4. com h org and dev unit 4

Unit 4: Community Participation
(Engagement)
in
Community Health Service
Draft Version 3
(12 hrs)
Upendra Raj Dhakal
Lecturer: Valley College of Technical Science, Kathmandu

Concept of CP and its form
• Participation: Involvement/Engagement ……….
• Participation as a mean: Way of using the economic and social resources of
community people to achieve predetermined objectives. Government and
development agencies see participation as a means of improving the efficiency of
their service delivery systems. It is static, passive and ultimately controllable form
of participation. It is mostly found in rural development programs.
• Participation as an end: Process oriented, confidence and solidarity among
community people are built up. It is considered as a permanent and intrinsic
feature of community. Development that increases and strengthens the CD
program making it sustainable and effective it is associated with development
activities outside the formal or government sector and is concerned with building
pressure from below for making change. There are three types of participation as
the stages the participation reaches as: Marginal Participation, Substantive
Participation and Structural Participation.
(Source: PH and PHC – Ramjee Pd Pathak & Ratna Kr Giri – pg 129)
CHOD Draft Version 3 (Feedback Welcomed) 2

Introduction
• A process by which a community mobilizes its resources, initiates and
takes responsibility for its own development activities and share in
decision making for and implementation of all other development
programs for the overall improvement of its health status.
• The key to the successful organization of PHC is community
participation, through the process, the people gain greater control
over the social, political, and economic and environmental factors
determining their health.

Objectives
• Awareness to people about the importance of CP and its relation to HFs for change in
health.
• Involve community people to identify and understand the nature of health related
problems.
• Create interest within community people to solve or reduce health related problem with
great zeal (passion).
• Enable community people to overcome hindrance to community participation in health
matters and others.
• To enable community people to utilize the locally available skills and resource materials.
• It enables people to become self – dependent
• It develops the capacity to identify and implement the new development activities with
great enthusiasm.
• To take them aware about the potentiality hidden inside them.

Importance
• It is cost effective method for reaching to health services of the people.
• People began to view health more objectively; people are more likely to accept preventive
approach in health care.
• Greater commitments of people in success of health programs.
• Health awareness becomes an integral part of community.
• Health workers get greater support from the people for their activities
• People become more and more self – reliant (centered) in their ability to prevent diseases and
promote positive health.
• Community makes additional resources available.
• Health services becomes more reliant (focused) to health need of the community.
• Less dependence on the government.
• Result of health measures are more durable
• Health planning is done at most peripheral and grass root level.

Levels of CP
• First Level of Community Participation
• Compliance or Force
• Collaboration
• Local Control (Community Empowerment)
• Second Level of Community Participation
• Lowest Level: ……….
• Mid Level: ………
• Highest Level: ………..
• Other Levels of Community Participation/Defined as forms in later slides
• Marginal:………..
• Substantial:…….
• Structural: ………

First level of community participation
a) Compliance or force: Unwilling or unwanted change brought by force.
Eg. Enforcement of law, creating the situation of fear, providing
incentives and the system of punishment. This sort of participation does
not long last and cannot bring sustainable positive results in the field of
public health.
b) Collaboration: To work with community with good relation with
community members. Good coordination and cooperation is essential.
c) Local Control (community empowerment): Challenges the existing
power structure as well as demands to redistribute power in order to
build the minimal, if not equal, economic base for previously excluded
group. Local people see all the development activities.

Contd ….local control (community empowerment)
• People exercise all right and duties.
• People utilize and mobilize local resources for CD.
• Community people, themselves plan, implement, monitor and evaluate the
local development program themselves.
• It creates sustainable and long lasting results.
• Empowerment implies enabling people to understand the reality of their
environment, reflect on the factors sharing that environment, and takes
steps to effect change to improve the situation.
• It is the process that encompasses people deciding where they are now,
where they want to go and developing the implementing plans to reach
their goals based on self reliance and sharing of power.

Contd ….local control (community empowerment)
Hence, in community empowerment or local control,
community people are able to:
• Define their needs, problems and issues.
• Develop plans and strategies to meet these needs, and
• Implement such plans to reap (gain) the benefits and accept the
outcomes rationally including hiring – firing and supervision of
health post.

