The document is a report produced by the Institute for Community Empowerment in Thailand and the Chiang Mai Health Promotion Network documenting their experiences with participatory action research and asset-based community development approaches. It describes how they worked with 11 community-based organizations to build capacity and empower community members to engage in decentralized healthcare. It also details how the communities developed a method to identify and evaluate social changes resulting from these asset-based approaches by asking how the projects have impacted community empowerment and self-determination. The report findings indicate that the asset-based work expanded beyond strengths and resources to also incorporate important cultural traditions like music, dance, and healing methods as a shared way of thinking.

1. A Vaccine for Globalization:
Through People-Led Health Promotion and Community Development
2004
Produced by:
Uthaiwan Kanchanakamol, Director of The Institute for Community Empowerment, Thailand
and
The Chiang Mai Health Promotion Network
• Ban Mae Faek Mai
• Ban Mae Huk
• Ban Mae Jong
• Ban Nong Wai (Muay Thai)
• Ban Saluang
• Ban San Pa Bao
• Ban Sri Boon Ruang
• Karen Hilltribes in Ban Mae Jaem
• Karen Hilltribes in Ban Mae Pakee
• Lahu Hilltribes in Pha Hom Pok Mountain
•
Society of Lanna Healers
Research and Editorial Assistance provided by:
Jennifer A. Meyer and Timothy A. Struna

2. A Vaccine for Globalization
A Vaccine for Globalization:
Through People-Led Health Promotion and Community Development
ICE and the CBO’s hope that by documenting and sharing their experiences future public
health and community development initiatives can build on their achievements and learn
from their struggles.
2004
Produced by:
Uthaiwan Kanchanakamol, Director of the Institute for Community Empowerment, Thailand
And
The Chiang Mai Health Promotion Network
• Ban Mae Faek Mai
• Ban Mae Hak
• Ban Mae Jong
• Ban Nong Wai (Muay Thai)
• Ban Saloang
• Ban San Pa Bao
• Ban Sri Boon Ruang
• Karen Hilltribes in Ban Mae Jaem
• Karen Hilltribes in Ban Mae Pakee
• Lahu Hilltribes in Pha Hom Pok Mountain
• Society of Lanna Healers
Research and Editorial Assistance provided by:
Jennifer A. Meyer and Timothy A. Struna
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3. A Vaccine for Globalization
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4. A Vaccine for Globalization
Preface and Acknowledgments
S
ince June 2001, the Chiang Mai area, Thailand, had been selected for a pilot
project in which health-care was decentralized to local governments and
community groups. Local area health-care was planned and programs implemented under
the authority of provincial health boards consisting of representatives from local
government, the communities themselves and the Ministry of Health. There was an
urgent need to prepare the communities and their representatives to effectively participate
in that new system. The participatory research project had been initiated in the year 2001,
entitled” Challenges of health in a borderless world” under the support of Fulbright New
Century Scholar program throughout the 2001-2002 grant years.
Within the broad range of research project, the critical aspect had been focused on
increasing community capacity and empowering community members to improve the
health and well-being of Chiang Mai hill tribes and low-income groups in three Thai
districts. The proposed research was participatory action in nature, aiming: to determine
how to improve implementation and effectiveness in promoting the integral development
of youth, seniors and women in Hill tribes and low income communities while increasing
community cohesion and collaboration through cultural, political, social and artistic
activities; to determine how to improve implementation and effectiveness in promoting
development of skills among sub-district administration / organization and municipality
personnel in the area of community development; to determine how to improve
implementation and effectiveness in promoting creation of community partnerships by
local actors for health promotion. This involves providing incentives, skills and strategies
to community members to enable their effective participation in designing and
implementing new autonomous health care and social service systems that meet local
needs. This was especially crucial for disadvantaged groups like the Chiang Mai HillTribes and other low-income communities.
Specifically, it was proposed that proven, effective participatory action techniques
are utilized to educate, empowers, and involves members of these communities. These
include training in the use of focus groups, Delphi methods, consensus development
through negotiation/compromise techniques, participatory planning, needs assessment
methods (with emphasis on "asset-based" methods developed by McKnight and
Kretzman) and basic program participatory evaluation techniques. In addition,
community organizations such as community hospitals, NGOs, local governmental
groups were enlisted as collaborators in this learning process. Their involvement had the
additional advantages of identifying issues early-on for discussion and resolution,
enabling coalition-building and increasing trust between the three partner groups.
In the year 2002-2003, the Thai Health Promotion Foundation provided funding for
the strengthening Chiang Mai community health promotion network and monitoring and
support for its project. The aim was to buildup a network of partners within an
atmosphere of working cooperation characterized by solidarity. It was believed that this
is partially attributable to the culture and traditions of Thai society, which are favorable
toward working to build up health, together with the fact that the state is interested in
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5. A Vaccine for Globalization
health.
Our participation in this study has led to an increased awareness of the dark side
of globalization and the need to prepare the community people for building a community
and social vaccine for combating those negative consequences. We believe that the social
vaccine concept will help bring a multiplicity of perspectives and approaches to global
health challenges and might be helpful to the south in setting priorities for defining the
global health agenda in the future.
Many people helped and encouraged us as we worked on this project. First we
would like to thank all the community leaders, the brave and strong marginalized people
who led health promotion and community development path by using asset-based,
internally focused, relationship driven, including Mr. Intorn Kao-prated, Mr.Tanagorn
Phomnuchanon,Mr.Preeda Thakrow, Ms.Phongpan Sakwongdaroon, Mr.Arnan Leraman,
Mr.Adul Srisawat, Mr.Aphichart Chawwiang, Ms.Kommoon Intasit, Mr. Pa-ae Jalawpa,
Mr. Pherapong Pattanaplaiwan, Ms.Prapai Armornsak, Mr. Phrommin Boacheanbaan,
Ms.Sawart Jantalae, Mr. Sonthichai Somkate, Mr.Wasan Wiwatcharearn, Ms.Fongjan
Wan-on, Ms.Narisa Pongsopa, Mr.Boonchoo Chantarabutr, Mr.Comchan Wichairat,
Ms.Boonsri Chom-ngern, Mr.Boonmee Sangnoon, Mr. Decha Chotsooksiangwiwek,
Ms.Boosaya Kunagornswat.Pra Pongtep Techakarugo
We would like to provide special recognition to all the state and local public
health leaders who have assisted us, including Dr. Amorn Nonthasute, ex-General
Director, Thai Ministry of Health, Mr. Teerapan Techa, Ms. Nit Kao Sa-ad, Mr.Terdsak
Seur-im.
Within the academic community, we have many outstanding colleagues who have
contributed to our work in a variety of ways. They include the 30 Fulbright New Century
Scholars from all over the world especially Dr.Ilona Kickbusch from Yale University, the
distinguished scholar leader, Assistant Professor Dr. Sasitorn Chaiprasit, Associate
professor Dr.Songwut Toungratanapan, Assistant professor Vichai Wiwatkunuprakarn,
from Chiang Mai University, Professor Dr.J.M.Navia and Professor Dr.David Coombs
from University of Alabama at Birmingham.
Finally, we would like to express our sincere gratitude to the Council for
International Exchange of Scholars (CIES), The Fulbright New Century Scholar Program
(NCS), Thai Health Promotion Foundation and colleagues, especially, Ms. Sirinapa
Sathapornwachana whose tireless patient contributed this project, Mr.Chaiwa
Sitkongtang, Ms. Jennifer A. Meyer and Mr. Timothy A. S. Struna who provided the
fruitful research and editorial assistance.
Uthaiwan Kanchanakamol DDS, CDPH, MPH
Fulbright New Century Scholar 2001-02
Director, Institute of Community Empowerment (ICE), Chiang Mai, Thailand
Chiang Mai Health Promotion Coordinator 2002-03, Thai Health Promotion Foundation
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6. A Vaccine for Globalization
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7. A Vaccine for Globalization
Abstract
In October 2001, the Institute for Community Empowerment (ICE) launched a
Participatory Action Research (PAR) project. ICE used participatory techniques and
Assets-Based Community Development (ABCD) strategies, for increasing community
capacity and empowering community members to actively engage in a newly formed
decentralized health care system. ABCD has been recognized by health and community
development professionals as a valuable alternative to the traditional needsbased/deficiency-focused approach for health programming and community
development. However, community members’ perspectives on ABCD are under
investigated, and methods for evaluating the impacts of ABCD are only beginning to be
addressed and analyzed.
The purpose of this case study was two fold; first to build a more holistic understanding
of ABCD programming by exploring community representatives’ perspectives on their
own ABCD programs.
And second to describe how 11 Community Based
Organization’s (CBO’s) developed a method to identify and evaluate social changes
within their communities by asking the question; “if the ABCD approach claims to lead
to community empowerment and self-determination, as written in the ICE program
‘Increasing Community Capacity for Health Promotion and Well Being Project’ how can
the participating CBO’s measure these potential changes in their communities?”
Information for this case study was gathered over a four month period, December 2003
through March 2004, under the direction of ICE. The methods used to gather information
were primarily qualitative including; document review, direct observation and participant
observation. Community representatives described their experiences through a series of
site visits, natural focus group discussions and semi-structured interviews.
The results from this qualitative investigation indicate that the CBO’s in this case study
expanded the standard process of building on ‘strengths’ (local assets, skills, local
resources etc.), to also include cultural traditions (local music, dance and traditional
healing methods). These cultural traditions go beyond traditional dance, health methods,
and music to encompass a shared ‘way of thinking,’ living and viewing the world. It is
here in the conservation of indigenous ways of thinking or being that we see the link to
both health (physical, mental) and the environment (physical or social community
development).
Community members mentioned frequently one of their frustrations with health and
community development programs in the past was they were limited to a specific age
group, disease group, or gender. By mobilizing communities around shared traditional
culture, in contrast to the standard approach of mobilizing around a specific problem or
disease, more community members from all age groups came together for health
promotion activities. Also, centering programs on their traditional/cultural ways of life
was consistent with how individual community members identified themselves, thus
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8. A Vaccine for Globalization
reinforcing their collective identity and self-esteem. Additionally, when CBO’s reached
out to local and external resources for partnership or support they did so with compelling
concepts in hand, thus leveling the playing field, or power structure.
To explore the second question, 11 CBO’s developed an evaluation method, based on the
concepts of participation and empowerment, to translate what they ‘see happening’ in
their community into ‘measurable variables and indicators’ of outcomes and impacts.
The evaluation method was developed during a series of workshops facilitated by the
director of ICE and attended by CBO representatives. Their 9-step method consisted of
identifying, clustering, categorizing, prioritizing, rating and reflecting on ‘changes’ that
had taken place within their community since they began their health promotion and
community development activities.
The evaluation was implemented in 11 different communities during a community
meeting facilitated by the director of ICE and 1-2 CBO representatives. The evaluation
provided quantitative information by using a number scale from 1 - 7 to rate each
identified change, and qualitative information by including community member
comments related to each rating.
The results of the 9 - step evaluation will be used by the CBO’s to supplement
quantitative reports submitted to funders to show evidence of the broad social changes
taking place in their communities. Secondly, the stories shared by community members
to define each significant change will be used to assist in the design and implementation
of future health promotion programs. Thirdly, the 9 - step method developed by the
CBO’s during workshops will be incorporated into a facilitator guide produced by ICE to
assist in conducting future workshops and evaluations.
This case study concludes there is evidence from the perspective of community
representatives that supports the utility of an ABCD strategy for community development
and health promotion. This observation also reflected the main themes revealed through
qualitative data analysis (community pride, traditional culture, freedom, community
dialogue, and community power). In addition, the self-identification and definition of
community changes; unity, local wisdom, warmth, etc., elicited through the facilitation of
community dialogue during each evaluation, reinforces the theory and adds to the
conclusion that when community members develop and evaluate their own health
promotion initiatives there is a stronger chance for sustainable community growth,
motivation for future health promotion efforts, and the creation of self-sustaining capacity
building initiatives. The director of ICE, Dr. Uthaiwan Kanchanakamol commented on
these phenomena and explained that by practicing health promotion and community
development through the conservation of indigenous knowledge and traditions the CBO’s
are effectively creating a ‘vaccine against the ill-effects of globalization.’
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9. A Vaccine for Globalization
TABLE OF CONTENTS
Preface and Acknowledgments
Abstract
Table of Contents
List of Figures
List of Tables
Glossary
2
5
8
9
10
11
Chapter I: Introduction
Thailand
Chiang Mai
ICE, Thai Health, and the Network
Purpose of Study
12
13
14
14
19
Chapter II: Literature Review
Community
Participation
Empowerment
ABCD
Appreciative Inquiry
Educational Pedagogy
Participatory Evaluation
Empowerment Evaluation
21
22
22
23
24
26
27
27
29
Chapter III: Community Perspectives
32
Chapter IV: Evaluating Social Change
55
Chapter V: Limitations
Chapter VI: Conclusions and Recommendations
89
92
References
Additional Resources
Appendix A: ICE Proposal
Appendix B: Overview of Project Operations
Appendix C: Example of Semi-Structured Interview
Appendix D: ICE User-guide
Appendix E: CBO Quantitative Evaluation Results
Appendix F: Time-Line
96
100
108
116
123
125
146
156
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LIST OF FIGURES
Figure Number
Page
1. Mae Chaem Rehabilitation and Development of Herbal Medicine Group
Variables of Community Change – Star Plot
73
2. Mae Chaem Rehabilitation and Development of Herbal Medicine Group
Indicators of Coordination – Star Plot
76
3. Frequency Graph
Summary of all identified ‘variables’
85
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LIST OF TABLES
Table Number
Page
1. Results of Step 1 – Step 5
65
2. Results of Step 6
69
3. Results of Step 7
70
4. Results of Step 8: Variables of Community Change and Central Tendencies
73
5. Cooperation Breakdown
74
6. Indicators of Cooperation
75
7. Mae Chaem Rehabilitation and Development of Herbal Medicine Group
Indicators of Coordination – Central Tendencies
76
8. Pile Sort 1
Summary of all identified ‘variables’
78
9. Pile Sort 2
Summary of all identified ‘variables’
79
10. Table of ‘Sorted Variables’
81
11. Types of Community Development Approaches
102
12. Qualitative Inquiry Activities
103
13. Themes and Illustrations
104
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GLOSSARY
ABCD:
AI:
CBO:
DDP:
GO:
ICE:
NFG:
NGO:
PAR:
PHC:
PRA:
SAO:
SBD:
ThaiHealth:
UNAIDS:
UNICEF:
WHO/SEARO:
Assets Based Community Development
Appreciative Inquiry
Community Based Organization
Department of Drug Prevention
Government Organization
Institute for Community Empowerment
Natural Focus Group
Non-Government Organization
Participatory Action Research
Primary Health Care
Participatory Rural Appraisal
Sub-District Administration Organization
Strength Based Development
The Thai Health Promotion Foundation
Joint United Nations Program on HIV/AIDS
United Nations Children’s Fund
World Health Organization South East Asian Regional Office
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Chapter I: Introduction
Thailand
The Thai government is a constitutional monarchy, and the country has
progressively moved towards democracy over the last thirty years. About 18% of the 62
million people in Thailand live in urban centers. Approximately 85% share a dialect of
Thai, in addition to 8% speaking Thai-Lao, found in the Northeast, and another 8%
speaking Northern Thai, commonly referred to as Lanna. Thai-Lao and Lanna share
some similarities linguistically, and in written form.
The predominant religion is
Theravada Buddhism, practiced by almost 95% of the population. The majority of
Muslim’s live in the southern region and make up the next largest religious group at 3%,
followed by Christians (1).
Health statistics include a 92+% literacy rate for both men and women, with free
compulsory education up to grade six.
Thailand is well recognized for a dramatic
reduction in their population growth from 3.1% in 1960 to about 1% today (1). At the
end of 2001, UNAIDS estimated that 1.8% of the adult population are living with
HIV/AIDS. This is one of the highest prevalence rates outside sub-Saharan Africa.
Thailand’s current health system offers universal health care through a recently
initiated policy known as the ‘30 baht program.’ Under this program, individuals can
receive any service at the local public hospital or health station for a 30 baht fee
(approximately 75 cents) (2). There is a specific list of drugs and services covered by
this program. Private medical care is also available in the provincial capitals. According
to Dr. Prawase Wasi (2000), a health care reform activist, Thailand has a sound health
care infrastructure. However, he calls for a change in the ‘ill-health orientation’ of the
disease control and prevention system to incorporate ‘good-health oriented’ systems of
health promotion as well as continued health care reforms based on improved national
health care research (3).
The government health care system is based on the Western bio-medical model.
Also officially recognized is the Aruvedic based Thai Medicine, ‘MorPatPhanThai,’ and
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Lanna or Northern Traditional Healing based on the holistic concept of “enhancing happy
living through the spirit, the body, the community and the environment” (4).
In the
North, traditional healers are referred to as ‘MorMuang,’ and practice at the community
level. Hill tribe groups also have local healers whose practices range from Shamanism to
herbalism and massage.
Chiang Mai
Chiang Mai, known commonly as “The Rose of the North,” is located 700 Km
north of Bangkok. Northern Thailand shares borders with Burma to the west and Laos to
the east. The city of Chiang Mai is over 700 years old and was ruled by the Burmese until
1775. The provincial population is estimated at 1.6 million people, of which 160,000 live
in the capital (1).
For over two hundred years, semi-nomadic ethnic minority groups referred to as
hilltribes have lived in the mountains of the northern region and along western borders.
Currently, their combined population includes approximately 550,000 people. The Tribal
Research Institute in Chiang Mai officially recognize 10 different hilltribes however,
there may be as many as 20 (1). In terms of linguistic groupings among hilltribes, the
most common are; Tibeto-Burman (Lisu, Lahu, Akha), Karenic (they refer to themselves
as ‘Ba-Kur-Yoa’, or Garieng) and the Austro-Thai-Chinese (Hmong, Mien). The Karen
are the largest group numbering around 322,000. In these high remote areas most people
practice subsistence farming, while a small percentage engage in ‘for profit’ agriculture
and recently, tourism. The predominant religions tend to be animist or ancestral worship,
unless influenced by missionaries or Buddhism (1).
ICE, ThaiHealth, and the Network
The Institute for Community Empowerment (ICE) is a Non-Government
Organization (NGO) directed by Dr. Uthaiwan Kanchanakamol.
The organization
promotes and practices health promotion through the concepts of Assets-Based
Community Development (ABCD). Their purpose is to facilitate the internal processes
of capacity building and empowerment among local communities through teaching the
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skills necessary to conceptualize, plan, implement, and evaluate health promotion and
community development programs. ICE works with 22 Community Based Organizations
(CBO’s) from three districts in the Chiang Mai province of Thailand. The 22 CBO’s are
located in city, suburban, and hill tribe areas all defined as low income or ‘marginalized’
communities.
In June of 2001, Chiang Mai and fifteen other provinces were selected as pilot
sites in which health care service decision making was decentralized to the local
provincial government and community groups. Decisions were to be implemented under
the authority of newly created boards consisting of members from local government,
representatives from CBO’s, and Ministry of Health officials. This national initiative
recognized the need for not only the participation of health service professionals and
local government officials, but the popular sector as well (see Appendix A).
In order to prepare local communities, especially members of marginalized
groups and women, with the skills necessary to act within this new system, ICE proposed
a Participatory Action Research (PAR) Program entitled “Increasing Community
Capacity and Empowering Community Members to Improve the Health and Well- Being
of Chiang Mai Hill Tribes and Low-income Groups in Three Thai Districts” (see
Appendix A). The ICE staff includes a director and two assistants. Most of their
operations, including a community radio station focused on health promotion and
community empowerment, are operated by volunteers. ICE’s founder and director was
influenced by years of professional academic public health experience, environmental
activism, as well as fieldwork among marginalized communities. The central themes of
ABCD, or Strength Based Development (SBD), are present in the operations at ICE,
while conceptual frameworks of the approach have been adjusted to fit the Northern Thai
context.
Unfortunately, a number of factors combined to breakdown the proposed
Provincial board development. However, ICE continued its work building partnerships
with CBO groups and assisting them in applying for health promotion program funding.
ICE continues to concentrate its energies on working with 22 local CBO’s assisting them
in moving through a relationship driven dialogue oriented process, in order to propose,
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conduct and evaluate their own community based health promotion and development
projects. (see Appendix B)
ICE was recognized by the Thai Health Promotion Foundation as a center for
teaching community capacity building techniques, with a focus on health promotion and
community development. The Thai Health Promotion Foundation, or ThaiHealth, was
established in 2001 as a state agency. This agency was created as part of the national
health care decentralization initiative to manage and distribute ‘sin tax’ money collected
from the two percent taxation of cigarettes and alcohol. ThaiHealth was set up to
encourage, support and fund health promotion activities for public health within the
concept: “All Thai People will have a better life and can earn their living with wellbeing. This development will proceed through by the collaboration of all key factors and
a unified intension. Through this concept Thai people can live well and be happy by
relying on themselves.” (5). Operating dimensions emphasize healthy public policies,
issue-based programs, and holistic ‘setting’ approaches. According to the ThaiHealth
website, “Most of Thai people’s health problems and deaths result from their personal
misbehavior, misbeliefs and other preventable causes such as smoking, drinking alcohol
or traffic accidents.” They continue, “The World Health Organization (WHO) has
defined the aim of public health not only to eliminate diseases from human life, but also
to build up well–being for balancing the physical, spiritual and social health. Moreover,
the WHO has declared health promotion strategies through the Ottawa Charter, and
Thailand has responded by pushing the substantial movements for well–being of Thai
people. Thai Health provides catalytic funding for projects that change public values,
people’s lifestyles, and social environments” (6).
The Ottawa Charter for Health
Promotion called for renewed commitment;
1. for the development of healthy public policy, and equity advocacy in all sectors.
2. to counteract the pressures towards harmful products, resource depletion,
unhealthy living conditions, and environments, and poor nutrition; and to focus
attention on public health issues such as pollution, occupational hazards, housing
and settlements.
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3. to respond to the health gap within and between societies, and to tackle the
inequities in health produced by the rules and practices of these societies.
4. to acknowledge people as the main health resource and find ways to support and
enable them to keep themselves, their families and friends healthy through
financial and other means, and to accept the community as the essential voice in
matters of its health, living conditions and well-being.
5. to reorient health services and their resources towards the promotion of health;
and to share power with other sectors, other disciplines and most importantly with
people themselves.
6. to recognize health and its maintenance as a major social investment and
challenge.
(Ottawa Charter link can be found at the ThaiHealth website)
The founding board of ThaiHealth was very progressive and interested in funding
local groups directly, bypassing the non-government organizations.
Thus, it was
important that these CBO’s learn to speak the language of the funder (and vice versa),
striving to bridge this standard communication disconnect. ICE receives only travel
reimbursement monies for their work from ThaiHealth, and all program operation
finances are transferred and managed directly by CBO’s. This decentralized approach
intended to give community groups the control to develop their own health promotion
programs, and to seek out the assistance of NGO’s or Government Organizations (GO’s)
to partner with, if appropriate. Prior to this paradigm shift, communities were dependent
on these NGO’s and GO’s to meet the needs of their community.
Recognizing the fundamental changes of this approach, ThaiHealth supported ICE
and its program, ‘Increasing Community Capacity for Health Promotion and Well Being
Program’. The goal of ICE’s project was to strengthen and empower communities to
meet this new challenge. ICE invited CBO members, considered to be ‘natural leaders’
of their respective communities, to attend workshops on how to conceptualize, plan and
implement local health promotion programs.
