Explore the Health Issue and Set Priorities

STEP 3: Together with the core group, explore the health issues within the broader community.

The previous step explored the core group members’ knowledge, feelings, beliefs and practices related to the health issue. That step also aimed to build trust, confidence and cohesion in the group. Some programs limit their activities during the exploration phase to this core group process and then proceed with the core group directly to the Plan Together phase. This approach may be appropriate when the core group consists of the entire community or when improvements in health status are sought only for group members, and group members have the decision-making authority, ability and resources to make improvements in their health themselves.

But often this is not the case when you are working with people who have limited access to information, services, time, and other resources. In many cases—especially when there are diverse perspectives and/or when collective action beyond the members of the core group is necessary to improve access, quality or availability of the means to better health—the program will need to extend beyond the core group to mobilize the broader community.

Just as the program team planned for the core group exploration process, now the core group (with assistance from the program team) needs to plan for the exploration process in the broader community. One of the first issues to decide is the extent to which the core group will be involved in developing and/or participating in this exploration process. Ideally, core group members would act on their own or as partners with the program team in designing this process, but in reality they often don’t; more often they participate in the actual conduct of the various exploratory exercises and studies, but using an approach predetermined by the program team to do so.

All other things being equal, the more involved the core group is in exploring what the broader community does, feels, and thinks about the issue the better. But “all other things” are sometimes not equal. Here are some criteria to keep in mind as you make your decision about this important question:

• The core group’s previous experience in developing and conducting an assessment or baseline study.
• The core group members’ interest in learning how to design community assessments.
• Time and resources available.
• Weighing overall program needs with community needs and desires.

Regarding the last point above, when demonstration projects are the subject of donor, development and scientific community interest, it may be wise to mix relatively “objective” baseline studies done by external research and evaluation organizations with participatory community research processes. In fact, if you have the resources to hire an external agent to conduct a baseline assessment, it is important to feed these results back to the community as input for their discussions on priority setting.

Whoever ends up being involved in this exercise (hereafter referred to as the information gatherers), this group will need to make three important decisions about this activity:

1. Objectives: What is it that they want to learn about this health issue in the broader community and why? What are their other objectives (raise community awareness, broaden community participation, involve local leaders, other)?
2. Methods: How will they gather and use this information? Does it already exist or do they need to collect it? Who will be responsible for organizing, coordinating, collecting, consolidating, and analyzing the information?
3. Resources: Which human, financial, and material resources will they need to carry out the assessment? What resources do they have now? What resources will they need to get? How will they get them? Are there specialists in monitoring and evaluation, epidemiology, social science, anthropology, sociology, and other related disciplines that can help them?

Gathering Information
Documenting Information