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1. Discussion: Strategies and Tactics in Healthcare Paper
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PLAGIARISM-FREE PAPERS ON Discussion: Strategies and Tactics in Healthcare
PaperStrategies and tactics are used to accomplish the goals and objectives developed
earlier. Strategies state what is to be done and tactics are the specific steps to be
implemented. In the following Assignment, you will look at a health care organization’s
strategic plan and analyze the relationship between strategies and tactics.To prepare for
this Assignment:Review this week’s Learning Resources.Locate and select a health care
organization’s strategic plan.To prepare this Assignment, write a 3-page paper that
addresses the following:Indicate the name and type of the health care organization you
selected.Provide a summary of the services provided and the market the health care
organization serves.Identify a strategy in that health care organization’s strategic plan and
report on (if present) or propose (if missing) one or more tactics for its
implementation.Analyze how the tactic(s) you propose or report on support the strategy.
Include a rationale justifying your tactic(s).Your written assignments must follow APA
guidelines. Be sure to support your work with specific citations from this week’s Learning
Resources and additional scholarly
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h_4115_settinggoalsandobjectivestraining_2008_.pptarticle.pdfUnformatted Attachment
PreviewThe Howard Journal of Communications, 20:370–393, 2009 Copyright # Taylor &
Francis Group, LLC ISSN: 1064-6175 print=1096-4649 online DOI:
10.1080/10646170903303832 Mobilizing and Empowering War-Torn African
Communities to Improve Public Health CORNELIUS B. PRATT School of Communications
and Theater, Temple University, Philadelphia, Pennsylvania, USA E. LINCOLN JAMES
Edward R. Murrow College of Communication, Washington State University, Pullman,
Washington, USA The objectives of this article are to (a) present a theoretical framework for
developing strategies and tactics that could be used to mobilize and empower African
communities and help reduce the crippling burdens of public-health challenges, even as
these societies suffer from the effects of wars and conflicts; (b) highlight reasons for
mobilizing and empowering communities as strategic responses to the effects of internal
armed conflicts on the delivery of health services, and, in turn, on a nation’s health; and (c)
recommend communication strategies and tactics for improving the health of Africa’s
populations both in peacetime and in wartime. The article draws upon two models—the
health belief model and the community mobilization model—that are described as war- and

2. conflict-victim mobilizing and empowerment models, which can be used to communicate
with and to motivate and inspire victims of African’s wars. Discussion: Strategies and
Tactics in Healthcare PaperThese models are applied in a case study of two Netherlands-
based international development and co-financing agencies, Cordaid and the Interchurch
Organization for Development Cooperation. The article concludes with suggestions for
theory-driven empirical research on the interface between public trust and health delivery.
This article is a substantial revision of a paper presented at the Unite for Sight Fourth
Annual International Health Conference, Stanford University School of Medicine, Palo Alto,
CA, April 14–15, 2007. We thank the editor and reviewers for their invaluable comments
and suggestions. Address correspondence to Cornelius B. Pratt, Department of Strategic and
Organizational Communication, School of Communications and Theater, Temple University,
221 Weiss Hall (265-65), 1701 N. 13th Street, Philadelphia, PA 19122. E-mail:
cbpratt@temple.edu 370 Mobilizing War-Torn Communities 371 KEYTERMS African wars
and conflicts, community mobilization model, Cordaid, health belief model, health
promotion, ICCO, persuasive communication In recent decades Africa has experienced more
brutal coups, drawn-out civil wars and bloody instability than any other part of the world . .
. .Violence causes as many deaths in Africa as does disease. —Commission for Africa, 2005,
p. 34The purpose of this article is threefold. First, it presents a theoretical framework for
developing strategies and tactics that could be used to mobilize and empower African
communities and help reduce the crippling burdens of public-health challenges, even as
these societies suffer from the effects of wars and conflicts. Mobilizing and empowering
such communities pose major challenges because the welfare of war-torn communities is
inextricably linked to their health status. Second, this article highlights reasons for
mobilizing and empowering communities as strategic responses to the effects of internal
armed conflicts on the delivery of health services, and, in turn, on a nation’s health. Our
intent is to evaluate the strengths of both mobilization and empowerment in stemming the
fallout from conflicts, namely, the reduction or elimination of health services, the
endangerment of life, and the social marginalization of victims of those conflicts. The health
promotion literature is replete with programs and health models in pre-colonial and
colonial Africa (e.g., Falola & Ityavyar, 1992; Feierman & Janzen, 1992), and in present-day
Africa (e.g., Airhihenbuwa, Makinwa, & Obregon, 2000; Diop, 2000; Ford, Williams,
Renshaw, & Nkum, 2005; Hildebrandt, 1994). With few exceptions (e.g., Cliff &
Noormahomed, 1988; Ityavyar & Ogba, 1992; Jinadu & Alali, 2002), that literature focuses
largely on peacetime circumstances. This article attempts to fill a void in the literature by
examining wartime conditions especially because conflicts have become a critical element
of Africa’s political and social landscapes. It is important, then, to give much-deserved
attention to the emergency needs of the victims of such conflicts. Thus, the third purpose of
this article is to recommend communication strategies and tactics for improving the health
of Africa’s populations both in peacetime and in wartime. To accomplish that goal, it draws
upon programs implemented by Cordaid and the Interchurch Organization for Development
Cooperation (ICCO), two co-financing international development agencies with major
wartime operations in the Democratic Republic of the Congo (DRC). Further, the approach
taken here is important because the models appropriate for peacetime conditions are not