There was no financial incentive for
attending the workshops; the only incentive was knowledge. The community analysis
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and program planning phases occurred over approximately nine months before the
CBO’s submitted proposals for funding and began implementation.
Each CBO is represented by a “natural leader,” sometimes more than one person,
and referred to throughout this document as a community representative(s).
These
leaders/representatives are not individuals who hold an official position in the community
necessarily, but they are the community members that seem to ‘get things done’. The
criteria ICE was seeking in a natural leader was someone who could;
•
Facilitate group discussions
•
Be a strong link between the community and resources
•
Stimulate participation
•
Catalyze and facilitate discussion
•
Be at ease during trainings
•
Comfortable working at the community level and
•
Effective in mediating conflict
(Personal communication with ICE director)
Beginning in late 2001, CBO representatives met for monthly workshops at ICE
to learn assets building processes and participatory action techniques. Some traveled up
to six hours one way to attend these sessions. During the first three months they learned
how to conduct assets mapping in their own communities. During the second three
month period they participated in future search conferences with local authorities from
their own communities in order to build participatory planning strategies.
CBO
representatives learned about health promotion paradigms, advocacy, mediation
strategies, team building techniques, social action strategies, and communication for
social change.
After workshops, these community representatives returned to their
community to facilitate a process with other community members in conceptualizing and
developing their own priorities, plans, methods, and budgets. During the second year
various health projects were implemented. Examples of some health initiatives include;
•
Traditional exercise groups
•
Family strengthening programs
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20. A Vaccine for Globalization
•
Cultural conservation programs
•
AIDS/drug prevention programs and
•
Herbal medicine conservation, teaching, and promotion projects
During their second year, the CBO representatives and their partners formed the
Health Promotion Network of Chiang Mai, and entered their second round of program
proposals. The original participants of the workshops conducted in year one continue to
meet once a month to offer support, share their experiences and learn from each other.
Purpose of Study
The aim of this report is to present examples of people-led heath promotion and
local community development programs, in a specific cultural context, using specific
strategies. Understanding the ABCD process, from the point of view of the community,
can provide insights into how applications in other settings might be coordinated,
supported, and directed toward improving the health of entire communities.
By
describing one groups’ effort, the authors hope to shed light on how an ABCD approach
to health promotion programming is perceived by community representatives living,
learning and practicing the process in their own communities.
It is our perspective that the opinions of community representatives practicing
ABCD based programming are unheard.
By framing the problem as an under
investigated area, the results can act holistically by adding diversity to the dominance of
professional opinions about ABCD as an approach. The public health professional or
community development worker can benefit from the information presented by learning
more about how to support community based programs, and limit the difficulties
encountered for communities practicing ABCD. The other beneficiaries of this work
include ICE and the CBO’s, as the results obtained can assist in organizational and
program development, as well as lessons learned.
Despite the growing interest in evaluation, and the growing numbers of evaluation
studies, there is still a lack of firm and reliable evidence on the impacts of NGO
development projects and programs (7). The majority of evaluations focus on outputs
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achieved and not outcomes or broad scale impacts (7). Social, ecological, and cultural
dimensions of reality have been overlooked or undervalued systematically by
development professionals (8). Ideally, an evaluation includes an examination of the
micro and macro-conditions of social, economic, and political environments in order to
understand the constraints to development and identify possible actions to remove or
lessen these constraints (9).
The need to develop an evaluation method to explore these dimensions requires
an approach that respects the extreme cultural diversity of ideas and practices to be found
around the world. The challenge comes from acknowledging that culture will influence
ones view of the world; based on the metaphor that ‘culture is a pair of glasses through
which we see the world in a particular way – where the glasses are constructed of ones
ideas, values, rules, customs, knowledge, beliefs and laws’ – thus one must critically
question the utility of universal standards of acceptability, prefabricated variables and
indicators of outcomes and impacts.
Any development activity that seeks to improve the quality of life of marginalized
people is rooted in the process of moving from a state of dis-empowered to empowered.
In terms of evaluating this ‘empowering process’ many have concluded that based on its
context specificity there is no universal model in which to measure this process (10).
ICE and 22 CBO’s located in Chiang Mai Thailand accepted the challenge of
developing a method to evaluate the potential outcomes and impacts of their ABCD
health promotion programs. This case study describes the efforts of ICE and the CBO’s
in developing, implementing and reflecting on their evaluation method and results.
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Chapter II: Literature Review
There is an enormous amount of information available pertaining to development,
community health, empowerment, participation, and evaluation. For the purpose of this
study, and in order to understand the approach taken by these CBO’s - key terms are
defined and a short history of their use in the field of public/international health provided.
Community
The WHO defines community as: ‘a specific group of people, often living in a
defined geographical area, who share a common culture, values and norms, and are
arranged in a social structure according to relationships which the community has
developed over a period of time. Members of a community gain their personal and social
identity by sharing common beliefs, values and norms, which have been developed by the
community in the past and may be modified in the future. Community members exhibit
some awareness of their identity as a group, and share common needs and a commitment
to meeting them’ (11).
Participation
In regards to health, participation can be defined as a right and duty of people to
be involved in decisions about activities that affect their daily lives (12). The WHO and
the United Nations Children’s Fund (UNICEF) claim that participation enables even the
very poorest sections of the community to take part in improving the health services
available to them, and thereby create a precedent for their participation in wider
community activities (12). The WHO mentions that the level of community involvement
is an important indicator in attaining Health For All (13).
The WHO declared community participation as a people’s right and duty in 1978
with the Alma Ata conference and the introduction of Primary Health Care (PHC) (12).
Although the concept of community participation is universally accepted there appears to
be a wide variety of interpretations in terms of its definition, practice, and evaluation
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24. A Vaccine for Globalization
(14). It seems the more one studies the concept of participation the more elusive it
becomes (15). However, community participation might best be defined as a multidimensional concept that takes on different meanings and significance in different
settings and circumstances (16).
Experience has shown that community participation in all phases of a project or
program – including evaluation – improves the quality, effectiveness, and is extremely
important for long-term sustainability of the particular development initiative (17, 18).
Empowerment
Empowerment can be broken down into processes and outcomes. Empowerment
is an enabling process through which individuals and or communities take control over
their lives and their environment in hopes of solving their own problems (19, 20). The
essences of development are dependent on these empowering processes (20).
The
outcome of this process is empowered individuals and groups who live in an environment
that enables them to influence the path of their lives (19). Creating this environment that
frees individuals to learn, participate in, critically reflect on, and take action in
community health and development initiatives has been an elusive priority in public
health for decades (19).
The elusiveness of empowerment results from the countless factors of influence
and their presence in several areas of development; including education, health, law,
science, government and economics (19).
Additionally, ‘empowerment’ can mean
different things, at different times, to different people. It can occur at the individual,
community, and societal level. There are no fixed and final definitions of empowerment,
merely suggestions based on individual behaviors, community conditions and norms,
environmental changes, and long-term changes in population health (20).
Most
importantly, problem-solving education, called conscientisation or self-reflected critical
awareness of ones social reality and ones ability to transform this reality by collective
action – must occur from within a person – it cannot be imposed from the outside (9).
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Development Approaches and ABCD
The type of program approach in public health, community and international
development have been passionately debated for decades. Methods for achieving various
visions of a better future range from those bound by romantic idealism, to those
pragmatically focused on hard economic realism. The past several decades of traditional
top-down and trickle down development programs, have yielded dismal results (21, 22,
23). “Barring some exceptions, most development initiatives, have often increased the
vulnerability of the most vulnerable: The poor, the illiterate, the women, the children, and
the marginalized. Strident questions have been raised about development for whom, with
what purpose, through what means, and for what ends?” (24)
The dominant bio-medical approach has become systematized into local, national
and international development and public health initiatives. Often this approach refers to
the view that a community, or ‘target population,’ is lacking something, most of the time
it is ‘knowledge’ or ‘resources.’ Generally, this ‘deficiency’ orientation provides an easy
opportunity for ‘experts’ or professionals to confirm their authority, without much regard
for the practical experiences of that target group, and ignores the underlying socioeconomic and political causes of ill health (26). An alternative to this needs based
approach is the strength or assets based community development approach, which starts
with what is ‘present’ in a community (not absent), more specifically with the capacities
of its residents and builds on the natural associational base in a community (27).
An ABCD approach stands in contrast to the ‘deficiency-oriented’ approach based
on surveying ‘needs’ and ‘problems’ of communities, which often results in the building
of patron-client communities (27). “Public, private and nonprofit human service systems
often supported by university research and foundation funding, translate the programs
into local activities that teach people the nature and extent of their problems, and the
value of services as the answer to their problems” (27). In some extremes, the members
of patron-client communities begin to identify themselves as fundamentally deficient,
with needs that can only be met by outsiders.
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26. A Vaccine for Globalization
Other authors have echoed similar concerns in the field of International
Development.
For example, Burkey (1993) writes, “all too many development
professionals unconsciously believe that rural development will be achieved through the
efforts of government and development agencies. They do not reflect on the possibility
that sustainable rural development will only be achieved through the efforts of rural
people themselves working for the benefit of themselves, their families, and hopefully
their communities. Government and agencies can assist this process, but they cannot do
it themselves. Unfortunately, after decades of this type of paternalism (top-down) all too
many rural people have also come to believe - they have been told so many times - that
this government or that agency is going to ‘develop’ them.
The result is apathy
interspersed with small peaks of expectation as one or another new development program
comes their way. Rather than promoting development such programs have ended up
developing dependency thinking.”
Kretzmann and McKnight (1993) point out that if the problem focused approach
is the only one available to communities, there is a clear risk for the unintended side
effect of further breaking down community capacities such as, problem solving skills and
self sufficiency. Communities depend on associations with ‘experts’ instead of building
relationships locally.
This process can devalue, deconstruct and delegitimize local
wisdom, culture, and identity, by placing control outside of the community. Kretzmann
and McKnight (1993) are careful not to advocate complete rejection of the outside
resources, only a balancing of the equation by strengthening local resources and
associations.
Advocates for ABCD have increased over the last decade largely because
development workers are thirsty for an alternative to the needs-based approach (28). Part
of the attraction to ABCD is the central focus that the community can drive their own
self-reliant development by discovering and utilizing residents’ assets and resources (28).
ABCD is a response to the observation that communities are becoming passive
consumers of services instead of active problem solving citizens (27).
Mathie and
Cunningham (2002) note that perversely these institutions (GO, NGO, donors and
academic researchers) have developed a systematized interest in maintaining this patron-
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27. A Vaccine for Globalization
client approach. ABCD is an effort to take back and build upon a community’s wisdom
and problem solving capabilities. According to Mathie and Cunningham (2002) ABCD
relies on in five critical elements;
1. Use methods to draw out strengths and successes in a community’s shared history
as its starting point for change (as in Appreciative Inquiry).
2. Pay particular attention to the assets inherent in social relationships, as evident in
formal and informal associations and networks.
3. Active participation and empowerment (and the prevention of disempowerment)
are the basis of practice.
4. A strategy directed towards sustainable economic development that is
community-driven.
5. Rely on linkages between community level actors and macro-level actors in
public and private sectors. Foster active citizenship to ensure access to public
goods and services, and to ensure the accountability of local government. It
therefore contributes to, and benefits from, strengthened civil society.
Appreciative Inquiry
Appreciative Inquiry (AI) is important to define because it is part of the first step
in the ABCD approach. Its’ main purpose, according to author Charles Elliot, is to find
the necessary energy for change and its two main tools are memory and imagination (28).
“According to Elliot, AI assumes that reality is socially constructed, and that language is
a vehicle for reinforcing shared meaning attributed to that reality. Communities that have
been defined by their problems (malnutrition, poverty, lack of education, corruption)
internalize this negativity.
What the appreciative approach seeks to achieve is the
transformation of a culture from one that sees itself in largely negative terms – and
therefore is inclined to become locked in its own negative construction of itself – to one
that sees itself as having within it the capacity to enrich and enhance the quality of life of
all its stakeholders – and therefore move towards this appreciative construction of itself”
(28).
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28. A Vaccine for Globalization
AI draws on theories of empowerment, knowledge construction, and educational
psychology regarding sources of individual and collective motivation (28). The essence
of popular education practice rests on the concepts of learning from experience and
dialogue (29). Freire (1970) argues that people have developed their own way of seeing
and understanding the world according to cultural patterns marked by the dominant
ideology. Through the process of coming together and reflecting on their lives, people
can learn about their larger socio-political, cultural and economic environments. This
combination of learning as experience and dialogue results in the development of critical
consciousness, which means a more in depth and reflective comprehension on the broad
social, cultural, political and economic conditions in which people live. It is this raised
level of consciousness that leads to group self confidence, and eventually collective
action (29).
Educational Pedagogy and Participatory Development
Similar to Freires’ educational pedagogy and liberation through critical
consciousness, participatory development also places people at the center of the process.
Participatory development is based on the premise that the people in marginalized
communities are not the target of development projects, but rather they are the ones who
determine, drive, and control the entire development process (30).
Participatory
development starts from the assumption that marginalized and low-income people better
understand the problems they face, and how to fix them (29). For an overview of the
definitions, strengths and weaknesses of four types of community development
see Table 11.
Participatory Evaluation
There is an increased emphasis and a growing recognition that the evaluation of
community-based initiatives should incorporate the participation of beneficiaries (10). In
projects where participants took the lead in all aspects of program design and
implementation, conventional evaluations were protested because the evaluations done by
outsiders failed to capture the specific meaning that the project (processes and results)
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29. A Vaccine for Globalization
had for its participants (31). This dissatisfaction stimulated the movement toward a
different approach to evaluation and has been explored throughout the nineties.
Participatory evaluations are typically done by community members, project staff,
or facilitators. At its most fundamental level, it is investigative, educational and capacity
building (32). It is a transparent process of self-evaluation using simple methods adapted
to the local culture to empower local people to initiate control and take corrective action
based on findings (33). Participatory evaluation embraces the concept of giving people a
voice and placing them at the center of all stages of an evaluation process. By assessing
the intended or unintended impacts of ones’ own program there may be a greater
potential to provide a more accurate representation of the values and concerns of the
multiple groups involved in decision-making, to promote the empowerment of
marginalized groups previously left out of the process, and increase the utilization of the
evaluation results through a sense of ownership of the results (17, 32, 34, 35, 36).
There are five general interdependent and overlapping functions of participatory
evaluation; impact assessment, project management and planning, organizational
strengthening or institutional learning, understanding and negotiating stakeholder
perspectives, and public accountability (10). With regards to an impact assessment of a
program carried out under the full or joint control of local communities, the community
participates in the definition of impact indicators, selecting and building methods,
developing the questions, collecting data, analyzing data, communicating assessment
findings, and designing actions to improve the impact of future development
interventions (10).
The participatory evaluation process is in constant motion, taking paths that may
seem uncharted, and is as diverse as the number of contexts in which it is applied (32).
There are a variety of concepts, methods, and applications developed in hopes of
engaging stakeholders to participate in producing useful participatory evaluation results
(10).
The evaluation is built on the concerns, issues and problems that present
themselves through discussion, dialogue and interaction – which are considered the main
tools to active participation (9, 32). Participatory approaches require a commitment of
time and energy as conflicting perspectives can slow or stop the process. It also requires
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30. A Vaccine for Globalization
a high level of trust and some consider the results less objective than traditional
evaluation as there are many barriers that could prevent the effective development of the
process – political, academic, personal, environmental, financial, and cultural to name a
few (9, 17).
Differences in opinion and confusion can occur early and often in the
evaluation process because it involves collaboration and negotiation among individuals
who may have not worked closely in the past. The effort requires patience and flexibility
in order for collective evaluation questions to take form.
One of the primary goals of a participatory evaluation is to share control of the
evaluation process, by placing control (power) in the hands of the community while
removing it from the outside evaluator (32). The premise behind participatory processes
is the progressive shift of power, with a sequence from control to empowerment (37).
The professional must talk less, dominate less, and control less, to empower and trust
others (37). Facilitating others analysis means disempowering ourselves, leading by
withdrawing, waiting while others think before they talk and act (37).
Participatory evaluations challenge conventional evaluation practices which were
founded on the tradition of scientific investigation.
Conventional or ‘top-down’
approaches to evaluation can be broadly characterized as; focused on complex procedures
to measure cost and production outputs against predetermined indicators, oriented to the
needs of funders and policy makers to determine accountability and continued funding,
seeking information that is objective, value-free, and quantifiable, and usually contracted
and conducted by outside experts seeking to maintain a distance between evaluator and
participants (10).
Arguments against the conventional evaluation includes; they are
costly, fail to involve program beneficiaries, the outside evaluator is too far removed
from the ongoing planning and implementation of development initiatives, and the
emphasis on quantitative measures tend to overshadow the qualitative information which
tend to provide a deeper understanding of outcomes and processes (10).
Empowerment Evaluation
Community empowerment and participation are the twin pillars of health
promotion and defined as a process of enabling people to increase control over and to
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improve their health (19). Empowerment evaluation is the use of evaluation concepts and
techniques, highlighting the importance of context – social, political, and value systems –
and incorporates it into the evaluation process (38). Empowerment evaluation embraces
the concept of sustainable human development – the strengthening of individual identity
and capacities to learn, adapt, and innovate along with the acquisition and internalization
of knowledge and information – must be part of any development process (8, 9). The
process helps beneficiaries by self-consciously guiding a program, rather than solely
judging its accomplishments (10).
The theory behind an Empowerment Evaluation, as defined by Zimmerman,
focuses on processes and outcomes. As stated earlier, an empowerment process attempts
to gain control, obtain needed resources, and critically understand one’s social
environment (39). The process is empowering if it assists people in developing skills so
they can become independent problem solvers and decision makers. Empowerment
outcomes are consequences or effects of interventions designed to empower or gain
control (39).
Fettermen adds an additional theoretical foundation of empowerment evaluation;
one that is based on self-determination, defined as the ability to chart one’s own path in
life (39). The empowerment theory consists of many interconnected capabilities; the
ability to identify and express needs, to establish goals or expectations and a plan of
action to reach them; to identify resources; to make rational choices from various
alternative courses of action; to take appropriate steps to pursue objectives; to evaluate
short and long term results, including reassessing plans and expectations and taking
necessary detours; and to persist in the pursuit of goals (39). If anyone of these links
break down it can reduce the likelihood of being self-determined (39).
Empowerment evaluation has its roots in community psychology and influenced
by action research and action evaluation (38). The purpose is to produce context-specific
definitions of success to allow program or project participants to determine their own
standards (39). The empowerment evaluation embraces the concept that participants
evaluate their own action and behavior according to the standards and values of their
setting, rather than judging according to outside criteria articulated by experts from a
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32. A Vaccine for Globalization
distance (40). Defining success appears to be dependent on whom you ask. The question
of ‘who measures’ results and ‘who defines’ success is the critical issue addressed with
Empowerment Evaluation (10).
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34. A Vaccine for Globalization
CHAPTER III: COMMUNITY PERSPECTIVES ON ABCD
Information presented in this section is in raw data format, including participant
observation, community discussion and natural focus group results from four different
communities. Reflections from the qualitative researcher are also included. The purpose
is to give the reader a sense or glimpse inside how community representatives think about
their programs, the ABCD approach, and how it is similar or different to other
approaches they have experiences in the past.
Methods
Qualitative methods were appropriate for eliciting perspectives from CBO
representatives (informants), and community members.
Data collection methods
included; participant observations, natural focus groups, and semi-structured interviews.
Participant observation was selected as a data collection technique in order to
engage in CBO activities, become familiar (thus reducing reactivity) and understand
more about the socio-cultural context. This process continued on a daily basis throughout
the entire three month study period.
The purpose of natural focus groups (NFG’s) was to build on what was uncovered
during participant observation.
NFG’s occurred in community settings, and I was
frequently invited to CBO representatives’ homes. The ICE director was not present
during NFG’s, in hope of achieving a more natural setting for truthful responses. Usually
elders, youth, monks or others would join our discussions, and frequently offer
unsolicited commentary.
These community visits allowed insight into how CBO
representatives interacted with their fellow community members. Four visits are profiled
to demonstrate the diversity of local settings.
Based on results of the participant observations, NFG’s and community visits,
questions for the 12 semi-structured interviews were formed. All but one of the
interviews occurred at the Expo, which was a two day event coordinated by CBO
representatives in which CBO groups presented their work, shared and exchange ideas.
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35. A Vaccine for Globalization
Therefore, CBO’s that did not attend the event were not interviewed. Semi-structured
interview questions were written in English and Thai and pre-approved by the director
(see Appendix C). Prior to asking questions, I explained I was interested in learning
about their opinions regarding the process they used for building their community health
promotion programs.
Data Management, Quality and Analysis
Responses to interview questions and two NFG’s were tape recorded and
translated from Thai to English by the researcher. During the translation process unclear
or unfamiliar words were reviewed with a native speaker, and final English transcription
was reviewed by the director of ICE for clarifications. Afterwards, the transcriptions
were printed for coding by hand. Qualitative analysis was done using open coding by
two English speaking researchers. Results are presented using quotes and long narratives
in order to illustrate relationships between the data, themes elicited and remarks in the
discussion section. For a table of qualitative inquiry activities including respondents’
roles see Table 12.
Results
Participant observation
CBO representatives were observed during meetings, workshops, and when
interacting with others in their own communities.
For example, the groups were
preparing for their exhibition at the end of 2003; however a very active member heading
up the planning for this event died suddenly, about three weeks before the event. The
CBO representatives, over 22 people, worked together to select new leadership and make
group decisions about new plans for the Expo. This was a difficult time as many
members were close to this individual; he was respected, and well liked. Although some
CBO representatives were visibly upset during meetings, they successfully reorganize a
new Expo event within a six week period.
In another example, CBO representatives were in the process of reorganizing
themselves as a Network. This occurred because during the second round of funding
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36. A Vaccine for Globalization
some groups had received approval for their requests, while others were denied. By
observing their reactions it was clear this was a significant blow to the group. During the
first year they had moved through the learning process together, built relationships, and
learned from each other. Now, it looked like they were breaking up into funded groups,
possibly funded groups, and non-funded groups.
They had to reach a consensus
regarding whether they would continue on as a Network, separate into clusters, or work
individually. In the end, they decided to remain together and elected a Network leader.
Group dynamics were also observed during Expo planning meetings. During
these meetings they debated the budget, organized the site and a schedule of activities.
Only one of these meetings was held at ICE, while the others were conducted at the Expo
site, in SanSai District.
During the participant observation process it was noted who was more active and
opinionated about certain issues, the researcher listened and made small talk during
coffee breaks, and started the beginnings of relationships with people. Observing the
director of ICE during these meetings was crucial for assessing how ABCD was being
facilitated. It was noted that he did a number of things very effectively. For example, he
spoke very little and never stated his point of view unless pressed by others. He spent
most of his time listening, and asking questions which kept the group focused. Often
when disagreement was upon them, he restated the question verbally or wrote the options
on a white board in order to help the group visualize what they were struggling with.
Overall, he was able to encourage dialogue by asking inquiring questions and assisted
with mediation when necessary.
Among CBO representatives some were more outspoken then others. Discussion
and decisions were conducted in a friendly professional manner. When decisions needed
to be made individuals voted by raising hands. Initiative leaders were selected through
nomination and voting. The person elected had the option of acceptance or not accepting
the position. A note taker produced meeting minutes for CBO representatives who could
not attend. Most of the time meetings were taped for assistance in writing up the
minutes. CBO representatives tended to arrive fifteen to twenty minutes late and dressed
casually.
