COMMUNITY HEALTH STRATEGY NOTES

Community health is the first level of healthcare provision in Kenya that is constituted of
(a)interventions focusing on building demand for existing health and related services by improving
community awareness and health seeking bheavior and (b) taking defined interventions services closer
to the community and households.

Community health unit is a health service delivery structure within a defined geographical area covering
a population of approximately 5,000 people. Each unit is assigned one community health
assistant/officer and 10 community health volunteers who offer promotive and basic curative services.

Community health volunteer is a member of the community selected to serve in a community health
unit.

Community health assistant /officer (CHA/CHO) is a formal employee of the county government
forming the link between the community and the health facility.

Community health committee refers to a committee that is charged with the coordination and
management of the community health unit and whose membership, representation and tasks is in line
with the Kenyan community health policy of 2020-2030

Community dialogue is a forum that draws participants from many segments of the community as
possible to exchange information, share personal stories and experiences, clarify viewpoints and jointly
develop solutions to community concerns.

Community action day are open events held to raise awareness about health and other community
development related issues and to implement the issues raised during the community dialogue and are
geared towards building community resilience.

Primary health care: This is essential health care based on practical, scientifically sound and socially
acceptable methods and technology, made universally accessible to individuals and families in the
community through their participation and at cost that the community and country can afford to
maintain at every stage of their development in the spirit of self-reliance and self-determination.

Universal health coverage means that all people and communities can use the promotive, preventive,
curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while
also ensuring that the use of these services does not expose the user to financial hardship.
PROBLEMS FACING COMMUNITY HEALTH STRATEGY

The community health strategy in Kenya has faced many challenges which are hindering it from
achieving the set goals and objectives.

Leadership and governance of community health units is under the direct mandate of CHC, these
committees have executed their leadership and oversight functions as defined in the community health
strategy.

Some of the problems include;

 Low motivation by CHC

 Poor implementation of the previous health strategy
 Low workforce numbers of CHAs /CHOs
 Inadequate capacity building of community health workforce
 Low motivation and retention of community health workforce
 Insufficient funds to support the strategy

Community health strategic objectives

 Strengthen management and coordination of community health governance structures at all

levels.
 Build a motivated, skilled, equitably distributed community health workforce.
 Increase sustainable financing for community health.
 Strengthen the delivery of integrated comprehensive and high-quality community health
services.
 Increase availability, quality, demand and utilization of data.
 Ensure the availability and rational distribution of safe and high-quality commodities and
supplies.
 Create a platform for strategic partnership and accountability among stakeholders and sectors
at all levels within community health.

What is social mobilization?

It is the process of bringing together allies to raise awareness of demand for particular programme
which would strengthen community participation for sustainability of projects.

It is also collective level effort to address issues and concerns of community through organized efforts.
What does community mobilization achieve?

A. It builds and improves the local community capacity.

B. Motivates community to work and solve their own issues.
C. Mobilizes local and external resources to be used in projects.
D. It promotes social cohesiveness.
E. It links the community with program or project coordinators.
F. It results in long term changes for community institutions.
G. It creates a sense of community independence.

Community entry “DOS”

 Seek out answers in the community in a respectful way.

 Listen more to the community members and speak less.
 Commit to suspending your assumptions about the community.
 Address cultural differences in a way that is not disrespectful to all parties involved.
 Get a respected and knowledgeable cultural mentor to guide you.
HEALTH TALK PLANNING

Health talk is just a brief event meant to give people simple facts and information about certain health
conditions so that they protect themselves and other people.

Steps in planning a health talk:

1.IDENTIFY LOCATION

One of the most important things in planning or organizing health talk is identifying the location or
setting,where the talk shall be carried out.Knowing the location is very key as it affects other variables
and factors such as the number of people who can be accommodated,use of certain teaching materials
like powerpoint presentations .

So it is very important to identify a setting which is very accessible to all community members and also a
location that the locals will feel comfortable.

2.IDENTIFY YOUR AUDIENCE

In order for the talk to be effective and useful you must first of all know the anatomy of your target
people. Knowing your audience is very critical as it affects the way you package your message and also
your health topic of focus,certain health issues are more identifiable with certain age groups,race and
gender.

Knowing your audience well makes delivery of the message easier.

3.IDENTIFY YOUR TEACHING MATERIALS

In health talk certain materials can be used to deliver the health message,commonly used materials

include small palmlets, powerpoint presentations,illustrations and personal stories sharing.

Knowing the materials you are going to use is important as that gives you more time to prepare your
materials well so that you have simplified and effective message that the locals can understand.

Also the teaching materials you use depends on the target audience,if the locals are not so literate then
some unconventional methods can be used so as to pass the intended message. The goal of teaching
materials is to educate the audience and give them relevant facts and information about health issues of
concern.
4.IDENTIFY YOUR HEALTH ISSUE OF CONCERN

The entire health talk is based on a health issue,its very important for the health educator to identify the
health issue of concern early so that he/she can prepare a lot of teaching materials that will be used in
the health talk. Also early identification of the issue gives the health educator a lot of time to familiarize
with the health issue and gain more up to date facts about the health issue.

Normally in choosing the health issue the process is influenced by the local community,health issues
persistent in the community are the ones chosen for health talk so as to create more awareness on
them.

5.IDENTIFY YOUR HEALTH EDUCATOR

This is very critical and important ,the success and failure of health talk may depend on the health
educator. Choosing the right health educator is the key,in choosing the health educator factors such as
the community culture,traditions and values are supposed to be considered.

The audience is supposed to be free and open with the health educator so as for them to have an open
and honest discussion,so in choosing the health educator all of these factors are supposed to be taken
into account.
HEALTH EDUCATION AND PROMOTION

Course Content

Introduction To Health Education

 Health Education
 Historical development
 Definitions
 Aims and Basic principles of Health Education
 Approaches to Health Education
 Targets for Health Education
 Health Education settings
 Who is responsible for Health Education?
 Role of Health Educator

Health And Human Behavior

H. Definition of behavior and other related terms

I. Factors affecting human behavior
J. The role of human behavior for prevention of disease

Working With Communities

 Definition of community
 Concept of community participation
 Benefit of community participation
 Helping people to organize: The role of Health Extension

Health Communication

 What is communication?
 Why communication
 Types of communication
 Components of communication
 Communication stages
 Common communication approaches
 Methods of communication
 Barriers to effective communication
 Characteristics of effective communication

Educational Methods And Materials

 Educational methods; Individual, Group

 Teaching materials; Audios, Visual aids
 Mass media
Training

 What is training?
 Types of training
 Phases of training

Planning, Implementation and Evaluation Of Health Education Programs

Planning process

 Information gathering
 Defining and prioritizing problems
 Setting goals and objectives
 Identifying and obtaining resources
 Selecting appropriate methods

Carry out and evaluate the project

 Development and implementing a project plan

 Evaluating the project

Ethical Issues in Health Education

 Basic Principles of Ethics

 Health workers responsibilities as a health educator

Lecture Notes

INTRODUCTION TO HEALTH EDUCATION

Health education-a combination of learning experiences designed to facilitate voluntary actions

conducive to health

Health promotion-a combination of educational and environmental supports for actions and conditions
of living conducive to health

Information: A collection of useful briefs or detailed ideas, processes, data and theories that can be used
for a certain period of time.

