content, collection of data, or sharing of personal expression. Use of technological tools to support content creation and sharing. Everything supported by contributory projects, plus the ability to analyze, curate, design, and deliver completed products. Everything supported by collaborative projects, plus project conceptualization, goal setting, and evaluation skills. None that the institution will specifically impart, except perhaps around program promotion and audience engagement. What goal and how will non participant visitors will perceive? The project will help visitors see themselves as potential participants and see the institution as interested in their active involvement the project will help visitors see institution as a place dedicated to supporting and connecting with community The project will help visitors see the institution as a community driven place. It will also bring in new audiences connected to the participants The project will attract new audiences who might not see the institution as a comfortable or appealing place for them. 16
  17. 17. Four Models of Community Participation in PHC CATEGORIES HOSPITAL-CLINIC BASED COMMUNITY ORIENTED COMMUNITY BASED COMMUNITY MANAGED Guiding principle Health of the people Health for the people Health with the people Health by the people Main character Authoritarian Paternalistic Democratic Liberating (more flexibility) Initial objectives Rigid and statistics oriented Closed and predetermined; defined before community is consulted Open ended and flexible; problems and needs evolved from the community Formulated by the community and based on their felt needs, vision of an alternative social order expressed by the people Tacit/Unspoken objectives Maintain status; perpetuate (preserve) existing health system Improve/alter certain aspect of the health system Transform the health system and initiate social reform Complete re-structuring of the health system together socio economic transformation Who is responsible for health Health is the sole responsibility of doctor (clinical staff) Health is the responsibility of health professionals (Public Health) Health is the responsibility of community health workers and leaders Health is the responsibility of everyone in the community 17
  18. 18. CATEGORIES HOSPITAL-CLINIC BASED COMMUNITY ORIENTED COMMUNITY BASED COMMUNITY MANAGED Outlook of health professionals As recipients (receivers) of health care As beneficiaries of health care program As partners in health care As managers of their own health program Level of community participation and main decision makers Community is just informed of health activities Community is just consulted on what can be done. Doctor and other health professionals decide Community actively discuss and decides plans and activities together with health professionals. Decision is shared by community and health staff Community identifies needs, defines objectives plans, implements, monitors and evaluates the health program on their own. The community is the main decision maker. View on awareness building The community should be kept ignorant of health The community is made aware to change their behavior or to pacify them if hardship leads to revolt It is a means for community organizing and for understanding the relationship of economic and political problems It is a means to generate people’s power and ensure continuing community participation Value given to community organizing The community is not capable of being organized As a means to change peoples attitude to cooperate with health authorities wholeheartedly As an end in itself and as an opportunity for people to develop leadership and management As the main tool for empowerment and as a long lasting safeguard to product the communities interest 18
  19. 19. CATEGORIES HOSPITAL-CLINIC BASED COMMUNITY ORIENTED COMMUNITY BASED COMMUNITY MANAGED Inter sectorial linkage and social mobilization Believe that they are doing their work sufficiently, thus there is no need of linkage Usually limited to government agencies or to these who give dole – outs With the agency government or non government who may be assistance in giving solutions to health and other issues. With organizations and institutions working for basic social changes Forms alliances and federations with them Effect on the people of the community Oppressive (Unfair) – rigid central authority allows little or no participation by the community Deceptive (Misleading)- pretends to be supportive allowing some participation but resists genuine changes Supportive – helps people find ways to gain more control over their lives Self – reliance (faith) and self – determination (will). People aware of their potentials and use them to the full and with responsibility. General impact No change Social change Behavioral change Structural change Data gathering, monitoring and evaluation Data limited to morbidity, mortality and health service statistics, MnE mainly the concern of hospital/clinic management No feedback of information to clientele or community Data gathered by outsiders via a long survey questionnaire with heavy emphasis on health data MnE done by health staff Little or minimal feedback of information to the community Data gathered by community health workers and kept simple; includes felt need and concerns Collection and analysis done together with health staff MnE done jointly by community health workers and health staff Regular feedback given to community Community decides what data to collect, community members gather, collate and analyze data on their own Self evaluation and self monitoring systems established Community members continuously informed of data gathered about relevant actions taken accordingly by them19