Levels of Public Participation
(Read it by your own) – not in syllabus
• Manipulation: It is aka “Non participation”. Public and
observers are manipulated into thinking that public
participation is in progress. This is often used when a
certain organization has to prove that “real people” are
involved in a project which is not even discussed with
these people.
• Therapy: This is many times referred as “both dishonest
and arrogant”. People without power are shushed, and
many time treated as mentally ill. It is called therapy
because, citizens are put together to make change
themselves rather than guiding a procedure. Eg.
Hospital recommending for home therapy …..

Contd ….
• Informing: Creating awareness by informing. It is a two way process:
not only citizens learn about coastal issues, officials can also learn
from citizens. Also, one way communication are frequently used to
inform community. Publics are informed at earlier stage for
preparedness. Drawback: low quality of information provided with
superficial information. If citizens are not properly informed, they
cannot truly participate.
• Consultation: It is “inviting citizens” opinions in decision making or
planning process. It is valid way of informing and participating. i.e.
consulting. There is no guarantee that citizens concerns and ideas will
be taken into account.

Contd …
• Placation: it is done after informing and consultation. Citizens get to advise
and even plan a great deal but it is the power holder that finally gets to
decide whether to even take these ideas into account or not. The level to
which citizens are placated depends on 2 things: “the quality of technical
assistance they have in articulating their priorities; and the extent to which
the community has been organized to press for those priorities”.
• Partnership: In a partnership, the power is shared by “negotiation between
citizens and stakeholders”. Planning and decision making tasks are carried
out through bodies like “joint policy boards”, “planning committees” and
other mechanisms that might enforce such a partnership. They work best
with an “organized power base” in the region or community where
meetings can be held, finances can be taken care off and where the group
can do business with its employees (lawyers, technicians etc..).

Contd …
• Delegate Power: the public has the dominant decision making authority in a plan
or program. This happens on not very many occasions and requires a number of
very dedicated citizens. It can also be that there are two groups, one power-
holder group and one public group. When decisions cannot be made through
negotiations between the groups, the citizens often hold the right to veto.
• Citizen Control: this is the highest form of authority that citizens may achieve and
it means that they are in full charge of a policy or plan and that they are “able to
negotiate the conditions under which ‘outsiders’ may change them.” There are
several drawbacks to full citizen control: it might support separatism and hostility
against public services, it costs more money and is usually less efficient and it
might enable the wrong people to have too much power. Besides all those
arguments, citizen control is not a professional way of dealing with things but in
some cases it might work and it is the only way to give full power to the
“powerless”.

Models of CP
• Contributory: Some sort of resource is shared/given voluntarily.
• Collaborative: A type of partnership. Two or more parties (of similar
status) working together.
• Co – creative: Bringing different parties (different status – like
company and group of customers) together to produce valuable
outcome.
• Hosted: Receiving and entertaining people
(examples in next two slides)

Categories Contributory Collaborative Co – Creative Hosted
Kind of commitment
We are committed to
help our visitors and
members and feel like
participating in the
institution
We are committed to
deep partnerships with
some targets in
communities
We are committed to
support the needs to
target communities with
goals align with the
institutional mission
We are committed to
invite community
members to feel
comfortable while using
institutions for their own
purpose.
How much control?
we want participants to
follow our rules and
engagement and give us
what we request
Staff will control the
process, but participants
actions will steer the
direction and content of
the final product
Some participants goals
and preferred working
styles are just as
important as those of the
staff.
Not much – as long as
participants follow out
rules, they can produce
what they want
How do you see?
The institutions requests
content and the
participants supply it,
subject to institutional
rules.
The institution sets the
project concept and plan,
and than staff members
work closely with
participants to make it
happen.
The institution gives
participants the tools to
lead the project and than
supports their activities
and helps them move
forward successfully.
The institution gives the
participants rules and
resources and then lets
the participants do their
own thing
Who are the
participants/what kind
of commitments we seek
from participants?
We want to engage as
many visitors as possible,
engaging them briefly in
the context of a museum
or online visit
We expect some people
will optional in casualty,
but most will come with
the explicit intention to
participate.
We seek participants
who are intentionally
engaged and are
dedicated to seeing the
project all the way
through.
We would like to
empower people who
are ready to manage and
implement their project
of their own.
15CHOD Draft Version 3 (Feedback Welcomed)