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Natural Focus Groups and Community Visits
There were four primary site visits in which NFG’s occurred. Selection of these
sites was dependent on invitation by the CBO representative, and the availability of
transportation. The site visits included four CBO’s:
1. Drug Prevention Demonstration Project (Rural, SanSai District), # 3 on Table 12.
2. Nong Hoi Community (Urban, Muang District), #12 on Table 12.
3. SaLuang (Rural, Hmong, Karen and low-land Thai), #11 on Table 12.
4. Karen Mae Chaem Group (Rural, Karen, Mae Chaem District), #1 on Table 12.
The following narratives are included verbatim in order to show exactly how
CBO representatives were describing what they were doing, and what was happening in
their communities. This was important for conclusions to be drawn about how ABCD
was taking place, what kind of participation was occurring, and what they thought about
the process.
After presenting the prominent results from each of the sites the
researchers’ immediate interpretations from the field are also included, and written in the
first person.
1. Drug Prevention Demonstration Project
The first site visit was attendance at a village presentation for the Bangkok Department of
Drug Prevention (DDP). This village was selected as a demonstration site because of
their success in reducing the amount of drug trafficking, drug use, and improving
prevention and rehab activities. This project was spearheaded by the village headman,
who is also the CBO representative working with ICE. On display was an impressive
wall of posters and pictures describing their activities for drug prevention. I had a chance
to eat lunch with the CBO representative, the village health worker and his coworker, and
talk with them about the project. Later, the CBO representative and the two health
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workers addressed the representatives from DDP and community members in a common
area located in from of the CBO representatives house.
During discussions with the village headman and community health workers, they
explained there were about 208 families and 689 persons in this village. One health
worker stated, “The village leader would come to me often before this project and we
would exchange ideas about how to build a healthy community. He would go back to his
team (representatives from the youth, elderly and women’s groups) and talk it over, and
then he would come back to me with more ideas. The village leader also contacted ICE
to ask the director if he has any good programs to strengthen the community.” Here I
concluded this was a very active CBO representative who was seeking out information,
sharing it within the associational network of the community, and in the process building
relationships with internal and external resources, such as the health worker and ICE.
I asked the CBO representative if he could tell me about how his community decided to
work on drug prevention he said, “There were people in the village addicted to drugs and
selling. The community ‘team’ met to discuss the problem, where does it come from and
how to work on it.” He explained that the results of their discussions were many
activities. For example, making community rules posted on a sign explaining what
would be tolerated and what would not be tolerated in their village. They also decided to
have activities to “strengthen families.” When I asked him why he explained that the
people in the community believed drug use was becoming a problem because families
were breaking down. To counter this they decided to have an activity bringing the elders
of the community together with the children to teach them how to play traditional
instruments, thus strengthening family relationships. They also developed a system for
assisting addicts who returned to the community after incarceration or detox. This
process involved coordinating a system for returning community members to live with
someone other than their family for at least the first three months. This was an effort to
manage the tendency to fall back into old patterns and minimalize quarrel. He went on to
explain about the youth group activities, including a ‘friend’s corner,’ where the youth
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could gather and spend time talking about drug issues with their trained peers and health
workers.
I inquired about how many people in the community were participating in project
activities and the health worker said he thought perhaps 60%. He explained, “If 60% of
the community participates then it is good enough, if there is more than we make merit.”
He also said, “You can say or write community participation, but if it is not in your heart
it won’t happen.” I asked what he thought of this project and he said, “It’s very hard
work and requires lot of meetings and discussions, but I am very happy. In my twenty
years as a health worker I have never seen anything like this.” At this comment I was
immediately struck by the sense that this health worker, who had been working at the
community level for over twenty years, thought what was going on here was different
then what he had been involved in previously. This significant statement was explored
further in each of the semi-structured interviews. Then I asked him what made this
project work here, and he said, “The health worker (referring to himself) uses common
sense, and the village leader is interested.”
During the addresses to the community members and the DDP representatives the health
worker said, “This model of community development is strong and means bringing
different groups together to work. The villagers have done this themselves with the
assistance of the community health worker to advise them on understanding the current
problem. There is no end to this process. The community does not have to wait for the
government, they can do it themselves. The villagers here are very determined and happy
for your encouragement. We are proud of how we received the money. Every group here
knows how much money there is and what they have decided to do with it. We (the health
professionals) join with the community to eat and drink and discuss all of our ideas, not
just accept orders, we can dialogue together. I am very proud we can communicate like
this. I am an assistant only to the community.” The village leader/CBO representative
echoed these words by stating, “When we meet and discuss what and how to do things we
use the words “we will try” not “you should.” I observed consistency here in what the
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health worker and the CBO representative were telling me over lunch, and what they later
told the DDP representatives and the 200 members of the general community also in
attendance.
I inquired about the role of ICE and they explained that both the CBO representative and
the health worker attended the workshops coordinated by ICE for learning community
development facilitation skills, and how to communicate and exchange information and
ideas with other CBO groups. They went on to explain that they had raised money for
this project from the Provincial Health Promotion office, DDP, and through village
donations, thus illustrating the multiple sources of fund gathering.
I noticed with this community, independence.
For example, the CBO
representative had initially come to the health worker and ICE for “advice on how to
build a strong community.” Therefore, the capacity building instincts were already there.
They could have been quickly squashed had ICE and the health worker not possessed a
complimentary philosophy.
2. Nong Hoi Community
This community is located on the outskirts of the main city of Chiang Mai. In attendance
were two government health officers, a retired nurse, and retired teacher who help with
the project activities, two police officers and members of the youth and elderly groups.
They had just presented their work to some government officials who had already left
when our group arrived. They began with an introductory speech, delivered by the local
monk, and the CBO representative. The group was seated at a large table and had lunch
after the monk took his food, which is customary. The meeting was at the home of the
CBO representative. I was introduced as a student working with the director of ICE.
The monk began by explaining that in their community they have about 700 permanent
residents and 300 transitory residents. He spoke about the importance of working within
the three institutions of the community the temple, home and school. “The Temple is
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very important as it is the center of moral and social development. Three years ago the
community headman was responsible for the community. Now the central government
has decentralized power, but the community is still unaware of their rights. They have no
representation. Also, three years ago drugs started to enter the community and there was
a need to help adolescents and witnesses to drug selling know what they can do. They
started to organize and promote activities, but they have no money. We try to use all
social structures in the community to get a wide picture of what was going on, and come
up with ideas to strengthen the community. We started groups for promotion of nutrition,
exercise, AIDS and drug prevention. We have a Little Doctor Competition to encourage
young people to become health promoters within their families. For example, with
mosquito prevention, we use a traditional method and have a contest for who can collect
the most (dead mosquitoes). We do this work because community members, police,
teachers and parents are closer to the villagers, and know the problems better, political
representatives only talk.”
The CBO representative then spoke, “the concept is the facilitation of bringing multiple
community groups together, and if we do this we improve the quality of life for our
community.
We study and learn about problems and solutions together through
community participation from different sectors of society. Our vision is to work together,
coordinate people, and not separate them.”
I asked if there were any problems while doing this program and the CBO representative
said, “Our community has no office for our work, we would like some money to buy land
so our children will have a place to continue conducting community activities. Also, they
(community members) didn’t know how to work together at first. They all have hearts,
but it is difficult to find time to talk together because people have different schedules. We
have to meet on Saturday or Sunday. We have to help people understand it is important
to love themselves, love their families, and love their communities, if we don’t love our
community who will?”
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42. A Vaccine for Globalization
The retired teacher explained, “In Thai society we don’t have a sense of teamwork. So
now we use activities like competition (little doctor) to create a sense of belonging in our
community, maybe this will start improving.” I tried to probe further by asking how they
will know if there is a growing sense of belonging. The CBO representative responded,
“The villagers think and try to solve their own problems. When we do an activity lots of
people come to see.
Now more community members are presenting their ideas at
meetings. Before they were quiet, now they dare to share their ideas in the room. We
don’t say whether on is right or wrong, we say what everyone has to say is useful, and let
someone try their idea.
For example, in the rural areas we have natural cures,
‘oopanya’ we are sharing this knowledge to promote health. We are manufacturing a
small amount to sell.” What I learned here was that through this community dialogue
process people had the potential to engage and share their own ideas as a member of the
community. I began to wonder what prevented them from doing that before.
I asked how will they see the benefits of your work.
The CBO representative
commented, “The drug problem has stopped, but we always have to keep our eyes open.
We have observed diabetes reduction and cholesterol reduction and less depression
among the old people. For example, some of them could not walk before our group
exercise program, now they are able to do more movement. Our younger generation is
studying meditation and now they are getting better grades. The hardest part is getting
that initial financial assistance to start, and then you have to show people that you really
mean what you say you will do, and that you are really interested in improving
community health and family.
The beginning is the most difficult. We, are worried
about our future, we might get a little more money from the drug prevention department,
but what about all of our other work?” Here I observed the potential to measure the
effect of there programs based on bio-medical markers for example, blood pressure,
cholesterol levels, etc. Ironically, in the same breath the discussion turned to funding,
and concerns about sustainability of their programs.
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43. A Vaccine for Globalization
Then the Monk followed up by explaining, “Number one, the community has gained
more knowledge about health, the environment and community development. Number
two, they own this problem and they know best how to solve the problem. Through good
participation they build a sense of belonging and care for each other. And three, they are
responsible as a group.”
In this community I learned that they were mobilizing resources and perspectives
from three segments of society, the temple, school and family. Building on multiple
points of view and community ideas they were selecting their own program activities.
They are excited about the results they are seeing. Some of the problems include,
funding, having space for a community center, and concerns about sustainability. How
they are going about their work is consistent with the ABCD model.
3. SaLuang
On the day I visited the SaLuang District, about a half and hour from the city of Chiang
Mai, the community was celebrating Children’s Day, a national holiday. I had a chance
to join in those activities of music, games, eating, and comedy show. Additionally, I
stayed over night with the CBO representative and his family. Upon arrival, I spoke with
one of the natural healers working in an alternative health center built alongside the
government health station, and eat lunch with the director of the health station.
The CBO representative and the natural healer explained that three groups were in their
district; low-land Lanna/Thai, and the high land tribes of Hmong and Karen. The talked
about how representatives from these groups came together to discuss ideas and resources
for a health promotion project. It turns out there is concern among these groups about
pesticide contamination. Especially, for the low land people who eat foods irrigated in
mountain run off, which they think contains high amounts of pesticides. They decided to
combine their knowledge of herbal medicines into one book for use by the community to
encourage organic growing and conservation of traditional treatments for common
ailments.
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44. A Vaccine for Globalization
The CBO representative explained, “At first there was me, and our team included about
10 other people and the director of the health station, who you will meet in a little bit.
Our experiences before were always working with the communities all the time. Then we
got together and talked about our community. In our community, we saw that people
were being exposed to a lot of chemicals. Like when they eat vegetables that have been
grown with a lot of pesticides. So then we sat together and talked about what we could
do to encourage our community to use herbal medicine and plant organically. If they do
this they don’t have to take the foreign medicine, or visit the doctor at the big hospital.
Our plan was to use herbal medicine and to help ourselves so we don’t have to waste a
lot of money or gold for the price of medicine. That was our idea, and that is what we
talked about together…. The ten others are from different groups in the area; from the
local healer group in the sub district area here, and the adolescent group.” The Lanna
Healer explained, “There are lots of different groups, the village leader group, and the
elderly group, the natural healers in all villages and the Community Development
Department workers. In these statements, there is evidence of local relationship building
and community dialogue.
I asked about how they learned about ICE and the Thai Health Foundation Funding. The
CBO representative responded, “we talked for a while here and there, and then a doctor
at the health station said she has a friend who is a coordinating work with the Office of
Health Promotion who told her about the Thai Health Foundation. Our team of 4-5
came together to talk about how to put the project together so we could request funding,
We waited for 3 months for funding approval. And then we called our team of 10 people
to come together and talk. We explained we now had the funding to do this project, but it
was up to them to figure out how to do it. We had to figure out how to collect the
information about herbs from throughout the community. From the old books written on
bamboo, in the Lanna language. The old healers would write their knowledge down in
small books. ”
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45. A Vaccine for Globalization
This group brought together interested community members including youth to visit
natural healers in all three areas and collect information about the plants they use and
various formulas. The CBO representative explained the steps they took for the project.
“We collected information from throughout the villages by mobilizing the adolescent
group to travel around and write down the information from all those who had any. The
next thing we did was travel to the forests in the mountains with people who knew where
to find the plants and photograph them.
After that, we brought together all the
information we had collected from all the local healers, and typed it into a computer,
then we had it printed into a book. But we did not have them printed to sell. The books
are available throughout the community at schools, temples and all the local healers
have one. We had the book printed in Thai script but here are Karen and Hmong words
included. For example, if you look here we have the name for this herb in four different
languages, Hmong, Karen, Thai, and the English scientific name.”
In addition to discussions with the CBO representative about the project, I also had the
chance to stay with him and his family and discuss his views on development. He had
many insightful comments that are worth sharing.
“The community became tired of outsiders coming in and taking information from us,
then writing something and getting famous, while not doing much for the community.
These outsiders tend to do things for a short period of time and then leave. They are not
doing the work honestly. We realized over time, that it is much better if we do it
ourselves.
If we do it ourselves we know that we are doing it for the love of the
community, and not for any other reason.”
“Outsiders think they know how to change things for the better, but we the local people
know better. It’s like trying to tell someone how to move around in their own house, it is
my house, who knows better where all the windows and doors are but me.”
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46. A Vaccine for Globalization
“The only thing the community learns when programs come from the outside is to wait,
wait, wait for the next program to come and give you something. We have forgotten how
to think for ourselves.”
I asked him to comment on the ABCD approach, he said “With this approach the
community gets to use their own thinking, and the development worker becomes the
coordinator. Often the weakness in the community is that they have lots of ideas, but
don’t know how to coordinate things to make it happen.”
“One of the problems with the way things were done in the past is that when the funding
for the project ended, so did the project. With this new approach the projects don’t end
with the funding cycle. The project will continue because community members came up
with the idea, they believe in it and will try to find money from other sources, maybe even
locally. I think this would be the best way anyway, if the money came from local
sources.”
I asked him “when you get money from outsider funders like in Bangkok or other
countries, what do they want to see in evaluations?” He said “We usually have to do an
evaluation that follows this long process and ends up not meaning very much to the
community. It is very confusing for us and very difficult trying to give them what they
want. I think it is better to evaluate a project using the communities own words, very
simply and summarize easily. That is how I do my evaluations. Sometimes I have to
explain to the funder why this is important for the community, and I make them
understand before I get money that they will get this type of evaluation. Sometimes I feel
if we meet half way, 50% what they want and 50% what the community wants that is
usually the best.”
“When doing a community project we have to be careful about 2 things: 1. who we get
the money from, and 2. what kinds of rule or limits with they make that might impact the
freedom we need to make the project appropriate for our own community. When they get
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47. A Vaccine for Globalization
money from far away, follow up is difficult. To call Bangkok can cost 100-200 baht per
phone call, and that is a lot of money for rural people.”
He explained that when he found out that the Thai Health Promotion Foundation did not
have their names on the list for next year he and seven other representatives from
different Chiang Mai CBO groups went to Bangkok to, “pound our fists on his desk” and
talk with the health promotion representative for 2-3 hours. We had to, “make him
understand what and why we were doing things this way, and to show the benefits of this
kind of work. I told him he has never even been to our community to see whether or not
the program has been beneficial or not, so he can’t pass judgment on it without even
visiting once.” He explained that later they heard the proposals for 8 groups have passed
the first tier for approval, now they are waiting for final approval.
“In the past the government in Bangkok would write a program and tell us the top
priorities. We did not have any freedom in what to work on or how to do things and this
is a very limiting approach to working in our community. Now, the communities are
writing the programs and sending the proposals to the government which allows for
much greater possibilities in terms of projects.”
I asked him this new way of doing things works better then the old way of doing things.
He said, “this new way works ‘because we see it’, and we don’t have to wait around for
someone to do it for us.”
Based on our discussions, it appears this CBO representative and community
members are critically reflecting on their social assets, how to mobilize them, as well as
weighing the pros and cons of the different approaches to community development.
During this site visit I was able to capture more about how this CBO was operating in the
community, how they viewed their roles, how they thought the ABCD process was
affecting their community. For example, the CBO representative explained that because
the three different groups (low-land Lanna, Hmong and Karen) came together to work on
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48. A Vaccine for Globalization
this project together, members of the high land groups are much more likely to come
down and join in community events these days.
The statement, “this new way works
because we see it” implored me to wonder what else he meant, and how he could
illustrate to others the changes they were seeing. Additional awareness was raised about
the concept of freedom, and it became more obvious how adapting projects locally is
crucial to community success.
The issue of passivity vs. pro-activity was also
prominent. For example, “we don’t have to wait around for someone to do it for us.”
Sustainability issues were explored in the statements, “One of the problems with the way
things were done in the past is that when the funding for the project ended, so did the
project. With this new approach the projects don’t end with the funding cycle. The
project will continue because community members came up with the idea, they believe in
it and will try to find money from other sources, maybe even locally.”
4. Mae Chaem - Karen Group
This village is located about five hours from the main provincial city. I was
invited to visit during the Christmas Holidays. The missionaries were active among the
Karen groups and in this village and they had a mass attended by 100-150 people. After
a community breakfast on Christmas day, I visited the CBO representative’s house, and
served tea. I was joined by a few other community members including 3 elderly men, 3
adult men and two adult women. Their roles in the village were not identified, but they
knew about the work of the health promotion program. The conversation was tape
recorded and resembled a natural focus group. I did not have any specific questions
prepared, and I didn’t anticipate the discussion to include 10 people. The Karen speak
their own language when talking to each other. Most of the men can speak Thai, and
some women. Young people of both sexes have been schooled in Thai and shift easily
back and forth. I asked questions in Thai and they were translated into Karen by one of
the adult men. In this setting I learned how they viewed ABCD, how it compared to
other health promotion work they had seen in community, how they viewed their medical
system, and the health status of their own community. The health promotion program in
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49. A Vaccine for Globalization
this community was centered on restoring and promoting native Karen wisdom about
herbal medicine.
In their view, the predominant mode of treatment for forest people is herbal medicine
cures that have been passed down from generation to generation. They commented that
western medicine came from the missionaries, and when the roads came people tried to
get the medicine from the ‘doctors’ at the government health stations, “Most of the time
they (their elders) would find herbal medicine in the mountains, they would boil the herbs
and use the Karen knowledge because most of the time the doctors in Chiang Mai don’t
come here. In the past for our parents, aunts and uncles, the roads did not reach here,
they couldn’t get here. It was very inconvenient… When people died they thought it was
because of a spirit (‘rok pee’) had entered their body and killed them.
About two years ago the government health stations arrived and one young man
commented, “The patients should have enough medicine to cure their disease, but it is
not enough. By the time they need it the medicine has expired, like 6 mo or 10 mo or 2
years past expiration. That is one of the problems. They use medicine that has already
expired and it does not cure them. These days’ things are a little better, but the villagers
still need to use herbal medicine to supplement, a lot.”
In regards to the development of the program the CBO representative said they wanted
to, “improve the community by looking after the culture through the conservation of
herbal knowledge.” The CBO representative explained, “Using the medicine from the
hospital, it’s good, but there are side effects. If you take too much you have a problem, if
you don’t take enough you won’t get the curing effect of the medicine. In the past our
relatives used herbal medicine and they survived, and didn’t need to go to the hospital.
So for kids these days if they have a swelling or a cold and take the hospital medicine
sometimes they have problems. But with herbal medicine you can take a lot and it won’t
cause harm…. for our lives maybe we can use our local knowledge to teach our children
about herbs, massage, and poultices, ,,,we already have these true medicines, we don’t
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50. A Vaccine for Globalization
have to buy them or go to the hospital. Why do we have to do that? So, that is how this
project got started.” He went on, “what can we do is make sure that the next generation
knows how to use and conserve the herbal medicine cures that we used in the past.
Before we didn’t have any hospitals around here or any doctors, and we survived, we
didn’t die, sometimes we died if it was a very difficult disease, or if we didn’t treat it in
time, but for treating common disease, coughs, colds, sore throats, headaches, and
rashes, we can use what we have always used…,”
I asked how this program was similar or different from others, one man stated, “It is like
this, the state programs are only interested in the outputs of their work. If they come and
test us they come once, this is not sustainable or useful. It is because the staff person is
only interested in the output of the work, not interested in the sustainability of the
program. But this type of program was concerned in doing whatever you want just
please make it beneficial, and please make it sustainable in the community. It is different
because there is much more freedom.
If it was a state program there would be many
limits and rules, and after the program it would be over, because the staff is only
interested in the outputs of the project, and not interesting giving too much else. After the
program it would end.” He continued, “If I look at the big picture, the state works health
programs and then it is up to the staff person to implement the program for the
community…But, in terms of herbal medicine, I think that if we have knowledge about
herbal medicine it is good, because you can take care of yourself, this is much better then
waiting for some worker to come take care of you.”
I asked them to talk about how they thought this project was affecting their community.
At this the CBO representative said, “We see the villagers helping themselves, they don’t
have to always go to the health station, they know the plants and they know how to use
them. The students know. They don’t have to go to the hospitals and take the poisonous
medicine. We also see the students teaching other students. For example, if one of their
friends has a headache they show them which plant to use and how to make it.”
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51. A Vaccine for Globalization
Form this site visit it started to become clearer how critical cultural identity was
for their programs. Not only were CBO’s moving and mobilizing local social assets in
the form of native wisdom, they were developing associations with other communities
through the vehicle of health promotion program for herbal medicine conservation. They
were engaging in community dialogue and discussion right there in front of me! There
were many breaks in the discussion in which different people disagreed with what
another was saying. The disagreement didn’t cause uproar or chaos, instead it appeared
to stimulate more dialogue. Most importantly, they were reaching back to their own
cultural identities and building from there.
Semi-Structured Interviews
12 semi- structured interviews were conducted with CBO representatives. After
analysis, re-reading and coding of transcripts, themes became salient and are presented in
Table 13.
In addition to the themes presented, a list of concepts that representative’s
mentioned during interviews regarding what they thought helped to make their programs
work, and what made them difficult was formed. These questions were asked directly
during the interview. Included in these lists are concepts mentioned by more than one
CBO representatives.
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52. A Vaccine for Globalization
Issues that made ABCD for health promotion work:
1) The ability to think and do for oneself
2) Groups decision making
3) Multiple activities under one project
4) Having those activities firmly fixed in native culture/community identity
5) Inclusion of all age groups
6) Funding and support from local and external resources
Difficulties of ABCD for health promotion:
1) Time
2) Communication
3) Group Decision Making
4) “Spoiled” by standard Development Approaches
5) Program Writing and Evaluation
One of the most frequently sited difficulties was the issue of time. Any effort to
gather community people together for community discussion was difficult secondary to
schedules, jobs, and family responsibilities. Other difficulties included communication.
Many communities were very far from the provincial center and ICE. Making phone
calls is very expensive and transportation can be long, uncomfortable, and costly.
Practicing mediation and consensus in decision making was also mentioned. The process
of reaching consensus and conclusions can be difficult if there were varied views among
community members.
The issue of evaluation came up more than once.
Some
representatives commented that they were interested in knowing more about evaluation.
There was frustration expressed over not being able to explain or show funders the “good
things” their programs were doing in their communities. The uncertainty of funding
resources was another major difficulty mentioned since the announcements of which
groups were funded and which were not was occurred prior to the expo.