Education: A complex and planned learning experiences that aims to bring about changes in cognitive
(knowledge), affective (attitude, belief, value) and psychomotor (skill) domains of behavior.
Communication: the process of sharing ideas, information, knowledge, and experience among people
using different channels.

Social mobilization-campaign approach combining mass media and working with community groups and
organizations

Health extension- an approach of promoting change through demonstration, working with opinion
leaders and community based educational activities.

Nutrition education-education directed at the promotion of nutrition and covers choice of food, food-
preparation and storage of food.

Family Life Education-education of young people in a range of topics that include family planning, child
rearing and childcare and responsible parenthood.

Patient education-education in hospital and clinic settings linked to following of treatment procedures,
medication, and home care and rehabilitation procedures.

Behavior Change Communication (BCC)-interactive process aimed at changing individual and social
behavior, using targeted, specific messages and different communication approaches, which are linked
to services for effective outcomes.

Advocacy-communication strategies focusing on policy makers, community leaders and opinion leaders
to gain commitment and support. It is an appeal for a higher-level commitment, involvement and
participation in fulfilling a set program agenda

Aims and principles of health education

Aims

 Motivating people to adopt health-promoting behaviors by providing appropriate knowledge

and helping to develop positive attitude.
 Helping people to make decisions about their health and acquire the necessary confidence and
skills to put their decisions into practice.

Basic Principles

All health education should be need based. Therefore before involving any individual, group or the
community in health education with a particular purpose or for a program the need should be
ascertained. It has to be also specific and relevant to the problems and available solutions.

Health education aims at change of behavior. Therefore multidisciplinary approach is necessary for
understanding of human behavior as well as for effective teaching process.

It is necessary to have a free flow of communication. The two-way communication is particularly of

importance in health education to help in getting proper feedback and get doubt cleared.
The health educator has to adjust his talk and action to suit the group for whom he has to give health
education. E.g. when the health educator has to deal with illiterates and poor people, he has to get
down to their level of conversation and human relationships so as to reduce any social distance.

Health Education should provide an opportunity for the clients to go through the stages of identification
of problems, planning, implementation and evaluation. This is of special importance in the health
education of the community where the identification of problems and planning, implementing and
evaluating are to be done with full involvement of the community to make it the community’s own
program.

Health Education is based on scientific findings and current knowledge. Therefore a health educator
should have recent scientific knowledge to provide health education.

The health educators have to make themselves acceptable. They should realize that they are enablers
and not teachers. They have to win the confidence of clients

The health educators should not only have correct information with them on all matters that they have
to discuss but also should themselves practice what they profess. Otherwise, they will not enjoy
credibility.

It must be remembered that people are not absolutely without any information or ideas. The health
educators are not merely passing information but also give an opportunity for the clients to analyze
fresh ideas with old ideas, compare with past experience and take decisions that are found favorable
and beneficial.

The grave danger with health education programs is the pumping of all bulk of information in one
exposure or enthusiasm to give all possible information. Since it is essentially a learning process, the
process of education should be done step-by-step and with due attention to the different principles of
communication.

The health educator should use terms that can be immediately understood. Highly scientific jargon
should be avoided.

Health Education should start from the existing indigenous knowledge and efforts should aim at small
changes in a graded fashion and not be too ambitious. People will learn step by step and not everything
together. For every change of behavior, a personal trail is required and therefore the health education
should provide opportunities for trying out changed practices.

Approaches to health education

 The persuasion approach

Deliberate attempt to influence the other persons to do what we want them to do (DIRECTIVE
APPROACH)
  The informed decision making approach

Giving people information, problem solving and decision making skills to make decisions but leaving the
actual choice to the people. e.g. family planning methodsMany health educators feel that instead of
using persuasion it is better to work with communities to develop their problem solving skills and
provide the information to help them make informed choices. However in situations where there is
serious threat such as an epidemic, and the actions needed are clear cut, it might be considered justified
to persuade people to adopt specific behavior changes.

Targets for health education

 Individuals such as clients of services, patients, healthy individuals

 Groups E.g. groups of students in a class, youth club
 Community E.g. people living in a village

Health education settings

When considering the range of health education interventions, they are usually described in relation to
different settings. Settings are used because interventions need to be planned in the light of the
resources and organizational structures peculiar to each. Thus, health education and promotion takes
place, amongst other locations, in:

 Communities
 Health care facilities
 Work sites
 Schools
 Prisons
 Refugee camps

Role of health educator

 Talking to the people and listening of their problems

 Thinking of the behavior or action that could cause, cure and prevent these problems.
 Finding reasons for people’s behaviors
 Helping people to see the reasons for their actions and health problems.
 Asking people to give their own ideas for solving the problems.
 Helping people to look as their ideas so that they could see which were the most useful and the
simplest to put into practice.
 Encouraging people to choose the idea best suited to their circumstances

HEALTH COMMUNICATION
Communication is the process of sharing of ideas, information, knowledge, and experience among
people to take action.

It facilitates creation of awareness, acceptance and action at individual, group and inter-group level.

Purposes of Communication

 To have dialogue with communities.

 Influence decision makers to adopt health promoting policies and laws.
 Raise awareness among decision makers on issues regarding poverty, human rights, equity,
environmental issues
 Ensure that the public gives support to government health promoting activities.
 Communicate new laws and policies to the public
 Raise public awareness in order to mobilize community participation.
 Develop community action on health issues.

Types of Communication

One-way communication

This is a linear type of communication in which information flows from the source to the receiver. There
is no input (feed back) from the receiver. It is commonly used in advertising; the message is designed to
persuade the receiver to take action prescribed by the sender

Sender…..message…….channel…….receiver

Two-way communication

Information flows from the source to the receiver and back from the receiver to the source. The addition
of feedback allows the sender to find out how the message is being received and so it can be monitored
and adapted to better suit the receiver’s needs.

Components of communication

 Source (sender)

Originator of message

 Message

Consists of what is actually communicated including the actual appeals, words, and pictures and sounds
that you use to get the ideas across.A message will only be effective if the advice presented is relevant,
appropriate, and acceptable and put across in an understandable way.

 Channel

Physical means by which message travels from a source to a receiver. The commonest types of channels
are verbal, visual, printed materials or combined audio visual and printed materials

 Receiver (Audience)

The person or a group for whom the communication is intended

Audience characteristics to consider;

 Educational factors
 Sociocultural factors
 Patterns of communication

 Effect and feedback

Effect is the change in receiver’s knowledge, attitude and practice or behavior.

Feedback is the mechanism of assessing what has happened on the receiver after communication has
occurred.

Stages of Communication

Stage 1:Reaching the intended audience

Communication cannot be effective unless it is seen or heard by its intended audience. A common cause
of failure is preaching to the converted

Stage 2: Attracting the audience’s attention

Any communication must attract attention so that people will make the effort to listen/read it.

