Harnessing community knowledge for health


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Harnessing community knowledge for health:-Case studies from community health service and information systems in Ethiopia.

PhD trial lecture by Zufan Abera Damtew

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Harnessing community knowledge for health

  1. 1. African and Western Indigenous Knowledge Systems - Relevance to HIS By Zufan Abera Oct, 2013
  2. 2. "African and Western Indigenous Knowledge Systems - Relevance to HIS" • African indigenous knowledge system….Ok • Western indigenous knowledge system?
  3. 3. Outline  Indigenous Knowledge systems  Combining the Indigenous and Scientific knowledge systems  Health Information Systems  Using Indigenous Knowledge for HIS  Conclusion
  4. 4. Indigenous Knowledge Systems “A systematic body of knowledge acquired by local people through the accumulation of experiences, informal experiments and intimate understanding of the environment in a given culture” (Rajasakeran et al., 1992). Outsiders mostly recognize certain aspects of the indigenous people. • Source- http://www.ankn.uaf.edu/IKS/Iceberg.html
  5. 5. Indigenous knowledge Systems Cont.  This knowledge system includes wholeness, community and harmony which are deeply embedded in cultural values (Mkabela 2005)  Indigenous people have traditionally acquired their knowledge through direct experience in the natural world. “Learning by doing”  Indigenous knowledge systems are constantly adapting and changing in response to new conditions.  This knowledge domain is an under-utilized resource for development, and mainstreaming is critical.
  6. 6. Indigenous knowledge Systems Cont.:- Differences between the two Knowledge Domains (Source.- Rahman, 2000:5) The common ground, include the knowledge is stable, but subject to modification, offer skill and procedure to do and way of doing. Indigenous knowledge Scientific knowledge Tacit knowledge (Subjective) Explicit knowledge (Objective) Knowledge of experience (body) Knowledge of rationality (mind) Traditional knowledge Modern Knowledge Analog knowledge (practice) Digital knowledge (theory) Holistic Compartmental
  7. 7. Indigenous Knowledge System:- Role for Different Fields  Agriculture  Animal husbandry and veterinary medicine  Use and management of natural resources, and biological diversity  Conflict resolution.-  Indigenous knowledge the gives basis for grassroots decision- making,  The role of elders and local judges  Saving and lending  Through indigenous organizations and associations, problems are identified, and solutions are determined.  Preventive medicine and psychosocial care
  8. 8. Indigenous Knowledge for Health:-Different Types of Healing Practices
  9. 9. Indigenous Knowledge for Health Cont.  The Nigerian indigenous post-partum care for the mother and the newborn  The indigenous community-based institutions:- for example, “Eders” in Ethiopia have the potential of Traditional Social Insurance for Supporting Health Care (Mammo, 1993, Mengesha, 2011).  Alternative medicine in Kenya has remained popular because of its accessibility, affordability and efficacy despite vilification through governmental policies (Falola and Heaton, 2008).  There is a need “ to build on local cultural realities, strengthen existing community resources and develop social capital for sustainable development”.
  10. 10. Indigenous Knowledge for Health Cont.:- Harmful practices  There are harmful practices originated from the indigenous knowledge, examples, cutting uvula of small children, female genital mutilation, etc.  Not all herbal medicines have good effects,  Some traditional medicines and practices are blamed as causing certain complications and deaths (Stewart 2001).  Some traditional healers may give «uncertain promises» in relation to treating some diseases.
  11. 11. African Indigenous Knowledge System  The acquisition of knowledge is collective and community oriented.  African knowledge system to be represented in the form of sculpture, wooden carvings, rock paintings, structured cultural institutions, etc.  Its rich complexities are found in the community ceremonies and rituals: such as, story-telling, proverbs, folktales, poetry, reasoning, praise, songs, puzzles, etc. • Afro-centric approach encourages cultural and social immersion:- indigenous peoples are active participants in the articulation of the views, concerns and research questions that they deem important to their cultural context.
