Harnessing community knowledge for health:-Case studies from community health service and information systems in Ethiopia. PhD trial lecture by Zufan Abera Damtew

1. African and Western Indigenous
Knowledge Systems - Relevance to HIS
By Zufan Abera
Oct, 2013

2. "African and Western Indigenous Knowledge
Systems - Relevance to HIS"
• African indigenous
knowledge
system….Ok
• Western indigenous
knowledge system?

3. Outline
 Indigenous Knowledge systems
 Combining the Indigenous and Scientific
knowledge systems
 Health Information Systems
 Using Indigenous Knowledge for HIS
 Conclusion

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. 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. 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. 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. Indigenous Knowledge for Health:-Different
Types of Healing Practices

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Health Information Systems
Health information systems are the foundations for
public health (AbouZahr and Boerma, 2005).

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. 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. 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. 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. 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. 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. Indigenous Knowledge for HIS
 How the indigenous knowledge benefit the Health
Information Systems of Africa?

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. 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. 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. 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. 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. 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. 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. 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. 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. 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.  Thank You