Attention attraction factors;

Physical characteristics

 Size e.g. size of the whole poster

 Intensity – bold reading in a sentence
 High pitched sounds e.g. police sirens
 Color-primary colors such as red and yellow
  Pictures-photographs and drawing

Motivational characteristics

 Novelty - an unusual features, unfamiliar and surprising objects

 Interest - felt needs of audience
 Entertainment and humor

Stage 3: Understanding the message (perception)

Once a person pays attention he/she then tries to understand it. It is a highly subjective process i.e. two
people may hear the same radio programme and interpret the message quite differently from each
other and from the meaning intended by the sender

Stage 4: Promoting change (acceptance)

A communication should not only be received and understood; it should be believed and accepted

Stage 5: Producing a change in behavior

A communication may result in a change in beliefs and attitudes but still may not influence behavior

Stage 6: Improvement in health

Improvements in health will only take place if the behaviors have been carefully selected so that they
really do influence health

Common communication approaches

 Informing-The new idea is introduced and made familiar to the target audience
 Educating - The new idea is explained including its strengths and weaknesses
 Persuading- The audience is given convincing argument that motivates them to take an action or
accept a new idea
 Entertaining -The attention of the audience is drawn to the new idea by stimulating the
audience’s emotions

Methods of Communication

Intra-Personal communication

It takes place inside a person. It includes the beliefs, feelings, thoughts and justification we make for our
actions
Interpersonal Communication

It means interaction between two or more people who are together at the same time and place

Advantages

 Two way communication

 The communication could utilize multi-channels (both verbal and non verbal) i.e. far more
channels are involved than is possible in mass communication.
 Useful when the topic is a taboo or sensitive.

Limitations

 Requires language ability of the source.

 Requires personal status.
 Needs professional knowledge and preparation.

Mass communication

It is a means of transmitting messages to a large audience that usually reaches a large segment of the
population. It uses mass media

Advantages:

 Reach many people quickly

 They are believable specially when the source is a credible one

Limitations:

 One sided (linear)

 Doesn’t differentiate the target

Common barriers to effective communication

 Competition for attention (noise)

 Language difference and vocabulary use
 Age difference
 Attitudes and Beliefs

How to overcome barriers of communication

The sender must know his/her audience’s:

 Background
 Age and sex
 Social status
  Education
 Job/work
 Interests/problems/needs
 Language

The messages must be:

 Timely
 Meaningful/relevant
 Applicable to the situation

The audience must remove their own barriers.

Members of the audience could be:

 The non-listener type – who refuse to listen.

 The know-it-all type – who thinks he/she knows the answer to everything.
 The impatient type – who is reluctant to sit and jumps to conclusion.
 The negative personality – who enjoys saying ‘no’ to everyone

Good presentation-requires complete understanding of the subject establishing good relationship with
the audience, choosing the right channels or media, proper utilization of the chosen media and using the
multimedia approach.

Characteristics of Effective Communication

 All barriers have been removed.

 The proper media has been chosen.
 A good presentation has been made.
 Two – way communication has been established

HEALTH & HUMAN BEHAVIOUR

Definitions of behaviour and other related terms

Behaviour is an action that has a specific frequency, duration and purpose whether conscious or
unconscious. It is what we “do” and how we “act”. People stay healthy or become ill, often as a result of
their own action or behaviour. The following are examples of how people’s actions can affect their
health:

Using mosquito nets and insect sprays helps to keep mosquito away.

Feeding children with bottle put them at risk of diarrhoea.

Defecating in an open field will lead to parasitic infection.

Unsafe sex predisposes people to unwanted pregnancy, HIV/AIDS and other STDsIn health education it is
very important to be able to identify the practices that cause, cure, or prevent a problem.

The words actions, practices and behaviours are different words of the same thing.

Life style: refers to the collection of behaviours that make up a person’s way of life-including diet,
clothing, family life, housing and work

Customs: It represents the group behaviour. It is the pattern of action shared by some or all members of
the society.

Traditions: are behaviours that have been carried out for a long time and handed down from parents to
children. 15

Culture: is the whole complex of knowledge, attitude, norms, beliefs, values, habits, customs, traditions
and any other capabilities and skills acquired by man as a member of society.

Distinguishing characteristics of culture

 Culture is symbolic. It is an abstract way of referring to, and understanding ideas, objects,
feelings or behavior – the ability to communicate with symbols using language. To convey new
ideas people may invent single words to represent many different ideas, feelings or values.
 Culture is shared. People in the same society share common behavior patterns and ways of
thinking through culture. For example people living in a society share the same language, dress
in similar styles, eat much of the same food and celebrate many of the same holidays.
 Culture is learned. A person must learn culture from other people in a society. For instance,
people must learn to speak and understand a language and to abide by the rules of a society.
 Culture is adaptive. People use culture to adjust flexibly and quickly to changes in the world
around them. For instance a person can adjust his diet when he changes an area of residence.

Examples of behaviours promoting health and preventing diseases

Healthy behaviours: - actions that healthy people undertake to keep themselves or others healthy and
prevent disease. Good nutrition, breast feeding, reduction of health damaging behaviours like smoking
are examples of healthy behaviours

Utilization behaviour: - utilization of health services such as antenatal care, child health, immunization,
family planning...etc

Illness behaviour: - recognition of early symptoms and prompt self- referral for treatment.

Compliance behaviours: - following a course of prescribed drugs such as for tuberculosis.

Rehabilitation behaviours: - what people need to do after a serious illness to prevent further disability.
Community action: - actions by individuals and groups to change and improve their surroundings to
meet special needs.

Factors affecting human behaviour

1. Predisposing factors: provide the rationale or motivation for the behavior to occur. Some of
these are:
 Knowledge
 Belief
 Attitudes
 Values

E.g. For an individual to use condom, he has to have knowledge about condom and develop positive
attitude towards utilization of condom.

• Knowledge is knowing things, objects, events, persons, situations and everything in the universe. It is
the collection and storage of information or experience. It often comes from experience. We also gain
knowledge through information provided by teachers, parents, friends, books, newspapers, etc.

E.g. knowledge about methods of prevention of HIV

• Belief is a conviction that a phenomenon or object is true or real. Beliefs deal with people’s
understanding of themselves and their environment. People usually do not know whether what they
believe is true or false. They are usually derived from our parents, grandparents, and other people we
respect. Beliefs may be helpful, harmful or neutral. If it is not certain that a belief is harmful, it is better
to leave it alone.

For example, a certain society may have the following beliefs:

 Holding materials made of iron by mothers during postpartum (Neutral)

 Diarrhea may end up with death (helpful)
 Measles can not be prevented by immunization (harmful)

• Attitudes are relatively constant feelings, predispositions or set of beliefs directed towards an object,
person or situation. They are evaluative feelings and reflect our likes and dislikes. They often come from
our experiences or from those of people close to us. They either attract us to things, or make wary of
them.

• Values are broad ideas and widely held assumptions regarding what are desirable, correct and good
that most members of a society share. Values are so general and abstract that they do not explicitly
specify which behaviors are acceptable and which are not. Instead, values provide us with criteria and
conceptions by which we evaluate people, objects and events as their relative worth, merit, beauty or
morality.
• Norms are social rules that specify appropriate and inappropriate behavior in given situations. They
tell us what we should and must do as well as what we should not and must not do.

For Example

We often regard greeting as a social norm to be conformed among members who know each other.

Murder, theft and rape often bring strong disapproval.

2. Enabling factors: these are characteristics of the environment that facilitates healthy behavior and
any skill or resource required to attain the behavior. Enabling factors are required for a motivation to be
realized.

