Prepare To Mobilize

Defining a community

As you select a health issue, you will also need to define the community or communities with which you will work. Community mobilization refers to “community” in its broadest sense. In the changing context of migration, urbanization, and globalization, the concept of “community” has evolved significantly beyond just a group of people who live in a defined territory. Today, community also refers to groups of people who may be physically separated but who are connected by other common characteristics, such as profession, interests, age, ethnic origin, a shared health concern, or language. Thus, you may have a teachers’ community, a women’s community, or a merchants’ community; you may have a community of people living with HIV/AIDS (PLWHA), displaced refugees, teenage boys, or men with STIs.

SO. AFRICA & RWANDA Defining Community

The AIDSCAP Project defined community in a number of different ways in order to focus on groups who were particularly at high risk for STD/HIV/AIDS infection. In South Africa, sex workers and their clients represented a particular social network or 'community' at high risk. Although geographically dispersed (representing truckers, migratory labor groups, etc.), this community was approached by the project to find solutions to the dangerously high rates of sexually transmitted diseases and infections. Community mobilization efforts focused on places where members of this particular social network would gather, such as brothels and bars.

In war-torn Rwanda, Save the Children's Psychosocial Assistance Program (PSA) worked to help rebuild social networks together with widows, widowers and children to develop a 'community' of caregivers to address children's and care-takers' psychosocial needs. During the first phase of the program, staff and program participants identified a 'community' of 12,000 separated and orphaned children in 70 residential care centers. The PSA program worked with these centers to restore some sense of normalcy to children's lives through recreational activities, training for caregivers on child development and the Convention on the Rights of the Child, including the importance of play and protection. The second phase of the PSA moved away from these centers and worked with geographically determined 'community' villages. Save the Children worked to build the capacity of these communities to monitor and support separated and orphaned children. Community associations were developed and members received training and technical assistance to respond to the psychosocial needs of children and foster families.

You may be in a position to have to choose from among a number of communities, in which case you will need to establish criteria.

Your first inclination might naturally be to choose communities that have the poorest health indicators, but it is important to remember that trying new approaches also means making mistakes and learning from them. It is easier to do this with more forgiving communities that have a history of success and can help analyze what went wrong.

VIETNAM: The Poorest of the Poor?

The Poverty Alleviation and Nutrition Program (PANP) in the coastal and lowland delta areas of Thanh Hoa Province, Vietnam was initiated by Save the Children in 1990 as part of a larger effort by seven international NGOs in response to national political concern for childhood nutrition. The Government offered Save the Children the choice of working in a province either in the north or in the south of the country. Thanh Hoa, in the north, was one of the country's poorest provinces, had a population of approximately 3 million and had no other international NGO's working there at the time. The magnitude of the problem of poverty, the potential for reaching greater impact through a large population base, responsive community leadership, and logistical proximity to Hanoi, where the field director was required to live, were all contributing factors to deciding where the project would be focused.

The Provincial chairman of the People's Committee decided that SC would work in the Quang Xuong District. The chairman chose the most populated district (250,000 inhabitants) with the highest levels of malnutrition. For the initial pilot phase, SC deliberately selected four of the poorest communes within Quang Xuong District totaling a population of 26,057. This choice of the "poorest of the poor" was based not only on SC's traditional criteria for targeting the beneficiaries of its services, but also on the belief that any model program that would emerge from these conditions would stand the best chance of being sustainable and replicable throughout the country.

In selecting the community, you should also consider issues such as whether there is strong or weak identification among members of the community, and how and whether minority voices will be heard, particularly when people who are directly affected or are at higher risk of being affected by the health need that your program intends to address are marginalized from others in the community and have limited access to information and services. For true participation of minority or marginalized groups in the broader community (rather than tokenism), research indicates that these minority groups need to have at least a 35 percent representation to have their voices heard as a group. When a minority’s representation reaches at least 35 percent, it has a much greater chance of forming alliances with others that result in changes in the overall group culture. At a 40-60 split, the group begins to become more balanced and individual voices can be heard.²

To Mobilize Or Not To Mobilize?