This document provides an overview of participatory learning and action techniques used in health projects in India. It discusses fundamentals of participatory learning and action including working with communities to understand their needs from their perspective. It also describes various techniques used, such as focus group discussions, resource mapping, and sociograms. Focus group discussions are explained in detail as a method for obtaining in-depth information from community members to inform programs.

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Participatory Learning and ActionParticipatory Learning and Action
Techniques in Health in IndiaTechniques in Health in India
Presented byPresented by::
Dr. Y.L. TekhreDr. Y.L. Tekhre
Associate ProfessorAssociate Professor
Department of Social SciencesDepartment of Social Sciences
National Institute of Health and FamilyNational Institute of Health and Family
Welfare, Munirka, New Delhi-67Welfare, Munirka, New Delhi-67
E-mail:E-mail: yade_lal@yahoo.co.in
Ph. [Resi.]Ph. [Resi.] 011-26161708011-26161708
(Office)(Office) 26107773 Ext: 384(Mobile) 986818269626107773 Ext: 384(Mobile) 9868182696

2. What I am going to presentWhat I am going to present
 FundamentalsFundamentals of PLAof PLA
 Applying the techniques of PLAApplying the techniques of PLA
forfor CNA/Action PlanCNA/Action Plan and otherand other
purposespurposes
 Listing out different PLAListing out different PLA
techniquestechniques
 Developing certain PLADeveloping certain PLA toolstools forfor
collection of datacollection of data
 Special attention onSpecial attention on FGDFGD andand
SociogramSociogram

3. FUNDAMENTALS OF PLAFUNDAMENTALS OF PLA
1.1. To work withTo work with communitiescommunities
2.2. To understand fromTo understand from their perspectivestheir perspectives what theirwhat their
needs and concerns areneeds and concerns are
3.3. To build on theirTo build on their local knowledge of their situationslocal knowledge of their situations
conditions, problems opportunities and expectationsconditions, problems opportunities and expectations
4.4. To enable them to develop theirTo enable them to develop their local solutionslocal solutions toto
the problems they facethe problems they face
5.5. PLA is a powerful means ofPLA is a powerful means of enabling local peopleenabling local people
((the poor, illiterate, women and the marginalizedthe poor, illiterate, women and the marginalized))
to appraise, analyze, plan and act and empowerto appraise, analyze, plan and act and empower
themselvesthemselves
66 Health professionals should assume the role ofHealth professionals should assume the role of
helpers facilitatorshelpers facilitators and act as catalysts and goodand act as catalysts and good
listenerslisteners

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PRE REQUISITE OF PLAPRE REQUISITE OF PLA
It Requires Attitude FavouringIt Requires Attitude Favouring::
ATAT 3 LEVEL-3 LEVEL- individual, professional and institutionalindividual, professional and institutional
ParticipationParticipation
Respect for community membersRespect for community members
Patience, enthusiasm, not rushingPatience, enthusiasm, not rushing
Humility, good concentrationHumility, good concentration
Listening, not lecturing - balanceListening, not lecturing - balance
Flexible planning, interact with othersFlexible planning, interact with others
Creativity in dealing with problemCreativity in dealing with problem
Should always include women + children andShould always include women + children and
community memberscommunity members
Enjoy itEnjoy it
Nobody is expert/perfectNobody is expert/perfect
Strive towards a process of empowerment ofStrive towards a process of empowerment of
marginalised peoplemarginalised people

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Why we need PLAWhy we need PLA
CHANGINGCHANGING GLOBALGLOBAL SCENARIOSCENARIO
Increasing influence of processes ofIncreasing influence of processes of
globalisations, libralisation and marketizationglobalisations, libralisation and marketization
throughout the worldthroughout the world
Paradigm shift in thinking of developmentalParadigm shift in thinking of developmental
professionals and policy makers/researchersprofessionals and policy makers/researchers
Accountability, social audit, empowerment, humanAccountability, social audit, empowerment, human
rights, participation, partnership, social capital,rights, participation, partnership, social capital,
sustainability, decentralisation, stakeholders,sustainability, decentralisation, stakeholders,
transparency, convergence, equity, synergy, capacitytransparency, convergence, equity, synergy, capacity
building, sharing, client centered, area and needbuilding, sharing, client centered, area and need
basedbased