Categories Contributory Collaborative Co – Creative Hosted
How will you manage?
We can manage it
lightly, the way we
would maintain an
interactive exhibit, but
we ideally want to set it
up and let it run.
We will manage the
process, but we are
going to set the rules of
engagement based on
our goal and capacity.
We will give much time
as it takes to make sure
participants are able to
accomplish their goals
As little as possible – we
want to set it up and let
it run on its own.
What kind of skill do
you want?
Creation of content,
collection of data, or
sharing of personal
expression. Use of
technological tools to
support content
creation and sharing.
Everything supported
by contributory
projects, plus the ability
to analyze, curate,
design, and deliver
completed products.
Everything supported
by collaborative
projects, plus project
conceptualization, goal
setting, and evaluation
skills.
None that the
institution will
specifically impart,
except perhaps around
program promotion and
audience engagement.
What goal and how will
non participant visitors
will perceive?
The project will help
visitors see themselves
as potential participants
and see the institution
as interested in their
active involvement
the project will help
visitors see institution
as a place dedicated to
supporting and
connecting with
community
The project will help
visitors see the
institution as a
community driven
place. It will also bring
in new audiences
connected to the
participants
The project will attract
new audiences who
might not see the
institution as a
comfortable or
appealing place for
them.

Four Models of Community Participation in PHC
CATEGORIES
HOSPITAL-CLINIC
BASED
COMMUNITY
ORIENTED
COMMUNITY BASED COMMUNITY MANAGED
Guiding principle Health of the people Health for the people Health with the people Health by the people
Main character
Authoritarian Paternalistic Democratic Liberating (more
flexibility)
Initial objectives
Rigid and statistics
oriented
Closed and
predetermined;
defined before
community is consulted
Open ended and
flexible; problems and
needs evolved from the
community
Formulated by the
community and based on
their felt needs, vision of
an alternative social
order expressed by the
people
Tacit/Unspoken
objectives
Maintain status;
perpetuate (preserve)
existing health system
Improve/alter certain
aspect of the health
system
Transform the health
system and initiate social
reform
Complete re-structuring
of the health system
together socio economic
transformation
Who is responsible for
health
Health is the sole
responsibility of
doctor (clinical staff)
Health is the
responsibility of health
professionals (Public
Health)
Health is the
responsibility of
community health
workers and leaders
Health is the
responsibility of
everyone in the
community

CATEGORIES
HOSPITAL-CLINIC
BASED
COMMUNITY ORIENTED COMMUNITY BASED COMMUNITY MANAGED
Outlook of health
professionals
As recipients
(receivers) of
health care
As beneficiaries of
health care program
As partners in health care As managers of their own
health program
Level of community
participation and
main decision
makers
Community is
just informed of
health activities
Community is just
consulted on what can
be done.
Doctor and other health
professionals decide
Community actively discuss
and decides plans and
activities together with
health professionals.
Decision is shared by
community and health staff
Community identifies needs,
defines objectives plans,
implements, monitors and
evaluates the health program
on their own.
The community is the main
decision maker.
View on awareness
building
The community
should be kept
ignorant of
health
The community is made
aware to change their
behavior or to pacify
them if hardship leads
to revolt
It is a means for community
organizing and for
understanding the
relationship of economic
and political problems
It is a means to generate
people’s power and ensure
continuing community
participation
Value given to
community
organizing
The community
is not capable of
being organized
As a means to change
peoples attitude to
cooperate with health
authorities
wholeheartedly
As an end in itself and as an
opportunity for people to
develop leadership and
management
As the main tool for
empowerment and as a long
lasting safeguard to product
the communities interest

