Organize the Community for Action

Overcoming barriers and resistance to participation

VIETNAM: Meeting with the Community

Once community resources and health facilities had been assessed and the nutritional baseline completed for the Poverty Alleviation and Nutrition Program (PANP), a series of community meetings were held in order to acknowledge the nutrition problem and understand its causes and identify solutions. An initial 'feedback' meeting was organized with the Village Health Committee and Health Volunteers. Program managers strived to include a wide participation at these meetings drawn from a cross-section of the community and including organized community groups, such as Women's Union and the Farmer's Union, along with the broader community. The purpose of the meetings was to:
  • Explain the definition of malnutrition
  • Report the results of the community's nutrition survey of young children
  • Identify casues of malnutrition in the community
  • Review the goal and objectives for a nutrition program
In the ongoing effort to build community ownership into project design and implementation, project staff reminded the local community partners at each organizing meeting of the time frame of the partnership (three years) and the long-term vision for sustaining program initiatives.

During these meetings, program managers along with Village Health Committee members discussed the following with the broader community:

    • Explained to participants the 3 conventional grades of malnutrition: mild, moderate and severe, with visual aids (pictures, real children from the villages, the growth chart).
    • Described the physical and behavioral symptoms of malnutrition in the young child.
    • Highlighted the fact that mild malnutrition often does not have visible symptoms and that regular weighing or growth monitoring is the only way to establish the nutritional status and growth pattern of the child, i.e. normal, faltering or malnourished.
    • Explained both the short-term and long-term adverse effects of malnutrition on young children.
    • Reported on the nutritional status of the children weighed during the most recent nutrition survey using the 3 grades of malnutrition, indicating how many children are well-nourished, and how many suffer from mild, moderate and severe malnutrition.
    • Explored the causes of malnutrition from the information gathered during focus group discussions with different groups.
    • Helped community members focus on current factors and practices that contribute to malnutrition in their young children. Shared information gathered on feeding, caring and health seeking practices.
Project staff also stated the goal of PANP and invited interested community members to work together in addressing the problem of malnutrition in their communities. (It should be noted that the goal of the program had been established by the donor agency. Specific PANP objectives and interventions would be determined in partnership with the community.) The goals of the PANP were to: (1) rehabilitate identified malnourished children in the community; (2) enable their families to sustain the rehabilitation of these children at home; and (3) prevent malnutrition in young children in the community.

Undoubtedly, it would be easier for your team to work only with those people who show up in response to a general announcement (“rounding up the usual suspects”), but this strategy may not be the wisest or most effective if you truly want to reach priority groups. There are many reasons people may not want or be able to participate in the community mobilization process. We believe that people should be free to decide whether or not they want to participate. There are times, however, when people genuinely want to participate but are unable to because of certain barriers. Knowing about these barriers and devising ways to overcome them can yield obvious benefits. Among the most common barriers:

  • Limited physical access to meeting sites.
  • Cultural limits to mobility and participation (e.g., women in purdah, caste structures, age).
  • Time constraints.
  • Responsibilities such as caring for children and animals, jobs, and the like.
  • Family members or others prohibiting an individual’s participation; for example, husbands may initially object to their wives participating in meetings because they may not see the benefit, particularly if no tangible incentives are provided.
  • Perception that the meeting is for others, particularly if the individual has never been invited to participate in community meetings or has been actively discouraged from doing so.
  • Opportunity costs of participation; if I attend this meeting I will not be doing something else that may be more beneficial to me or my family.
  • Low self-esteem; I wouldn’t have anything to contribute.
  • Lack of identification with other participants; my needs are different and they wouldn’t understand.
  • Fear of group processes, having to speak in front of a group.
The team needs to identify the barriers to participation and work with community members who would like to participate to develop strategies to overcome their reluctance. (For further details, see pages 74-77.) Often those most affected by the health problem that you are working on are experiencing the greatest number of barriers to participation.

Factors which influence participation
Raising awareness