Examples of enabling factors include:

 Availability and or accessibility of health resources

 Government laws, priority and commitment to health
 Presence of health related skills E.g. Enabling factors for a mother to give oral rehydration
solution to her child with diarrhea would be:
 Time, container, salt, sugar
 Knowledge on how to prepare and administer it

In general, it is believed that enabling factors should be available for an individual or community to
perform intended behavior.

Behavioral intention is willingness/ readiness to perform a certain behavior provided that enabling
factors are readily available.

3. Reinforcing factors: these factors come subsequent to the behavior. They are important for
persistence or repetition of the behavior. The most important reinforcing factors for a behavior to occur
or avoid include:

 Family
 Peers, teachers
 Employers, health providers
 Community leaders
 Decision makers

We are all influenced by the various persons in social network. Pressure from others can be a positive
influence to adopt health promoting practices as well as an obstacle. Influential people

significant influence to change others. In the case of a young child, it is usually the parents who have the
most influence. As a child grows older, friends become important and a young person can feel a
powerful pressure to conform to the peer group.

E.g. a young man starts smoking because his friends encouraged him to do so.
The role of human behavior in prevention of disease and promotion of health

What is prevention?

Prevention is defined as the planning for and the measures taken to forestall the onset of a disease or
other health problem before the occurrence of undesirable health events. There are three distinct levels
of prevention: primary, secondary, tertiary prevention.

Primary prevention

Primary prevention is comprised of those activities carried out to keep people healthy and prevent them
from getting disease. Examples of important behaviors for primary prevention includes using rubber
gloves when there is a potential for the spread of disease, immunizing against specific diseases, exercise,
and brushing teeth. And any health education or promotion program aimed specifically at prevention of
the onset of illness or health problems is also an example of primary prevention.

Secondary prevention

Secondary prevention includes preventive measures that lead to an early diagnosis and prompt
treatment of a problem before it becomes serious. It is important to ensure that the community can
recognize early signs of disease and go for treatment before the disease become serious. Health
problems like tuberculosis can be cured if the disease is detected at an early stage. The actions people
take before consulting a health worker, including recognition of symptoms, taking home remedies (‘self-
medication’), consulting family and healers are called illness behaviors. Illness behaviors are important
examples of behaviors for secondary prevention.

Tertiary prevention

Tertiary prevention seeks to limit disability or complication arising from an irreversible condition. Even
at this stage actions and behaviors of the patient are essential. The use of disability aids and
rehabilitation services help people from further deterioration and loss of function. For example, a
diabetic patient should take strictly his/her daily insulin injection to prevent complications.

WORKING WITH COMMUNITIES

What is community?

Community could be defined as organized groups of people who share a sense of belonging, beliefs,
norms, and leadership and who usually interact within a defined geographical area.

The concept of community participation

The health of the community will improve only if the people themselves become involved in planning,
implementing, and having a say about their own health and health care. Nevertheless, involvement will
not just happen.
Many people emphasize the importance of community participation for any development issues,
including health promotion, to become a success. However, the question is how serious are we about
involving individuals, families, and communities? Are we prepared - mentally and professionally – to
listen to their concerns, to learn from them what they feel is important, to share with them appropriate
information, to encourage and support them? Are we ready to assist them in choosing from alternative
solutions, in setting their own targets and evaluating their own efforts? In many cases, so far, the answer
is “NO”

In health education, we are concerned about how people actually feel, not how we think they should
feel. We are interested in how people look at their own problems, not only in the problems we see
ourselves. We want people to develop the confidence and skills to help themselves.

The traditional approach in planning health care or health education program involves the decision to be
made by experts. This approach is sometimes called the ‘top-down’ approach and contrasted with the
‘bottom-up’ approach where members of the community make the decisions. In this model people are
just told what to do. We make decisions and expect them to follow.

The concept of community participation or involvement encompasses the process by which individuals
and families assume responsibility for the community and develop the capacity to contribute to their
health and the community’s development. It is a means by which the emphasis is on strengthening the
capacity of communities to determine their own needs and take appropriate action. Communities
should not be passive recipients of services.

The following are examples of actions that does not indicate genuine participation

 Involvement of individuals from the community in responding to health assessment survey

questionnaires,
 Requesting the community members to contribute labor to dig a latrine for the school in its
village,
 Holding a meeting to ask people’s opinions on the issue of uncontrolled population growth,
 Requesting mothers to bring their children to a clinic for vaccination

We may say communities are participating when they are actively involved in:

 The assessment of the situation/needs

 Problem identification
 Priority setting and making decisions
 Sharing responsibility in the planning, implementing, monitoring and evaluationThe role of
experts should be limited to helping them identify their problems and to point out methods for
dealing with the problems.

Checklist for identifying the degree of participation in a program:

 Is the community involved in planning, management, control and evaluation of the health
program at community level?
  Were the felt needs of the community well entertained in the planning?
 Is there a mechanism for dialogue between health system personnel and community leaders?
 Are community representatives nominated in decision-making at higher levels?
 Is there any evidence of the external agents changing their plans as a result of criticism from the
community?
 Are deprived groups, such as poor, landless, unemployed, and women, adequately represented
in the decision making process?
 Are local resources such as labour, buildings, and money exhaustively used?

Benefits of community participation

 It leads development endeavors to success.

 Shifts the emphasis from the individual to the community e.g. If all members of a community are
convinced of the benefits of cleanliness, they will help each other to find pure water sources and
keep such sources clean. They will build and use latrines everywhere in the community and keep
them clean as well.
 As communities often have detailed knowledge about their surroundings, their participation
makes programs relevant to local situation.
 Ensures community motivation and support. If the community is involved in choosing priorities
and deciding on plans it is much more likely to become involved in program implementation and
take up of the services because they are seen to be meeting their needs.
 Promotes self-help and self-reliance. If community members do their own development work,
they learn and become more conscious of their needs and potentials for solving their own
problems, they make use of local skills, they learn to be responsible for projects and their
maintenance, and they gain the necessary self-confidence to tackle further and perhaps more
complicated development projects.
 Improves trust and partnership between the community and health workers.
 Enhances the implementation of the health extension package program

Helping people to organize

Success in community participation involves a series of overlapping stages.They include:

Knowing the community:

 Learning about the community (its structure and pattern)

 Contacting with families, leaders and community groups.
 Discussing on concerns and felt needs.

Taking some actions:

 Actions on achievable, short-term aims based on felt needs which bring the community together
and build confidence.

Further activities and organization building:

  Build up-on existing community organization or associations.
 Formation of committee e.g. Health committee
 Educational in-puts
 Select and train volunteers
 Decision making on priorities

Further actions by the community themselvesIn the process of promotion of community participation,
community leaders are very essential.

Who are the leaders?

 A leader is a person whose ideas or actions influence others to get things done that the people
want done.
 Could be a person of wisdom and sound judgment
 Might be one whose advice has been valuable in the past.
 Might be wealthy and powerful
 Is known to be religious

Why are leaders important?

 Usually make decisions that result in success or failure of a project

 They are trusted and the community members are ready to work with them.
 Help people in the community know you and gain confidence in you.
 Serve as an officer in an organization or chairperson of a committee.

EDUCATIONAL METHODS & MATERIALS

Ways to put across health messages:

 Direct – Interpersonal (Individual and groups)

 Indirect – Mass media and visual aids.

