Continuing on from our previous section, where we looked at some of the basic principles of community involvement. We're going to now look at how these are applied to specific tools for community participation and change. One of the frameworks that we like to use is Rothman's model of community change. This has four different components, four different approaches, and these correspond with some of the principles of community involvement, the levels of participation that we talked about before. There is the social policy planning component or approach, which very much aligns with acceptance. There's social mobilization which again, by the name, is related to mobilization participation. Social action is direct involvement, and locality development is getting from involvement into community control. No one model fits all. We can move back and forth. And as we've seen, of course, as we may start at a level of lower participation and hopefully by the time we finish working in a community, they're much more in control. We can use more than one approach. The social policy planning is very common among experts in various kinds of agencies and think tanks. They have done research, they've studied how people react to things. They can design expert programs, ideal programs, provide leadership. The area of urban regional planning is an area where social policy planning. The idea is if we make cul de sacs, what'll happen? If we make grids of roads, if we locate schools and shopping centers nearby, they try to think of how they can design areas that will ideally serve people, and they will use them. Again, the idea of planning your services. How do we deliver a family planning service in a way that provides the best for people? And again, by doing this, it's assumed that people are rational and they're going to see this as a good program and want to utilize it. Again, it's, is acceptance because when the experts are involved and the people are not, they tend to overlook some of the human nature issues. They overlook some of the local traditions, and social issues. Community action is geared toward addressing imbalance of power. We talked about the community process of mapping and identifying resources. And we also recognize that, in low income countries, communities don't have all the resources they may need. so community action is a process of the community itself lobbying, trying to get resources from the local government council, from other agencies. This may be in the process of community organizing. People may actually protest. They may demonstrate. It can take a variety of terms. So, basically, the community is organizing itself to redress imbalance of, or lack of key resources that they need. Community development is the process where people identify their problems. They try to figure out what's the best way to go about solving them. And they organize or mobilize their own resources, their own human resources, their own skills, their own material resources to solve their own problems, very much local self help. Finally there's community mobilization. And though this was not in Rothman's original model, I'll show you in a minute how it seems to be a logical extension, where the programs are externally designed, but community members are expected to contribute their resources to solve the problem. As we've said before, this is, the immunization campaigns are an example. So the way I've tried to make sense of this, again, looking at Rothman but adding another level to it, is that we can see in these approaches that there are two key variables. Who provides the leadership to solve the problem, and where do the resources come from? And so we see this locality development, this self-help approach, local leadership, and mobilizing local resources to solve their own problems. Where the local leadership, where the people themselves realize they don't have all of the resources they need, they reach out for external resources. Like I said, they lobby or even protest. That's where you have social action internal leadership, external resources. Where you have internal resources, but external leadership that tells people what to do with those resources, that's community mobilization. And finally, the social policy planning is where the outside experts bring in their resources and expect you to utilize them. So this is how we've tried to conceptualize these different approaches. And again, as we said before, you see community development work going on that may use a mixture of these depending on the nature of the problem. What we ultimately are looking toward is how can the community benefit from these various programs, ones they organize themselves, ones that are brought in from the outside, to improve their capacity to solve problems. And what we see in this diagram is the parallel track of social or community change along the top, and individual change along the bottom. So as the community as a whole gets organized, they mobilize their own social resources, their own leadership to encourage or control people. They participate, the various groups are involved, decisions are made. They increase their competence to get things done. And this results in development outcomes, whether it's improved roads, markets, schools, access to all of these resources, improvement and indicators, such as employment, education, etcetera. What happens is when all of this is going on in the community, when the community is working to solve problems, this basically sets up an environment, where individuals feel empowered also. We're doing this for the community. I can also do this to help myself and my family. And so, in a community that has increasing capacity, individuals also feel a capacity increase to seek health services, to change health behavior. And again, you see healthy outcomes resulting in terms of reduced morbidity, mortality. So this process is a parallel process. That as the community is gaining capacity to solve problems, individuals also feel empowered, in that setting, to try to improve their health, improve their own educational and other indicators. Some of the things that change in this process as the community gains capacity? You see increased participation. Leadership improves. More people are taking leadership roles, leaders are actively encouraging others to participate. The community gains new skills to solve problems, whether these skills may be communication skills, they may be management skills. The community gets access to new resources. The social networks are strengthened and improved. They may develop new groups, new associations in the community to address problems. It increases the sense of community or identity, that we can do things to