1. Meet with key community leaders 2. Orient local health personnel
3. Organize or strengthen a Village Health Committee
B. Select and train resource persons
1. Write job descriptions 2. Conduct a task analysis
3. Develop participant selection criteria 4. Recruit staff and volunteers
5. Conduct a training needs assessment 6. Select course content
7. Develop training strategy 8. Establish training methodology 9. Set up training evaluation strategy 10. Prepare training and evaluation materials
11. Conduct training
O
nce you have decided that a PD/Hearth program is feasible for your geographic and cultural situation, you can begin Step 2.A. Mobilize the Community
PD/Hearth is a community-run program requiring active community participation. Since the process demands community self-discovery and action, an implementing agency cannot successfully run a PD/Hearth program without community participation and support.
Although an implementing agency may initiate the PD/Hearth process through training community members, it is up to the community, from the start, to learn to manage and supervise the project. It requires an intense initial investment to transfer these management skills to the community, which is an underlying principle of the PD/Hearth approach.
CHAPTER TWO
CHAPTER TWOCHAPTER TWO
CHAPTER TWOCHAPTER TWO
Step 2: Mobilize, Select & T
Step 2: Mobilize, Select & TStep 2: Mobilize, Select & T
Step 2: Mobilize, Select & TStep 2: Mobilize, Select & Trainrainrainrainrain
m o n i t o r & e v a l u a t e
STEP 1Decide if this program is right for you STEP 2 Mobilize community; select and train STEP 3 Prepare for Positive Deviance Inquiry STEP 4 Conduct Positive Deviance Inquiry STEP 5 Design Hearth Sessions STEP 6 Conduct Hearth Sessions STEP 7 Support New Behaviors STEP 8 Repeat Hearth Sessions as Needed STEP 9 Expand PD/Hearth Programs
1. Meet with Key Community Leaders, including:
♥
Local hamlet leaders or chiefs♥
Informal health sector representatives such as traditional healers and birth attendants and local medicine vendors♥
Religious leaders♥
Tribal or caste leaders♥
Grandmothers♥
School directors/teachers♥
Local groups, clubs, associations♥
Decision makers, opinion leaders, local heroes♥
Business leadersDiscuss the health situation in the community, especially for children under five years of age. Check to see if there is a concern or interest among community members and leaders about the level of malnutrition in their community. Is it a high priority? Which children’s age groups are most at risk of malnutrition? The Under 5s? Under 3s? Under 2s? Do people consider it a problem? Do they understand the lost potential of malnourished children? Try presenting these themes using drawings or pictures and asking community leaders to discuss what they see and its relation to the situation in their own community. Providing local health and nutrition data in an understandable format is often a good motivator for action.
Providing Data in an Understandable Format
In Mali, CARE staff prepared big bar graphs to show the average nutrition status of children in a community in comparison to those of children from other villages. When the charts were explained to the village leaders, one exclaimed, “I’m embarrassed that the children here are more malnourished than those in other places. We must do something about this now!”
2. Orient Local Health Personnel
Formal and non-formal health resources need to be identified and involved in order to coordinate efforts for Hearth. Health facility staff can identify available resources and services for ill children and severely malnourished children. Children identified at Growth Monitoring Promotion (GMP) sessions as suffering from third degree malnutrition or a variety of other illnesses need to be referred to a local health clinic. Decisions regarding universal de-worming, protocols for Vitamin A distribution and appropriate content and reinforcement of health messages at Hearth sessions all require
For PD/Hearth to work,
the whole village must
be excited about getting
rid of malnutrition.
EXAMPLE
Involve influential
people in the PD/
Hearth process –
especially those who
might raise barriers if
they are not brought in.
close linkage with health services. Roles for health center staff include treating malnourished children with underlying diseases such as pneumonia, measles, night blindness, tuberculosis, or malaria; coordinating outreach activities for Growth Monitoring Promotion sessions; increasing and maintaining immunization coverage; facilitating the distribution of iron and Vitamin A supplements for pregnant women, and Vitamin A and de- worming medication for children; and participating in the review and analysis of Hearth results.
3. Mobilize the Village Health Committee
The management of Hearth rests with the community. Building the capacity of a local village health committee is necessary to transfer skills and to create ownership. If such a committee does not exist, one needs to be created from the initial meetings of the community leaders. Ideally, the committee is elected, but village leaders may also appoint it. Criteria for effective members include, a concern for improving health and nutrition status in their community, time available to devote to this effort, good teamwork skills, and the respect of others. It is good to have formal and informal community leaders on the committee. Formal leaders, or those close to the formal leadership structure, can influence community decisions, prioritization and resource allocation. The activities of the Village Health Committee may start with Hearth, but once they have experience, they may move on to address other issues in the community. A good training curriculum for staff working with Village Health Committees and involved in other community mobilization efforts is referenced in the resource section of this manual.
Through the Village Health Committees, communities can be empowered to:
♥
Supervise community health workers♥
Manage Hearth sessions♥
Plan and evaluate results♥
Monitor vital events♥
Produce visual score boards that illustrate the measurable impact of Hearth and share these with community members and leaders♥
Manage growth monitoring and promotionCapacity building of the local community begins with the initial meeting to discuss an intervention in nutrition. Subsequently, the Committee learns the skills needed to manage Hearth and growth monitoring through their involvement in implementation. Establishing a partnership starts from day one, followed by monthly or bi-monthly meetings that use UNICEF’s “Triple A” cycle of assessment, analysis and action to support community training. These three activities, Assessment, Analysis and Action become the framework for managing the program.
The “Triple A” cycle consists of:
A
SSESSMENT Collecting both quantitative and qualitative current information on key indicatorsA
NALYSIS Interpreting theinformation, making sense of it, identifying areas of success, and areas that need improvements
A
CTIONDeveloping strategies or action plans to solve identified problems and improve implementation activities