  20. 20. PHC Revitalization – WH Question? - Voluntary or government: No responsibility of state, and PHC members expect PHC to be executed by community as a volunteer organization (i.e.. no role of state to execute PHC), and ignore activities that does not do fund raising for the PHC. It is considered as unrealistic concept. (see in Four approach of CP <first slide> in next slide) - Infrastructure and service equality: ………..??? - Wide spread community participation: …maximum involvement ...??? - CP in fullest sense: ……….fully managed by community……….??? CHOD Draft Version 1 (Feedback Welcomed) 20
  21. 21. Four Approaches of CP 1. Anti-/reluctant (unwilling) communitarians and economic conservative approaches: • Community is constructed as ‘mythical’ or sentimental and actors argue for non – state intervention and self regulation of citizens while often (paradoxically) arguing that the community will look after the individual. • Actors acknowledge the need for the community support but that is not really ‘work’ and can be largely done through voluntary work. • Communities who do not contribute to economic agendas are ignored. CHOD Draft Version 1 (Feedback Welcomed) 21
  22. 22. Contd …Approaches of CP 2. Technical – functionalist communitarians and managerialist approaches: • Community is constructed as a relatively stable and homogenous entity. • Actor see community engagement as “maintaining equilibrium”. • Their goals are a minimum of fuss, maximum efficiency and they rely on expert – driven consultation with communities. • They see participation as a political and participants are often recruited from well – established community groups for their abilities. • Actors can see themselves as neutral arbiters (mediators) of disputes (quarrel). • Under this approach conflict is avoided and notions of justice largely ignored. CHOD Draft Version 1 (Feedback Welcomed) 22
  23. 23. Contd …Approaches of CP 3. Progressive communitarians and empowerment approaches: • Community is constructed as complex and problematic. • Actors see social justice as important and they pay attention to the processes of participation. • They see participation as a change agent but their emphasis is on incremental rather than radical change. • However, while focusing on the politics of inclusion/exclusion, wider structural impacts on communities are largely ignored. • Actors are generally egalitarian (not favoring any) and inclusive in approach, relying on face – to – face contact and debate. • Conflict is acknowledged, while not necessarily ensuring that under – represented groups are present. CHOD Draft Version 1 (Feedback Welcomed) 23
  24. 24. Contd …Approaches of CP 4. Radical/activist communitarians and transformative approaches: • Community is constructed as esteemed places where “ordinary folk” live and real life takes place. • Actors are concerned with discrimination and oppression (domination). • They link personal and local issues to national and global ones, seeking to transform social order. • Their focus is on the redistribution of resources and the fight against poverty. • Power relations are at the forefront of their analysis of problems. • Many see existing community participation as a smokescreen to the real issue of injustice. • They seek to recruit people who are often sidelined and prefer bottom up approaches. CHOD Draft Version 1 (Feedback Welcomed) 24
  25. 25. Some other approaches • Spontaneous participation: local initiatives, no external support, self sustaining, ………. • Induced participation: External initiatives taking support from external resources, ……….. • Compulsory participation: People are mobilized or organized willy – nilly. To perform any activities. CHOD Draft Version 1 (Feedback Welcomed) 25
  26. 26. Forms of participation Forms of participation can be categorized as Participation as Means or Participation as an end (see in concept of CP); or on the basis of objectives as Co- operation seeking participation and Power – Sharing participation. • Cooperation – seeking participation: • To receive information: …….. • To submit protests: ……… • To make suggestions: ………. • To be consulted before final decisions are taken: ….. • Power – sharing participation: • Solving their own health problems: ………. • Assessing their health needs:……….. • Taking responsibility for mobilizing local resources: ………….. • Suggesting new approaches and solutions to their problems: ………. • Creating and maintaining local organizations: …………, and • Administration and financing of the health services: ……………… CHOD Draft Version 1 (Feedback Welcomed) 26
  27. 27. Process of CP (On the basis of stage participation has reached) Marginal Participation: (act as if ….) • Role of the community people is limited and transitory. • Less direct influence in outcome. • Eg. HP staff take a trouble explaining available services at that time, so that people are informed and can come to HF for services. • Since it costs a great deal to provide health services, it is a big waste of money if people do not come for the health facility. • In many community development programs where plans and objectives are determined beforehand, the community people achieve only a marginal influence on performance. • It is hence the lowest level of community participation. CHOD Draft Version 1 (Feedback Welcomed) 27