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WHAT IS PARTICIPATORYWHAT IS PARTICIPATORY
APPROACH?APPROACH?
A process through which theA process through which the
stakeholders influence andstakeholders influence and
gain control overgain control over
development initiatives,development initiatives,
decisions and resourcesdecisions and resources
which affect themwhich affect them
(WORLD BANK, 1994)(WORLD BANK, 1994)

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A multidimensional andA multidimensional and
multifaceted construct – formultifaceted construct – for
developmental professionalsdevelopmental professionals
– not only actions and– not only actions and
orientations by local peopleorientations by local people
but also professionals,but also professionals,
experts and outside agenciesexperts and outside agencies

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WHAT TO DO IN PLAWHAT TO DO IN PLA
Look, listen and learn, don’t lecture,Look, listen and learn, don’t lecture,
create mutual trustcreate mutual trust
Be sensitive, humble, nice, andBe sensitive, humble, nice, and
transparenttransparent
Learn and share together, not toLearn and share together, not to
interrupt, avoid leading steps, be selfinterrupt, avoid leading steps, be self
critical, unlearncritical, unlearn
Use your own best judgment at allUse your own best judgment at all
time, optimal ignorance, accepting ortime, optimal ignorance, accepting or
embracing errorembracing error

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Allow sufficient time for teamAllow sufficient time for team
interaction for – changing theinteraction for – changing the
agenda, discover + investigate theagenda, discover + investigate the
unexpectedunexpected
Everyday schedule time for writingEveryday schedule time for writing
field notes, think about how and infield notes, think about how and in
what form the results will be usedwhat form the results will be used
Show interest in learning from theShow interest in learning from the
people, respect the communitypeople, respect the community
members, ask for their advicemembers, ask for their advice

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Treat ordinary people asTreat ordinary people as equal partnersequal partners
in learning processin learning process
No touch and goNo touch and go, get rid of superiority, get rid of superiority
complexcomplex
Team composition:Team composition: willingness to workwillingness to work
with teamwith team
AssignAssign each team membereach team member a role fora role for
presenting the findings of PLA, make thepresenting the findings of PLA, make the
presentation interestingpresentation interesting

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SIGNIFICANCE OF PLA TEAMSIGNIFICANCE OF PLA TEAM
The different viewpoint of teamThe different viewpoint of team
members will complement each-members will complement each-
other and will provide a moreother and will provide a more
comprehensive picturecomprehensive picture
Multi-disciplinary team have differentMulti-disciplinary team have different
skills and backgroundsskills and backgrounds
Method which empower communityMethod which empower community
members to express, share, enhancemembers to express, share, enhance
and analyze their knowledgeand analyze their knowledge

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VARIOUSVARIOUS
METHODS/TECHNIQUES OF PLAMETHODS/TECHNIQUES OF PLA
Transect walkTransect walk
Resource mappingResource mapping
Matrix rankingMatrix ranking
Seasonality diagrammingSeasonality diagramming
Causal diagramCausal diagram
Focus group discussionFocus group discussion
Venn diagramVenn diagram
Daily activity chartDaily activity chart

13. What I am going toWhat I am going to
present within the FGD?present within the FGD?
 What is Focus Group DiscussionWhat is Focus Group Discussion
 Why we need and how to conduct itWhy we need and how to conduct it
– PreparationPreparation
– Piolation/how to carryPiolation/how to carry
– Report writingReport writing
– SociogramSociogram
 DemonstrationDemonstration
 SociogramSociogram
 For whom FGD is more usefulFor whom FGD is more useful

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Objectives
Identify the :
Purpose, uses, and limitation
of FGD as a method of data
collection in research,
monitoring and evaluation.
FOCUS GROUP DISCUSSIONFOCUS GROUP DISCUSSION

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WHAT IS FGD
A FGD is a group discussion of
6-12 persons guided by a
facilitator, during which group
members talk freely and
spontaneously about a certain
topic

16. Characteristics:Characteristics:
 Group situationGroup situation
 Limited member (6-12)Limited member (6-12)
 Participants talk with each otherParticipants talk with each other
 Guided by facilitator +RecorderGuided by facilitator +Recorder
 MembersMembers stimulatedstimulated by theby the
comments of otherscomments of others
 Make difference with (Make difference with (PPPPPP))
purpose, process and people.purpose, process and people.