improve ourselves. We're a progressive community. It improves the understanding of the history, because they can draw on, well, we've done this in the past, let's do it better. Or, let's re, let's we've fallen off, we should be doing more. In the past we had a credit union, we had this and that but we let it slide. Now we should go back to that and try to improve that resource. The community becomes more powerful, influential, and this helps, of course, when you're dealing with local governments or other external powers, so that the community can negotiate what it needs. Community values improve, in terms of care for each other, in terms of importance of education and health. And the ability to critically reflect on what they've done, and use that lessons learned to plan future action. As we said before, its not enough for the community to participate and implementation. They have to participate in evaluation of what they have done, so that they can learn those lessons and make strides in the future. In this process of community capacity building, in this process of different approaches or models of community change, we have change agents. We have public health workers. We have teachers. We have agriculture extension agents. We have people who are in the community, in theory, to provide help. And of course, help is only helpful if it's perceived as helpful by those trying to be helped [LAUGH] . Which is a roundabout way of saying that perceptions are the key issue. You may think you're being helpful and somebody may think you're being annoying. So, this is a key issue to look at. So, the change agent, under a social planning approach, is the expert who knows everything. Unfortunately, these experts may not know the community they're working with. When we're talking about locality development, the change agent is a facilitator. Encouraging people to think carefully about what they're doing, helping them identify their own resources, encouraging them to take action. In social action, we have the community organizer. Somebody who can provide encouragement for the community to identify what it needs, and helps it strategize so it can lobby or protest effectively to get the resources it needs. Community mobilization requires a manager. Somebody who can coordinate the resources that the agency is bringing in, and, and identify and coordinate the resources needed for the community. So each of these different types of change agent reflect the philosophy and attitude about the community's capacity to solve its own problems. The expert doesn't think much about the community's capacity. The facilitator, in contrast, thinks that the community is the only way you can really get things done. Without the community you won't see change. And so the importance of building the capacity relying on community capacity is very much built into the role of the facilitator. So, again, these different attitudes about the community are central to how the change agent works. That said, these different models, these different approaches, can be carried out by some specific tools. And there are many different agencies that have a toolbox that can be used for community action. And so, we're going to give some examples of this. And we'll, again, put more resources on the website in the online library for you to find. And also hopefully when you're doing your assignments, you can even suggest or talk about some of the ones that you're personally familiar with or have read about. So some of the tools help the community learn, learn about itself, learn about its resources, learn about its needs. Other tools guide the community in planning various interventions, various actions to solve their problems. Other tools enable the community to deliver basic services, enabling through skills and resources. And finally, there are tools that help advocate for better services. This may be linked to our social action aspects. How can the community have a greater voice in getting its needs met? So again, each of these reflect a different approach in Rothman's model. This is not meant to be exhaustive, but we do hope we'll look at several of these tools: community coalitions, quality improvement teams, which arise out of the community action cycle, community-directed interventions, participatory appraisal, and care groups. And as we have mentioned before, the care group model has been presented in the human resources lecture. So please be aware of that and think about that as we're looking at the remainder of the tools, and when you're working on your assignment. You can certainly draw on that, and again, other tools that you're aware of. No one tool does everything. Community coalitions are really good at learning and planning and advocating. Community-directed interventions are very helpful in delivering specific services. So these are the kinds of things we need to be aware of; that we should be able to combine tools, no one size fits all. Every agency you work with may have its own tool kit. There are some groups that do, again, bring these things together on their websites, and we'll try to make these available so you can see other things. But it's always important to be willing to mix and match, be creative, and ultimately the community itself should determine which tools are best. So these are tools that can achieve a minimum of community participation. At least participation and involvement. We rarely start at the level of community control, because again, oftentimes, we are hired by an agency that has an agenda. You may be working for a specific disease control program. you may be working for an adult literacy program, whatever it is. So, the people that hire you have an agenda, they have money to achieve something and they need results. As we said before, if you approach this in the right way and the community is more involved along time, the benefit is that they will use their experience to move forward even after you've left, into solving other problems. So even if you have an agenda to begin with, you want to set the stage where the community can take more responsibility over time. So again, regardless of what we bring in, we need buy-in and ownership of the community, or else people may not perceive these various health problems as a need, and may not be willing to contribute their time and energy to these. So we're hoping that we will progress along that continuum from acceptance up through control, that the community will take more responsibility for setting agenda. And more responsibility for solving their own problems. This is a general background to the concept of community tools. And in the next sections, we'll talk about some of the specific tools that we outlined.