  28. 28. Contd … Substantive Participation: (active role of community ….) • Community people are actively involved in identifying their needs, determining priorities and carrying out health related activities even if the mechanism of these activities is extremely controlled. • This is higher level of community participation in which the community members take part actively as assessing local aids, planning, implementing and evaluating the results of health activities. • When they do this, they develop the spirit of self – reliance (trust). • This type of participation also helps in the mobilization of the locally available internal resources. • Substantive participation is means by which many CD programs achieve their objectives, but there are evidence that substance of participation is limited to the benefits of the project activities. CHOD Draft Version 1 (Feedback Welcomed) 28
  29. 29. Structural Participation: (CP as an integral part and major basic for Health activities) • Highest level of CP where local people completely own and manage health issues. • CP is an integral component of project and ideological basis for performing activities. • Community people play active and direct role in CD • Community understand real need for health and development ad thus can volunteer with free labor to upgrade their health status. • It is real community involvement and complete mobilization of local resources. • It provides social control over health infrastructure. Contd … CHOD Draft Version 1 (Feedback Welcomed) 29
  30. 30. Participation in Health service delivery and process utilization • Community people come to know their own situation better and are motivated to solve their common problems. • This enables them to become agents of their own development instead of being passive and beneficiated of development aid. • The second recommendation (of 22 recommendations) of Alma Ata conference has emphasized in CP. • CP must incorporate: assessment of situation, problem identification, priority setting, acceptance of responsibility, community contribution, …. • There are five different phases in HS Delivery and P Utilization: ..next slides… CHOD Draft Version 1 (Feedback Welcomed) 30
  31. 31. Participation in community Resource Identification phase. (PHSD&PU…..) • Community participation cannot be done if resources are not identified. • Local committee can be formed for rapport building for R. Identification. • Resources might be: HRs, Money, Materials, Time Frame, Management, … • For Time Frame: Program not executed as per the Gantt chart will generally increase the total project cost. Not only the cost, completing the program as per the schedule will minimize the wastage of resources and accomplish the objectives in the minimum possible time. • Management: ….next slide….. CHOD Draft Version 1 (Feedback Welcomed) 31
  32. 32. Contd …. Management: • Sources of local resources:  Government Organizations and Programs  NGOs  Individual or Private resources • Internal resource’ mobilization and participation in community resource identification phase (aspects)  Identify its need  Plan its solutions  Maximum peoples participation  Resource identification and mobilization • Ways to identify resources:  By rapport building  Making awareness  Making understanding  Coordination and communication  Good and acceptable behavior/socially acceptable • Conclusion: Evaluation of social reliance and awareness, mutual relation between different organizations, … CHOD Draft Version 1 (Feedback Welcomed) 32
  33. 33. Participation in community Needs Identification phase, (PHSD&PU…..) • It is important to prioritize needs by identifying them in the community • Real need cannot be identified if community people are not identified. • Co – working will help sharing the knowing and identifying resources. • Actions for Health Workers (facilitator) for the involvement of community: Providing adequate introduction and information to local leaders, main figures, active persons and even gossipmongers, about the cause of need identification. Asking in advance for the suggestion from the stakeholders. Carry out some portions of activities adopted for determining health needs through survey, interview, observation, etc. Involving community while performing any activities in community diagnosis Identify three kinds of needs: Observed need, Real need and Felt need. • Health need assessment: prioritizing needs for health and then arranging hierarchy. While prioritizing needs, resources and feasibility should be taken into consideration. CHOD Draft Version 1 (Feedback Welcomed) 33
  34. 34. Participation in Planning health programme phase (PHSD&PU….) • Planning is a process of developing a detailed systematic and future – oriented programme, which directs or sets the goals and takes action to reach the goal. • Steps of community participation: Collection of baseline data or information. Identification of problems or needs and their prioritization Setting the objectives of the programme Deciding the target group of the program. Finding the resources for the program Selection of the methods and media for the program Deciding the criteria for the evaluation of the program Fixing the criteria for monitoring of the program Developing of working schedule (Plan of Action) of the program • SUCCEED: Set a brief clear task, Use hands on multi – sensory materials; Creating informal and relaxed climate; Choose a growth producing activities; Evoke feelings beliefs, needs, doubts, perceptions and aspirations; Encourage Creativity, analysis planning and Decentralize decision making . CHOD Draft Version 1 (Feedback Welcomed) 34