CATEGORIES
HOSPITAL-CLINIC
BASED
COMMUNITY ORIENTED COMMUNITY BASED COMMUNITY MANAGED
Inter
sectorial
linkage and
social
mobilization
Believe that they are
doing their work
sufficiently, thus there
is no need of linkage
Usually limited to
government agencies or to
these who give dole – outs
With the agency government or
non government who may be
assistance in giving solutions to
health and other issues.
With organizations and
institutions working for basic
social changes
Forms alliances and federations
with them
Effect on the
people of
the
community
Oppressive (Unfair) –
rigid central authority
allows little or no
participation by the
community
Deceptive (Misleading)-
pretends to be supportive
allowing some
participation but resists
genuine changes
Supportive – helps people find
ways to gain more control over
their lives
Self – reliance (faith) and self –
determination (will). People
aware of their potentials and use
them to the full and with
responsibility.
General
impact
No change Social change Behavioral change Structural change
Data
gathering,
monitoring
and
evaluation
Data limited to
morbidity, mortality
and health service
statistics, MnE mainly
the concern of
hospital/clinic
management
No feedback of
information to
clientele or
community
Data gathered by
outsiders via a long survey
questionnaire with heavy
emphasis on health data
MnE done by health staff
Little or minimal feedback
of information to the
community
Data gathered by community
health workers and kept simple;
includes felt need and concerns
Collection and analysis done
together with health staff
MnE done jointly by community
health workers and health staff
Regular feedback given to
community
Community decides what data
to collect, community members
gather, collate and analyze data
on their own
Self evaluation and self
monitoring systems established
Community members
continuously informed of data
gathered about relevant actions
taken accordingly by them19CHOD Draft Version 3 (Feedback Welcomed)

PHC Revitalization – WH Question?
- Voluntary or government: No responsibility of state, and PHC
members expect PHC to be executed by community as a volunteer
organization (i.e.. no role of state to execute PHC), and ignore
activities that does not do fund raising for the PHC. It is considered as
unrealistic concept. (see in Four approach of CP <first slide> in next
slide)
- Infrastructure and service equality: ………..???
- Wide spread community participation: …maximum involvement ...???
- CP in fullest sense: ……….fully managed by community……….???

Four Approaches of CP
1. Anti-/reluctant (unwilling) communitarians and economic
conservative approaches:
• Community is constructed as ‘mythical’ or sentimental and actors
argue for non – state intervention and self regulation of citizens while
often (paradoxically) arguing that the community will look after the
individual.
• Actors acknowledge the need for the community support but that is
not really ‘work’ and can be largely done through voluntary work.
• Communities who do not contribute to economic agendas are
ignored.

Contd …Approaches of CP
2. Technical – functionalist communitarians and managerialist approaches:
• Community is constructed as a relatively stable and homogenous entity.
• Actor see community engagement as “maintaining equilibrium”.
• Their goals are a minimum of fuss, maximum efficiency and they rely on
expert – driven consultation with communities.
• They see participation as a political and participants are often recruited
from well – established community groups for their abilities.
• Actors can see themselves as neutral arbiters (mediators) of disputes
(quarrel).
• Under this approach conflict is avoided and notions of justice largely
ignored.

3. Progressive communitarians and empowerment approaches:
• Community is constructed as complex and problematic.
• Actors see social justice as important and they pay attention to the
processes of participation.
• They see participation as a change agent but their emphasis is on
incremental rather than radical change.
• However, while focusing on the politics of inclusion/exclusion, wider
structural impacts on communities are largely ignored.
• Actors are generally egalitarian (not favoring any) and inclusive in
approach, relying on face – to – face contact and debate.
• Conflict is acknowledged, while not necessarily ensuring that under –
represented groups are present.

4. Radical/activist communitarians and transformative
approaches:
• Community is constructed as esteemed places where “ordinary folk” live and real
life takes place.
• Actors are concerned with discrimination and oppression (domination).
• They link personal and local issues to national and global ones, seeking to
transform social order.
• Their focus is on the redistribution of resources and the fight against poverty.
• Power relations are at the forefront of their analysis of problems.
• Many see existing community participation as a smokescreen to the real issue of
injustice.
• They seek to recruit people who are often sidelined and prefer bottom up
approaches.

Some other approaches
• Spontaneous participation: local initiatives, no external support, self
sustaining, ……….
• Induced participation: External initiatives taking support from
external resources, ………..
• Compulsory participation: People are mobilized or organized willy –
nilly. To perform any activities.