Another representative expressed the “conditioning of NGO’s” as a difficulty to
over come. He noted in his community, “they are spoiled by the NGO, so all they
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53. A Vaccine for Globalization
(community members) know is how to do is spend money.” By practicing ABCD they
“have to learn how to plan, report and evaluate their work.” He also mentioned that the
project ideas and activities were too big and there was not enough leadership, negotiation
strategies or skills among the group members. In the same case there was concern about
the ideas for activities coming from only one or two people instead of a community
group. Interestingly, the individual in the representative position for this CBO has a long
30 year history in the NGO field. He sited himself as a difficulty, because of his NGO
training, and was planning to remove the difficulty by removing himself from the CBO
representative position.
Discussion
The information elicited from the semi-structured interviews was consistent with
the information drawn from participant observation and the NFG’s. The semi-structured
interviews were useful for ICE in terms of citing weaknesses and strengths of the process.
The NFG’s and participant observations provided more in-depth information related to
socio-cultural context and insider perspectives.
Some initial assumptions were confirmed in the data and support its validity. The
consistent statements from community representatives, “we did it ourselves,” “it was the
ideas of the villagers,” “we are proud” and “they are proud of themselves” provide
convergence when triangulated with ABCD methods, and the theories of selfactualization and self-sufficiency (41, 42). Based on the principles of ABCD and the
theoretical constructs of educational psychology, self-efficacy, and empowerment, the
themes generated from the semi-structured interviews are also consistent and
confirmatory.
The primacy of traditional culture and cultural identity appear to be critical pieces
of CBO program building, and provide evidence of a difference between the ABCD
processes as described by Kretzmann and McKnight, and the process being supported by
ICE.
Kretzmann and McKnight emphasize the mobilization of resources (capacities,
skills) and local relationship building. In this cases study there is evidence of resource
mobilization and local relationship building, with the explicit emphasis of traditional
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54. A Vaccine for Globalization
culture as strength through which health promotion and community development are
taking place. Based on this observation, I believe what is happening among the groups in
this case study may be even stronger than the ‘standard’ ABCD approach. CBO’s are
conserving indigenous knowledge and traditions through health promotion and
community development programs, therefore preventing the identity destroying aspects
of rapid growth. As the director of ICE often stated, “what they (CBO’s) are doing is a
vaccine against the ill-effects of globalization.”
Additionally, by expanding the process of building on ‘strengths’ (local assets,
skills etc.) to also include cultural traditions (local music, dance, traditional healing
methods) this allowed CBO’s to reach out to local and external resources with something
compelling in hand, thus leveling the playing field, or power structure.
Therefore,
through the ABCD approach, as practiced here, there was a better chance for more equal
partnerships between CBO’s and local and external associations. Mobilizing around
traditional culture brought more people together, from all age groups, since the focus was
not on a specific problem or a disease. Centering on traditional ways of life was also
more in line with how the community, and individuals, identified themselves, thus
reinforcing their collective identity and self-esteem.
These inferences were based on the interpretation of how CBO representatives
and community members described themselves, or in other words, an ‘emic’ perspectives
of their own community.
Although these groups are considered ‘marginalized’ by
professional development standards (based on income access to resources, education
etc.), when they described their communities, none described themselves as poor, weak,
impoverished, or through a list of problems. For example, “we are Karen, we live like
Karen, we live comfortably” or another “we are a typical Thai community, and the
environment is good because we live out in the countryside” or “our community is in a
rural are and we live using the rural ways of life.” A similar phenomenon occurred
when trying to investigate community identified health problems.
I often asked
community members to tell me what kinds of health problems there were, and most
frequently they responded by stating “we don’t have any.” This was also confirmed in
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55. A Vaccine for Globalization
the evaluation report written by a contractor hired through the Thai Health Promotion
Foundation.
From a broad point of view, I considered whether Thai social systems were well
matched for an ABCD approach. For example, more than one group described the
importance of building their work on the traditional social systems of temple, school, and
village. Therefore, when thinking about what ‘strengths’ to build upon, they reached
back to the system of a traditional community. These community ties, they explained,
had been breaking down secondary to shifts in the administrative structure, growth,
development etc.
Part of their projects was to restore those relationships between
community resources.
Similarly, many of the projects focused on teaching and promoting traditional
health models. “Lanna health is focused on the four precepts for holistic health. A
‘happy life’ was to be achieved through the spirit, body, the community and the
environment. Through spirit a human could reach the supernatural. The human body is
described as containing the four elements; Earth, Water, Wind and Fire, and their balance
a critical.
Herbs are a part of the environment that can be used for health. And in a
community people survive by helping each other. These are the four things that combine
to make a healthy life according to Lanna principles” (4).
Therefore, both traditional Thai social structure and the traditional northern
healing philosophies include an emphasis on community relationships, which may have
supported the transition to an ABCD approach for health promotion and community
development.
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57. A Vaccine for Globalization
Chapter IV: Evaluation
The purpose of this section is to address the question, ‘if the ABCD approach
claims to lead to community empowerment and self-determination, as written in the ICE
program ‘Increasing Community Capacity for Health Promotion and Well Being Project’,
than how will these CBO’s measure these potential changes in their communities?’
An answer is provided by describing the efforts of ICE and the 11 CBO’s in
developing an evaluation method. The evaluation method was based on the concepts of
participation, empowerment and suitable in their community for taking on the challenge
of identifying their program outcomes and impacts. For the purpose of illustration we
chose to highlight the specific effort of the MaeChaem community, whose project was
the Rehabilitation and Conservation of Herbal Medicine, to demonstrate how the
evaluation was implemented.
Development of the Evaluation
The 22 CBO’s were entering their third year of ABCD for health promotion
programming. They had already submitted project specific quantitative reports required
by ThaiHealth for justification of funding.
However, the CBO’s had not learned
techniques to evaluate possible empowering or broad societal impacts in their
communities as a result of this new approach to health development. ThaiHealth was
anxious to determine if these changes were transpiring in the community and hired an
external evaluator from Bangkok to assess the situation.
The 22 CBO’s were exposed to an external process evaluation during the summer
of 2003.
The purpose was to evaluate outcomes, the capability of CBO’s, their
effectiveness in modifying health habits, the capability of ICE, goal – objective –
indicator alignment, identification of best practices and motivate a system of future
evaluation among the CBO’s. Information collected was analyzed and each CBO was
then quantified into three categories; Good, Fair, and Needs Work.
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58. A Vaccine for Globalization
Several CBO representatives felt the external evaluator did not spend enough time
in the community to gain a full understanding of what they were doing and how they
were doing it.
Several CBO members expressed the potential of losing identity if
externally located NGO’s and GO’s used standards, based on their outside values, to
judge the worth of their programs. Members of the CBO’s claimed that there were so
many other things going on in their community that this externally conducted evaluation
did not reflect. They expressed frustration that they can see changes, but don’t know how
to express it on paper for the funders to see as well.
Dr. Uthaiwan presented the idea of learning how to do participatory evaluations to
the 22 CBO’s at the December 28th Network meeting. He informed the Network that
these evaluations would supplement and not substitute their current program summary
reports submitted to ThaiHealth. In response to Dr. Uthaiwans’ request, 11 of the 22
CBO representatives volunteered to attend workshops in order to learn participatory
evaluation techniques. The CBO’s involved in the development of the evaluation method
were; Saluang Group, MaeHak Group, BanMaiJong School, Lahu Group, Muay Thai
Group, Three Age Group, MaePaKee Group, SanPaBao Group, SriBoonRuang Group,
MaeSa Group, and the Mor Muang Group.
Prior to the workshops, volunteer community representatives and ICE
collaborated on developing a User-guide (see Appendix D) to assist in facilitating the
evaluation workshops.
The guide was based on participatory and empowerment
evaluation, in addition to the ABCD approach in order to be consistent with the CBO’s
health promotion program planning. It outlined a hypothetical path for developing and
implementing the evaluation. The guidelines were flexible, however ICE felt it was
important to put it on paper so the process was truthful and transparent. The guide was
not handed out to the CBO’s during the workshops because ICE intended that the CBO’s
would move through the process of developing a context specific and community owned
method.
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Background information
The community of MaeChaem is approximately a 5 hour drive ‘up the mountain’
from ICE headquarters in Chiang Mai. There is one health post in the village that focuses
on primary care. There are a total of 60 families in the village, which is an increase of 20
families over the last few years. In the past, families clustered to form compounds that
tended to be far away from each other and scattered throughout the forest. Over the past
10 years, the village has gradually seen the development of roads and the introduction of
electricity.
The community has both a primary and secondary school.
The CBO
representative explained that the community has a strong local representation within the
government and there is much less foreign missionary work in the area as a result.
However, there are still strong ties with a Baptist organization that sends money into the
area. The church is currently constructing a new clinic in the village.
Analysis Plan
Data collected and analyzed is presented in a chronological format detailing the
evolution of the evaluation method.
1. A description of the Workshop; detailing the process of how ICE and the CBO
representatives worked together in developing the evaluation method.
2. A description of the actual Evaluation Method steps; detailing each step of the
evaluation as decided upon by ICE and the CBO’s at the workshops.
3. A description of how one CBO implemented, displayed and reflected on the
evaluation method during their Community Meeting. (This group was singled out
for description because an ICE coworker is from the community, they were the
last of the 11 CBO’s to do the evaluation and they were one of the few groups that
went deeper into the evaluation by defining indicators of a chosen variable.)
4. Finally, an Overall Summary of all Evaluation Results. All variables identified by
the 11 CBO’s who conducted the evaluation were complied through a qualitative
process of pile sorting.
The process was repeated two times; once to sort
according to social, physical, and mixed capital; a second time according to
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60. A Vaccine for Globalization
similar themes. The final outcomes of the variable summary displays were agreed
upon by a process of democratic consensus between the two researchers and ICE
staff.
Workshops
The evaluation method was developed during a series of workshops attended by
representatives of 11 CBO’s and facilitated by the director of ICE. Appreciative inquiry
was the tool to address the challenge which faced the 11 CBO representatives in
developing their own method, one that would best meet the needs of the community to
identify, prioritize, measure, document in a format to help reflect on what was done,
where they are today, which way they want to go, and how far they need to go and
demonstrate impacts in their communities as a result of their health promotion programs.
The evaluation method required a mechanism for involving stakeholders in
recognizing, defining and measuring variables and indicators.
ICE recognized that
researchers and development workers have prefabricated long lists of variables and
indicators for empowering and social changes.
However, they felt that community
involvement in variable and indicator identification needed to be developed and
negotiated based on indigenous and experiential knowledge, taking into consideration the
linkages between social, cultural, economic, political, and environmental systems in a
community. ICE thought the process of identification would ideally lead to a better
understanding of what caused the changes.
The workshop began by posing the question; ‘what are different things that we
can evaluate in our community?’ The 11 CBO representatives listed several possibilities;
activities, social changes, what works and what doesn’t, and a combination of all three.
They voted on trying to evaluate social changes. Then the 11 CBO representatives were
asked ‘what questions do we need to ask in order to identify any social changes?’ Other
questions and concerns raised and addressed at the workshops included; availability of
resources required of the community to design, collect and analyze the data, an
understanding of the amount of time that they realistically had to participate in the
process, as well as taking into consideration that people participate in diverse ways, at
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61. A Vaccine for Globalization
different times, with varying patterns, and through different structures within their
context.
Deciding how much time between information collection, analysis and
reflection would pass. How to assure that the process was not associated with faultfinding or finger pointing, that people were not being monitored, if the findings will be
abused or not, how to deal with a pull toward just looking at activities, how much
information is needed, how precise does it have to be, and how will the results assist in
creating common solutions and assist in bridging the communication gap between the
CBO’s and their funders.
The evaluation method slowly materialized over three workshops. Refinement
and ongoing revisions were made according to continuous and flexible spirals or cycles
of participatory learning; planning, acting, evaluating, and reflecting during the three
workshops and during actual implementation.
The resulting mission for the evaluation was, ‘To utilize an ABCD approach to
empower community members to identify and evaluate common and unique community
changes, secondary to their ABCD for health promotion programs.’ The final guidelines
for developing and implementing the evaluation method were;
o Communities will evaluate their own changes according to the values of their
setting based on local knowledge and ideas, rather than judging their approaches
according to outside criteria
o The entire process will be collective and participatory, fostering selfdetermination, building capacity and putting control into the hands of the
communities by first identifying and building on existing community strengths.
o The evaluation method will be meaningful to the community, CBO members, the
Network, and funders.
o Methods will be sensitive to local settings, taking into consideration; time,
language, education, etc
o Methods will be adaptable for when perceptions and conditions change, and will
reinforce community competence
o Information will be collected in a collaborative manner
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62. A Vaccine for Globalization
o Results will be both qualitative and quantitative because community perspectives
through experienced based stories are crucial in helping to explain the situation
behind the numbers.
o Results will be easily displayed, understood, relevant, and highly valued by the
community and their funders.
o Results can be used to guide future decisions and community action to increase
long-term sustainability of all health promotion initiatives, with hope of gaining
an understanding of social reality.
Evaluation Method
The 9-step evaluation method developed at the workshops is described below for
comparison to the user-guide presented in Appendix A.
Step 1: Before
The evaluation would begin by talking about the CBO’s program, framing
everyone’s mind set around what they did. The facilitator would then ask everyone to
think about what the community was like before this program. Everyone would write
their responses down, one thought per page.
Knowing that some community members can’t write, the group still felt
comfortable taking this approach because there would be enough younger community
members in attendance to assist. If this was not possible, responses could be taken orally
with the facilitator writing them on a board.
The purpose of this step was to ask a simple and open question, one that would
allow for responses to range from possible outputs to impacts. Some members were
concerned that by having such an open ended question, there was the potential to get
answers that were not related to the project, for example; ‘I had only one child before the
program and now I have two children.’ Despite this concern, the group decided the
simple and open question would be the most effective first step and worthy of a try.
Step 2: Cluster
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63. A Vaccine for Globalization
The facilitator would then collect all the responses, read them aloud to the group,
discuss each response and clarify meanings when appropriate.
The group would
collectively arrange all responses into similar categories and stick them to the wall.
The basis for this idea came from a PRA method of pile sorting; however the
group did this activity collectively.
Step 3: After
The facilitator would ask the group to think about what it is like now in the
community, two years after our program started (similar to Step 1). Everyone was
instructed to write their responses down, one thought per page.
Step 4: Cluster
Again, the facilitator would collect all responses, read them aloud to the group,
discuss each response and clarify meanings when appropriate. The group would then
stick each response on the wall if they related to the clusters already formed, or they
would create new ones.
Step 5: Categorize
After all responses were clustered and stuck to the wall, the facilitator would
negotiate a process of categorizing and defining each cluster with a neutral key word.
The group felt it essential to use a neutral word so when it came time to rate the category
one would have a nonbiased range to choose from; negative to positive scores.
Step 6: Prioritize
Once all clusters were categorized according to a general consensus of the group,
they were each given two pieces of paper. The facilitator would then instruct each
member of the group to walk around, read the responses and vote by placing each paper
on the category that represented the most important change in the community.
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64. A Vaccine for Globalization
The votes were tabulated and each neutral key word was listed in order of
priority, based on the outcome of the voting. The facilitator would then have the group
decide how many key words would be rated.
Step 7: Rate
The facilitator handed out an empty results form. Each member of the group
filled out the left side of the form with the prioritized neutral key words. The facilitator
would negotiate the meaning of each number on the rating scale from 1 to 7. Once a
consensus was reached on the scale, each participant would rate each neutral key word
and then justify their score with a personal story or experience written on the right side of
the form.
Step 8: Display
Once all the scores were tabulated and averaged, they were displayed on a star
plot. The idea for the star plot came from work by Rifkin and her efforts to evaluate
participation, and the work of Chambers in his evaluation wheel (37, 43).
Step 9: Reflect
The star plot was displayed for the group and the facilitator asked participants to
comment on what they were looking at, what they thought of the process, and what they
can use the results for.
Community Meeting
The MaeChaem evaluation was conducted at the residence of the head CBO
representative. The two CBO members who attended the workshops were running the
local elections at the school and were not able to attend the meeting. A third member of
the CBO, a local teacher, facilitated the meeting with assistance from Dr. Uthaiwan.
Twenty-four community members attended the meeting and participated in the
evaluation. The age of participants ranged from 11-75, slightly over half were teens and
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65. A Vaccine for Globalization
young adults. There were 8 men and 16 women (1 older man, 2 teachers, and 4 married
older women).
The teacher opened the meeting with introductions and the community members
participated in singing a song. Dr. Uthaiwan and the local teacher explained that today
they will together think about their community, what it was like 2-3 years ago and what it
is like now. The discussion started by thinking about the CBO program they were
involved in and other projects that were implemented in their community the last few
years. Initially they could not think of any other besides their own program. Then, one
woman said there was a CARE project in the area that worked with the housewives group
to assist with income generation projects. Another woman said that in the past a religious
organization had a drug detoxification program nearby. They remembered the program
started during the time when the government cracked down on opium growing by
burning all the opium fields. At that same time, NGO’s were invited by the government
to work with local groups to develop alternative income generation activities. They said
the detoxification program lasted about 2-3 years, but was no longer running. They said
they would like to transform the now unused site into an herbal garden area as an
extension of their health promotion program. After this discussion the facilitators then
started the evaluation method developed at the workshops (See Steps 1 – 9).
The facilitators asked the group what it was like in the community ‘Before’ their
program started. The facilitator asked them to think about it while he passed out blank
pieces of paper. Responses were written in both Thai script and in BaKurYo. BaKurYo
(Ba means ‘people’ and KurYo means ‘live easy/simply’) is how they refer to
themselves, as well as Karen. The responses were read aloud and discussed. Then they
were clustered (Step 2) by consensus into similar themes and posted on the wall. When
this process was finished, the second question (Step 3) was asked relating to what it is
like in the community ‘After’ this program has been running for 2 years. The responses
were again read aloud, discussed and clustered (Step 4) into similar themes – using
clusters already on the wall or adding new ones when necessary. The facilitator then had
the group take each cluster and categorized (Step 5) or labeled them by consensus. Table
1 lists an example of what resulted from the first 5 Steps of the evaluation method.
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66. A Vaccine for Globalization
Table 1: Summarized Results of Steps 1-5:
Step 1 - What was it like ‘Before’ the project?
Step 2 - Clustering similar themes.
Step 3 - What is it like now or ‘After’ the project has been running for 2 years?
Step 4 - Clustering similar themes.
Step 5 - Categorizing all responses.
*(number of times mentioned in brackets)
Steps 1 and 2 -Before
“We did not have any
development activities”
(2)
“There were no changes
in the village”
“We did not have any
development work, and
don’t have any roads”
Steps 3 and 4 -After
Step 5
“The village development is better”
DEVELOPMENT
“We know more about development work”
ACTIVITIES
“The village has more development
activities”
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67. A Vaccine for Globalization
Table 1: (continued)
Steps 1 and 2 -Before
“In the village we had no
cooperation”
never
helped
“We
others”
“We had no cooperation”
(4)
“Health was not good”
(3)
“We did not have growth
about health”
“We did not have unity
in Ban Jam Luang, we
did not have unity
together”
“Little mouse thinks we
did not have unity ka”
“Not have much unity”
“We did not have
activity of conserving
herbal medicine”
“In the past our village
did not know how to use
herbal medicine”
“We did not have any
conservation activities of
herbal medicine”
Steps 3 and 4 -After
“Now we have cooperation - for example building a
new house and other activities like during Christmas
time”
“Now we have more cooperation - for example groups
of housewives work in cooperation, and we have sports
activities”
“Now we can see clearly better cooperation for example
at new years”
“Now we have more cooperation”
“Now we cooperate better”
“The SSS project we cooperate and know more and we
do activities and conserve and preserve our traditional
culture and make conservation of herbal medicine and
massage and take care of our health”
“Now we know about curing health”
“We have better health” (2)
“We have more love and unity because we have a
group”
“Our village knows unity more than before”
“Now know unity more”
“Have more unity” (2)
“Have unity together a lot more than before”
Step 5
COOPERATION
HEALTH
UNITY
“We know more about herbs”
CONSERVE
“Make everyone learn about herbal medicine”
HERBAL
“Health is better, not have pain and illness and know MEDICINE
about how to use herbs more”
“Know more about herbal medicine more and make not
buy medicine”
“Health is better and don’t have pain or illness”
“Everyone learns a lot more about herbal medicine and
we have more unity”
“We have opportunity to use herbal medicine more and
to massage and not have to go to the doctor far away”
“Know more about herbal medicine”
“Know about herbal medicine more”
“Program led to knowledge and ability more for
example knowing more about herbal medicine and
having more unity”
“We help preserve and conserve herbal medicine”
“These days most of us use herbal medicine first”
“Have more knowledge and have understanding and
everyone knows about herbal medicine more”
“Can conserve herbal medicine”
“Have knowledge about using herbal medicine more”
“Have use of herbal medicine more”
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68. A Vaccine for Globalization
“Have activities of planting herbal medicine in the
forest”
“We have belief and knowledge about many kinds of
herbal medicine”
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69. A Vaccine for Globalization
Table 1: (continued)
Steps 1 and 2 -Before
Steps 3 and 4 -After
“The village was not
growing”
“We did not have any
growth”
“We
had
little “Now we have more knowledge”
knowledge and ability”
“Now we can have more knowledge about many things”
*(I probed to find out why they thought they had no
knowledge in the past, they responded by saying,
“before we had no roads - no way to get information,
now our kids are going down to schools, and now we
have our own schools.)
“Love and happiness was “Have unity and love a lot more”
“Have love a lot”
only a little”
“We did not have love
for each other, now we
have more love for each
other, much more”
“Travel
was
very
inconvenient and made
us not able to visit each
other”
“Now we have massage for health”
“Now we have conservation of traditional culture”
“We have more fun and amusement”
Step 5
GROWTH
KNOWLEDGE
and ABILITY
LOVE
ROADS
TRAVEL
and
MASSAGE
TRADITIONAL
CULTURE
AMUSEMENT
After each response was discussed, clustered, and categorized; the facilitator
handed out two pieces of paper (cut into the shape of hearts) to each participant. The
facilitator instructed each person to take their paper and stick it on the most important
change (Step 6) that has taken place in the community since the program started. The
facilitator explained to not vote according to what was the biggest or most significant
change, but the most important change. The group walked up to the wall, had some
discussion and each person voted by placing their piece of paper on the wall over the
most important change for their community. Table 2 lists the results of Step 6.
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70. A Vaccine for Globalization
Table 2: Results of Step 6 - Prioritize all Categorizes identified through Steps 1 -5:
*(number of votes given to each Category in brackets):
Development Work
Growth
Cooperation (12)
Health
Unity (8)
Herbal Medicine Conservation (1)
Knowledge and Ability
Love and Happiness (2)
Travel
Massage activities
Traditional Culture
Amusement (1)
After the voting, the facilitator handed out a blank form and asked the group to rate,
on a scale of 1-7, how they thought the community was doing in regard to these changes
today (Step 7). The facilitator negotiated a definition for each number (1-7) and when the
group came to a consensus, they voted on the top 5 changes and were instructed to write a
story next to the score to justify their response.Table 3 lists the results from Step 7.
Table 3: Results of Step 7 - Rate the top 5 Categorizes followed by personal story to
justify each score:
*(score in brackets) *[number of times mentioned in brackets]
COOPERATION
(5) “When we have Christmas activities all of the villagers work together”
(4) “Have cooperation not a lot and not a little because we don’t give too much cooperation to
each other.”