  35. 35. Technique for Planning • To get everyone together • Finding formal and informal leaders of the community • Assist the leader to explain program to the community • Invitee groups for planning: Senior citizens, Young school children, Campus Youth Traditional Healers (and Traditional Birth Attendants – TBAs) Informal leaders, social workers, Mothers Club, leaders Employees of government office, I/NGOS or project staffs. Formal leaders of the municipality (Urban or Rural) Members of Health facilities, School committees …. ………………………………………….. • Determining priorities of need • Asking the people for their problems • Community sensitization and triggering CHOD Draft Version 1 (Feedback Welcomed) 35
  36. 36. Participation in Health Program Implementation phase (PHSD&PU…..) 1. Program starts implementing only after being approved by policy making authorities. 2. It provides basis for increasing self – confidence and self reliance. 3. After community identifies needs, they get involved in seeking solution and get involved in implementing phase, which will guide towards success. 4. Health worker should adopt some strategies for the implementation:  Building a commitment  Mobilizing and utilizing resources  Training of HRs  Organization of the community  Monitoring the progress  Supervising of health workers  Keeping record and report CHOD Draft Version 1 (Feedback Welcomed) 36
  37. 37. Contd …. 5. Building of commitment 6. Mobilizing and utilizing resources 7. Training of HRs 8. Organization of Community 9. Monitoring the process 10. Supervision of health work 11. Keeping record and report CHOD Draft Version 1 (Feedback Welcomed) 37
  38. 38. Implementation committee formation process • Advertisement of the purpose • Collection of names of the interested group (and shortlisting) • Inclusion of local leaders or govmt. and non govmt representatives • Formation of different sub – committees • Describing the job, duty and responsibilities to be performed by each member and group Committee can be as advising committee, technical committee and evaluation committee. CHOD Draft Version 1 (Feedback Welcomed) 38
  39. 39. Participation of community in Health Program Monitoring and Assessment phase • Monitoring is a periodic, regular, ongoing more or less record of some particular function. • Monitoring is a process of collecting and analyzing the information from program implemented • Monitoring is done through observation, interview, record report reviews, etc.. • Monitoring helps in finding progress of implementation and achievements • Monitoring is done frequently whereas evaluation is done once or twice in a year. CHOD Draft Version 1 (Feedback Welcomed) 39
  40. 40. Contd …. • Assessment is a plan of care that identifies the specific needs of the client and how those needs will be addressed by the healthcare system. • Ways/Methods of assessment: Interview, Observation, Study of official records, meeting and discussion, ……. CHOD Draft Version 1 (Feedback Welcomed) 40 Evaluation Organizing and implementing a project Monitoring Planning of Health Action Assessment and analysis Cycle of Health Assessment of Health Action
  41. 41. Contd …. Importance: • Increases the resource for health. • Achieves culturally sensitive and acceptable services • Extends the coverage beyond the formal health system • Builds upon existing cultural structure • Directs efforts to community health problem • Breaks the viscous circle of dependency • Empowers people CHOD Draft Version 1 (Feedback Welcomed) 41
  42. 42. Enabling Process of CP Factors influencing enabling process: • Communication skills: interpersonal and group communication • Process of conducting a successful meeting • Process of decision making in a group situation • Process of conducting a discussion in a meeting CHOD Draft Version 1 (Feedback Welcomed) 42
  43. 43. Communication skills • Communication is a process of transmitting information, ideas or views from one person or group to another with some objectives. • Elements of communication: Communicator or Sender or Source, Message, Channel, Audience or receiver, Effect, Feedback • Communication skills: Spoken words, Songs and written scripts, Symbols, Signals, Feelings and facial expressions, gestures and body language, position, eye contacts, ….. • Ways of interpersonal communication: Interview, Counselling, Questionnaires, …. • Ways of Group Communication: Group Discussion, Demonstration, Role plying, Mini Lecture, Problem solving, Seminar, Field trip, Workshop, Symposium, etc. • Ways of communication: Verbal, Visual, Audio – visual, Formal – informal, one way – two way, individual, group, mass. CHOD Draft Version 1 (Feedback Welcomed) 43
  44. 44. Process of conducting successful meeting CHOD Draft Version 1 (Feedback Welcomed) 44 Following things should be kept in mind while conducting meeting: • Prior information sharing and agenda sharing; • Objectives; • Subject matters for discussion; • Participants; • Place, time and date; • Information about the meeting; • Problem solving. Steps in finding the solution: • Identifying the problem; • analyzing and clarifying the problem; • collection of data regarding the problem; • utilizing data in solving the problem; • viewing possible results of each problem; • setting importance and evaluation of the problem; • choosing best solution to put in practice; • defining the conclusion of the solution; • Implementing, monitoring, evaluating and feedback.