Forms of participation
Forms of participation can be categorized as Participation as Means or
Participation as an end (see in concept of CP); or on the basis of objectives as
Co- operation seeking participation and Power – Sharing participation.
• Cooperation – seeking participation:
• To receive information: ……..
• To submit protests: ………
• To make suggestions: ……….
• To be consulted before final decisions are taken: …..
• Power – sharing participation:
• Solving their own health problems: ……….
• Assessing their health needs:………..
• Taking responsibility for mobilizing local resources: …………..
• Suggesting new approaches and solutions to their problems: ……….
• Creating and maintaining local organizations: …………, and
• Administration and financing of the health services: ………………

Process of CP (On the basis of stage participation has reached)
Marginal Participation: (act as if ….)
• Role of the community people is limited and transitory.
• Less direct influence in outcome.
• Eg. HP staff take a trouble explaining available services at that time, so that
people are informed and can come to HF for services.
• Since it costs a great deal to provide health services, it is a big waste of
money if people do not come for the health facility.
• In many community development programs where plans and objectives
are determined beforehand, the community people achieve only a
marginal influence on performance.
• It is hence the lowest level of community participation.

Contd …
Substantive Participation: (active role of community ….)
• Community people are actively involved in identifying their needs,
determining priorities and carrying out health related activities even if the
mechanism of these activities is extremely controlled.
• This is higher level of community participation in which the community
members take part actively as assessing local aids, planning, implementing
and evaluating the results of health activities.
• When they do this, they develop the spirit of self – reliance (trust).
• This type of participation also helps in the mobilization of the locally
available internal resources.
• Substantive participation is means by which many CD programs achieve
their objectives, but there are evidence that substance of participation is
limited to the benefits of the project activities.

Structural Participation: (CP as an integral part and major basic for Health
activities)
• Highest level of CP where local people completely own and manage health issues.
• CP is an integral component of project and ideological basis for performing
activities.
• Community people play active and direct role in CD
• Community understand real need for health and development ad thus can
volunteer with free labor to upgrade their health status.
• It is real community involvement and complete mobilization of local resources.
• It provides social control over health infrastructure.
Contd …

Participation in Health service delivery and
process utilization
• Community people come to know their own situation better and are
motivated to solve their common problems.
• This enables them to become agents of their own development instead of
being passive and beneficiated of development aid.
• The second recommendation (of 22 recommendations) of Alma Ata
conference has emphasized in CP.
• CP must incorporate: assessment of situation, problem identification,
priority setting, acceptance of responsibility, community contribution, ….
• There are five different phases in HS Delivery and P Utilization: ..next
slides…

Participation in community Resource Identification
phase. (PHSD&PU…..)
• Community participation cannot be done if resources are not
identified.
• Local committee can be formed for rapport building for R.
Identification.
• Resources might be: HRs, Money, Materials, Time Frame,
Management, …
• For Time Frame: Program not executed as per the Gantt chart will
generally increase the total project cost. Not only the cost, completing
the program as per the schedule will minimize the wastage of resources
and accomplish the objectives in the minimum possible time.
• Management: ….next slide…..

Contd ….
Management:
• Sources of local resources:
➢ Government Organizations and Programs
➢ NGOs
➢ Individual or Private resources
• Internal resource’ mobilization and participation in community resource identification
phase (aspects)
➢ Identify its need
➢ Plan its solutions
➢ Maximum peoples participation
➢ Resource identification and mobilization
• Ways to identify resources:
➢ By rapport building
➢ Making awareness
➢ Making understanding
➢ Coordination and communication
➢ Good and acceptable behavior/socially acceptable
• Conclusion: Evaluation of social reliance and awareness, mutual relation between
different organizations, …