(4) “Because we have work we help each other”
(4) “Have cooperation when we play sports”
(6) “Help each other cooperate”
(6) “Help to do”
(5) “Help each other work”
(6) “Cooperation for example when we build churches and schools”
(5) “Cooperation have more”
(5) “Working together”
(5) “Work to build church and school”
(6) “We have cooperation a lot better for example, working in groups”
(5) “Because we have good cooperation in building houses and working in the field”
(6) “Cooperation together for example building church and school”
(5) “For example in working to build the church and houses” [2]
(5) “Building a church and a school”
(6) “Building a church and a school”
(7) “It is the best thing”
(7) “It is the most important for Karen”
(5) “In village development”
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71. A Vaccine for Globalization
Table 3: (continued)
UNITY
(5) “On the 25th of the month we have group village meetings and we see everyone has a lot of
unity”
(5) “New Years activities and building new homes we have good unity”
(5) “If we have an activity we have unity more every time”
(5) “If we have sports we have good unity”
(4) “We help each other survive and have unity”
(5) “Help each other do activities”
(6) “We play sports activities”
(5) “For example the meeting on the 18th was very interesting”
(7) “We have more unity”
(7) “We all have to have unity together”
(6) “In the meeting everyone shows their interests in the community”
(3) “For example in the meeting we have only a few people”
(4) “Working in groups have unity”
(5) “Our meetings every month show the interests of the community”
(5) “In the village meeting the community is very interested”
(4) “For example at Christmas we have good unity”
(6) “We work together”
(5) “We have unity in many activities”
(6) “We know each other more”
(6) “Unity of the community is better, love and unity together is better”
(4) “Have more unity”
LOVE
(4) “When one person in the village does a good thing we all see and are glad and let them
know”
(5) “We understand each other”
(5) “Peek at love”
(6) “Love each other a lot”
(5) “Love each other in the community”
(5) “Have active compassion sharing and love”
(5) “Getting along well, show our affection for each other”
(5) “We have more love”
(5) “Love is beneficial for us”
(5) “Have love for each other”
(3) “Love not a lot because not have enough knowledge”
(5) “Love for each other”
(4) “We help each other” [2]
(5) “We help each other” [2]
(6) “We help each other”
(5) “Makes us know and endure more”
(5) “The love of the village is better”
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72. A Vaccine for Globalization
Table 3: (continued)
CONSERVATION OF HERBAL MEDICINE WISDOM
(5) “Conservation of the herbal medicine for example making a place for the conservation of
herbal medicine (in the forest)”
(5) “When we make a space and study herbal medicine conservation in the forest”
(6) “If we are not comfortable we can use herbal medicine, we should conserve herbal
medicine”
(6) “Because we don’t have to go buy medicine”
(5) “Conservation of herbal medicine”
(7) “Herbs are medicine”
(4) “It is medicine we can eat”
(5) “Now we know how to use herbal medicine”
(4) “Conservation of water and the forest”
(6) “Development activities of herbal medicine”
(6) “Using herbal medicine is very beneficial us”
(4) “We need to conserve herbal medicine for the kids and relatives because it is
beneficial/useful for use”
(3) “Activities to conserve herbal medicine”
(5) “Conservation of herbal medicine to save and make more”
(5) “We are conserving herbal medicine for the benefit of all of us and all of our kids and
relations always”
(5) “Conservation of herbal medicine”
(4) “Some people take medicine from the hospital and don’t get well, then they take herbal
medicine and get better”
(5) “We will conserve herbal medicine”
(6) “Conservation of herbal medicine is very important for the people who are far away from
the doctor”
(6) “Want the conservation of herbal medicine to be sustainable”
(5) “Want to use herbal medicine and want it to be sustainable”
AMUSEMENT (FUN)
(3) “When we have sports we go to give support”
(5) “For example playing sports is having fun”
(4) “For example we play sports and have fun”
(4) “Help each other play football”
(7) “Play sports”
(4) “Play sports” [2]
(5) “Plan activities all kinds”
(4) “For example takraw”
(5) “Play sports” [3]
(5) “Play sports is a lot of fun”
(5) “For example at Christmas we have sports”
(6) “We have fun always”
(5) “Christmas and sports” [3]
(5) “Makes us happy - think well of each other”
(4) “Christmas and sports”
(5) “Play sports and Christmas”
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73. A Vaccine for Globalization
The facilitator collected and tabulated all the scores. Table 4 depicts the central
tendencies of each prioritized change. Each change identified through the first 7 Steps of
the evaluation method were determined to be the ‘variables’ of changes that had taken
place over the previous 2 years. The facilitator took the five prioritized ‘variables’ and
with the help of some participants displayed the results on a star plot (See Figure 1).
The facilitator asked the group if they were interested in taking one of the identified
changes and repeating the evaluation process to further understand what the identified
change means to the community.
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74. A Vaccine for Globalization
Table 4: MaeChaem Rehabilitation and Development of Herbal Medicine Group
Variables of Community Change
Measures of central tendency and variability for ratings
Concepts
Cooperation
Unity
Love and Happiness
Conservation of Herbal Knowledge
Amusement
Mean
5.25
5.04
4.75
5
4.75
Median
5
5
5
5
5
Mode
5
5
5
5
5
Range (min-max)
4-7
3-7
3-6
3-7
3-7
Variables of Community Change
Star Plot
Cooperation
7
5.25
Amusement
7
7
Unity
5.04
4.75
1
5
7
Conservation of Herbal Knowledge
4.75
7
Love and Happiness
Figure 1: MaeChaem Rehabilitation and Development of Herbal Medicine Group
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75. A Vaccine for Globalization
The group decided to explore deeper into the category of ‘COOPERATION’ by
repeating Steps 1-8. The ‘Before’ and ‘After’ questions regarding the program were
adapted to have the context of ‘COOPERATION’ in mind. The evaluation was adapted a
second time and the facilitators conducted the process orally. The facilitators wrote the
participants responses on a piece of paper stuck to the wall. Table 5 lists the results of
this process.
Table 5: Cooperation Breakdown by repeating Steps 1 and 3
COOPERATION
Before (Step 1):
‘People in the community did not come in
force to meetings’
‘People did not come on time to meetings’
‘Before we were not brave to present our
opinions at the meetings’
*(this was probed further to get the
response that they did not have any
information and less schooling so we were
shy to say something)
‘We did not have an introduction to
making a group together’
‘We were isolated from each other’
‘People didn’t go to visit each other
before because travel was very
inconvenient’
‘People didn’t go to funerals because they
are afraid of ghosts’
‘People move around’
After (Step 3):
‘Everyone goes to church more, and more
willing to exchange information and ideas
at meetings’
‘Everyone came together to build the
natural irrigation system in the community
forest’
‘Everyone can say good ideas in the
meetings and some times it is hard to get
people to stop talking’
‘Have the activity of organizing groups’
‘Travel is more convenient because of the
roads and people can visit each other
regularly’
‘People go to funerals more because we
have electricity so we are not afraid to
walk at night’
‘We don’t have gambling and also have
songs, “utaa”-usually sung by the elderly,
some drinking depending on religion’
‘We go to work in the city and kids go to
study in the city so they bring back
information’
‘We have active conservation of herbal
medicine and use herbal medicine,
planting at home and at school and in the
forest’
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76. A Vaccine for Globalization
The facilitator then negotiated a ‘neutral key word’ to describe what linked the
categories of ‘Before’ and ‘After’.
Each term identified was determined to be the
‘indicator’ for ‘COOPERATION’. Table 6 lists what resulted from this process.
Table 6: Indicators for Cooperation
1.
2.
3.
4.
5.
6.
Coming together in force
Brave to express
Come together as a group
Think/do/decide together
In the habit of visiting each other
Think/make/do/decide and use beneficially together
The facilitator repeated Step 7 of rating where the community felt they were
currently. Scores were given to each indicator on the same scale of 1-7, but the group did
not write comments to justify their scores as they were running out of time. Table 7 lists
the central tendencies of each indicator.
A star plot was also displayed for group
reflection (See Figure 2).
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77. A Vaccine for Globalization
Table 7: MaeChaem Rehabilitation and Development of Herbal Medicine Group
Indicators for Cooperation
Measures of central tendency and variability for ratings
Concepts
To attend in force
Participation
Dare to express/Brave to perform
Come together as a group
Think/Do/Decide together
Visiting each other as habit
Working together for the benefit of the
community
Mean
5.13
4.96
4.67
5.83
4.75
4.88
5.17
Median
5
5
5
5
5
5
5
Mode
5,6
5
5
5
5
5
5,6
Range (min-max)
2-6
1-6
2-6
3-7
2-6
3-7
2-6
Indicators for Cooperation
Star Plot
To Attend in Force
7
Working together for the
benefit of
the community
7
7
5.13
Community
Participation
5.17
4.96
Visiting each
other as habit
7
1
4.88
4.67
7
Dare to express/
Brave to perform
4.75
5.83
7
Think/Do/Decide together
7
Come together as a group
Figure 2: MaeChaem Rehabilitation and Development of Herbal Medicine Group
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78. A Vaccine for Globalization
At the end of the meeting the facilitator hung both Star Plots on the wall and
completed the evaluation methodology by having a reflection (Step 9) on the process and
results of the evaluation. The local teacher commented that the process was “not all easy
and not all hard, but now it is enough for us to go ahead on our own”. Another teacher in
the group said she listened to what was happening and in the beginning was not sure
where the process was going, but in the end it gave her new creative ideas for doing
things in the community. A woman from the housewives group commented that “we
never did anything like this before, it is too good.” Another member of the participants
stood up and said “everyone is very satisfied with what happened today, and it is much
different than someone coming here and saying this is bad or that is good - today
everyone learned something.” Another member of the group said “now we can see
ourselves - it is very good - and we can see in the future where we should go and how far
- for myself I have not cooperated much, now I see and want to do more, I heard many
things today, it gave birth to much imagination. I believe our community will be strong.”
Overall Summary of Evaluation Results
Eleven of the 22 CBO’s participated in implementing the evaluation method
created during a series of workshops. The 11 CBO individual results are displayed in
appendix E for review.
All variables of community change, identified during the
implementation of the evaluation, were pile sorted into Social, Physical and Mixed
capital. This procedure was done by three members of ICE’s evaluation team. The three
members of the evaluation team compared results and came to a democratic consensus.
Table 8 lists the results of this process.
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79. A Vaccine for Globalization
Table 8: Pile Sort 1 – All ‘Variables’ pile sorted into Social, Physical and Mixed Capital
(number of times mentioned by a CBO in brackets)
Social Capital
Physical Capital
Mixed
Unity (8)
Participation (2)
Cooperation
Participation/Cooperation
Community Power
Togetherness
Know Friends
Thinking
and
Deciding
Together
Wisdom of Local People
Self-care with old wisdom
Hill Tribe Culture
Culture
Conservation
of
Herbal
Knowledge
Self-care with Health
Leadership in Group
Health Status
Physical Health
Community exercising groups
Sports Interest
Strong Health
Physical Exercise
Mental Health (2)
Strong Community
Family Warmth (2)
Active Compassion
Compassion
Kindness
Human Relationships
Love and Active Compassion
Happy, Joy, Gay (2)
Love and Happiness
Amusement
Community Relations
Family Life (2)
Strength
Revitalization
Education
Knowledge about Health
Interest in Learning
Learning
Knowledge about Drugs
Knowledge
Drug Prevention
Responsibility by Community
and Family
Place to Play
Resources (Funding) (2)
Local Growth/Development (2)
Networking (2)
Decreased Illness
Economic Situation
Decreased Stress (2)
Stop using Addictive Drugs
Using Free Time
Gangs
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80. A Vaccine for Globalization
Each member of ICE’s evaluation team (3) pile sorted all variables from the 11
CBO’s, with out any restriction. The three members of the evaluation team compared
results and came to a democratic consensus. Table 9 lists the results of this process.
Table 9: Pile Sort 2 – All ‘Variables’ pile sorted into similar themes
* (number of times mentioned by a CBO in brackets)
Unity (8)
Community Power
Networking (2)
Togetherness
Know Friends
Strong Community
Community Relations
Human Relationships
Strength
Wisdom of Local People
Self-care with old wisdom
Hill Tribe Culture
Culture
Conservation of Herbal Knowledge
Self-care with Health
Health Status
Physical Health
Community exercising groups
Decreased Illness
Strong Health
Mental Health (2)
Decreased Stress (2)
Revitalization
Leadership in Group
Responsibility of Community and Family
Family Warmth (2)
Active Compassion
Compassion
Kindness
Love and Active Compassion
Happy, Joy, Gay (2)
Love and Happiness
Family Life
Education
Knowledge about Health
Interest in Learning
Learning
Knowledge about Drugs
Sports Interest
Resources (Funding) (2)
Local Growth/Development
Community Development
Economic Situation
Participation
Cooperation
Participation/Cooperation
Thinking and Deciding Together
Outliers:
Amusement
Drug Prevention
Use of Addictive Drugs
Place to Play
All ‘variables’ were then compiled into a chart, based on the result of the final
pile sort, to display the frequency of similar identified ‘variables’ from all 11 CBO’s.
The quantitative results were then averaged to provide a display of scores given to each
of the 9 identified themes of community change. Table 10 lists the results of this process.
Results of all the CBO’s identified ‘variables’ were then graphed, based on the final pile
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81. A Vaccine for Globalization
sort, in order to visualize similarities and frequencies of identified changes and their
current self-assessment score among all CBO’s participating in ABCD for health
promotion (See Figure 3). See Appendix E for individual quantitative results for all 11
CBO’s who participated in the evaluation.
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82. A Vaccine for Globalization
Table 10: All ‘Variables’ identified by the 11 CBO’s and their average ‘Score”
Concepts 1-9
1. Unity
o
o
o
o
o
o
o
o
o
Unity (8)
Community Power
Networking (2)
Togetherness
Know Friends
Strong Community
Community Relations
Human Relationships
Strength
1
Community Groups 1-11
2
3
4
5
x
x
x
x
6
7
8
x
x
x
x
x
9
10
11
x
x
x
x
x
x
x
4.11 4.38
5.41
6.63
5.73
5.48
x
6.49
5.55
5.04
2. Warmth
Family Warmth (2)
Active Compassion
Compassion
Kindness
Love
and
Active
Compassion
o Happy, Joy, Gay (2)
o Love and Happiness
o Family Life
o
o
o
o
o
x
x
x
x
x
x
x
x
4.39
5.68
4.67
5.71
x
5.57
4.75
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83. A Vaccine for Globalization
Table 10: Continued
Concepts 1-9
3. Local Wisdom
Community Groups 1-11
1
2
3
4
o Wisdom of Local People x
o Self-care
with
old
wisdom
o Hill Tribe Culture
o Culture
o Conservation of Herbal
Knowledge
o Self-care with Health
4
4. Education
o
o
o
o
o
o
Education
Knowledge about Health
Interest in Learning
Learning
Knowledge about Drugs
Sports Interest
5
6
7
8
9
10
11
x
x
x
x
6.63
6.64
4.88
x
5.73
5
x
x
x
x
x
5.2
x
5.77
6.08
6.09
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84. A Vaccine for Globalization
Table 10: Continued
Concepts 1-9
5. Physical Health
Community Groups 1-11
1
2
3
4
5
6
7
8
9
10
11
x
o Health Status
o Physical Health
o Community exercising
groups
o Decreased Illness
o Strong Health
x
x
x
6.14
4.55
x
6.29
5.11
6. Resources
o Resources (Funding) (2)
o Local
Growth/Development
o Community
Development
o Economic Situation
x
x
x
x
x
4.82
2.88
5.27
7. Mental Health
o Mental Health (2)
o Decreased Stress (2)
o Revitalization
x
4.45
x
4.44
x
x
6.11
x
6.23
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85. A Vaccine for Globalization
Table 10: Continued
Concepts 1-9
8. Participation
Community Groups 1-11
1
2
3
4
x
Participation
Cooperation
Participation/Cooperation
Thinking and Deciding
Together
4.44
9. Leadership
o
o
o
o
x
o Leadership in Group
o Responsibility
of
Community and Family
3.71
Outliers
5
6
7
8
9
10
11
x
x
x
5.35
5.25
6.18
x
5.4
Amusement
Drug Prevention
Use of Addictive Drugs
Place to Play
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86. A Vaccine for Globalization
X=frequency of prioritized changes as identified by the CBO’s
Y= frequency of current scores given to identified change as determined by the CBO’s
Outliers:
Local
Wisdom
Unity
Warmth
Phys.
Health
Education
Ment.
Health
Resources
Amusement
Drug Prevention
Use of addictive
Drugs
Places to Play
Leadership
Participation
Variables of Change
Figure
3:
Frequency
of
CBO
identified
and
prioritized
‘Variables’
vs.
the
current
‘Score’
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87. A Vaccine for Globalization
Evaluation Discussion
ICE and the 22 CBO’s wanted to develop an evaluation consistent with their
ABCD approach to health promotion.
The workshops were designed to practice a
thinking process of participatory learning and collective decision-making by providing an
environment for dialogue. Some might criticize the concept of having the ‘questionmakers’ also be the ‘question-answers’.
However, others point out that when a
community has the chance to examine itself through questions created and asked to itself,
there is potential to lead to a new consciousness of ones surroundings (9). This approach
taken by ICE opened the door for the discovery of new and innovative ways to evaluate
broad societal impacts, and assisted the CBO’s in explaining these impacts to outside
funders.
During the workshops health professional and non-health professional; native
Thai, English and Lanna speakers engaged in a discussion of local health issues and
evaluation techniques.
Universal terminology was an obstacle to overcome.
For
example, the word ‘Empowerment’ is not a native Thai word. There was much debate
regarding the meaning and possible translation of this word and others. The process was
slow, and at times appeared to move in circles, but in the end it contained a great deal of
potential for the CBO’s to take ownership in learning how to self-examine their situation.
The development of the evaluation method was a learning experience for everyone
involved in the process, from community representatives to workshop facilitators.
The evaluation method developed at the workshops strongly resembles a sixelement process for empowerment evaluation described by Fawcett et al. (19). These
steps include; determine where you are now, where they would like to go, how to get
there, monitor to make sure you are on track and making progress, collect and analyze
data along the way so you can adjust course, and apply what you have learned to
strengthen the organization for the next program (19). It also relates to what Green and
Kreuter detail in the Precede-Proceed Health Promotion Planning Model, specifically
when forming a social diagnosis (44). The social diagnosis phase of the Precede-Proceed
Model is the identification and analysis of social and economic conditions, perceived
quality of life or the aspirations of the target population (44). This phase is necessary for
any thorough health promotion planning process (44).
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88. A Vaccine for Globalization
The 9 steps developed by the CBO’s stands to be criticized for its lack of
scientific rigor and objectivity. However, with regards to objectivity, it has been argued
that perhaps objectivity is gained not through detachment from the setting via an outsider,
but through intimate involvement in and reflection about the setting (19). Additionally,
the CBO’s felt a complex methodology with statistically measurable objective data
gathered solely through quantitative means, similar to their current summary reports,
would defeat the purpose of a community-wide, user-friendly and community-owned
process for evaluating broad scale societal impacts. Thus, the simplicity of the method
was its strength.
During the implementation of the evaluation method; the quality of the evaluation
was largely dependent on the facilitator. The specific skills of the facilitator directly
reflected on each community’s results, the amount of reflection and the potential
utilization of findings. For example, the clustering and categorizing steps were easily
monopolized by a few individuals if the facilitator did not make direct efforts to bring all
community members into the decision making process.
A few CBO’s took the evaluation process further by repeating the 9 steps and
developing indicators for achieving one specific identified variable. This additional
process turned out to be one of the most enlightening phases of the evaluation. However,
to deeply explore into the meaning of each variable was time consuming and challenging.
It was initially the most confusing phase because they were attempting to define and
measure very intangible concepts, i.e. ‘COOPERATION’.
The process of gathering the qualitative data was essentially much more important
then the actual scores given to each variable. The results were completely community
specific and subjective. ICE is unable to generalize or compare results among different
communities because each community defined their own variables, indicators, and
standards of acceptability. This will also make tracking changes over time difficult
because the majority of identified variables were not static, i.e. love, unity, etc. The data
did provide answers to what the changes were, however an understanding of why the
changes occurred remains up to the participants of the evaluation to determine.
The CBO’s wanted the results to be put together in an easy and understandable
format. The displayed results would be a starting point for discussion and action. Action
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89. A Vaccine for Globalization
to either change the evaluation steps to meet their needs (i.e. writing down their answers
to the before and after questions or doing the process orally), to address areas of
identified importance for future projects, and to improve current efforts. The Star Plot
provided this, however some CBO’s decided that the next time they wanted to try to
display the results in a different format.
The intention of ICE was that the evaluation method would function as a
benchmark in which CBO’s can revisit and repeat independently. However, only 11 of
the 22 CBO’s participated in the workshops and implemented the evaluation in their
communities. The 11 CBO’s who did not participate in the process expressed concern
that this author was going to ‘steal their ideas’ return to the US, patent them and leave
them empty handed. Despite ICE’s constant reassurances this was not the intention of
the author, some remained steadfast in their refusal to participate.
A representative from ThaiHealth was invited to attend the Network meeting
when the 11 CBO’s shared their evaluation results and reflected on the process. The 11
CBO’s who did not participate did not attend the Network meeting when the evaluation
results were presented. However, the participating CBO’s proudly discussed their results
and several different CBO representatives engaged in dialogue regarding what each
others definition of similar identified variables were. The ThaiHealth representative was
impressed with what the CBO’s had accomplished, and was glad to see a renewed
appreciation for evaluation among the CBO’s who participated. She was excited to hear
that one CBO had repeated the evaluation method with another community program,
without the facilitation of ICE.
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CHAPTER V: LIMITATIONS
Limitations
Overall, the study was limited by time, language, availability of CBO’s, and
personal bias. Race, gender and nationality may have influenced how people responded
to questions, or how much they shared about their opinions. Translation should also be
mentioned as Thai is not our first language for the assistant researchers; therefore errors
of interpretation may have occurred. The 3 months time frame limited the depth of
knowledge obtained by this study and limits the ability to analyze the utility of the 9-step
evaluation results, as this will be evident by future program proposal writing and
evaluation. Researchers spent only one or two days in different community settings and
recognize this provides only a glimpse into a communities’ reality.
The primary
limitation for data collection was not being able to interview all CBO representatives.
The CBO’s moving through the ABCD based process for health promotion with more
success were more likely to be present at the Expo, meetings, participating in developing
and implementing the evaluation, and invited us to visit their community. Therefore, it is
possible we missed collecting information from groups that may have been less
successful.
It is impossible in qualitative research to remove every threat to validity (45).
Although we tried to construct an objective account, our personal views may have
colored the interpretation of the data. There is no guarantee that a different investigator
would have interpreted the data in the same way. Field notes and transcripts are available
for others to analyze.
Attempts to maintain internal validity were obtained by constantly reframing and
restating an interviewee’s words during the conversation, in order to confirm intention
and concept links, and by immediate transcription. External validity of the conclusions
could be increased by another study using the same methods under similar circumstances
in another location. The conclusions are not generalizable, they are only specific to the
groups encountered and addressed in the case study. However, the processes and insights
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92. A Vaccine for Globalization
presented here may be easily transferable to another setting practicing ABCD based
approaches to health promotion and community development. Additionally, aspects of
the evaluation building process and final steps may be transferable to other settings.
Insider/Outsider Issues
As a result of the participant observation and NFG’s, community representatives
appeared to feel at ease, perhaps trusting, when talking with me about their work during
the semi-structured interviews. Many became excited and animated while telling the
story of how their community worked on their projects. They appeared comfortable with
my ability to speak their language, and ask questions about the projects with the same
words CBO representatives and community members used. As the researchers gained
acceptance into their group, reactivity declined. The participant observations and NFG’s
also helped shape the questions for the semi-structured interviews. This was fundamental
for gaining insight into how they viewed their work, where ideas came from, and how
they framed struggles and successes.