  45. 45. Process of decision making in group situation There are three levels of decision making • Individual Level (Micro level): Decision is taken in accordance with ones own judgement; taking into account the personal gains and the group acceptance. • Group Level: Decisions are taken after collective discussion and thinking. These decisions are necessarily of common interest to every member. • Mass Level (Macro level): Prominent and influential opinion leaders usually take the decisions and it is not necessarily that such decisions be fully accepted by everyone in the micro level. CHOD Draft Version 1 (Feedback Welcomed) 45
  46. 46. Contd …. Factors helping in decision making • Good leadership • Maturity of the group • Effective communication • Absence of interference from any outside group • Availability of resources CHOD Draft Version 1 (Feedback Welcomed) 46
  47. 47. Contd …Process of decision making (7 steps) 47 CHOD Draft Version 1 (Feedback Welcomed)
  48. 48. Process of conducting discussion in a meeting • Process of discussion depends upon the type of leadership practicing. i.e. Autocratic, Democratic and Laissez – faire CHOD Draft Version 1 (Feedback Welcomed) 48 Autocratic Democratic Laissez - Faire
  49. 49. Contd …. Process of conducting successful discussion in meeting: • Define the topic of meeting and make sure, it is understood by all members. • Define the objective of the meeting • Formal introduction and task distribution and play role accordingly • Equal participation by all members • Everybody should see, listen and understand other participant • Express views towards topics in all possible aspects • Discussion should be taken on the basis of all group members agreements and sufficient rationale to discussion • All should be committed to their role performance after discussion and decision • In meetings, written documents should be kept about, what is discussed, who the participants are and what is its outcome. CHOD Draft Version 1 (Feedback Welcomed) 49
  50. 50. Process of CB resource identification • Assessment of resources: all resources should be identified before selecting the feasible resources that we require. • Resources for the health services: 6Ms, Management, Time/Phase Sources of the local resources: Government Organizations or programs, NGOs, Individual or private resources • Internal resource mobilization and participation in community resource identification phase: Need identification, Planning, maximum peoples participation, Identifying and mobilizing appropriate resources • Ways to identify resources: Rapport building, discussion in the meeting, co-ordination and communication, making awareness on the program, making understanding, sharing good behavior,… CHOD Draft Version 1 (Feedback Welcomed) 50
  51. 51. Barriers of community participation • Lack of information • Insecurity • Injustice and inequalities • Lack of transparency • Geographical constrains • Other social and psychological factors CHOD Draft Version 1 (Feedback Welcomed) 51
  52. 52. Barriers …. Lack of information • Hiding information: ……… • Falsifying information: ……… • Manipulation: ………… • Facilitator not updated with knowledge and skill: ……… • Over – loading with information: ………….. • ……….. CHOD Draft Version 1 (Feedback Welcomed) 52
  53. 53. Barriers ………. Insecurity • Hiding or displaying real identity of people for the shake of dignity: ……. • Transparency, impartiality and accountability: ……………. • Taking consent: ………… • Physical and mental violence: ………. • Many times truth might be unspoken, …. or keeping quite creates difficult situation: ……………………. • ……….. CHOD Draft Version 1 (Feedback Welcomed) 53
  54. 54. Barriers …………. Injustice and inequalities CHOD Draft Version 1 (Feedback Welcomed) 54
  55. 55. Barriers ….lack of transparency • Hiding the budget: ………… • Utilizing facilities: ……….. • Misinterpreting Terms of References, Memorandum of Understandings: ………., ….. • Hiding information: …….. • Miss – utilization of materials: …………. • …… CHOD Draft Version 1 (Feedback Welcomed) 55
  56. 56. Barriers …. Geographical constrains • Inaccessible : …….. • Distance and difficulty: ……….. • Even if facility is near, some feel difficult going for participating: ……… • Seasonal or disasters: …………. CHOD Draft Version 1 (Feedback Welcomed) 56