To transmit information effectively, you have to choose appropriate educational tools. For example,
where resistance is anticipated because the changes recommended are contrary to deeply held
traditions, intensive interpersonal educational efforts may be necessary. Where the benefits of a
recommended change are so great that resistance is low, mass media can be used.

The important thing to remember is that effective health communication is seldom achieved through
the use of one method alone. Nearly always, a combination of techniques is needed to achieve behavior
changes. Both effectiveness and costs must be considered in choosing a combination of techniques.
Besides, selection of local media is appreciably useful.
I. Educational methods

1. Individual educational methods - Counseling

Counseling is one of the approaches most frequently used in health education to help individuals and
families. It is a person-to-person communication in which one person is helped by another to increase in
understanding, ability and confidence to find solutions to own problems.

This service could be given to patients at the health center, to pupils at school, to families during a home
visit or during casual visits to community (e.g. Market place, at water well etc.)

Home Visits

Advantages

 When people are in their home, they usually feel happier and more secure. You may find that
people are more willing to talk in their own homes than when they are at the clinic.
 It also gives an opportunity to see how the environment and the family situation might affect a
person’s behavior; thus, making observations and any necessary suggestions for change right
there.
 Keeps a good relationship with people and families
 Encourages the prevention of common diseases.
 Enables detecting and improving troublesome situations early, before they become big
problems.
 Enhances checking on the progress of a sick person, or on progress towards solving other
problems.
 Motivate the family on how to help a sick person in which their participation is needed.

Therefore, health extension workers should visit all homes in their communities regularly. Home visits
become convenient if we design our own family health education folder for use.

Purposes of counseling

 To help individuals increase knowledge of self

 To encourage individuals or families to think about their problems and understand the causes.
 Help people commit themselves to take action on their own will to solve the problems.
 Help individuals to choose, but not forcing them to do so

Principles in counseling

 Counseling requires establishing good relationship between the counselor and the client
 Counselors should assist people identify their own problems.
 Counselors develop empathy (understanding and acceptance) for person’s feelings. It is thinking
by putting self on the shoe of the others.
 Counselors should never try to persuade people to accept their advice. Rather help people to
 think about all the factors involved in their problems and encourage them to choose the
solutions that are best in their particular situation.
 Counselors should always respect the privacy of the people they are helping. They never reveal
information without specific permission.
 Counselors should share information and ideas on resources, which the client needs in order to
make a sound decision. For example, many people do not realize the connection between their
behavior and their health.

2. Group Educational Methods

It is needless to mention that much of the problem solving in the community has to be done by group
work and cannot be attempted at individual level alone. Specifically, working with groups is a major
activity in health education. When people get together to identify, define, and solve a problem, they
have many more resources than when they work individually.

What is a Group?

A group could be defined as a gathering of two or more people who have a common interest. Example
of groups often found in a community:

 A family
 A health committee
 People working at the same factory, business, or agency
 A class of school children
 A farmers’ cooperative

 A youth club
 People attending a religious ceremony together
 Some friends getting together to relax
 A gathering of patients at a clinic
 People riding together on a bus

Types of Groups

 Formal groups

Groups that are well organized with some rules and regulationsE.g. Farmer’s – cooperative, Women’s
Associations

 Informal groups

Groups that are not well-organized E.g. People attending market on a particular day People attending
funereal ceremony
Characteristics of formal group

 Has a purpose or goal that everyone strives to achieve together.

 There is a set membership, so people know who is a member and who is not.
 There are recognized leaders who have the responsibility of guiding the group to wards
achievement of its goals.
 There are organized activities such as regular meetings and project.
 The group has rules that members agree to follow and works towards the welfare of the
members.

Characteristics of informal gatherings

 May have some features in common, but no special goal that they are trying to achieve together
E.g. People riding together on a bus
 No special membership or feeling of belonging
 People come and go at will
 No special leader selected, no special rules apply
 Usually no special activity is planned by the people themselves E.g. People coming to watch a
football match
 There is usually more concern for self, and less for the welfare of the other people.

Group Dynamic

Group dynamics is a field of study concerned with scientific methods to determine why groups behave
the way they do. Group dynamics is of immediate importance to the health educator (including HEWs)
who is interested in helping groups to get together, discuss, take decisions and implement their
programs to solve the problems. In a positive dynamism, it is necessary that the commonness of
purpose a sense of belonging and an attitude of selflessness be developed amongst the individuals.
Otherwise it will be difficult for the group to stay as a cohesive unity and turn out useful work or achieve
its objectives.

Some of the important qualities and behavior patterns for a group to function harmoniously and
effectively are listed below.

 They have to be group conscious. In other words, they should understand that they are an
integral part of a group with certain objectives.
 There should be a sense of shared purpose /goal.
 A spirit of interdependence and helpfulness and selflessness is very essential
 There should be frankness and sincerity of opinion and purpose
 There should be a sense of freedom among the members to discuss matters without any fear or
complex
 Responding politely to the suggestions of others
 Attending meetings regularly and on time.
 Thanking each other for suggestions given.
The Value of Group Education

 In a group, one can find the support and encouragement needed to promote and maintain
healthy practices.
 It permits sharing of experience and skills.
 Working in groups makes it possible to pool the resources of all members.E.g. to dig a well,
group of families can contribute enough money

Common Methods Used for Group Education

a) Group discussions

Health education has been quick to recognize that groups provide an ideal set-up for learning in a way
that leads to change and action. Discussion in a group allows people to say what is in their minds. They
can talk about their problems, share ideas, support and encourage each other to solve problems and
change their behavior.

Size of a group

For sharing of ideas an ideal group is the one with 5-10 members. If the members are large every one
may not have a chance to speak.

Planning a discussion

Planning a discussion involves:

 Identification of the discussants that do have a common interest E.g. mothers whose child suffers
from diarrhea.

 Getting a group together

 Identification of a comfortable place and time:

Conducting the discussion

 Introduction of group members to each other

 Allow group discussion to begin with general knowledge E.g. any health problems they have
ever faced
 Encourage everyone to participate.
 Have a group act out some activity (drama, role play) Have a villager report on a successful
experienceLimit those who talk repeatedly and encourage the quiet to contribute.
 Limit the duration of discussion to the shortest possible, usually 1- 2 hrs.
  Check for satisfaction before concluding the session. E.g. Do they think that they are learning?
Do they think the group should continue? 68

b) Meetings

Meetings are good for teaching something of importance to a large group of people. They are held to
gather information, share ideas, take decisions, and make plans to solve problems. Meetings are
different from group discussions. A group discussion is free and informal, while meetings are more
organized. Meetings are an important part of successful self-help projects.

Planning a meeting

 It should be need based

 Determine the time and place
 Announce the meeting through village criers or word of mouth.
 Prepare relevant and limited number of agendas.

Conducting the meeting

 Should be led by a leader

 Encourage participation as much as possible
 Try to reach at consensus based decisions
 Use some visual aids to clarify things
 Finally, get ready to take actions to solve problems.

c) Clubs

There are many kinds of organizations to which women, men and young people belong. Clubs are
becoming popular in many areas. They provide an opportunity for a systematic way of teaching over an
extended period of time. E.g. a group of citizens could form an association to deal with problems related
to a major local disease or to protect the environment.

d) Demonstrations

A demonstration is a step-by step procedure that is performed before a group. They involve a mixture of
theoretical teaching and of practical work, which makes them lively. It is used to show how to do
something. The main purpose of demonstrations is helping people learn new skills. The size of the group
should be small to let members get the chance to practice. It is particularly useful when combined with a
home visit. This allows people to work with familiar materials available in the locality.

