Act Together

Health education: a dialogue of knowledge

Regardless of the CM program, one capacity building task that often falls to the program team is to do some kind of “health education,” whether for the core group, for others on the mobilization team, or for members of the community in general. People want to learn more about the health issue, more about strategies, or more about better health practices. And the program team can certainly play an important role and provide an important service in this regard.

But you and your team should give some thought to how you respond to requests for health education. A natural reaction for health professionals is to revert to the didactic style, a top-down, one-directional approach where health professionals determine what individuals, groups and communities should learn and do, and then explain the “right” way to do these things.

But it may be useful to approach health education more as a dialogue of knowledge, a two-way conversation in which both parties have something to contribute. Community members also have important health knowledge, especially about local conditions and practices. Rather than repeat generic messages in “health talks” that community members may privately reject, the program team should strive to create a climate and a forum wherein everyone can educate everyone else.

BOLIVIA: Negotiating "New and Improved" Health Practices

During the Warmi Project community planning process, community members expressed their desire to have educational materials focused on maternal and perinatal health that they could use in women's and future literacy groups. As few materials existed at that time, a local NGO was identified to work with the women's groups and newly identified and trained lay midwives to develop materials. The midwives wanted to have a reference book and the women's groups decided on a series of four short booklets on prenatal care, labor and delivery, attention to the newborn and post-partum care.

The process used by project facilitators supported the project philosophy by beginning with discussions with several women's groups in each of the three geographic zones to identify the objectives of the materials. They then worked with the midwives and women's groups to develop the content beginning with how women viewed their bodies and reproductive functioning, current practices and beliefs. For each module, facilitators listened to the women and midwives and then shared the current recommendations from the Ministry of Health using terms that the participants understood and introducing medical terms with their definitions. The facilitators and the women's group participants discussed each of the current and recommended practices. When they were different, participants discussed the feasibility and desirability of adopting the recommended practice from their perspective. Some recommended practices were accepted by many of the women and others were debated. Traditional helpful and benign practices were included in the educational materials. Traditional practices that were known to be harmful or potentially harmful were discussed and "new, improved practices" were agreed upon.

For example, women greatly feared that the placenta would rise after the baby was delivered and could suffocate or cause other harm to them. They recognized that a retained placenta could be dangerous and this was supported by their belief that there are appropriate times during a reproductive cycle when organs should rise and fall. Additionally, the traditional belief was that the placenta housed one of the baby's souls and until the placenta was delivered, the baby was not truly born. Several practices resulted from these beliefs. When the placenta was retained, women would tie one end of a string to the severed umbilical cord and the other to their big toe to anchor the placenta so that it wouldn't wander. Problems occurred when the string was short and the woman moved her leg, provoking hemorrhage. Some women did not want to give up the practice entirely, but agreed to make the string longer and ensure that it was clean.

Understanding these beliefs helped during the discussion about immediate breastfeeding. Instead of focusing on the previously repeated but ineffective messages about immediate breastfeeding (that it helps to inoculate the baby-its first vaccine), the facilitators presented the advantage that immediate breastfeeding causes the uterus to contract, thereby helping the placenta to be delivered more rapidly. This information was important for the women-- it fit within their experience, responded to their need to ensure rapid exit of the placenta and respected their perspective. Ultimately, many women changed the previous practice of waiting two or three days to breastfeed when their "good" milk came in to immediate breastfeeding within one hour of delivery.

Save the Children Federation, Bolivia Field Office and Center for Interdisciplinary Community Studies (CIEC)