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Why we need FGD?Why we need FGD?
Participatory (with comty+people)Participatory (with comty+people)
Qualitative methodQualitative method
Low costLow cost
Direct approach with civil societyDirect approach with civil society
Comparative ideas can be developedComparative ideas can be developed
Observation and non-verbalObservation and non-verbal
communicationcommunication

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UUSES OF FOCUS GROUP DISCUSSIONSES OF FOCUS GROUP DISCUSSION
ObtainObtain in-depth informationin-depth information onon
concepts, perception, ideas ofconcepts, perception, ideas of
the groupthe group
FormulateFormulate appropriateappropriate
questionsquestions for more structured,for more structured,
large scale surveyslarge scale surveys

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Supplement information onSupplement information on
communitycommunity knowledge, beliefs,knowledge, beliefs,
attitudeattitude and behaviour alreadyand behaviour already
available but incomplete oravailable but incomplete or
unclearunclear
 Develop appropriate messages for
certain programme including
national health programme
 Explore controversial topics

20. 04/12/1504/12/15 2020
HOW TO CONDUCT FGD
Preparation
Recruitment of participants
• Same socio-economic group/similar
background, homogeneous group
• Each major category of man/women
• Participants should be invited at least
1 or 2 days in advance, and the general
purpose of the FGD should be explained

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Physical arrangement
1. Arrange chairs/seating
arrangement in circle
2. Area/place will be quite
adequately, lighted, no disturbance
3. Try to hold FGD in a neutral
setting – encourage for free and
frank expression, views, ideas.

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Preparation of a discussion guide
• Written list of topics
• Series of open-ended questions
Conducting the session
• One member of the team
(research) should act as
• ‘facilitator’ to stimulate + support
• ‘recorder’ to unbiased systematic
recording

23. Functions of the Facilitator
• Introduce the session – purpose of FGD,
kind of information needed
• Encourage discussion – be enthusiastic,
humorous, encouraging
• Encourage involvement – avoid a Q. A.
Session, importance of each participants
• Build rapport–observed non-verbal
communication, body language, tone of
voice etc.

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• Avoid being placed in the role of
expert – you are not suppose to
teach/educate counselling them
• Control the rhythm of the meeting
– control the time, topic,
discussion
• Summarise, check for agreement
and thank the participants – any
additional comments

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Function of the Recorder
Should cover content + emotional reaction
Item to be recorded
• Date, time, and place
• Names & characteristics of participants,
group dynamics (level of participants,
dominant participants, interested
participants)
• Opinion of participants – own words,
key statements, vocabulary used by them

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• Help in resolve conflict situation if
any
• Support to maintain friendly and
informal atmosphere
Number and duration of sessions
At least 2 sessions for separate group
75 MIN. EACH FGD
Preparation of discussion guides (15 min.)
Discussion (50 MIN.)

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Analysis of Results
 After each FGD, both ‘facilitator’ +
‘recorder’ review and analyse
 Full report + comment on unclear
aspects and controversial topics
 Compare answer of different sub-
group, any further suggestions

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Report Writing
o Decide to whom you are writing
the report
o List of the topics guided by the
objectives of FGD
o Composition of Groups of
Participants (group dynamics)

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ToTo wwhom FGD is more usefulhom FGD is more useful
Developmental professionalsDevelopmental professionals
ResearchersResearchers
Policy makers/decision makersPolicy makers/decision makers
Programme ManagersProgramme Managers
Social reformers/mobilizesSocial reformers/mobilizes
Programme implementersProgramme implementers
Counselors and grassroot workersCounselors and grassroot workers

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SociogramSociogram
AA sociogramsociogram is a graphicis a graphic
representation ofrepresentation of socialsocial links thatlinks that
a person has. A sociogram cana person has. A sociogram can
be drawn on the basis of manybe drawn on the basis of many
different criteria: Socialdifferent criteria: Social
relations, channels of influence,relations, channels of influence,
lines of communication etclines of communication etc

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Characteristics of SociogramCharacteristics of Sociogram
Social relationsSocial relations of individual in aof individual in a
groupgroup
Understand theUnderstand the IPCIPC within the groupwithin the group
Level of awarenessLevel of awareness on specific issueson specific issues
To know theTo know the group dynamicsgroup dynamics
Group work methodGroup work method (action research)(action research)
Ways and means toWays and means to resolve theresolve the
conflictconflict

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Examples of sociogramExamples of sociogram
(Pay and stay: high income group)(Pay and stay: high income group)
IssueIssue:: Relationship among the elderlyRelationship among the elderly
living in old age home.living in old age home.
E1
E2
E4
E3
E5