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CHAPTER VI: CONCLUSIONS AND RECOMMENDATIONS
Conclusions
This case study has provided valuable information about community perspectives
related to ABCD approaches and a context specific method to evaluate social changes
among people-led community health and development programs in Chiang Mai Thailand.
The original purpose of this case study was two fold; first to describe one group’s effort
in hopes of shedding light on how the ABCD approach is perceived by community
groups, and the second refers back to the question, ‘if the ABCD approach claims to lead
to community empowerment and self-determination, as written in the ICE program
‘Increasing Community Capacity for Health Promotion and Well Being Project’ how can
these CBO’s measure these potential changes in their communities?’
Based on analysis of the data, every CBO who was part of this investigation
believes their ABCD based approach to health promotion and community development
is; leading to positive changes in their communities, and different from other health and
community development programs they were exposed to in the past. Perhaps this is
because they now have an alternative to hold up against the standard needs-based
approach, making comparison and contrast meaningful.
Additionally, the resulting
evaluation method, based on the concepts of participation and empowerment,
incorporated social, cultural, environmental and political factors into the evaluation of
outcomes and impacts of their health promotion programs.
Despite the lack of
generalizability, ICE and their research assistants pile sorted all variables resulting in 9
separate categories; unity, warmth, local wisdom, education, physical health, resources,
mental health, participation and leadership. When looking at the three most identified
changes; unity, warmth and local wisdom, which can be classified as social capital, can
we answer yes to the question; Does ABCD approaches lead to empowerment and selfdetermination? We believe the answer is a resounding yes and will argue that the ABCD
approach does in fact lead to empowerment and self-determination as evidenced by the
top three mentioned variables; unity, warmth and local wisdom. Therefore, ICE and the
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95. A Vaccine for Globalization
CBO’s were successful in developing a way to evaluate and translate what they ‘see
happening in their community’ into ‘measurable variables and indicators’.
The evaluation results will be used to supplement quantitative reports submitted
to funders for the purpose of showing evidence of the broad social changes taking place
in their communities. The self-identification and definition of these community changes;
unity, local wisdom, education, love, etc., elicited through the facilitation of community
dialogue will be used to assist in the design and implementation of future health
promotion programs. The 9 – step evaluation method developed by the CBO’s during
three workshops will be incorporated into a facilitator guide produced by ICE to assist in
conducting future workshops and evaluations with local CBO’s.
The process of developing and implementing the evaluation has potential to lead
to improved future development practices because community specific, reliable methods
were created to gather data that is meaningful to the community, in addition to being
respected by the ‘professional’.
Perhaps someday, overwhelming evidence will exist to shift the balance of health
services and community development initiatives from top-down, problem-oriented,
outsider defined, funded and researched, to a more local bottom-up, strength-based
orientations. Otherwise, institutions will continue to teach deficiency oriented methods
as the preferred approach for public health and community development, thus making
sustainable empowering community development an unattained dream for the majority of
the world’s people, most especially those groups considered marginalized.
Recommendations
Recommendations for ICE include focusing on the difficulties mentioned by CBO
representatives including the issues of time, communication, and evaluation.
Communication alternatives could be explored by rotating the location of the monthly
meetings.
Coordinating the development of CBO and Network timelines detailing
upcoming deadlines might also be considered. Providing representatives with more
workshops on negotiation and leadership could also be explored.
Many CBO
representatives stated program writing and evaluation were areas they wanted to improve.
The second purpose of this case study was to describe how ICE and 11 CBO’s
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successfully developed a method to identify and evaluate social changes within their
communities secondary to their health promotion programs. The CBO’s accepted the
challenge of learning how to evaluate outcomes and impacts of their programs with the
hope of generating action to transform social structures and conditions that oppress them.
ICE could have easily compiled a prefabricated list of variables and indicators, based on
a literature review, and conducted an evaluation to identify outcomes and impacts with
the mindset of “Why do these CBO’s need to develop and implement their own
evaluation?” This author feels there are reasons, too many to count, for why these CBO’s
are labeled ‘marginalized’ and considered hopelessly stuck in the ‘vicious cycle of
poverty’. The most significant reason for what keeps them ‘stuck’ or ‘marginalized’ is
their dependency on local and international ‘elites’ or ‘professionals’ (9). However, one
is naïve to think that global interdependence is not an inevitable fact of life. With these
factors in mind, ICE and these CBO’s collectively believed the key to stopping the
‘vicious cycle of poverty’ lies in trying to balance the equation of inside and outside
responsibility in order to break the cycle. They understand that empowerment and
development cannot be transplanted from the outside, but instead must come from within.
This case study hopes to raise critical consciousnesses of health professionals,
both practitioners and community development workers in respecting people-led
processes, working to counter institutions and systems whose aims are to derail and
devalue the process, and recognizing that the creation of an environment which allows for
genuine dialogue, or two-way communication, holds potential to lead to group cohesion,
maintenance of cultural identity, sustainable social transformation, and increased quality
of life. Additionally, efforts should be made to balance the overwhelming dominance of
needs based public health programming by finding ways to include or collaborate with
those interested in ABCD based strategies. The process clearly takes time, as all are
engaged in co-learning; however, based on the case study presented here the benefits
clearly outweigh the investment. Continued efforts to make community representatives
voices, opinions, critiques and insights part of the community development and public
health dialogue are fundamental.
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Institute of Planners. July, 1969, pp. 216-224.
Castelloe, P., Watson, T., & White, C (2002). Participatory change:
An innovative approach to community practice. Journal of Community Practice,
10(4), 7-32.
Community Based Monitoring and Evaluation Team: Sleeping on our own Mats: An
Introductory Guide to Community Based Monitoring and Evaluation. The World
Bank, Rural Development II, Africa Region. October 2002.
Community Tool Box. Accessed 12/2/03. http://ctb.ukans.edu
Cooke, B. and Kothari, U. Participation the New Tyranny? St. Martin’s Press, New
York, NY. 2001.
de Negri, B., et al., (1998). Empowering Communities: Participatory techniques for
Community Based Program Development. Volume 1(2): Trainer’s Manual.
Nairobi, Kenya: Center for African Family Studies in Collaboration with Johns
Hopkins University Center for Communication Programs and the Academy for
Educational Development.
Elliott, C. (1999). Locating the energy for change: An introduction to appreciative
inquiry. Winnipeg, MB: International Institute for Sustainable Development, (in
Mathie, A. and Cunningham, G).
Fetterman, D. (2001). Foundations of Empowerment Evaluation. Thousand Oaks: Sage
Publications.
Freire, P. (1985). The Politics of Education: Culture, Power, and Liberation. NY: Bergin
and Garvey.
International Institute for Sustainable Development. Appreciative Inquiry and
Community Development. Retrieved May 1, 2004. Website:
http://www.iisd.org/ai/default.htm.
Participants at the 1994 Indicators of Sustainability Conference and Workshop organized
by SANREM (the Sustainable Agriculture and Natural Resource Management
Collaborative Research Support Programme)
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Patti-Jean Naylor, Joan Wharf-Higgins, Lynne Blair, Lawrence Green, Brian O’Connor.
Evaluating the participatory process in a community-based heart health project.
Social Science and Medicine. Vol. 55, 1173-1187. 2002
Robert Chambers. Whose Reality Counts? Putting the First Last. Intermediate
Technology Publications, 1997.
UNAIDS Thailand : Epidemiological fact sheets on HIV/AIDS and sexually transmitted
infections 2002 update FactSheet - 1/1/2002 –UNAIDS, UNICEF, WHO.
Retrieved May 10, 2004. Website:
http://www.unaids.org/html/pub/publications/fact- sheets01/Thailand
Varkevisser C.M. et al. Designing and Conducting Health Systems Research Projects.
International Development Research Centre, Ontario, Canada. 1991.
Werner, D., (1997). Questioning the Solution: The Politics of Primary Health Care and
Child Survival. Palo Alto: HealthWrights.
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Table 11: Types of Community Development Approaches: Definitions, Strengths and Weaknesses
(Adapted from Castelloe and Watson 2002, and Mathie and Cunningham, 2002)
Community
Organizing
(Alinsky, 1973)
Popular Education
(Freire, 1970)
Participatory
Development
(Chambers1997)
Assets Based
(McKnight and Kretzman, 1993)
Definition
An outside organizer
enters a community,
and
mobilizes
citizens around a
particular injustice.
Involves
education
and dialogue based on
interactive
colearning, resulting in
raised
levels
of
critical consciousness,
leading
to
group
action.
Community
members
control,
develop
and
organize
their
own
development, thus building
capacity and sustainability.
Starts with what is present in a
community by building on individual
and community talents, skills and
assets (rather than problems and
needs). Internal focus on forming
local relationships, communitydriven development, and limits
dependency on external agencies
Strengths
-Reaches
out
to
citizens by forming a
group.
-Focused on building
strategies
for
fundamental system
change.
-Useful if groups
already exist.
-Dialogic co-learning
promotes equity.
-Group process as a
focus.
-Emphasis
on
analyzing broad social
constructs that result
in injustice.
-Focus usually on -Less emphasis on
only one issue.
guiding how a project
-Lack of focus on might flow.
broad social issues.
-Little discussion on
-Less emphasis on actual group building.
individual learning.
-Uses PRA for assessment,
planning, implementation.
-Control
by
the
community.
-Emphasis on the capacity
of grassroots groups in an
effort
to
ensure
sustainability.
-Provides a method to construct a
shared meaning.
-Recognizes the value of social
capitol.
-Values strengths regardless of power
imbalances.
-Avoids dependency on outsiders.
-Emphasizes local networks for
economic development.
-Rarely used to analyze
social, cultural, political or
economic forces that result
in oppression.
-Varied
definitions of
participation.
(*see appendix, C)
-Level of interaction with external
resources unclear.
-Need to ensure inclusion of
marginalized groups.
-Concern over participation given
cultural hierarchies.
-Need an enabling environment.
-No clear direction in terms of what
happens if leadership becomes
formalized.
Weaknesses
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Table 12: Qualitative Inquiry Activities
CBO
Participant
Informal
Observation
Discussions
and (IFGD)
Site Visit
1.
Mae X
Chaem
X
X
2. Mae Ba X
Kee
X
x
3.
Yang
X
X
Nong X
4. Ban
HuayBong
X
x
5. Ban Nong X
Wai
(muaythai)
6.
X
SriBauLuang
7.
Ban X
MaeJong
x
x
x
8.
Lanna X
Healer
Fellowship
x
9.
Ban X
BinDok
10. Society X
of
Lanna
Healers
11. SaLuang X
x
X
X
12. Nong Hoi X
X
Semi-Structured
Interview
Respondent(s) and their
role in the community
X (2 CBO reps who are
teachers
in
the
community and approx
8 teens)
X (2 CBO reps; 1
Teacher of religion and
1
Comm
Dev
Volunteer, and 8 teens
X (1CBO rep who is a
part time community
health worker)
X (1 CBO rep who is a
village
health
volunteer)
X (1 CBO rep who is a
coach of Thai boxing
X (1CBO rep who is a
farmer)
X (1 CBO rep who is
the principal of the
school and 3 teachers)
X (1 CBO rep who was
the leader of the Lanna
Healer Fellowship)
X (2 CBO reps; 1
village headman and 1
active
community
member
X (1 CBO rep who is a
Lanna Healer)
X
X (2 CBO reps; 1
Lanna Healer and 1
Comm Dev Worker)
13. Sri Poom X
X (2 CBO reps both
teachers, and 8 teens)
(The small x refers to visiting that site, but with the purpose of doing a different activity.)
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Table 13: Themes with illustrations
Themes
Example (I1, I2 means interview one, interview two etc.)
“The project came from the ideas of the community, they
wanted to do this. It is the thinking of the villagers” (I1)
Independent
Ideas
“It is the ideas of the villagers, they are the ones that decide
(freedom-‘eesalaa’)
what to do and they talk to understand the problem. It is not
from the top (upstairs), no one is going to make us live the way
they think by giving us a project, we came together to do this
the way we though we should, and we did it together…”(I2)
Co-operation
“Many groups came together to do this, youth, elderly,
(‘quamruammeugan’
directly
translated women…”(I1)
means, a feeling of all
“we accept anyone who is interesting in doing
hands together)
something…”(I2)
“All hearts together and all thinking together, if we don’t we
can’t live together.” (I7)
Acceptance
“no one is left out…”(I6)
“The villagers used to accept programs from the top all the
time…now they think themselves and propose programs to the
System reversal
(examples here are top.” (I1)
macro I1 and micro
“If we don’t begin to do this, we would not be able to get
I2)
anyone together in order to think about some of our current
problems, and the problems will stay.” (I2)
“They are proud of themselves, they did not think they could
to it…now they can see it with their face and eyes that the
Pride/Esteem
(pride-‘poomjai’ jai is community can do it…The work they do leads to peace and
the word for heart, pride for the community” (I1)
poom is similar to full
or swollen, so together “If it is their own thinking they will be proud of themselves,
is means a full hearted and they will have the experience of problem solving, this will
be a fire and let them to do good things in the future, when
feeling.)
they encounter a difficulty they will be able to use the
experience for solving problems.” (I5)
“…we (the community) feel proud, proud, proud, they (the
members of the community) feel they can help themselves,
teach others and help their families (using herbal medicine).”
(I10)
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Themes
Community Dialogue
(These examples show
relationship building,
recognition of social
assets
and
the
development
of
critical
consciousness).
Example (I1, I2 means interview one, interview two etc.)
“When they meet they are able to speak and listen and
exchange together…” (I1)
“We think together, we want the home family and school to
work together, (teachers, monks, parents, youth,) we all come
together to discuss the current problem, where they come from
and why…” (I5)
“Working in the community is the most difficult because we
have no right to be there, we are not the leaders of the village.
Collaboration in our own villages can be a problem; (at the
same time) collaboration is probably what made the program
work.” (I5)
“You have to do this kind of work with your heart, and have
unity in making a network for your project, the funding is
important we can’t do it by ourselves, villagers don’t have the
money to support this work directly…”
“People started communicating.” (I11)
Community
Power
(empowerment?)
(‘palang’ is the word
for power, ‘chumchom
mi palang’, means the
community has power.
There is no native
for
word
empowerment,
the
translation is ‘serm
sang palang’, ‘serm’
means fill or renovate
and ‘sang’ is to build.
So, it is to renovate or
build power that may
already be there.)
“In the past the villagers did not know the power of
community, now they have a group that brings them
together…everyone is accepted.” (I1)
“we have more power from pride, we can’t study very high,
and we don’t have a monthly salary in the 10,000’s we make
enough to keep our families, we want to use our time to work
for others, and that we have a lot, this is our pride (motivation)
and we can do it, this is what we want to do the happiness of
the people in our village, our friends, it is our happiness as
well. This is the kind of power that we have, and the power
that we have not yet used.” (I2)
“This is a good project for everyone, because it builds
individual and community power for health promotion and
better development…and the kids learn leadership skills…”
(I10)
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Themes
Example (I1, I2 means interview one, interview two etc.)
Traditional Culture
(culture- watanatam”)
“The study of wisdom of the old culture is a big concern
because now everyone is studying high tech and the traditional
wisdom is being lost, there is no school requirement for this.”
(I5)
“We are similar (to other health programs) because we are
working on issues like drugs, AIDS, and using time usefully,
but different because we recognize that no one wants anyone
else to know they are involved in something related to a
problem. So, we look to our traditional way of life, see what
we can learn from our culture, and build activities around those
positive things.” (I4)
Thoughts on Outsiders “why don’t they (funders) support us why don’t they give it to
us, in our village our own donations are so little, people here
have bad economic situations and only make enough to eat.
The problem is they (the funders) don’t’ believe that we can do
it, why is that? Why don’t they believe in us? That is the
problem.” (I2)
“Maybe there is funding from the outside, but I don’t want it,
why is it that our own country of Thailand is not helping
us.”(I2)
“The only thing the community learns from programs coming
from the outside is to wait, wait, wait for the next program to
come and give you something. We have forgotten to think for
ourselves.” (I7)
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Themes
Example (I1, I2 means interview one, interview two etc.)
“Because now we have friends that feel the same way we do,
How do you think and we have a network for loving the environment, we can
your community is think and plan activities together…” (I4)
building or renovating
“Absolutely! From this experience students will have power in
power
their hearts and bodies for working in the community and
(empowerment)?
society. They will have the experience of thinking for
themselves, and doing things for themselves.” (I5)
“If it is their own thinking they will be proud of themselves,
and they will have the experience of problem solving, this will
be a fire and let them to do good things in the future, when
they encounter a difficulty they will be able to use the
experience for solving problems.” (I5)
“This process is empowering because people accept their own
problems, identify their own knowledge, set their purpose and
goals, choose methods for problem solving and do by
themselves. They have the experience from their efforts and
they evaluate what they have done by themselves.” (I6)
“Because it builds the feeling of conservation and uses things
that we already have for a benefit.” (I4)
“it builds unity with nearby villages, before we were isolated
from each other and never had any coordinated activities to
raise consciousness about nutrition and health” (I7)
“We show other villages the elderly group here, and they get
excited and go to the office and make their own group.” (I11)
“Because we (parents, development workers, village headman)
are working together honestly, and we all understand each
other better.” (I3)
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Appendix A: ICE Proposal
The Research Proposal
“Challenges of Health in a Borderless World”
TITLE
Increasing Community Capacity and Empowering Community
Members to Improve the Health and Well-Being of Chiang Mai
Hilltribes and Low-income Groups in 3 Thai Districts
TYPE OF RESEARCH Participatory Action Research
OVERALL GOALS
•
•
•
To determine how to improve implementation and effectiveness in promoting the integral
development of youth, seniors and women in Hilltribes and low income communities while
increasing community cohesion and collaboration through cultural, political, social and
artistic activities;
To determine how to improve implementation and effectiveness in promoting development
of skills among sub-district administration/organization and municipality personnel in the
area of community development;
To determine how to improve implementation and effectiveness in promoting creation of
community partnerships by local actors for health promotion.
PROJECT SIGNIFICANCE AND HEALTH ISSUES INVOLVED
Recently, Chiang Mai was chosen as the pilot province from which to implement universal
coverage health insurance beginning June 1, 2001. Apart from this national innovation public
health project, Chiang Mai pilot is one of 15 sites throughout the country, which form part of an
initiative for health-care decentralization to local government and health-care reform. This project
will be launched in October 1, 2001.
The innovation model of this health decentralization is establishing of the new form of health
local autonomy which called “ The Area Health Board or the Provincial Health Board .”
The Area Health Board will be comprised of 3 parties, namely representatives from local
government organizations, representatives from the popular sectors in communities or civil
society and representatives from the ministry of public health. It means that the current health
system reforms in Thailand need to be contributed by the popular sector. And yet, there is still a
desperate need to encourage strategies of increasing and strengthening community capacity and
empowerment given the persistence of inequities in health.
Producing better health and improving quality of life at individual and collection levels need
building community capacity for action oriented at changing living conditions. Community
participation is not possible in a vacuum, people need incentive to participate and the best
incentive is to provide the opportunity to solve problems and issues that effective daily life.
All activities in this project will be focused on inspiring experiences of community participation
and empowerment of powerless and marginalized groups those who are in highland communities
(hilltribes), sub-urban communities and urban communities.
In working with communities to promote health, several abilities and skills from diverse
disciplines and fields are needed. For example include advocacy, negotiation, policy formulation,
strategies for community development of social networks, participatory techniques and social
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action communication. Concentrating in the problem-solving capacities of communities is
essential for obtaining success in participatory work.
Increasing and strengthening community capacity will help powerless people to help themselves.
Not only addressing poverty and social need at local level but also address the complex subject of
building community capacity for action oriented at changing living conditions, producing better
health and improving quality of life at the individual and collective levels.
Recognizing almost all action as political, participatory action-research assumes that work has
implications for the distribution of power in society and that control of the production of
knowledge is central to the maintenance of power. Attempts to upset the status quo and introduce
more democratic procedures necessitate active involvement in distribution of power, relation
between social groups, and the production of knowledge.
THE SPECIFIC ACTIVITIES:
5. 1 How will the project be implemented?
To make communities get involved and develop their own capacity:
Participatory Action Techniques, e.g. focus groups, Delphi, consensus development, participatory
planning, future search conference and logical framework etc., will be used to stimulate
community participation, the focus to be maintained is the assessment of the situation and
prioritization of needs and problems made by citizens. Identification of problems and needs is the
best starting point for community capacity building and the goal is the participation of those who
have never had the opportunity of being heard;
A new strategy, “asset-based community development” developed by Kretzman and Mcknight
(1993) will be used. It is an innovative methodology that “leads toward the development of
policies and activities based on the capacities, skills, and assets of lower income people and their
neighborhoods”. The map of community assets provide a tool for discovering individual and
collective capacities and talent, as opposed to the usual practice: making an
inventory
of
deficiencies of individuals or communities. It recognizes that each individual has talents,
abilities, interests, and experiences that constitute a valuable arsenals that can e used for
community development.
The “alternative path of asset-based, internally focused, and relationship-driven” map is a
comprehensive inventory of all possible capabilities of a local community. The community assets
map includes not only individual’s strengths but also citizen associations like churches, clubs,
cultural groups, and local institution like schools, libraries, hospitals, parks, etc. Internally
focused refers to concentrating on the problems solving capacities of the community. Together
they provide answers for building or rebuilding relationships between and among individuals,
local association organizations and institutions.
The community epidemiology approach will be applied by using small communities/groups as the
starting point to build larger and multi centric aggregates, where the individuality and cultural
characteristics of a given group are not lost or subsumed. This approach allows moving
progressively towards great integration between communities. All partners will be expected to
reach consensus and committed themselves to achieve their desired health goals.
Development of community partnerships.
For the real approach to community participation, the commitments should be made for
establishing “co-partnership” in health. This approach implies community involvement at high
decision making levels in health service administration, in quality control activities and in
establishing transparent financial resources management procedures at institutional levels.
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At the community level, workshops and education activities for improving community
organization and support, technical assistance for community groups and provision of appropriate
spaces for discussions, negotiation and consensus building will be implemented.
Strategies, skills, and resources for working together;
Health care institution like community hospitals and health centers will invite NGOs and CBOs to
join partnerships as “co-partners”.
Workshops for health workers in community participation methods and strategies as a way to
improve the health of the communities will be conducted.
Skills such as advocacy, mediation, social action communication, negotiation, policy formation,
abilities in resolving interest conflicts and consensus building will be trained as participatory
action learning.
5.2 How will the proposed activities promote dialogue and dissemination of
information about development ?
By providing local-local dialogue meetings workshops, seminars and future search conferences
participants will conduct 2 ways communications, participatory planning process and
participatory action-learning which promote dialogue and dissemination of information about
community development;
1-With culture and socio-political approaches, participants will gain the maturation of community
participation process and strategies as a way to improve the health of communities;
2-It is believed that local-local dialogue creates awareness, develops communication and forges
collaboration among local actors. In some cases, it can be described as a forum for conflict
resolution, providing an opportunity to forge partnerships where mistrust and conflict have
prevailed and to focus community action on issues that directly affect everyone.
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5.3 Describe the project timeframe on how the it will take place?
A one-year project timeframe in which the project will take place.
Month
1 2 3
Activities
4
5
6
7
8
9
10 11 12
1. Asset-based community development
- Develop the community assets map
in 5 sub-districts of Mae Cham
district and 2 municipalities of
Muang and Sansai districts.