Planning the Demonstration

 Identify the needs of the group to learn

 Collect the necessary materials such as models and real objects or posters and photographs.
  Make sure that it fits with the local culture. E.g. for nutrition demonstration you have to use the
common food items and local cooking methods.
 Prepare adequate space so that everyone could see and practice the skill.
 Choose the time that is convenient for everyone.

Procedures

 Introduction: Explain the ideas and skills that you will demonstrate and the need for it
 Do the demonstrations: Do one step at a time, slowly. Make sure everyone can see what you are
doing. Give explanations as you go along.
 Questions: Encourage discussion either during or at the end of the demonstration. Ask them to
demonstrate back to you or to explain the steps
 Summarize: Review the important steps and key points briefly.

Checklist to evaluate a demonstration

 Did the audience learn how to do what was demonstrated?

 What evidence was given that the audience plans to carry out this practice on their own
 Visit members of the audience to see if they are using the new methods demonstrated.
 How could your demonstration be improved?

e) ‘Village’ criers

They spread information in the community in the past eras & even today in remote areas where modern
mass media are scarce. When they have some thing to say, ordered by village leaders, they may use a
bell or drum to attract attention. Drum beats and other sounds can be a special code or signal that
people understand. The significance about these people is that the villagers know who is the real village
crier and may only respect information coming from him or her. The following messages could be
passed on:

 A reminder to mothers to immunize their children

 A request that people participate in a village sanitation campaign
 A call for people to work in a community project such as digging a well
 A warning about dirty water during cholera outbreak

f) Songs

People sing to express ideas and feelings, such as love and sadness, to tell story of a famous person,
commemorate religious days etc. Particularly village people like to sing and dance and almost every
village have someone who can sing and put works to music. In addition to expression of feelings, songs
can also be used to give ideas about health. You can give topics that you want to make popular to those
persons for synthesis and dissemination. For instance, the following issues could be entertained:

 The village without safe water

 The malnourished child who got well with the proper food to eat
  The village girl who went to school to become a health extension worker
 The house where no flies and mosquitoes breed

g) Stories

Stories often tell about the deeds of famous heroes or of people who lived in the village long ago. Story
telling is highly effective, can be developed in any situation or culture, and requires no money or
equipment. It should include some strong emotions like sadness, anger; humor, or happiness as well as
some tension and surprise. An older person, instead of directly criticizing the behavior of youth, may tell
stories to make his/her points. He/She may start by saying, “I remember some years ago there were
young people just about your age...” and then continue to describe what these young people did that
caused trouble. Stories may also be a way of re-telling interesting events that happened in a village. So
stories can entertain, spread news and information so that people are encouraged to look at their
attitudes and values, and to help people decide how to solve their problems.

h) Proverbs

They are short common-sense sayings that are handed down from generation to generation. They are
like advice on how best to behave. Some proverbs are straight for ward- others are more complicated.

Examples

 One does not go in search of a cure for ringworm while leaving leprosy unattended. This is to
mean: try to solve the most serious problem first.
 A young man may have as many new clothes, but not as many worn-out clothes, as an old man.
This is to mean: An old man has more experience than a young one
 Prevention is better than cure.

The first proverb could be useful during a talk to mothers that emphasizes the importance of bringing
their children to the clinic when they are sick, instead of going about some other business. The second
proverb could encourage young people to respect and care for their elderly parents.

i) Drama

Drama is less common in villages, but it is a good means to entertain people in a message. Their
preparation, practice and others may incur time and money. This means that it is somehow difficult to
prepare repeatedly. Yet, they are extremely useful for conferences, workshops and refresher courses.

Ask members of the community to help write the script (e.g. teachers or individuals who enjoy and are
capable of writing such scripts.) or to play a drama someone else has played earlier. Dramas should have
one main learning objective but can often include 2 or 3 other less important objectives as well. Alike
stories, dramas make us look at our own behavior, attitudes, beliefs and values in the light of what we
are told or shown. Plays are interesting because you can both see and hear them.

General principles
  Keep the script simple and clear
 Identify an appropriate site
 Say a few words at the beginning of the play to introduce the subject and give the reasons for
the drama
 Encourage questions and discussions at the end

j) Role – playing

Role-playing consists of the acting out of real-life situations and problems. The player tries to behave in
a way that the character might behave when faced with a given situation or problem. It is used to show
different people feel about a problem and what they should do about it. Role-playing can be used to
start off a discussion, to see what possible consequences of a certain action are, and to develop a better
understanding of why people feel as they do. We learn about our own behavior during a role-play, we
can discover how our attitudes and values encourage cooperation and problem solving or, how our
attitude and values create problems.

II. Teaching materials (aids)

Teaching materials include all materials that are used as teaching aids to support the communication
process and bring desired effect on the audience. The following are some selected teaching aids that are
commonly used in health education programs.

1. Audios

Audios include anything heard such as spoken-word (talk), music or any other sounds. Talks are the
most commonly used audio teaching methods.

Characteristics of audios:

 Effective when based on similar or known experience

 Could be distorted or misunderstood when translated
 Easily forgotten

1.1 Health talks

The most natural way of communicating with people is to talk with them. In health education, this could
be done with one person, a family, or with groups (small or large). Health talks have been, and remain,
the most common way to share health knowledge and facts. However, we need to make it more than
advice and make effective by combining it with other methods, especially visual aids, such as posters,
slides, demonstrations, video show etc.In principle, it should be given to smaller group (5 to 10 people)
though it could be given for larger group like radio talk. In health talks, unclear points could be asked
and discussed.

In preparing a talk, consider the following points:

 Know the group: their interests and needs

  Select single and simple topic: e.g. Nutrition is too big as a topic. Thus, select subtopic such as
breast-feeding, weaning diet etc.
 Have correct and up-to- date information.
 Limit the points to only main once.
 Write down what you will say, use examples, proverbs and stories to help emphasize points.
 Make use of visual aids.
 Practice your whole talk
 Make the talk as short as possible - usually 15-20 minutes talk and 15 minutes discussion.

2. Visual aids

Visuals are objects that are seen. They are one of the strongest methods of communicating messages;
particularly when accompanied with interactive methods.

Advantages

 They can easily arouse interest

 Provide a clear mental picture of the message
 Speed up and enhance understanding
 Can stimulate active thinking
 Create opportunities for active learning
 Help memory and provide shared experience. Visuals are more effective than words alone, and
it will be rather more effective when extended to practice (action).

The Chinese proverb goes for this:

 If I hear, I forget
 If I see, I remember
 If I do, I know

Like wise, it is a common understanding that you remember 20% of what you hear, 50% of what you
hear and see, and 90% of what you hear, see and do. With repetition close to 100% is remembered.