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Analysis:Analysis:
E3 is social, having leadership qualitiesE3 is social, having leadership qualities
E1 bedridden no contact with othersE1 bedridden no contact with others
E2 only talks and contact with E3E2 only talks and contact with E3
E5 only talks and contact with E3E5 only talks and contact with E3
E4 mutual understanding with E3E4 mutual understanding with E3
ConclusionConclusion: Loneliness within this group can be: Loneliness within this group can be
taken care of, if the grup have a level oftaken care of, if the grup have a level of
interaction among themselves; where theyinteraction among themselves; where they
can share:anxieties, problems or evencan share:anxieties, problems or even
solutions.solutions.
E3 is more dynamic, can play a role as aE3 is more dynamic, can play a role as a
leaderleader
Group activities were planed: lunch, TV etc.Group activities were planed: lunch, TV etc.

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The result of FGD after 20 daysThe result of FGD after 20 days
E1
E2
E5
E4
E3

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Progress in relationshipProgress in relationship
Small initiative brought a change inSmall initiative brought a change in
their loneliness as E2, E4 and E5their loneliness as E2, E4 and E5
started communicating/contact withstarted communicating/contact with
each othereach other
E3 became the Catalyst (E3 became the Catalyst (SutradharSutradhar))
More work is possible to improve theMore work is possible to improve the
relationship to avoid lonelinessrelationship to avoid loneliness
among them.among them.

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Example 2: Moderate relationshipExample 2: Moderate relationship
(Govt old age home : free)(Govt old age home : free)
E8
E10
E7
E12
E9
E11
E1
E2
E3
E6
E5E4

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Analysis:Analysis:
E10 has aE10 has a leadership qualityleadership quality
E12 is aE12 is a lonerloner
E2, E5, E1 and E3 hasE2, E5, E1 and E3 has lessless
interactioninteraction with others than E10with others than E10
ManyMany behavioural problemsbehavioural problems
identified, relationship is poor andidentified, relationship is poor and
less interaction among them etc.less interaction among them etc.

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Conclusion:Conclusion:
Suggestions:Suggestions:
EffectiveEffective planningplanning forfor
improvement in theirimprovement in their interactioninteraction
is neededis needed
Participation inParticipation in group activitygroup activity isis
requiredrequired
Possibility toPossibility to utilize their leisureutilize their leisure
timetime in productive work etc.in productive work etc.

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Example 3: Excellent situationExample 3: Excellent situation
(Arya Mahila Ashram)(Arya Mahila Ashram)
E10 E12 E7
E8
E6E3E5
E2
E11
E4E9
E!

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Analysis:Analysis:
The individual hasThe individual has less chances to beless chances to be
lonelylonely
The group isThe group is well organisedwell organised andand
concerned with each other throughconcerned with each other through
multiple activitiesmultiple activities..
All the individuals are involved in oneAll the individuals are involved in one
or the other committee related to theor the other committee related to the
functioningfunctioning of old age home.of old age home.
Continuous communicationContinuous communication andand
interaction exists among theminteraction exists among them
Clear andClear and concreteconcrete relationsrelations

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Conclusion:Conclusion:
Out of above 3 examples, the lastOut of above 3 examples, the last
one can beone can be analysedanalysed as role model inas role model in
which every individual has a socialwhich every individual has a social
relationship in a group.relationship in a group.
social environmentsocial environment may be a basicmay be a basic
reason for their group behaviourreason for their group behaviour
Some of the characteristics of thisSome of the characteristics of this
group can begroup can be replicatedreplicated in other oldin other old
age home, if possible.age home, if possible.

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Seasonal CalendarSeasonal Calendar
PURPOSEPURPOSE::
– Changes during the year how to present informationChanges during the year how to present information
ISSUESISSUES;;
– Climate: Rainfall + TemperaturesClimate: Rainfall + Temperatures
– Crop – Cash + otherCrop – Cash + other
– Live stock; Labour DemandLive stock; Labour Demand
– Income Generation ActivitiesIncome Generation Activities
– Marketing; Human diseasesMarketing; Human diseases
– Social events (Marriage, festival, etc.)Social events (Marriage, festival, etc.)
– Types and quality of cooking/heating fuel, diet,Types and quality of cooking/heating fuel, diet,
income and expenditureincome and expenditure