- Community epidemiology approach.
2. Future Search Conferences among
NGOs. CBOs, local authorities in
participatory planning
- Two (3 days) meetings in Mae Cham
district
- A 3 days meeting in Muang District
- A 3 days meeting in Sansai District
3.
Training Workshop on:
- Health Promotion: New Public
Health
- Advocacy & Mediation
- Team Building and Leadership
- Social Action Communication
- Community Radio (CR): How to be
the local DJ and produce good CR
program
4. Coordinated Action by multiple actors,
sectors
5. Monitoring
and
Evaluation
participatory ME Team
by
6. Evaluation Conference (2 days)
7. Reporting
5.4 Organizational Arrangement and Autonomous Provider Network:
6 TARGET
• Twenty-one community based organizations in 3 districts will be setup.The youth, seniors
and women in low income communities would actively involve in public decision making
processes to ensure that practical gender and group interests are adequately address to
appropriate healthy public policies and programs conducive to their own positive health and
quality of life;
• Five local administration organizations and 2 municipalities in 3 districts will be provided
with training in principles of community development and health education. The Sub-district
Administration Organizations (SAOs) and municipality members, community leaders include
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•
youth, seniors and women would develop community capacity include community
participation, leadership, rich social networks, ability to articulate values, sense of history,
sense of community, critical reflection, ability to bring in sources, skills, and ability to exert
power;
Co-ordinated actions by multiple actors or sectors in 3 districts will be performed. At local
level, local actors which are CBOs, NGOs, SAOs and municipality members, would work
together to improve the conditions of rural poor and to influence healthy public policy at local
and provincial levels.
7 EVALUATION
What are the specific outcomes and how will these be tracked and measured?
Describe who the activities will benefit and the expected impact of activities;
Describe how you will measure the effectiveness of your activities.
SAOs and municipality members involved in the project will gain skills and abilities necessary to
identify and analyze community problems; with particular concern to working plan training and
using development program to help solve community problems.
CBOs members involved the project will directly gain skills and experiences in working together.
Low income and marginalized populations involved in the project will acquire instruments to
reduce the burden of poverty and other causes of social exclusion.
The expected impact of activities is concrete mechanism to energize social change. The most
practical approach to success is to stimulate and support participatory movements at the
community level. It is expected that CBOs, and local authorities will create the right
opportunities for participation, negotiation and consensus building not only in health issue but
also environmental protection and resource management issues.
It is rather difficult to measure the effectiveness of activities in this project because they are
cultural-socio-political interventions.
Anyhow, several key aspects need highlighting here. First, it should be based on the contextual
situation of each place where the project is implemented. In other words, there is not a unique list
of indicators for evaluating cultural-socio-political processes. Second, evaluation should be
participatory. Community should be involved in the evaluation process. Third there is general
agreement that evaluation should be both quantitative and qualitative. Fourth, this communitybased project is given-short-term funding and insufficient time to develop the groundwork. Just
as the seeds for change are beginning to be established project money is withdrawn. It is
important to find out appropriate criteria of evaluation of the effectiveness of the project
activities.
Measurement of changes in community capacity is still many ways in their infancy. Anyhow, an
attempt will be made to assess community participation, which illustrate enhanced community
capacity:
Extension: who participate and who does not?
Depth of intensity: in which type of activities do they participate?
Modalities: in what ways do people choose to participate?
Impact: what are the impacts of achieving health goals?
Sustainability: how is better participation assured for the future?
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New-conceptualizations of community building stress many of the same principle within an
overall approach that focuses on community growth and change from the inside through
increased group identification
discovery, nurturing and mapping of community assets,
creation of critical consciousness,
all toward the end of build stronger and more caring community
Participatory, empowering type of evaluation are especially suited to the principles, goals and
methods of community initiatives, all of which include collaboration and capacity building as
desired out-comes.
There is 6-element process for empowerment evaluation. These 6 steps provide the framework
for the following dissension of empowerment evaluation methodology, using the metaphor of the
process as a journey.
Participants determine where they are now (Step I), where they would like to go (Step II) and
how to get there (Step III), they monitor the journey to make sure that they collect and analyze
making progress (Step IV). They collect and analyze new information a long way so that the
project can adjust its course, if necessary in response to changing conditions or unexpected results
(Step V). Finally, they support what they have learned to strengthen the organization and
prepare for the next journey (Step VI).
The ‘participant’ referred to have included volunteers, staff, organizers, and members of the
community active in the project and intended beneficiaries. Support team referees to the
professional evaluators and related staff.
Step I: Assessing community concern and resource.
Where we are now?
The support team assists local participants in doing and inventory community asset needs
program strengths and weakness. It is critical that the local community becomes involved and
gains trust and ownership of the evaluation process during this initial period.
Methods
Community meeting
Focus group
Interview
Survey
Community mapping
Step II: Setting a mission and objectives.
Where do we want to go?
Community members lay the foundation for evaluation by establishing realistic criteria for
success and improvement. The principle activities if this step is a facilitated group meeting that
includes creative brainstorming, sorting and categorizing of ideas critical discussion and
prioritizing based agreed-upon criteria, and reach of consensus.
Step III: Developing strategies and action plan. How will we get there?
Community members develop a set of strategies for accomplishing project goals and objectives.
The outline of action plans can be sketched out in the strategy development meeting, with detail
determined latter by smaller subgroups.
Step IV: Monitoring process and outcomes.
How do we know we are on track?
Evaluators help participants determine what type of evidence is needed to document progress
toward their goals. The team must develop monitoring systems that are realistic and make best
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use of community resources. Documentation include periodic written activity logs or reports
tracking of key events, port folios, interviews, surveys, observation and community data for
change such as in the rate of disease or injury.
Step V Community information to relevant audiences.
Who need to be notified along the way?
Participants and community at large can be engage in reflection, interpretation of meaning,
problem-solving, based on evaluation data, to improve the project or take advantage of new
opportunities. Communication method can include written reports, community meetings,
newsletter, and presentations at meeting coalitions and other forums.
Step VI: Promoting adaptation, renewal, and institutionalization.
How can we use what we have learned to prepare for the next journey?
Evaluation findings must be acted upon to be useful to the community. Evaluators help
participants use the lessons learned to strengthen future action. The support team uses
organization development, facilitation, and training skills to help strengthen its leadership and
structure, integrate evaluation into ongoing operations. Building capacity includes striving for
sustainability of hard-won improvements.
8 PARTNERSHIP TO IMPLEMENT ACTIVITIES
Partnership to implement activities will comprise of NGOs, CBOs and local authorities in 3
districts of Chiang Mai Province.
NGOs include the Campaign Committee for Local Autonomy (CCLA), the Pgazk’ Nyau
Association for Social and Environmental Development (PASED), Institute of Community
Empowerment (ICE) and the Northern Co-ordination Center for Community Based Organizations
(NCCCBO) will link with networks and facilitate workshops and assist in technical skills.
CBOs include members of youth, senior, and women community based organizations from 5 subdistrict in Mae Cham District and 2 sub-district in Muang District will take strong participation
and mobilize community. Even though they lack participatory experiences, poor organization
skills, poor networking, and lack of collective initiative, activities in this project will help build
networks, build organization skill and build collective initiative.
Local Authorities include members of CAOs from 5 sub-district in Mae Cham District and
members of municipality from sub-districts in Muang and San Sai Districts will participated in
decision making processes, implement project and sustain project. Although they lack technical
capacity, lack credibility with community activities in this project will help initiate dialogues,
encourage co-operation with CBOs and NGOs.
9 EXPANSION
After the participatory action process, participants will use the lessons learned to strengthen
future action. Crucial future expansion of the project will be in strengthening networks among
communities not only for health, but also for environmental issues and education. The success of
this project in terms of concrete improvements in the health and educational status of community
members will persuade popular sectors of the possibilities for real community participation in the
future.
At the end of the one year program, it will be expected that grass-root groups would recognize
and develop their assets and abilities in order to participate in decision – making. Genuine
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116. A Vaccine for Globalization
participation will in turn provide opportunities to choose healthy lifestyles and practical methods
for developing programs to enhance community development.
When a community shares ownership of goals, process, and skill, the loop of community capacity
begins to move like a spiral rotation creating accelerated movement. Community-wide initiatives
and community organizing typically address complex problems with multiple interrelated causes
in a trial and error fashion. Success requires patience, persistence and compromise because
multiple constituencies may be affected in multiple ways.
With respect to the innovative aspects of this proposed project for increasing community capacity
and community empowerment, best practices will be documented and replicated to hopefully
provide other communities with alternative models. After exchanging ideas and learning from
this project, other communities may adopt this innovative model as “early adopters” to help
themselves in community development.
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Appendix B: Overview of Project Operations
Duration for all projects was May 1,2002-April 30, 2003
Data for this table was obtained from the translation of an external evaluation document completed at the request of the Thai Health
Foundation. Some data may be missing secondary to translation errors.
Overall Summary of Projects and Activities
Classification (topic focus)
Exercise Promotion
Health Education
Narcotic Prevention
Conservation of Local Wisdom
Community Care for Health
Total
Number of Projects
2
8
3
7
2
22
Classification (target focus)
Traditional Medicine
Youth Group
Elderly Group
Tribal Group
Special Project
5
7
4
4
2
Project Name
Location
1. Developing Potential T. San Pa Pao
among the Elderly for A. San Sai
Health (578)
Budget
(40baht=$1)
44,500 B, $1112.50
Budget (40B=One dollar)
156,107B
764,170B
337,115B
1,098,295B
172,800B
2,526,587B ($63,164.68)
Activities
Target Group
Actual
-Elderly meetings
-Seminars
-Income
generation
activities
60 persons
89-100 persons
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118. A Vaccine for Globalization
Project Name
Location
2.
Lanna Healer A. Muang
Community
Health
Promotion (561)
Budget
(40baht=$1)
659,100B,
$16,477.50
Activities
Target Group
Actual
-Promotion of Fong Gern
(Lanna movements) for
exercise
-Self and family massage
-Health Care by Lanna
Wisdom
-Teaching and Learning
Promotion of Health
through Lanna Wisdom
-Herbal
garden
promotion.
330
200
330
360
250
80
30
25-30
-Lanna
Medicine
Campaign
-Lanna Medicine Quality
Development
-Study and breeding
stock of rare herbs
3.
Self Reliable T. HangDong
Community
Health A. HangDong
Development (570)
105,00B, $262.50
28 villages, (more than expected)
532 Families
no
specific in general numbers
of men and women
numbers
are about equal
available
-Seminars for Traditional 15
Medicine exchange
-Demonstrations
-Courses of instruction 30
massage, 45
including;
compress making, herb
use.
15
70
10
(30elderly,
monks, 8 students,
government
5
officers)
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119. A Vaccine for Globalization
Project Name
Location
4.
Herbs for Health T. SaLuang
(573)
A. MaeRim
Budget
(40baht=$1)
104,400B, $2610
5. Restoring Knowledge T. SanSaiLuang 52,600B, $1315
of using Herbs in the A. SanSai
Family and Traditional
Medicine
Promotion
(574)
6. Promoting, Restoring T. SanSai
and Conserving Thai A. Prao
Traditional
Medicine
and Wisdom (575)
53,400B, $1335
Activities
Target Group
Actual
-Village Meetings
-Trekking to Survey
Herbs in the Forest
-Newsletter
-Herb Text Book
-Food Contesting
-Seminars
-Village Meetings
-Herbal Book
-Study Visits
120
70
150
100
200
500
100
200
50
100
-Study Tour
-Student Training
Breeding Plants
55 elderly in
the village, 25
family of the
elderly, and
10 interested
others
60
and 60
14 villages
7. Creating Supportive T. MaeFaekMai 104,112B, $2602.80
Relationships for Health A. SanSai
between
Children,
Youth and Elderly (576)
-Village Meetings
-Elderly Group Meetings
-Traditional
Music
Activity
-Family Camp
Overall more than
100
72
38
9 villages
40
40
85 joined by 85 joined by 5VHW
5VHW
50 youth
30 youth
30 Families
10 Families
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120. A Vaccine for Globalization
Project Name
Location
8. Research for Health T. TaladYai
Promotion in School and A. Doisaket
Community
9. Health Promotion in
the area of Sri Boon
Luang Health Station
10. Promoting Exercise
for
Health
and
Development
of
Learning
Process
Among 3 age Groups
11.
Building the
Strength of Spiritual
Leaders
Network
“Dtala” among Lahu
Tribe (580)
12.
Restoring and
Developing Indigenous
Knowledge
for
Community Health Care
(581)
Budget
(40baht=$1)
80,000B, $2000
Activities
Target Group
Actual
Students 50
50
Community
1800
1800
T. Mae Lao
A. Mae Eye
55,100B, $1377.50
now
26 Dtala from Network
-Village Meetings
connects 48 villages
-Follow up meetings for 16 villages
problem solving
T. Jam Luang
A. MaeJam
60,845B, $1521.13
-Recover and Reinforce
Elderly Wisdom
-Transmit Wisdom to
Teacher 5
youth
Student 17
-Study Tour
17
Teacher 5
Student 20
25
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Project Name
Location
13.
Restoring and T. SanSai
Developing Leadership A. Prao
Capability
for
Community Health Care
of MaeBaKee (582)
14. Herb Conservation T. SanPaPao
and Caring for Health A. SanSai
(583)
Budget
(40baht=$1)
62,555B, $1563.88
Activities
63,000B, $1575
Target Group
-Herbal Seminars
-Fence building and trash
disposal
-Herbal
Medicine
instruction
-Leadership development
among youth
-Reproductive
health
education for youth
30 elderly,
60 housewives,
50 youth
50
-Trekking to Survey
Herbs
-Use of Herbs Training
15.
Encourage
and
Support for training
youth in Thai Boxing in
order
to
oppose
narcotics (584)
16.
Lively Family
Development for Strong
Community free from
Narcotics (585)
T. MaeFak
A. SanSai
Actual
50-60
104,122B, $2603.05
T. NongYang
A. SanSai
63,000B, $1575
15/day
15/day
40 (6 female)
-practice Thai Boxing
-morality camp
40 (6 female)
-Re-entry program for (208
Families)
returning addicts
50 youth
-Village Standards
30
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122. A Vaccine for Globalization
Project Name
Location
17.
Glorification of T. NongYang
A. SanSai
Non-Narcotic
Community (586)
18. Life skills training T. HarnKeaw
for narcotic prevention A. Muang
and health promotion
among children and
youth of Chiang Mai
(588)
19.
Modern Youth T. Sripoom
Caring for Health and A. Muang
Environment (589)
20. Youth Network for A. Muang
Health (590)
Budget
(40baht=$1)
68,675B, $1716.86
202,240B, $5056
Activities
Target Group
Actual
-Practical Training
-Youth Training
-Against Drug Sticker
-Health Files
-Non-Narcotic Banner
-Friends Corner
25
40
200
25-30
40
200
117
117
100
114
5-12
48 youth
5Female/10male
360
5-12
98
5
360
64
360
175F and 200M
30
30
30
30
3000
3000
1200
1200
-Teamwork and skills
workshops
-First Camp
Leadership
-Camp
Development
-Run Camp Two by
themselves
-Activities about Lanna
Traditional Ways of Life
107,765B, $2694.13
150,000B, $3750
-Summarize
Lessons
Learned
-Radio Program and DJ
training
-Radio
Scheduling
training
-Web site development
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Project Name
Location
21.
Strengthening T. Nong Hoi
Community Network of A. Muang
health promotion by
personal
Communication Media
(593)
Budget
Activities
(40baht=$1)
119,950B, $2998.75 -Participatory Training
-personal
Communication training
-activities in community
-observation and study
tour
Target Group
Actual
30
35
25
20
640
640-700
100
22.
Studying and T. SanPaPao
Developing
non- A. SanSai
poisonous production of
fruits and vegetables
(596)
144,300B, $3607.50 -manure making, study,
170
theory, and practice
-youth camp
-customer/consumer
500
workshop
250-300
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124. A Vaccine for Globalization
Appendix C: Example of Semi-Structured Interview
แบบสัมภาษณ การประเมินโครงการขวงสุขภาพ ครั้งที่ 2
ณ ขวงบานศรีบุญเรือง ต.ปาไผ
อ.สันทราย เชียงใหมวันที่ 24-25มกราคม 2547
Project: (ชื่อโครงการ)
Community: (ชื่อชุมชน)
What is your role in the community? (ทานมีบทบาทอะไรในชุมชนของทาน ?) ( Health worker,
Farmer, Leader…)
Please tell me about your community? (ชุมชนของทานมีลักษณะเปนอยางไร ?)
Health,ดานสุขภาพ
Social ดานสังคม
environment ดานสิ่งแวดลอม
Please tell me about your community project? (โครงการสรางเสริมสุขภาพที่ทานทําอยูเปนอยางไรบาง ?)
How is this project similar or different from community development/health promotion
projects done in the past?
(โครงการนี้ แตกตางจากโครงการสุขภาพอื่นๆ ในอดีตหรือไม?)
How?
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125. A Vaccine for Globalization
(อยางไร?)
Now that you have this project what has happened in your community? เมื่อทําโครงการไปแลวมี
อะไรเกิดขึ้นบาง ?
What do you think helped to make the project work (or not work)?
(มีอะไรบางที่ทานเห็นวาไดชวยใหโครงการไปไดสวยหรือ…..ไมสวย ?)
How and why?
(อยางไร และ ทําไม? )
What do you think was the most difficult thing about doing this project?
(อะไรที่ทานเห็นวาทํายากที่สุดในโครงการนี้ ?)
What has your group done to overcome this difficulty?
(ทีมงานของทาน เอาชนะมันไดยังไง ?)
What are the community plans for the future?
(ทานมีแผนที่จะทําอะไรในชุมชนของทานในอนาคต?)
How do you plan to do that?
(ทานวางแผนกันยังไง?)
Do you think that we are empowering ourselves ?
(ทานคิดวาเรากําลังเสริมสรางพลังของเราเองหรือไม)
How ?
(อยางไร ?)
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126. A Vaccine for Globalization
Appendix D: ICE User-guide
A User-guide for developing:
A PARTICIPATORY EVALUATION ON EMPOWERMENT
For:
THE INSTITUTE OF COMMUNITY EMPOWERMENT
AND
COMMUNITY FACILITATORS
INTRODUCTION
Participatory evaluations challenge conventional evaluation practices. Although a
participatory evaluation of social changes (empowerment) is an uncharted process, it has
the potential to catalyze a community or group to learn more about what they have
achieved and foster community consciousness. This interest can lead to improved future
development initiatives if community specific and reliable measurements can be
developed to gather data that is meaningful to the community.
The guide was created for use in facilitating a participatory evaluation of
empowerment by Community Based Organizations (CBO’s) affiliated with the Institute
for Community Empowerment (ICE). The participatory evaluation guide is presented in
three sections:
1. Background:
a) Definitions of Terms and Tools
2. Planning, Process and Reflection:
a)
b)
c)
d)
Phase 1: Establish Community Evaluation Team
Phase 2: ICE Workshop for Community Facilitators
Phase 3: Community Meeting - Evaluation
Phase 4: Community Evaluation Team – Reflection
3. Attachments
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127. A Vaccine for Globalization
Participatory evaluation asks one important and fundamental question:
“Whose questions are being asked and answered in the evaluation?”
1. BACKGROUND
a) Definitions of Terms and Tools
The following is a collection of brief definitions intended to provide a basic
understanding of some key terms used in participatory evaluation.
•
A facilitator is a person who is knowledgeable about a specific topic or process. In
this case the facilitator is knowledgeable in participatory evaluation methods.
However, knowledge is not enough; the facilitator must be genuinely committed to
the nature of participation.
Important characteristics of a facilitator include;
a) Create an environment of sharing and reflection – asking open-ended
questions.
b) Encourage trust – validating everyone’s opinions and ideas, be non
judgmental.
c) The capacity to listen – letting everyone finish thoughts without
interrupting.
d) Help the group to ask key questions – see Appreciative Inquiry.
e) Guide discussions – keeping the group focused on topics and mediating
conflicts.
f) Plan actions to help bring together the viewpoints of the various
stakeholders.
g) Delegate tasks and responsibilities – once plans are crystallized make sure
responsibilities are equitably distributed among the group.
Additionally, the facilitator is both a catalyst and a manager of the evaluation
without controlling the process. Their primary function is to release the creative
energies within people. The facilitator plays an important role in assessing the levels
of understanding, the perceived benefits of participatory approaches, and promoting
capacity building among participants. This can be done through greater ownership of
the results of the evaluation effort and use of those results to create more effective
future programming.
•
Appreciative Inquiry (AI) is a process based on the idea that human systems grow
toward what they persistently ask question about. This concept is paramount for the
facilitator to embrace if they are going to help a group navigate their way towards
positive change.
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128. A Vaccine for Globalization
•
A stakeholder is an actor that has a vested interest in a given project, activity, or
issue. Stakeholders may include groups affected by development actions, such as the
poor, women, workers, farmers or the community at large, as well as other actors that
can affect the outcome of a project, i.e., government officials, institutions, and project
personnel. In participatory evaluations, stakeholders assume an increased role in the
evaluation process as question-makers, evaluation planners, data gatherers and
problem solvers.
•
Quantitative methods utilize numerical analysis to gather information from
stakeholders. Data collection methods include surveys, attendance records, statistical
and epidemiological data.
•
Qualitative methods minimize the use of numerical analysis. Data collection methods
include techniques such as; observation, semi-structured and open-conversation
interviews, testimonials and focus groups to gather information from stakeholders.
•
Baseline data is a description of the conditions at the beginning of a program or
project. Data collected later can be measured or compared against baseline data to
assess changes. In a participatory evaluation, it is important that stakeholders identify
important factors or sources of information and the indicators required for measuring
the results of their work. Baseline data serves as foundation material for future
evaluations.
•
Triangulation is the process of using different methods of data collection to crosscheck and cross-validate existing information.
•
A Beneficiary Assessment involves the participation of beneficiaries in evaluating a
planned or ongoing development activity and builds on the experience of participant
observation. Assessing the value of an activity as it is perceived by its principal
users, by letting beneficiaries' voices, values and beliefs be expressed. Methods
include direct observation, conversational interviews, and participant observation.
Beneficiary assessment is an approach to information-gathering that places the
emphasis on the perceptions of the principal actors.
•
Direct Observation is a data gathering process where a person takes field notes while
observing an activity without participating.
•
Participant Observation is when an outsider lives and learns in a community for a
period of time ranging from several weeks to months.
•
A Semi-structured Interview are less formal than a structured interview and allow for
conversation to be the method of learning. Preparation usually involves outlining the
broad areas of inquiry, leaving specific questions to be formulated during the
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129. A Vaccine for Globalization
interview itself. The questions should be sequenced with the easier questions coming
first and more difficult or personal coming later thus allowing the interview time to
gain the confidence of the person being interviewed. The questions are open-ended
and seek to collect in-depth information on attitudes, opinions, thought processes, and
knowledge.
•
Listening sessions are public forums you can use to learn about the community's
perspectives on local issues and options. They are generally fairly small, with specific
questions asked of participants. They can help you get a sense of what community
members know and feel about the issue, as well as resources, barriers, and possible
solutions.
•
A Focus Group brings together a representative group of 10 to 15 people, who are
asked a series of questions. A facilitator guides discussion. Focus groups can be used
in the field to build project designs or help to assess project performance. They can
be used in an evaluation as a means of starting a discussion, identifying needs and
clarifying key points.