  57. 57. Barriers …. Other social and psychological factors • Cultural and language barriers: ……… • Resource barrier: ……. • Religious barriers: …….. • Beliefs and taboos: ………….. • Myths and guiding principles: …………. • Psychological barrier: Way of individual thinking, fear: ……… • Financial Barrier: …………… CHOD Draft Version 1 (Feedback Welcomed) 57
  58. 58. Assessing and Prioritization • Assessment is a plan of care that identifies the specific needs of the client and how those needs will be addressed by the healthcare system. Ways/Methods of assessment: Interview, Observation, Study of official records, meeting and discussion, ……. • Need identification: Felt need, Observed need and Real need: … • Prioritizing real needs on specific criteria. (using standard scales or checklists), availability of resources and feasibility of completion: …. CHOD Draft Version 1 (Feedback Welcomed) 58
  59. 59. Prioritization Techniques • Ranking: using ordinal scale with numerical value based on its importance. • Numerical Assignment: Grouping requirements into different priority group with each group representing some stakeholder s can relate to. Stakeholders must develop common understanding for this. • MoSCoW: • Mo – (Must Have) a new bike for traveling, an extra seat. • S – (Should Have) a low seat, a four-cylinder engine. Unlimited mobility. • Co – (Could have) a red color body, extra wind protection. • W – (Wont have) Bluetooth and a helmet with a double ventilation system. • Bubble Sort Technique: two requirements are compared with each other and swapped. • Hundred Dollar method: multiple stakeholders democratically vote for the requirement. Stakeholders get conceptual 100 $ which they distribute among the requirements by un/dividing $ in to fragments as a sample. • Analysis Hierarchy Process (AHP): was designed by Thomas L. Saaty. Stakeholder decompose their gal into smaller sub – problems, which can easily be comprehended and analyzed in the form of hierarchy. Judgements are made about the relative importance of each element. CHOD Draft Version 1 (Feedback Welcomed) 59
  60. 60. Contd… • Five Whys: With five whys, the analysist asks the stakeholders repeatedly (five times or less) why the requirement is necessary until the importance of the requirement is established. • Business Value Based: On the basis of importance of probability of financial profit making. • Technology Risk Based: On the basis of risk associated in implementing the plan. • Kano Model: Requirement prioritized on the basis of customers preference (e.g.. Attractive, one – dimensional, Must – be, Indifferent, Reverse) • Walking Skeleton Model: Requirement selected minimal carefully so that end to end features are build within a short span of time. • Validated Learning: Selected on the basis of highest market risk. • ………………………………………………….CHOD Draft Version 1 (Feedback Welcomed) 60
  61. 61. Kano Model CHOD Draft Version 1 (Feedback Welcomed) 61
  62. 62. Involving in Planning, Implementing and Evaluating Strategies for involving community in planning process: EBPH Framework CHOD Draft Version 1 (Feedback Welcomed) 62
  63. 63. Involving in Planning, Implementing and Evaluating Strategies for involving community Implementation: • Building commitment: ……. • Training of HRs: ……… • Mobilizing and utilizing resources: ………. • Organizing of the community: …….. • Monitoring the program: • Planning and scheduling • Determining what and how to monitor • Conduct monitoring, and • Submit report with suggestions and recommendations • Supervising the health workers: ……. • Keeping records and reports: ………… CHOD Draft Version 1 (Feedback Welcomed) 63
  64. 64. Involving in Planning, Implementing and Evaluating Strategies for involving community evaluation: • Stakeholders participation • Internal, External and Social Audit on financial transactions. • Data Audit. • Management of time • Management of cross – cutting issues • Considering activities, results, short term and long term outcomes • …………….. CHOD Draft Version 1 (Feedback Welcomed) 64
  65. 65. References • http://www.strengtheningnonprofits.org/resources/e- learning/online/communityassessment/Print.aspx CHOD Draft Version 1 (Feedback Welcomed) 65

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