2.1. Non-projected materials (aids) or graphics

They are shown or displayed and do not necessarily depend on any projected equipment.

a. Leaflets

Leaflets are unfolded sheet of printed material. Leaflets can be very appealing if their message is simple
and clear, and if the language is understood by the reader. In preparing them, short sentences and
paragraphs should be used, illustrated with simple drawings or pictures that are easily understood. They
need to be pre-tested before distributed to the villagers.

b. Newspapers/Newsletters
Newspapers might be of some help in reaching the villagers. Very often, though, the national or regional
newspapers do not reach smaller communities, or the people are unable to read them. In this case,
newsletters, written by the villagers themselves, teachers and extension workers can become the
communities’ newspaper. Place copies on a bulletin board or wall in a public meeting places (market,
well, bar).

c. Photographs

Photographs can be used to show people new ideas or new skills being practiced. They can also be used
to support and encourage new behavior. They are best used with individuals and small groups. People
can compare photos taken of malnourished children in the village before and after receiving treatment.

Advantages

 They can be photographed in the town where you work thus assuring familiarity and recognition
by the people.
 They are relatively inexpensive and reproducible for different uses (posters, flipcharts)
 You can make them your self.

d. Posters

A poster is a large sheet of paper, often about 60 cm wide by 90cm high with words and pictures or
symbols that put across a message. It is widely used by commercial firms for advertising products, but
can also be used for preventive purposes.

Advantages

 Give information and advice, e.g. beware of HIV/AIDS!

 Give directions and instructions, e.g. how to prevent HIV / AIDS
 Announce important events and programmers, e.g. World AIDS day

Standard rules in making posters:

 All words should be in the local language

 Words should be limited and simple
 Symbols that illiterate people will also understand should be used
 Mix of colors should be used to attract attention
 Only put one idea on a poster.

General principles:

 They should contain the name of the event, date, time, and place
 They should be large enough to be seen from some distance;
 They could be used for small or larger groups
 Should be placed where many people are likely to pass
  Do not leave them up for more than one month, to avoid boredom
 Never use them before pre-testing.

e. Flipchart

A flipchart is made up of a number of posters that are meant to be shown one after the other. In this
way, several steps or aspects of a central topic can be presented such as about family planning. Their
purpose is to give information and instructions, or record information when prepared with blank pieces
of paper.

f. Flannel graphs

A flannel graph is a board covered with flannel cloth. The flannel graph is one of the most effective and
easily used teaching aids because it is cheap and portable. Pictures and words can be placed on the
board to reinforce or illustrate your message. It is very useful with people who do not read and in groups
of less 30 people.

g. Displays

A display is an arrangement of real objects, models, pictures, poster, and other items, which people can
look at and learn from. Like a poster, it provides ideas and information but where as a poster contains
only one idea, a display has many. E.g. how a child develops and grows.

2.2. Projected aids

Projected materials are simply educational materials that are shown to people using a projector. They
are used to facilitate lectures or seminars/trainings. The group should not be more than 30

The commonly utilized once are slide projectors (color pictures on a transparent object), overhead
projectors (display written or drawn materials on a transparency), and power point projectors. They are
expensive, requires expertise and electric power. They are useful to underline the most important points
in a talk or lecture.

Mass Media

It is one way of giving health education. The communication that is aimed to reach the masses or the
people at large is called mass communication. The media that are generally used for mass
communication go by the name of mass media. The commonly used mass media are microphones or
public address system, radio, television, cinema, newsprints, posters, exhibitions.

Mass media are the best methods for rapid spread of simple information and facts to a large population
at low cost. However, the major concerns with this method of communication are availability,
accessibility and popularity in a given community.

Selection of Teaching Methods and Materials

The selection of the teaching methods and aids depends on

 The type of the message

 The purpose
 The people addressed
 Availability of resources
 Availability of skills

TRAINING

What is Training?

Training is the process of education in which both the mind and body are brought under exercise and
discipline. It is the act of acquiring necessary qualification or occupation or feat of physical skill or
endurance.

Types of training

 Pre-service: involves the preparation in general of any trainee for qualifying for a certain set of
professional or specific job oriented roles.
 Orientation training: refers to a preparation for the specific job to be performed in a particular
position.
 In service training: It is a refresher course given with a view of updating knowledge and skills of
the workers in any department or organization.

Phases of Training

 Preparation (pre-training) phase

 Training phase
 Post-training (follow-up component)

a. Preparation phase

This phase involves several activities to be carried out.

 Conducting training need assessment. This is to ask whether there is a need gap for a certain
kind of health workers to carry out some work
 Identify aims of the training program.
 State needs or problems that are expected to be solved
 Identification of the trainees.
 Recruiting and selecting learners is the single most important step in any training program. This
is because the problems to be solved primarily rests on their attitude and behavior when they
are deployed for services. Therefore, the community members must have an important part in
choosing who is going to be trained.
  Know who the learners are. Their educational and training background experiences they have
with this problem, topic or subject, their interests, and their social and cultural background. 9
 Identify resources available- time, equipment, space, trainers and written materials including
books, handouts...
 Determine the four important areas (domains) of learning going to be changed (knowledge,
belief, attitude and skill)
 Determine the teaching methods to be used depending on the targeted domain of learning.
 Arrange living condition of the trainees and facilitators (food, lodging, transportation,
recreation, financial support).
 Determine how the learners and the program be evaluated. This may include pre-test and post
test, feedback from the trainees at the end, follow-up for the graduates.

Choosing Training Methods

Some of the important questions to ask our selves to determine the type of methods to use are:

 What are the learning objectives? Is it to influence or change thinking, believing, feeling or
doing?
 Who are the learners? Educational, cultural, motivational, future role, experience status.
 How much time do we have?
 What other resources are available?
 How can active involvement by the participants be made certain?

b. Training Phase

Based on these curies, the following methods or combinations of them can be used.

 Lecturing- the most common and easiest method but the least efficient especially in addressing
how to do a job.
 Lecture and discussion-asking questions encourage participation. It gives more opportunity to
learn.
 Provision of textbooks /handouts.
 Learner presentations
 Demonstrations-essential tools of training in task learning
 Audiovisual support- flipcharts, posters, slides, models.
 Popular art forms-they are one of the most effective training methods for many resources.
These include dramas, role- plays, poems, sings, games, puppets

Training Phase

In the actual training phase training curriculum is to be followed and the necessary arrangements has to
be made for concurrent monitoring and evaluation.

c. Evaluation of Training

Evaluation is a process of determining the degree or amount of success with pre-determined objective.

Steps for evaluation

 Input evaluation- examines what resources were used based on which we can calculate the cost
per graduate-efficiency.
 Process evaluation- looks at what methods are used; see how trainees are progressing, training
run as per the schedule...
 Output evaluation- reviews the quality and numbers of people trained to see if they meet
standards and the targets or objectives set during the planning process. This includes the
knowledge and skill tests.
 Outcome/Impact evaluation- examines what the results or effects the graduates have achieved
in the work they are trained for. This is performed using field assessment through observations
and surveys.

ETHICAL ISSUES IN HEALTH EDUCATION

Ethics is the philosophical study of the moral value of human conduct and the rules that govern it. It is
the right thing to do for society and self.

Moral refers to those beliefs about how people ought to behave.

Basic ethical principles

1. The principle of autonomy

This principle means that people, being individuals with individual differences must have a freedom to
choose their own ways and means of being moral with the framework of the other four principles.