Participation in community Needs Identification
phase, (PHSD&PU…..)
• It is important to prioritize needs by identifying them in the community
• Real need cannot be identified if community people are not identified.
• Co – working will help sharing the knowing and identifying resources.
• Actions for Health Workers (facilitator) for the involvement of community:
➢Providing adequate introduction and information to local leaders, main figures, active
persons and even gossipmongers, about the cause of need identification.
➢Asking in advance for the suggestion from the stakeholders.
➢Carry out some portions of activities adopted for determining health needs through survey,
interview, observation, etc.
➢Involving community while performing any activities in community diagnosis
➢Identify three kinds of needs: Observed need, Real need and Felt need.
• Health need assessment: prioritizing needs for health and then arranging
hierarchy. While prioritizing needs, resources and feasibility should be taken into
consideration. CHOD Draft Version 3 (Feedback Welcomed) 33

Participation in Planning health programme phase
(PHSD&PU….)
• Planning is a process of developing a detailed systematic and future – oriented
programme, which directs or sets the goals and takes action to reach the goal.
• Steps of community participation:
➢Collection of baseline data or information.
➢Identification of problems or needs and their prioritization
➢Setting the objectives of the programme
➢Deciding the target group of the program.
➢Finding the resources for the program
➢Selection of the methods and media for the program
➢Deciding the criteria for the evaluation of the program
➢Fixing the criteria for monitoring of the program
➢Developing of working schedule (Plan of Action) of the program
• SUCCEED: Set a brief clear task, Use hands on multi – sensory materials; Creating
informal and relaxed climate; Choose a growth producing activities; Evoke feelings
beliefs, needs, doubts, perceptions and aspirations; Encourage Creativity, analysis
planning and Decentralize decision making .

Technique for Planning
• To get everyone together
• Finding formal and informal leaders of the community
• Assist the leader to explain program to the community
• Invitee groups for planning:
➢Senior citizens, Young school children, Campus Youth
➢Traditional Healers (and Traditional Birth Attendants – TBAs)
➢Informal leaders, social workers, Mothers Club, leaders
➢Employees of government office, I/NGOS or project staffs.
➢Formal leaders of the municipality (Urban or Rural)
➢Members of Health facilities, School committees ….
➢…………………………………………..
• Determining priorities of need
• Asking the people for their problems
• Community sensitization and triggering

Participation in Health Program Implementation
phase (PHSD&PU…..)
1. Program starts implementing only after being approved by policy making
authorities.
2. It provides basis for increasing self – confidence and self reliance.
3. After community identifies needs, they get involved in seeking solution and get
involved in implementing phase, which will guide towards success.
4. Health worker should adopt some strategies for the implementation:
➢ Building a commitment
➢ Mobilizing and utilizing resources
➢ Training of HRs
➢ Organization of the community
➢ Monitoring the progress
➢ Supervising of health workers
➢ Keeping record and report

Contd ….
5. Building of commitment
6. Mobilizing and utilizing resources
7. Training of HRs
8. Organization of Community
9. Monitoring the process
10. Supervision of health work
11. Keeping record and report

Implementation committee formation process
• Advertisement of the purpose
• Collection of names of the interested group (and shortlisting)
• Inclusion of local leaders or govmt. and non govmt
representatives
• Formation of different sub – committees
• Describing the job, duty and responsibilities to be performed
by each member and group
Committee can be as advising committee, technical
committee and evaluation committee.

Participation of community in Health Program
Monitoring and Assessment phase
• Monitoring is a periodic, regular, ongoing more or less record of some
particular function.
• Monitoring is a process of collecting and analyzing the information from
program implemented
• Monitoring is done through observation, interview, record report
reviews, etc..
• Monitoring helps in finding progress of implementation and
achievements
• Monitoring is done frequently whereas evaluation is done once or twice
in a year.

Contd ….
• Assessment is a plan of care
that identifies the specific
needs of the client and how
those needs will be addressed
by the healthcare system.
• Ways/Methods of assessment:
Interview, Observation, Study
of official records, meeting and
discussion, …….
Evaluation
Organizing
and
implementing
a project
Monitoring
Planning of
Health Action
Assessment
and analysis
Cycle of Health Assessment of
Health Action

Contd ….
Importance:
• Increases the resource for health.
• Achieves culturally sensitive and acceptable services
• Extends the coverage beyond the formal health system
• Builds upon existing cultural structure
• Directs efforts to community health problem
• Breaks the viscous circle of dependency
• Empowers people