  12. 12. African Indigenous Knowledge System Cont.  African knowledge is vulnerable because many of the carriers of this knowledge are dying without the documentation of these knowledges.  To preserve such knowledge, a new path must be charted; for example participatory video can be used as a means of collecting and disseminating indigenous knowledge ”In Africa, when an old person dies it is like when a library burns down” Amadou Hampâté Bâ, Malian philosoper
  13. 13. Western Indigenous Knowledge System  The basic component of any country’s knowledge system is its indigenous knowledge. It encompasses the skills, experiences and insights of people, applied to maintain or improve their livelihood.  The indigenous people in Western countries also have their unique way of living style,  Example, the Alaska people in Northern America:- the knowledge base that Alaska Natives have acquired through cumulative experience over millennia.  Aboriginal Australians.  Sami People:- The Sami people live in four European countries Traditional face paint to an Aboriginal boy
  14. 14. Western Knowledge System Cont.  Western knowledge system often is portrayed as superior, universal, and as not having the ‘‘cultural fingerprints’’ that appear to be much more noticeable in other knowledge systems (Gough 1998: 508).  The representation of “Western science” is used as criteria for declaring ‘‘other’’ knowledges as non-science.  All knowledge forms need to be treated equally
  15. 15. Combining the Indigenous and Scientific knowledge systems  There is no seamless combination of the two knowledge systems  The three frequently mentioned reasons 1. The incommensurability of the two types of knowledge systems,  The two knowledge systems have their own way of knowing  The indigenous knowledge regarded as primitive, simple and static;  Not amenable to systematic scientific investigation. 1. The underlying political and power dimensions of the participants or stakeholders involved (Nadasdy, 1999:2).
  16. 16. Combining the Indigenous and Scientific Knowledge Systems:- the Power Imbalance  Many beneficial local practices disappear only because of the intrusion of foreign technologies or development concepts  The local environmental knowledge of the rural community in Ethiopia was discredited because they were held responsible for producing environmental degradation (Hoben, 1995).  Higher yielding sorghum varieties were introduced in Ethiopia to increase food security, but faced sustainability problem (Oduol, W. 1992)…
  17. 17. Combining the Indigenous and Scientific Knowledge Systems Cont:- Conflict of Interests 3. The competing underlying interests Who should benefit from the discovery of the new drug? The Traditional healer The Scientist The Community
  18. 18. Creating Knowledge Alliance  However, understanding knowledge production as performance enables seemingly disparate knowledges to work together so as to produce new knowledge spaces, Turnbull (1997: 560). Examples  Establish a continuum between scientific and the community weather forecast (Rengalakshmi, 2006)  Combining of technical knowledge, scientific knowledge and indigenous community knowledge for GIS in India (Puri, 2003, 2007)  Knowledge alliance from community and scientific sources for health service provision and HIS (Damtew and Aanestad, 2012)
  19. 19. Health Information Systems Health information systems are the foundations for public health (AbouZahr and Boerma, 2005).
  20. 20. Why Health Information Systems  There is a need by the health sector of developing countries to use the limited resource effectively  This requires sound management that is based on information  Measuring the health status of the population, and design intervention programs  Information is required to evaluate national and international efforts, example, the Millennium Development Goals.  Evaluate effectiveness /efficiency of health services given to population
  21. 21. Health Information Systems in Developing Countries  Collect every possible data (For example Braa et al.,2007; Mengsitie, 2010)  Be vertically designed: where Data/info exclusively flowing upwards  Focus on international and national requirements rather than local demands  Have data of poor quality  Used little for decision making activities  Duplication and waste among parallel health information systems: Health Care measurement in developing countries has been dominated by fragmented donor-driven efforts (Chilundo, 2005).
  22. 22. Health Information Systems in Developing Countries Cont.  Several registers used by health workers for registering similar information  Duplication of efforts.  Share health workers time  Enormous investment has gone into computerized health information systems  Health data compiled using computer
  23. 23. Health Information Systems in Developing Countries Cont. Strong belief that Health information system=Technology Mostly, the introduction of IT in developing countries entails through donors’ initiatives There is minimal user participation from the inception of ideas of such systems, their initiation, design, development and implementation HIS systems in developing country mostly fail
  24. 24. Health Information Systems in Developing Countries Cont.  The HIS failure can be a total failure or Partial failure (Heeks, 2002)  The “sustainability failure” of an initiative that succeeds initially is common in developing countries.  The domain of developing country information systems is particularly dominated by the transfer of Northern designs to Southern realities.
  25. 25. Health Information Systems in Developing Countries Cont.  When knowledge and technology are imported, the systems in which they were operating in the country of origin also gets reflected…this dependency on outside initiatives has resulted in the weakening of the survival strategies of African communities (Zegeye and Vambe, 2006).  Design is always design from somewhere (van der Velden, 2013).  Hence the methods and concepts for the system design must be shaped by local practices and conceptualization (Bidwell, et al., 2013)
  26. 26. Indigenous Knowledge for HIS  How the indigenous knowledge benefit the Health Information Systems of Africa?