Respect for autonomy involves respecting another persons rights and dignity such that a person reaches
a maximum level of fulfillment as a human being. In the context of health promotion and health care
this means that the relationship between health extension worker and community member is based on
a respect for him or her as a person and with individual rights.

Rights in relation to health care are usually taken to include:

 The right to information

 The right to privacy and confidentiality
  The right to appropriate care and treatment

2. Beneficence (doing good)

Beneficence means doing or promoting good as well as preventing, removing and avoiding evil or harm.

E.g. provide information about emergency first aid to reduce the risks of HIV infection or accident.

3. Non-maleficence (doing no harm)

Non-maleficence holds a central position in the tradition of medical ethics and guards against avoidable
harm to subjects. In short, it refers to non-infliction of harm to others. E.g. use of sterile needles.

4. Justice (fairness)

This principle states that human being should treat other human being fairly and justly in distributing
goodness and badness among them. In other words justice should include

 Fair distribution of scarce resources

 Respect for individual and group rights
 Following morally acceptable laws

5. The principle of truth telling (honesty)

At the heart of any moral relationship, there is communication. A necessary component of any
meaningful communication is telling the truth, being honest.

Ethics for the performance of health extension workers as health educators

Health extension workers as health educators assume profound responsibility in using educational
processes to promote health and influence human well-being. They are also responsible for the
implementation of health extension package program. Ethical precepts that guide these processes must
reflect the right of individuals and communities to make decisions affecting their lives.

Health extension workers responsibilities as a health educator

 Affirm an equal right, believing that health is a basic human right for all.
 Provide people with relevant and accurate information and resources to make their choices
freely and intelligently.
 Support change by freedom of choice and self-determination, as long as these decisions pose no
threat to the health of others.
 Be advocates for healthful change and legislation, and speak out on issues deleterious to public
health.
 Avoid and take appropriate action against unethical practices and conflict of interest situations
 Respect the privacy, dignity and culture of the individual and community and use skills with
these values.
 Share their skills, experience and vision with their clients and colleagues.
 Observe principles of informed consent and confidentiality of individuals.
 Maintain their highest levels of competence through continued study, training and research.
 Accurately represent their capabilities and education as well as training and experience and act
within the boundaries of their professional competence;
 Ensure that no exclusionary practices be enacted against individuals on the bases of sex, marital
status, color, age, social class, religion, ethnic background, national origin, or other
nonprofessional attributes in rendering service, employing, training, or promoting others.
ADVOCACY

Advocacy is an activity done by an individual or group that aims to influence decisions within political,
economic and social institutions.

Advocacy includes activities which aim to influence public policy, laws and budgets by using facts, their
relationships, the media and messaging to educate government officials and general public.

Advocacy can include many activities that a person and organization can undertake, which includes
media, campaigns, public speaking, commissioning and publishing research.

Lobbying (often by lobby groups) is a form of advocacy where a direct approach is made to legislators on
a specific piece of legislation.

Advocate is anybody who provides advocacy support to people in need of such support in solving a
certain issue affecting them.

Advocacy campaign is a set of actions targeted for support of a certain policy or proposal.

GOALS OF ADVOCACY

Drafting and passing new laws against certain issues and problems facing certain groups of people in the
society.

Reforming the judicial system.

Monitoring the implementation of international human rights standards in the local context.

IMPORTANCE OF ADVOCACY

To initiate changes in the system on behalf of the victims.

To change situations for groups of people who share similar problems.

Systems advocacy makes efforts to change policy and practices at the local, national and international
levels.

Both system and individual advocacy are critical to ending discrimination against victims.

FORMS OF ADVOCACY

There are several forms with each representing a different approach in a way to initiate changes in the
society.

SOCIAL JUSTICE ADVOOCACY

People’s participation and a vision of a just society as promoted by social justice advocates.

Advocacy represents the series of actions taken and issues highlighted to change the what is into what
should be considering that is what should be more decent and a more just society.
MEDA ADVOCACY

Strategic use of media as a resource to advance social and public policy initiative.

MASS ADVOCACY

Any type of action taken by large groups. (large demonstrations)

HEALTH ADVOCACY

Support and promotes patient’s healthcare rights as well as enhance community health and policy
initiatives which improves quality of healthcare services.

BUDGET ADVOCACY

Civil society organizations engage in advocacy activities to ensure that the government is accountable
for the budget.

It enables citizens and social action groups to compel the government to be more alert to their needs.

LEGISLATIVE ADVOCACY

Reliance on the state legislative process as part of a strategy to create change

BUREAUCRATIC ADVOCACY

Experts use their chance to represent certain issues to decision makers, they use bureaucratic advocacy
to influence agenda.

INTEREST GROUP ADVOCACY

Lobbying is the main tool used by interest groups doing mass advocacy, it requires resources and
organizations to be effective.

IDEOLOGICAL ADVOCACY

Approach groups fight and present their ideas to decision -makers through protests and other avenues.

How to reach decision makers?

Decision makers can be reached through one o or a mix of two or more of the following channels;

 Through efficient advisers

 Through media
 Through community action
 Through legislators and community representatives
 Through local organizations
 Through outstanding and influential leaders
 Through social movement
 Through alliances building with stakeholders
Effective communication for advocacy purposes

 Carefully plan advocacy strategy with involvement of potential target audience.

 Identify and involve relevant stakeholders in creating and shaping the message.
 Tailor the content and form of the message to the specific stakeholders groups.
 Develop a mechanism for generating interest and participation of people in sharing and creating
knowledge.
 Fit communication forms and channels to the national and local media landscape, use both
formal and informal channels.

ADVOCACY STRATEGIES

Advocacy requires action which requires that social power of organization be exercised through public
events which are intended to demonstrate power.

Advocacy through media

One of the most common advocacy strategies used to advocate on health-related issues. It requires
identification of issues and concerns related to community wellbeing.

Media advocacy should provide advocacy visual images, soundbites and statistical data which can be
easily understood by audiences.

Using courts

Court system provides another avenue for advocacy efforts, courts can be used to provide guidance on
certain health issues affecting the people.

Legislative

Legislative advocacy are strategies that are often used by organizations seeking to have their voices
heard.

Although the specific procedures vary depending upon the legal system at the country, this is a common
strategy.

Coalition

Groups or people coming together to advocate for a certain issue affecting them.

Use of storytelling

Effective advocacy storytelling is one of the most powerful advocacy strategies.

It involves sharing personal narratives about people have been affected by certain health issues.

Topics covered by health advocacy groups are often subjects which most people can relate with at
personal level.
Leverage stakeholders

When you are advocating for a healh issue it is important to get a variety of different stakeholders to
speak on your behalf to other people.

Working together with other stakeholders to push your agenda is a good way to get more support for
your agenda is a good way to get more support for your issue.so it is important to get your message out
there.

You can involve community members if you get the interest of community members then you can
definitely rally them to support your agenda.

You can also involve professionals and experts like nurses and doctors because people tend to believe
more in professionals in certain fields since they believe they have the necessary knowledge in that field.

Community health approach

Goal of community health policy is empowerment of individuals, families and communities to attain
highest possible standard of health with strengthening of community health service delivery across all
health domains towards attainment of strong, equitable, holistic and sustainable community health
structures.