Enabling Process of CP
Factors influencing enabling process:
• Communication skills: interpersonal and group communication
• Process of conducting a successful meeting
• Process of decision making in a group situation
• Process of conducting a discussion in a meeting

Communication skills
• Communication is a process of transmitting information, ideas or views from one
person or group to another with some objectives.
• Elements of communication: Communicator or Sender or Source, Message,
Channel, Audience or receiver, Effect, Feedback
• Communication skills: Spoken words, Songs and written scripts, Symbols, Signals,
Feelings and facial expressions, gestures and body language, position, eye
contacts, …..
• Ways of interpersonal communication: Interview, Counselling, Questionnaires, ….
• Ways of Group Communication: Group Discussion, Demonstration, Role plying,
Mini Lecture, Problem solving, Seminar, Field trip, Workshop, Symposium, etc.
• Ways of communication: Verbal, Visual, Audio – visual, Formal – informal, one
way – two way, individual, group, mass.

Process of conducting successful meeting
Following things should be kept in
mind while conducting meeting:
• Prior information sharing and
agenda sharing;
• Objectives;
• Subject matters for discussion;
• Participants;
• Place, time and date;
• Information about the meeting;
• Problem solving.
Steps in finding the solution:
• Identifying the problem;
• analyzing and clarifying the problem;
• collection of data regarding the problem;
• utilizing data in solving the problem;
• viewing possible results of each problem;
• setting importance and evaluation of the
problem;
• choosing best solution to put in practice;
• defining the conclusion of the solution;
• Implementing, monitoring, evaluating and
feedback.

Process of decision making in group situation
There are three levels of decision making
• Individual Level (Micro level): Decision is taken in accordance with
ones own judgement; taking into account the personal gains and the
group acceptance.
• Group Level: Decisions are taken after collective discussion and
thinking. These decisions are necessarily of common interest to every
member.
• Mass Level (Macro level): Prominent and influential opinion leaders
usually take the decisions and it is not necessarily that such decisions
be fully accepted by everyone in the micro level.

Contd …. Factors helping in decision making
• Good leadership
• Maturity of the group
• Effective communication
• Absence of interference from any outside group
• Availability of resources

Contd …Process of decision making (7 steps)
47
CHOD Draft Version 3 (Feedback Welcomed)

Process of conducting discussion in a meeting
• Process of discussion depends upon the type of leadership practicing.
i.e. Autocratic, Democratic and Laissez – faire
Autocratic Democratic Laissez - Faire

Contd ….
Process of conducting successful discussion in meeting:
• Define the topic of meeting and make sure, it is understood by all members.
• Define the objective of the meeting
• Formal introduction and task distribution and play role accordingly
• Equal participation by all members
• Everybody should see, listen and understand other participant
• Express views towards topics in all possible aspects
• Discussion should be taken on the basis of all group members agreements and
sufficient rationale to discussion
• All should be committed to their role performance after discussion and decision
• In meetings, written documents should be kept about, what is discussed, who
the participants are and what is its outcome.

Process of CB resource identification
• Assessment of resources: all resources should be identified before
selecting the feasible resources that we require.
• Resources for the health services: 6Ms, Management, Time/Phase
Sources of the local resources: Government Organizations or programs,
NGOs, Individual or private resources
• Internal resource mobilization and participation in community
resource identification phase: Need identification, Planning, maximum
peoples participation, Identifying and mobilizing appropriate resources
• Ways to identify resources: Rapport building, discussion in the meeting,
co-ordination and communication, making awareness on the program,
making understanding, sharing good behavior,…

Barriers of community participation
• Lack of information
• Insecurity
• Injustice and inequalities
• Lack of transparency
• Geographical constrains
• Other social and psychological factors

Barriers …. Lack of information
• Hiding information: ………
• Falsifying information: ………
• Manipulation: …………
• Facilitator not updated with knowledge and skill: ………
• Over – loading with information: …………..
• ………..

Barriers ………. Insecurity
• Hiding or displaying real identity of people for the shake of dignity:
…….
• Transparency, impartiality and accountability: …………….
• Taking consent: …………
• Physical and mental violence: ……….
• Many times truth might be unspoken, …. or keeping quite creates
difficult situation: …………………….
• ………..