•
Mind Mapping is a tool used at various stages of a project. It involves participants in
drawing maps of thoughts, ideas, terms, definitions and concepts on the floor, ground
or paper. Mapping can provide insight into the meaning of identified issues within the
community. The importance of ensuring a good cross section of participants in a
mapping exercise and different gender interpretations of one's community is critical.
•
A Testimonial records a person's thoughts, feelings and experiences in the first person
narrative style. It is a way of learning about a project or its impact through the voices
of participants and stakeholders. They can also help to corroborate other sources of
data and information and provide a more personal insight into a project's
achievements.
•
A Venn diagram, of usually circular areas, can be used to look at relationships within
institutions or relationships between the community and other organizations. It
illustrates different participant perceptions of access to resources or of social
restrictions. Circles of various sizes are cut out of paper and given to participants,
who are then asked to allocate the circles to different institutions, groups or
departments. The larger the circle the more important it is. The circles may overlap,
showing the degree of contact between institutions or groups.
2. PLANNING, PROCESS, AND REFLECTION
This section provides general steps that a facilitator can use to build an evaluation
method to measure social changes (empowerment) within the community. The section is
presented in phases and steps, but this is not meant to show the process to be linear.
Remembering that participatory evaluations and the nature of social changes
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130. A Vaccine for Globalization
(empowerment) within the community are context specific there cannot be one tool or
recipe, no strict course or syllabus that the facilitator can follow. The facilitator and the
community members invited are learning as they move through the process, but the
facilitator needs to be responsible for altering steps according to the context of the
community and the flow of the meetings discussion.
The following is a visual aide to help conceptualize the section. Each phase is
described in detail.
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131. A Vaccine for Globalization
Establish a Community Evaluation
Facilitation Team (CEFT)
Phase 1
Phase 2
Workshop
provided by
experienced
Facilitators
(CEFT) attends a Workshop on
Facilitating Participatory
Evaluations
Facilitators conduct a meeting with their
community members/groups to build the
evaluation tools
Phase 3
Immediately collect
evaluation tool
responses at the
meeting
Phase 4
Workshop
provided by ICE
or
Make a plan to use the
evaluation tool in the
larger community to
collect responses.
Facilitation Team and/or Community Members analyze the
responses and plan how to communicate what they learned to the
community and other interested groups
Facilitation Team meets to reflect on the
process, share lessons learned and discuss
recommendations for future plans with their
communities, the Fellowship and IC E.
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132. A Vaccine for Globalization
a) Phase 1: Establish Community Evaluation Team
Purpose:
To identify a group of community members interested in facilitating a
participatory evaluation of social changes (empowerment) within their community. This
group will be called The Community Evaluation Team and will be trained as evaluation
facilitators.
Objective:
•
Establish a community based evaluation team (4-6 members)
Activities:
o Make contact with community groups
Identify and contact 4-6 representatives from different community groups in order to
ensure an understanding of various community programs, the local power structures, and
different socio-cultural group perspectives within the community. These individuals will
make up the Community Evaluation Team.
o Invite them to the ICE facilitator workshop
Materials:
•
None
b) Phase 2: ICE Workshop for Community Facilitators
Purpose:
The facilitator workshop will orient the group to the process of doing a
participatory evaluation of social changes (empowerment) within the community. This
team will be responsible for returning to their communities and facilitating a meeting to
collaboratively make decisions about how the evaluation will be designed, conducted,
analyzed and presented.
Objectives:
•
Clarify roles of the facilitator.
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133. •
•
A Vaccine for Globalization
Exchange knowledge regarding participatory evaluations of social changes
(empowerment).
Facilitators feel prepared to return to their communities to facilitate their own
evaluation process.
Activities:
o Explain to the team why they are here and what they will do;
1. To do an evaluation of community changes that have occurred as a result of the
community driven development programs.
2. Sometimes these community changes are easy to see, but difficult to explain.
Through this participatory evaluation process we hope to find a way to identify,
describe, evaluate, and share with others what has happened in our community.
3. Make sure team members understand that there is no best model of doing a
participatory evaluation.
4. Flexibility during the process is important.
5. The evaluation tools developed and the methods used will depend on the
communities’ interests.
o Get an idea of what the group knows about participatory evaluation;
1. Find out if anyone has experience in doing evaluations.
2. If so, have those with experience share their thoughts about the strengths and
weaknesses of the methods they used.
o Review the role of the facilitator in conducting and finalizing a participatory
evaluation:
1. Understand that the validation of community members’ experiences is the basis
for building and conducting the evaluation.
2. Motivate community members to find solutions and act on them.
3. Assess constraints and resources or enabling and inhibiting factors of conducting
the evaluation.
4. Define parameters for the participatory evaluation (i.e., what can and cannot be
achieved based on time and local resources).
5. Facilitate the collective identification for the focus of the evaluation.
6. Identify when training in data-gathering methods is necessary.
7. Facilitate the collective date gathering process.
8. Facilitate the collective analysis of the data.
9. Facilitate the coordination of resources for resolving problems identified during
the evaluation.
10. Facilitate how to take collective action.
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134. A Vaccine for Globalization
11. Understand that a participatory evaluation is dependent on the skills and interest
of the community team.
12. See Facilitator in Terms and Definitions for more information.
o Review the following steps with the facilitator:
1.
2.
3.
4.
5.
6.
7.
Planning the Community Meeting
How to explore the meaning of Social Changes (empowerment)
How to prioritize the identified terms
How to develop questions to identify each term
How to develop a tool or method based on these questions
What is required to conduct the evaluation
The importance of reflecting on the process once completed
o Are we ready?
c) Phase 3: Community Meeting – Evaluation Building
Overall Purpose:
This meeting will be held to develop the evaluation tool for measuring social
changes (empowerment) within the community.
Overall Objectives:
•
Explain to the community members purpose of the meeting.
•
Collectively define social changes (empowerment).
•
Collectively prioritize the top 2 or 3 terms.
•
Collectively develop questions to identify these changes.
•
Collectively develop an evaluation plan.
•
Delegate responsibilities to carry out the evaluation.
Overall Materials:
•
•
•
•
Meeting area
Snacks and water
Large pieces of paper
Small pieces of paper
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135. A Vaccine for Globalization
• Marking pens
• Name tags (if appropriate)
• Pins or tape
• Board
Outline of Meeting:
1) Introduction
o We are trying to do an evaluation of community changes that have occurred as a
result of the community driven development programs we have been doing the
last 2 years.
o Explain that sometimes these community changes are easy to see but difficult to
explain. Through this evaluation process we hope to find a way to identify,
describe, evaluate, and share with others what has happened in our community.
o Make sure everyone understands that there is no best way to show these changes,
but we are going to take a collective attempt to do it.
o The evaluation tools or methods developed today will depend on our interests.
o Flexibility during the process is important.
2) Explain the role of the facilitator
o Give brief description of what your role will during the meeting.
3) Get an understanding of what evaluation means to the group
Purpose:
Determine what the group knows about evaluations and if they consider them
important and if important, to who and why.
Objectives:
•
Define evaluation.
•
Who are the stakeholders in the evaluation.
•
What will the evaluation results be used for.
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136. A Vaccine for Globalization
Activities:
o Mind Mapping: Ask the question: “What does evaluation mean to our
group?”
(This will provide each member an opportunity to explain what it means
and will allow the group to come up with a collective and working definition of
evaluation-making sure everyone is clear)
o List on the Board: Ask the question: “Who wants to know the results of our
evaluation?
(This will provide a list of stakeholders, and who the questions should
be asked to and who should be invited to future meetings)
o List on the board: Ask the question: “Is it useful for us to observe or evaluate
social changes within the community (empowerment)?”
(This will provide an understanding of interest in continuing with the
meeting and a list of ways to use the results of the evaluation)
Materials:
•
•
Large pieces of paper
Marking pens
4) Explore the meaning of empowerment or social changes within the community
Purpose:
Explore the meaning of empowerment, or social changes in the community. The
facilitator directs the focus of the group towards defining and understanding this
concept based on individual and community experiences.
Objective:
•
Collectively define empowerment, and identify important social changes
within the community.
Activity: (there are two possible ways to do this)
1. Mind Mapping: Ask the question: “What are examples of things that have
changed in our community since doing our projects?”
(Either break up into small groups of 4-5 or keep the group as one)
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137. A Vaccine for Globalization
A
F
E
Social
Changes/
Empowerment
B
D
C
•
An example might look like this:
Group Discussion: The facilitator can ask the group to discuss the map and
share their ideas about each response. Then, each response needs to be
narrowed to a key term or word. The facilitator can ask for further
description of what they means by asking the questions:
“Lets talk more about C and what it means?
“How do we see C in our community?”
“What are some examples of C in our community?”
Materials:
•
•
•
•
Large and small pieces of paper
Making pens
Pins or tape
Board
2. List on the board: Ask the question: “What was it like in your community
before this program, and what is it like now?”
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138. A Vaccine for Globalization
Have each group member write on one pieces of paper “what it was like
before the project” and on the other paper “what was it like now”. Then pin
these responses up on the board in two columns; Before and After
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•
An example would look like this:
A
B
D
Before
After
C
E
F
Group Discussion: The facilitator can ask the group to discuss each
response and share their ideas. Then the facilitator will draw several arrows
connecting the Before and After and ask for further description of what each
response means in order to get to the root term or word which will be
labeled on each arrow.
A
B
D
Term 1
Before
C
After
Term 2
Term 3
E
F
Materials:
•
•
•
•
Large and small pieces of paper
Making pens
Pins or tape
Board
5) Choose the top three changes/terms to define further
Purpose:
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140. A Vaccine for Globalization
Limit the focus of the evaluation down to two or three important terms
representing social changes or empowering factors.
Objective:
•
Choose three factors/changes that the group feels are the most important to
evaluate.
Activities:
o Group discussion and vote to choose the top two or three terms/changes
•
Decision making can be either consensus or majority. The vote can be
done in a variety of ways. For example, voting by raising hands. Or
writing on a piece of paper the top two or three terms and counting the
votes. Or asking the group to choose the best, and see the natural
breakdown of the top three through this voting process.
Materials:
•
•
Small pieces of paper
Pens
6) Develop questions for each identified term
Purpose:
Continue to build the evaluation tool by getting the group to further define what
each of the three identified terms mean and how they can be evaluated in the
community.
Objective:
•
Discuss how the identified community change is experienced in the
community.
•
Discuss the different levels or the range of the identified community change.
Activities:
o Group discussion: Ask the questions
“What are the different ways people in our community experience ________?”
• Facilitator writes these comments on the board
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141. A Vaccine for Globalization
“What are the different levels or the range of ________?” i.e. good to bad, 0 to
100…
• Facilitator writes these comments on the board
“What does each level mean and what are some examples of each?” i.e. 0 means
?, 100 means ?... an example of 0 is ?, an example of 100 is ? …
• Facilitator writes these comments on the board
Materials:
•
•
Large pieces of paper
Pens
7) Develop a tool for assessing the identified terms in our community
Purpose:
Summarize ideas and build a form that will be used to measure the identified
social community changes (empowerment).
Objective:
•
Develop an evaluation tool for measuring community changes or
empowerment.
•
Make it easy and clear.
Activities:
o Group Discussion: The facilitator needs to ask questions that will help the
team take the identified terms and develop a tool to use in the community.
This process can begin by summarizing the identified terms and defining
specific experiences and a range that best describes each term on the board.
o Group Discussion: The facilitator leads the group in a discussion of what
questions we need to ask to learn where our community is today based on
each term identified. This can be done by asking the question:
“How can we find out how members of our community are experiencing Term
1?”
See Appendix 1 for an example Range vs Experience Tool
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142. A Vaccine for Globalization
o Group Summary: The facilitator summarizes what the group has come up
with for each term. The facilitator will help the group choose which questions
they like the best and help the group finalize the evaluation tool. The
facilitator can ask the following questions:
“Do we want to collect simple answers to each question or do we want to have
people tell us stories about each term based on their experiences, or do we want to
do both?” “For example, tell me a story of how you feel about term __1__ based
on personal experiences (if the experience they mention is not listed on our
evaluation tool, can we add it later or do we have a section called other?) We
document what they say. Then, show the range we developed today and have
them rate their experience accordingly.”
Materials:
•
•
Large pieces of paper
Pens
8) Develop and Evaluation Plan
Purpose:
To collectively decide on an evaluation plan. Clearly identify the tasks needed to
be completed for the evaluation.
Objective:
•
Who is going to do it?
•
When is it going to be done?
•
Who are we going to ask the questions to?
•
How many do we need to ask the questions to?
•
Who will analyze the data collected?
•
When will the results be given to the community?
•
Who will the results be given to?
Activities:
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143. A Vaccine for Globalization
Group Discussion: The facilitator asks the group to discuss how to do this
evaluation in the community. The following questions can be asked:
•
•
•
•
•
•
•
•
Who do we ask these questions to?
How many people do we need to ask?
Who will ask the questions?
When will we ask these questions?
Who will analyze the data?
When will we analyze the data?
How will we document and display the findings?
When will we share our findings with the community?
Materials:
•
•
Pens
Large pieces of paper
9) Closing Remarks- set a date for a reflection meeting
The facilitator needs to question any weaknesses in the evaluation tool, and how it will be
conducted prior to final approval.
d) Phase 4 – Community Meeting: Reflecting on the Evaluation Process
Purpose:
To have a discussion about how the evaluation process went and determine if we
want to do it again. By virtue of the participatory methods used to develop the
evaluation, facilitators need to know that good feedback is achieved when one feels they
can openly criticize the process without fear of any bad feelings or repercussions, and
that their suggestions will be acted on.
Objective:
•
•
Identify lessons learned
Discuss recommendations for the next evaluation.
Activity:
Group discussion:
•
•
Has the participatory evaluation process been effective?
What would its long-term impact be?
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144. A Vaccine for Globalization
•
•
•
•
•
•
•
•
•
•
•
•
How did we identify the major stakeholders?
What steps were taken to include or exclude various stakeholders?
What conclusions can we make about the stakeholders' roles as question-makers
and question-answerers?
What would we have done differently?
What difference(s) might our decisions have made?
Discuss and analyze the strengths and weaknesses of the data-gathering process.
Discuss the documentation and display of the evaluation findings.
Discuss how we used our findings.
Discuss the overall management of the participatory evaluation. What can you say
about the various elements, including:
o evaluation tool building workshop timing
o selection of participants
o group dynamics
o overall organization
Do we want to repeat this evaluation process in the future?
What resources or support might be needed to repeat the participatory evaluation
in the future?
What would we recommend other communities to do if they are interested in
doing a participatory evaluation of empowerment?
Materials:
•
Large pieces of paper and Pens
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Attachment 1: Example of Rating Evaluation Tool
Variable
Range
1 = and 2 = and 3 = and 4 = and 5 = and
its
its
its
its
its
Meaning Meaning Meaning
Meaning
Meaning
Stories
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Attachment 2: Example of Data Display – Star Plot
Experience
5
Experience
Experience
5
5
1
5
5
Experience
Experience
5
Experience
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147. A Vaccine for Globalization
Appendix E: CBO Quantitative Evaluation Results
SaLuang Herbal Medicine Group
Variables of Community Change
Measures of central tendency and variability for ratings
Concepts
Mean
Unity
Participation
Wisdom of Local People
Resources (Funding)
Leadership in Group
4.11
4.44
4
2.88
3.71
Median
4
5
4
4
4
Mode
4
5
3,5
4
4
Range
(min-max)
3-5
3-5
3-5
1-4
3-4
Star Plot
Unity
5
4.11
Leadership
5
5
Cooperation
4.44
3.71
1
2.88
4
5
Funding/Resources
5
Conservation of Local Wisdom
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Mohr Muang Group
Variable of Community Change
Measures of central tendency and variability for ratings
Concepts
Mean
Physical Health
Unity
Strong Community
Mental Health
Family Warmth
Active Compassion
4.55
4.55
4.21
4.45
4.45
4.33
Median
5
5
4
4.5
4
4
Mode
5
5
4
5
4
4
Range
(min-max)
4-5
4-5
3-5
3-5
4-5
4-5
Star Plot
Physical Health
5
4.55
Active Compassion
5
5
Unity
4.55
4.33
1
4.45
Family Warmth
4.21
5
5
Strong Community
4.45
5
Mental Health
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SiBaoRuang Elderly Group
Variable of Community Change
Measures of central tendency and variability for ratings
Concepts
Mean
Unity
Cooperation/Participation
Local Growth/Development
Resources
Mental Health
Economic Situation
6.63
5.35
5.06
4.89
4.44
4.50
Median
Mode
7
5
5
4.5
4.5
5.5
7
5,7
4,5,7
4
3
6
Range
(min-max)
2-7
2-7
3-7
3-7
1-7
1-7
Star Plot
Unity
7
6.63
Economic Situation
7
7
Cooperation/Participation
5.35
4.5
1
4.44
5.06
Mental Health
7
4.89
7
Community Growth
7
Resources
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SanPaBao, Elderly Group
Variable of Community Change
Measures of central tendency and variability for ratings
Concepts
Mean
Community exercising groups
Family warmth
Happy, Joy, Gay
Decreased Illness
Decreased Stress
Revitalization
Self-care with old wisdom
6.75
5.94
5.41
5.52
5.74
6.47
6.63
Median
7
6.5
5
5
6
7
7
Mode
Range
(min-max)
4-7
2-7
3-7
3-7
3-7
5-7
5-7
7
7
5,7
7
7
7
7
Star Plot
Community coming together to exercise
7
6.75
Self-care with old wisdom
7
7
Family warmth
6.63
5.94
1
Revitalized
7
5.41
6.47
7
Happiness, joyful, and gay
5.74
7
Reduced stress
5.52
7
Reduced illnesses
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MaebaKee Health Promotion and Leadership Development Projects
Variable of Community Change
Measures of central tendency and variability for ratings
Concepts
Mean
Community Development
Knowledge about Health
Unity
Health Status
Education
Hill Tribe Culture
5.27
5.11
5.41
5.11
5.29
4.88
Median
5
6
5
5
6
6
Mode
5
6
5
5,6
6
6
Range
(min-max)
2-7
3-7
4-7
3-7
2-7
1-7
Star Plot
Community Development
7
Hill Tribe Culture
5.27
7
7
Knowledge about Health
5.11
4.88
1
5.29
5.41
Education
7
7
Unity
5.11
7
Health Status
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Three age groups working towards Health Promotion Projects
Variable of Community Change
Measures of central tendency and variability for ratings
Concepts
Mean
Unity
Compassion
Community Power
Happiness
Networking
Togetherness
Decreased Stress
6.23
4.67
4.86
5.82
5.95
5.86
6.23
Median
7
5
5
6
6.5
6
7
Mode
Range
(min-max)
1-7
2-7
3-7
3-7
3-7
3-7
3-7
7
6
5
7
7
6,7
7
Star Plot
Unity
7
6.23
Decreased Stress
7
Compassion
7
6.23
4.67
1
Togetherness
7
4.86
5.86
5.95
7
Networking
7
Community Power
5.82
7
Happiness
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Muay Thai Group
Variable of Community Change
Measures of central tendency and variability for ratings
Concepts
Mean
Drug Prevention
Place to Play
Sports Interest
Strong Health
Kindness
Human Relationships
Know Friends
Interest in Learning
6.33
5.71
5.78
6.29
5.71
5.33
5.62
5.75
Median
Mode
7
6
6
7
7
5
6
6
7
6
6
7
7
5
7
7
Range
(min-max)
3-7
4-7
3-7
4-7
3-7
3-7
3-7
2-7
Star Plot
Drug Prevention
7
6.33
Interest in Learning
7
7
5.75
Know
Friends
7
Place to Play
5.71
5.62
5.78
7
Sports Interest
5.33
6.29
Human Relationships
7
5.71
7
Strong Health
7
Kindness
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Lahu Group for the Promotion of Dala Spiritual Leader for Drug Prevention
Variable of Community Change
Measures of central tendency and variability for ratings
Concepts
Mean
Unity
Thinking and Deciding Together
Culture
Strength
Learning
Networking
6.55
6.18
6.64
6.18
6.08
6.73
Median
7
6
7
6
6
7
Mode
7
6
7
6
7
7
Range
(min-max)
5-7
5-7
5-7
5-7
5-7
5-7
Star Plot
Unity
7
6.55
Networking
7
7
6.73
Thinking and Deciding
Together
6.18
1
6.09
6.64
Learning
7
7
Culture
6.18
7
Community Strength
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BanMaeJong School
Variable of Community Change
Measures of central tendency and variability for ratings
Concepts
Mean
Family Life
Using Free Time
Gangs
Knowledge
Exercise
Participation
5
5.58
4.46
5.78
6
5.25
Median
5
6
5
6
6
5
Mode
5
6
5
5
6
5
Range
(min-max)
4-6
4-7
1-7
4-7
5-7
4-7
Star Plot
Family Life
7
5
Participation
7
7
Using Free Time
5.58
5.25
1
4.46
6
Physical
Exercise
7
7
Gangs
5.78
7
Knowledge of Drugs
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Mae Hak Group
Variable of Community Change
Measures of central tendency and variability for ratings
Concepts
Mean
Unity
Responsibility of Community
and Family
Love and Active Compassion
Community Relations
Use of Addictive Drugs
Knowledge about Drugs
Self-care for Health
Family Life
Median
Mode
5.45
5.4
6
5
6
5
Range
(min-max)
4-7
3-7
5.73
5.64
5.7
6.09
5.73
5.4
6
6
5.5
6
6
5.5
7
5,6,7
5
6
7
7
4-7
4-7
4-7
4-7
3-7
3-7
Star Plot
Unity
7
Family Life
5.45
7
5.40
Self-care
for Health
7
5.73
7
Responsibility of
Community and Family
5.40
5.73
7
Love and Active
Compassion
5.64
6.09
Knowledge about Drugs
7
5.70
7
Community Relations
7
Stop using Addictive Drugs
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Appendix F: Timeline
o
December 1 – 27: Collect background information of ICE and the CBO projects via document analysis and
non participant observation of community meetings, activities and ceremonies.
o
December 28: Meeting with all CBO representatives to discuss developing and implementing participatory
evaluation of social changes. Establish time for workshops and pilot community to conduct the first
evaluation.
o
December 29 – January 14: In collaboration with ICE staff, create first draft of a Facilitator Guide which
includes a methodology for conducting a workshop on participatory evaluation of social changes.
o
January 9 – 10: Site visit with pilot community to build relationships with members of the CBO and to get
understanding of how they feel about the evaluation.
o
January 15: First evaluation workshop.
o
January 16: Compile evaluation methodology for Pilot CBO.
o
January 17: Workshop for 5 CBO members from the pilot community who will facilitate their community
groups in doing the evaluation.
o
January 18 - February 7: Incorporate changes into the evaluation methodology based on the outcome of the
workshop and further discussions with the facilitators.
o
February 8: Community meeting with 30 members of the Herbal Project participates in the Pilot evaluation
process. Representatives from 18 other CBO’s observed the process and 11 asked to go through the
process in their communities.
o
February 11: Workshop for the 11 CBO’s, decide on when to do it.
o
February 17: Second group
o
February 18: Third and Fourth Groups
o
February 22: Fifth group
o
February 23: Sixth and Seventh Groups
o
February 25: Eight Group
o
February 27: Ninth and Tenth Groups
o
February 29: Eleventh Group
o
March 1 – 6: Summary of Evaluation Data
o
March 7: Meeting with CBO representatives, Thai Health Foundation, Ministry of Public Health
Representative, other interested individuals to present the Summary of Evaluation Data and get feedback
regarding the process; strengths, weakness, and recommendations.
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