Process Documentation of Community Involvement

Abstract

• Name: Process Documentation of Community Involvement
• Purpose: To analyze how communities participate in the design and implementation of maternal and child health programs. Lessons learned are intended to improve the effectiveness of involvement by community leaders and beneficiaries in the design and implementation of maternal and child health programs at community level.
• Type of Design: Descriptive, cross-sectional.
• Sample Size: N/A
• Where Used: Madagascar, Nigeria, Zambia and Ethiopia.

To survey tool

Basic Information

Name: Process Documentation of Community Activities

Origin: BASICS

Source: BASICS

Purpose: The Process Documentation of Community Involvement had been developed to analyze how communities participate in the design and implementation of maternal and child health programs. Lessons learned are intended to improve the effectiveness of involvement by community leaders and beneficiaries in the design and implementation of maternal and child health programs at community level

Basic Description: This tool enables health care managers to undertake systematic documentation of community involvement in maternal and child health programs.

Country Applications: Nigeria, Zambia, Ethiopia and Madagascar.

Languages Available: English

Technical Scope: In depth analysis of the design, implementation and sustainability of the community component of maternal and child health programs.

Type of Methods: Qualitative: document review, interviews based on a semi-structured questionnaire and focus group discussions.

Design: Descriptive and cross-sectional. Data gathering includes interviews with project managers, community leaders and beneficiaries of maternal and child health programs. It allows sufficient flexibility for describing unique program elements and adequate standardization to enable cross-country comparison.

Key Users of Information

Managers and planners of maternal and child health programs at national and local levels who design, implement or monitor community health activities.

Objectives and Scope of the Tool

The tool assists planners in analyzing the process of designing, implementing and ensuring the sustainability of the community component of maternal and child health programs. Lessons learned from such analysis are intended to improve the effectiveness of the involvement of community leaders and beneficiaries in the design and implementation of the maternal and child health programs.

Key Monitoring Needs and Evaluation Questions Tool Seeks to Address

This tool provides an in-depth analysis of the process of designing and implementing community health interventions, particularly the role of the community. The tool is used to draw lessons to improve the effectiveness and the sustainability of such interventions. This type of process documentation focuses on three core questions:

• How was the community involvement designed and organized?
• How have community programs been implemented and managed?
• What evidence of and prospects for sustainable community involvement and work exist?

Key Indicators

To describe and analyze a community-based MCH program, the tool/approach asks the following questions:

How was community involvement designed and organized?

• What are the specific objectives of community involvement and how does it fit within the overall project?
• What was the project design and implementation process?
• Who was involved in the design? What role did the "community" play?

How have community programs been implemented and managed?

• What was implemented? What was not implemented? Why not? What were the barriers to implementation as designed?
• What were the specific strategies used to work with/interact with or involve the community?
• What is the organizational structure that has guided these projects?
• What has been the technical content or focus of the project?
• How much technical assistance has been provided?
• How has the implementation been monitored over time?
• How has the larger environment affected the way the project has been designed and implemented?
• What (agenda, methods, intervention strategy, etc.) was brought to the communities? What evolved out of working with the communities?
• How do the public and private sector interact?

What evidence of and prospects for sustainable community involvement and work exist?

• What are the system and programmatic achievements? What are the products of the design and implementation process?
• How much of what has been done is the result of one charismatic leader versus the development of a system and ongoing structure?
• What are the essential elements to maintaining a high level of commitment and activity?
• What is the history of decision-making? What crises have been faced?
• What are the elements of the project that suggest that the activities or the entire program might be sustained or not?
• How has the tension between "community-based" and "going to scale" been addressed? How have project team members advocated for the community approach? How have they maintained the value of this approach?

Research Design

This tool suggests three main methods for conducting the process:

1. Document Review: Understanding the original design of the program requires reviewing relevant documents such as:

• Workplans
• Annual and quarterly reports
• Trip reports
• Technical reports (if any)
• Products of the community program (e.g. training curricula, health education materials, implementation guidelines, etc.)
• Meeting minutes, emails, faxes etc.
• Community or District actions plans and/or proposals

Key items to abstract from documents include:

• List of activities/steps/processes to be rated
• Changes from the original design
• Conflicts and/or delays around activities
• Key products of the program (e.g. action plans, proposals, health education materials, etc)
• Organizational structure of the program
• Short-term technical assistance needed

2. Interviews with Professional Staff

The tool includes a guide to interviewing relevant professional staff at the central, district, and health facility levels. If NGOs and other agencies have been involved, they should also be interviewed.

Activity Rating: Interviewees are then asked to rate, from their point of view, the activities which have been implemented to promote community involvement. The rating classifies activities into four categories: absolutely essential; highly recommended; complementary to program goals; and not recommended for future programs.

Based on the results of the activity rating, managers and health planners can form a priority list of activities needed required for successful community involvement in future programs.

3. Interviews/Focus group discussions with community members

Individual interviews or focus group interviews could be conducted with community leaders, TBAs, CHWs and beneficiaries (mothers). The interviews should address the following questions:

• Who was involved in the design? What role did the "community" play?
• What was implemented? What was not implemented? Why not? What were the barriers to implementation as designed?
• What were the specific strategies used to work with/interact with or involve the community?
• What (agenda, methods, intervention strategy, etc.) was brought to the communities? What evolved out of working with the communities?
• What are the essential elements for maintaining a high level of commitment and activity?
• What is the history of decision-making? What crises have been faced?
• What are the elements of the project that suggest that the activities or the entire program might be sustained or not?

Lessons from experience
The Process Documentation of Community Involvement has been utilized by the BASICS project in four countries: Madagascar, Nigeria, Zambia & Ethiopia. The key issues and questions addressed were:

Madagascar: Consensus building process on messages; Link between community work and mass media

Nigeria: Linkages between Community Based Organizations (CBOs) and health facilities in an urban setting; Public-private linkages or lack thereof

Zambia: NGO partnership process especially coordination with districts and the participatory proposal development approach

Ethiopia: Development and implementation of joint action plans between community and health facility staff

The greatest challenge in implementing this exercise is often allowing sufficient flexibility to describe unique program elements while ensuring sufficient standardization for making cross-country comparisons.

The questionnaire, interview guide for health professionals and guide for focus group discussions were extremely useful in structuring the analysis. However, it is recommended that they be adapted and tested for each country situation. Since this is a qualitative tool, the ability to conduct a successful interview and lead an effective focus group discussion is key to the success of data gathering and analysis. Findings should be disseminated in a way that reflects the needs and interests of different audiences from central policy makers, to local managers, health workers, community leaders and beneficiaries.

References

Clemmons L., What Communities Have to Say About Community Involvement Approaches. BASICS' IEC and Community Mobilization Strategies for Child Survival in Madagascar. 1998, BASICS

Bhattacharyya K., Process Documentation of BASICS' Community Activities, Guidelines and Methodology. 1998 BASICS.

Brieger W., Documentation Exercise: A Process Evaluation of the Community Partners for `Health. Lagos, Nigeria. 1997, BASICS.

Contact Person
Karabi Bhattacharyya
BASICS Project
1600 Wilson Blvd.
Arlington, VA 22209
703-312-6800