Explore Health Issues and Set Priorities

In the last phase on community organizing, we looked at how to identify and organize a core group of participants. Now it’s time to begin an in-depth exploration of the issue or health focus of the community mobilization effort. This phase may be referred to by a number of names, such as a needs assessment, participatory research, the “discovery” phase, “autodiagnosis,” or others depending on the project team’s approach and strategies.

Participatory Exploration

External organizations often see this phase as a data collection exercise primarily meant to help them “design the intervention.” Many fail to recognize that this phase, particularly when done in a participatory manner with the community, is an intervention. It is part of an ongoing process that furthers community dialogue and builds awareness around the health issue. When carried out in partnership with community members, this exploratory phase can foster community ownership and create an impetus for change by bringing together and mobilizing key actors. The exploratory phase builds common understanding, skills, and relationships between individuals and groups who are affected by and/or care about the health issue. And it gives those who participate in the Plan Together phase important information on key subjects, including:

• The community’s social and demographic characteristics.
• The community’s morbidity rates and, in some cases, mortality rate estimates.
• The current health status related to the community mobilization health issue.
• People’s current values, knowledge, attitudes, beliefs, and practices related to the health issue, such as care-seeking, utilization of health services, care provision, and home/community-based behaviors.
• The number of people directly and indirectly affected by this health issue.
• The groups most affected by this health issue, what they think and do about it, and how others perceive them.
• Traditional and cultural views on why this health condition exists.
• Available community resources.

This participatory exploration phase deepens critical reflection and dialogue around the health issue, which is particularly important when people may not perceive the health issue as a priority or when the topic, such as reproductive health, is rarely if ever discussed publicly or even privately.

All too often, programs and strategies are implemented based on external untested assumptions or on externally prescribed health behaviors without first understanding the individual, group, and community perceptions and underlying causes and influencing factors of the health issue. In keeping with Stephen Covey’s wise saying— “Seek first to understand, then to be understood”(1990)— the program team’s role in this phase is to ask questions to help the core group and other participants understand the current situation as it relates to the issue, to serve as resources to provide helpful information toward this end, and to listen.

Once this information has been collected (in steps 2 and 3 of this phase), the program team and the core group can conduct an in-depth, participatory analysis (step 4) of what it means for and how it affects the intervention that will be planned in the next phase. This analysis will help the team do the following:

• Determine the current health/social situation.
• Establish a quantitative and qualitative baseline.
• Generate community awareness, interest, and consensus.
• Garner support for the issue.
• Increase understanding of causes of the problem(s).
• Develop a common language to talk about the health issue.
• Increase community members’ skills in identifying problems and prioritizing them.
• Sensitize external team members to existing belief systems.
• Build program ownership and teamwork.
• Identify program participants in the mobilization process.
• Develop a base for program planning.
• Justify resource allocation/funding.
• Identify gaps and opportunities for improvement.