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HOW TO PREPARE SEASONALHOW TO PREPARE SEASONAL
CALENDARCALENDAR
– Use big size graph paper and draw 12/18 calendarUse big size graph paper and draw 12/18 calendar
OR sit on the ground make the linesOR sit on the ground make the lines
– Ask any alternative method local materialsAsk any alternative method local materials
– Combine all seasonal patterns into one diagramCombine all seasonal patterns into one diagram
– Cross-check and define the SCCross-check and define the SC
AREAAREA::
Social events, seasonal diseases, malaria,Social events, seasonal diseases, malaria,
dengue etc.dengue etc.
Occupational diseasesOccupational diseases
Maternal deaths, industrial accident, etc.Maternal deaths, industrial accident, etc.
Migration, export, import, crops, examsMigration, export, import, crops, exams

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CAUSAL FLOW DIAGRAMCAUSAL FLOW DIAGRAM
(Child mortality Age 0-6 years)(Child mortality Age 0-6 years)
Kanchanpuri
Village
In Delhi
4 died
in1987
No
death
No
death
One died
In 1982No
Death
One died
In 1995
One died
In 1989
One died
in 1989
No death
NoNo
deathdeath
No
death
Malaria
Worm infestation Diarrhoea
Chickenpox
Scabies
Evil spirit
Night
blindness
Rheumatism
Typhoid
Malnutrition
Cough and cold

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Causal diagram OR impact diagramCausal diagram OR impact diagram
ARE useful to find out the inter-links between eventsARE useful to find out the inter-links between events
and trace the cumulative resultand trace the cumulative result
Smoking
Time loss
Work efficiency
down
Prestige/
insult
Habit
Health loss
Money loss
Peer group
pressure
Parents were
smoking
Enjoyment
Tension
Work situation
IMPACT
CAUSES
Area
climate
Sleeping
disorders

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MAPPINGMAPPING
Variety of mapsVariety of maps
SocialSocial
MobilityMobility
BodyBody
Historical etc.Historical etc.
Ask for previous map if any:Ask for previous map if any:
select any topic:demography,select any topic:demography,
social, residential, occupationsocial, residential, occupation
stratification, field land use,stratification, field land use,
water, literacy, natural, etc.water, literacy, natural, etc.

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RankingRanking
Ranking or scoring means placingRanking or scoring means placing
something in ordersomething in order
Pair-wise ranking, for example, helpsPair-wise ranking, for example, helps
identify the main problems or preferencesidentify the main problems or preferences
of individual community members andof individual community members and
Their ranking criteria, and enables theTheir ranking criteria, and enables the
priorities of different individual to be easilypriorities of different individual to be easily
comparedcompared
Useful for sensitive informationUseful for sensitive information

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Pair wise ranking matrix favorite pastimes
ModeMode TV RE SL MU SP Score/Rank
TV TV TV MU TV TV 3 B
RE RE MU RE RE 2 C
SL MU SP SL 0 E
MU MU MU 4 A
SP SP 1 D
TV= Television, RE= Reading,
SL= sleep, MU= Music, SP= sports

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Overall preference for method of FP
Methods
Temporary
Reliable Available Simple
to use
Resistance
to side
effects
Condom
Norplant
Oral pill
Permanent
Vasectomy
Tubectomy
Max = 5 please give the marks according to your own feelings

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Treatment sequence matrix
Place of
treatment
Home
remedies
Medical
shop
Govt.
hospital
Private
hospital
Praye
rs
Spirit
ual
Traditional
methods
Commo
nness
Scabies
Headache
Skin
Stomach
Measles
ENT
STI/STD
Devil or
evil
Jaundice
1=Go first; 2=Go second etc. [what people actually do]

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How to prepare action planHow to prepare action plan
55Ws andWs and OneOne HH
WHATWHAT: the title, rationale, objectives: the title, rationale, objectives
WHEREWHERE: geographical area, population: geographical area, population
coveredcovered
WHENWHEN: the time, frame breakup: the time, frame breakup
WithWith WHOMWHOM: staff, community/leader: staff, community/leader
WHOWHO: PLA team, consultant,: PLA team, consultant,
representativesrepresentatives
HOWHOW: intervention, methodology, tools: intervention, methodology, tools
and techniques, qualitative Vsand techniques, qualitative Vs
quantitativequantitative

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Thank youThank you