  27. 27. Indigenous Knowledge for HIS  The health information systems – incorporate not just technological but also social and organizational factors People Procedure Culture (Values, Norms, tradition, etc) Processes     Behavioural Sub-system Interaction Technological Sub-system Hardware Software Network Data
  28. 28. Impediments to Use Indigenous Knowledge for HIS  Policy-Practice gap: example banning of TBAs not to offer delivery service in Malawi (Kanjo, 2012).  Training of health workers and the community using the western methodology:  Over-relying on technology  Minimal involvement of the peripheral level staff, and the community in the design and implementation of HIS  HIS require documentation; but most indigenous people (knowers) do not write and read  Loose feedback mechanism  Shortage of Resources
  29. 29. Using Indigenous Knowledge for HIS:- Problems and Possible Solutions  Consider the reality for Policy and HIS design Problems Possible solutions • Policy- practice Gap • Consider the realities at the ground • Use local input in the process of policy formulation • Over-relying on technology • Consider the Social-cultural factors, • Constantly renegotiating and collaboration between external designers, users and the community
  30. 30. Using Indigenous Knowledge for HIS:- Problems and Possible Solutions Cont.  Adjust training programs to local realities Problems Possible solutions  Training of health workers and the community using the western methodology:  Offer Trainings to the community using the community dialogue, rituals and practices  Example: training of TBAs about the importance of registering the delivery service through traditional song and dance (experience from Malawi)
  31. 31. Using Indigenous Knowledge for HIS:- Problems and Possible Solutions Cont.  Community health information systems Problems Possible solutions  Minimal involvement of the community for their own health issues.   Nurturing the community health information systems 
  32. 32. Using Indigenous Knowledge for HIS:- Problems and Possible Solutions Cont.  Documenting M-CH data by TBA Problems Possible solutions  HIS require documentation; but most indigenous people (knowers) do not write and read • Improvisation and use the available materials, and other opportunities that help for documentation  Registering by the local midwife by adding small stones in a five-part box (Experience from Sierra Leone).
  33. 33. Using Indigenous Knowledge for HIS Cont.  Strengthen the feedback mechanism Problems Possible solutions  No or very little feedback mechanism (The reports flow up-ward) • Inform the community about their own health status and achievements • Use prior knowledge as a foundation to build on and teach new concepts – the constructivist way of learning (experience from South-Africa). • Use indigenous community-based institutions for strengthening collaboration for health  Shortage of Resources • Strengthen the HIS and use the available resources effectively • Develop community ownership, and use the community potential for health and HIS
  34. 34. Summary Indigenous knowledge system Combining the two knowledge system Improve Public health Evidence-based decision making Sustainable HIS Scientific knowledge Technology, standards Local solutions and alternatives
  35. 35. Conclusion Indigenous knowledge is not yet fully utilized in the development process. The importance of indigenous knowledge is acknowledged to enhance sustainable development endeavors Sound health information systems are essential to make evidence-based decision making  There is no universal knowledge. Establishing knowledge alliance between the indigenous and scientific sources is required for the betterment of HIS
  36. 36. References  Byrne, E., Sahay, S. (2007). Participatory Design for Social Development: A South African Case Study on Community- Based Health Information Systems. Information Technology for Development, 13 (1) 71–94.  Damtew, Z., Aanestad, M. (2012). Benefits of Local Knowledge in Shaping Standards:-A Case Study from Community Health Service and Information Systems in Ethiopia. Scandinavian Journal Information Systems. 24 (2), 27-50.  Hoben, A. (1995). Paradigms and politics: the cultural construction of environmental policy in Ethiopia. World Development, 23 (6): 1007-1021.  Kanjo, C., (2012). In Search of the Missing Data: A case from Maternal and Child Health Data in Malawi. Faculty of Mathematics and Natural Sciences, University of Oslo.  Puri, S. (2007). Integrating scientific with indigenous knowledge: Constructing knowledge alliances for land management in India. MIS Quarterly, 31 (2): 355-379.  Rajasekaran, B., Warren, D.M. and S.C. Babu (1991). Indigenous natural-resource management systems for sustainable agricultural development – A global perspective. Journal of International Development, 3 (1): 1-15.  Turnbull, D. (2000). Masons, Tricksters and Cartographers: Comparative Studies in the Sociology of Scientific and Indigenous Knowledge. Amsterdam, Harwood Academic Publisher
  37. 37.  Thank You