Barriers …………. Injustice and inequalities

Barriers ….lack of transparency
• Hiding the budget: …………
• Utilizing facilities: ………..
• Misinterpreting Terms of References, Memorandum of Understandings:
………., …..
• Hiding information: ……..
• Miss – utilization of materials: ………….
• ……

Barriers …. Geographical constrains
• Inaccessible : ……..
• Distance and difficulty: ………..
• Even if facility is near, some feel difficult going for participating: ………
• Seasonal or disasters: ………….

Barriers …. Other social and psychological factors
• Cultural and language barriers: ………
• Resource barrier: …….
• Religious barriers: ……..
• Beliefs and taboos: …………..
• Myths and guiding principles: ………….
• Psychological barrier: Way of individual thinking, fear: ………
• Financial Barrier: ……………

Assessing and Prioritization
• Assessment is a plan of care that identifies the specific needs of
the client and how those needs will be addressed by the
healthcare system.
➢Ways/Methods of assessment: Interview, Observation, Study of official
records, meeting and discussion, …….
• Need identification: Felt need, Observed need and Real need: …
• Prioritizing real needs on specific criteria. (using standard scales
or checklists), availability of resources and feasibility of
completion: ….

Prioritization Techniques
• Ranking: using ordinal scale with numerical value based on its importance.
• Numerical Assignment: Grouping requirements into different priority group with each
group representing some stakeholder. Stakeholders must develop common understanding
for this by rating scale for each requirements. Than, numerical average is taken for each
and prioritized accordingly.
• MoSCoW:
• Mo – (Must Have) a new bike for traveling, an extra seat.
• S – (Should Have) a low seat, a four-cylinder engine. Unlimited mobility.
• Co – (Could have) a red color body, extra wind protection.
• W – (Wont have) Bluetooth and a helmet with a double ventilation system.
• Bubble Sort Technique: two requirements are compared with each other and swapped.
• Hundred Dollar method: multiple stakeholders democratically vote for the requirement.
Stakeholders get conceptual 100 $ which they distribute among the requirements by
un/dividing $ in to fragments as a sample.
• Analysis Hierarchy Process (AHP): was designed by Thomas L. Saaty. Stakeholder
decompose their goal into smaller sub – problems, which can easily be comprehended
and analyzed in the form of hierarchy. Judgements are made about the relative
importance of each element.

Contd…
• Five Whys: With five whys, the analysist asks the stakeholders repeatedly
(five times or less) why the requirement is necessary until the importance of
the requirement is established.
• Business Value Based: On the basis of importance of probability of financial
profit making.
• Technology Risk Based: On the basis of risk associated in implementing the
plan.
• Kano Model: Requirement prioritized on the basis of customers preference
(e.g.. Attractive, one – dimensional, Must – be, Indifferent, Reverse)
• Walking Skeleton Model: Requirement selected minimal carefully so that
end to end features are build within a short span of time.
• Validated Learning: Selected on the basis of highest market risk.
• ………………………………………………….CHOD Draft Version 3 (Feedback Welcomed) 60

Kano Model
Kano Model: Requirement
prioritized on the basis of
customers preference (e.g..
Attractive, one – dimensional,
Must – be, Indifferent, Reverse)

Involving in Planning, Implementing and Evaluating
Strategies
for involving
community
in planning
process:
EBPH
Framework

Strategies for involving community Implementation:
• Building commitment: …….
• Training of HRs: ………
• Mobilizing and utilizing resources: ……….
• Organizing of the community: ……..
• Monitoring the program:
• Planning and scheduling
• Determining what and how to monitor
• Conduct monitoring, and
• Submit report with suggestions and recommendations
• Supervising the health workers: …….
• Keeping records and reports: …………

Strategies for involving community evaluation:
• Stakeholders participation
• Internal, External and Social Audit on financial
transactions.
• Data Audit.
• Management of time
• Management of cross – cutting issues
• Considering activities, results, short term and long term
outcomes
• ……………..
CHOD Draft Version 3 (Feedback Welcomed)
64

References
• http://www.strengtheningnonprofits.org/resources/e-
learning/online/communityassessment/Print.aspx

4. com h org and dev unit 4

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