3. particularly transferable to wartime situations, in light of the massive communication, trust,
and security 372 C. B. Pratt and E. L. James issues that emanate from the presence of
thousands of refugees and internally displaced people.According to Toole, Waldman, and
Zwi (2006), these refugees and displaced people have created ‘‘hidden emergencies,’’ yet
generally do not attract considerable media and international attention. Indeed, two
significant reports published in 2005 caught the attention of health-care specialists
worldwide. The first, produced by the Commission for Africa (2005), argued, inter alia, for
rebuilding systems and scaling up services to deliver public-health services in Africa, where
more people than in anywhere else in the world have been forced out of their homes,
ending up in slums in over-crowded cities and towns. The second report, produced by a
joint ministerial Development Committee of the World Bank and of the International
Monetary Fund (2005), proposed a five-point agenda for fostering momentum in
implementing the United Nations Millennium Development Goals and the Monterrey
Consensus. The agenda included a major intensification of human development services,
such as basic health care, sanitation infrastructure, control of diseases, and women’s access
to education and health care (The World Bank, 2005).The latter also asserted, ‘‘It is
important to ensure that global programs organized around specific health interventions
are aligned with recipient countries’ priorities and support— rather than undermine—the
coherence of their health sector strategies and systems’’ (p. iii). To accomplish all three
purposes, emphasis will be placed on the centrality and importance of the community- and
culture-grounded strategies and tactics. Such targeted, community-mobilizing approaches
could appeal to both non-governmental and government agencies as they facilitate the
implementation of innovative public-health initiatives. In essence, then, this article argues
for a fundamental shift in persuasive communication strategies and tactics for improving
the health of Africa’s populations torn by violent and low-intensity conflicts. It presents,
mutatis mutandis, both a complement and a corrective to the dominant approaches to
delivering health services in Africa during peacetime. USING THEORY TO MOBILIZE AND
EMPOWER AFRICA’S COMMUNITIES The community mobilization and health belief models
are described here as war- and conflict-victim empowerment models because they both
involve communities in transactions to control the impact of conflicts on their health—an
outcome on which they generally have minimal, if any, influences. According to Guttman
(2000), the mobilization model emphasizes involvement of communities in their health
goals, objectives and strategies.1 Of the four models that he identifies, the mobilization
model is the only one that emphasizes high community involvement as both a health-
delivery goal Mobilizing War-Torn Communities 373 and as a strategy. That emphasis casts
health programs as a ‘‘social-action process in which individuals and groups act to gain
mastery over their lives in the context of changing their social and political environment’’
(Wallerstein & Bernstein, 1994, p. 142). Discussion: Strategies and Tactics in Healthcare
PaperThe mobilization model, which has been effective in both health (Hidelman, 2002) and
non-health contexts (Kwimba, n.d.), calls for communities to be mobilized and empowered
to help define problems and proffer solutions that increase grassroots organizations’
capacities or the strategic use of resources to gain political leverage and to mobilize diverse
constituencies (Guttman, 2000). Indeed, Guttman also noted the unique capacity of the

4. model to involve consulting, mentoring, and training in skills and to value conflict, in that
stakeholders are more likely to acknowledge differences among groups about what is
important and how things should be done. A second model, the health belief model (HBM),
focuses on the information-processing strategies of individuals who can then help engender
community activism for health promotion and improvement, but only to the degree that
enabling administrative and societal factors allow. Like the community mobilization model,
it is a framework for motivating people to act on a common health concern, to avoid a
negative health consequence, and to improve overall public health. The model has six
components, all based on the individual’s perceived (a) susceptibility to a health problem;
(b) severity of the health problem; (c) benefits from the effectiveness of engaging in a
proposed preventive behavior; (d) barriers to engaging in a preventive behavior; (e) cues to
action, that is, physical or environmental events that trigger action; and (f) confidence in
one’s ability to perform a preventive health behavior (Dutta-Bergman, 2006; Discussion:
Strategies and Tactics in Healthcare PaperRosenstock, 1974). Indeed, White (n.d.)
recommended that to mobilize a community for action, a plan must be developed such that
it (a) determines attitudes toward a problem, (b) assesses public expectation, (c) provides
adequate information about the far-reaching effects of the problem, and (d) develops
effective information that acts as a catalyst for community support and involvement. The
strengths of both these models lie in their similarities and in their being readily amenable to
being used pari passu. For example, empowerment occurs at two levels: at the individual
level (characteristic of HBM), by which people are both motivated and persuaded to develop
their health-related competencies such as knowledge or resources; and at the community
level (characteristic of CMM), by which additional network, resources, and opportunities
are developed (Becker, Guenther-Grey, & Raj, 1998). The Rwandan government, for
example, empowers local populations by initiating decentralized (health) service delivery
as an instrument for fighting poverty by having them participate in planning and managing
local health initiatives (at the individual level), and mobilizing them for reconciliation, social
integration, territorial reform, and well-being (at the community level; Malinga, 2008). Both
models also involve reciprocal 374 C. B. Pratt and E. L. James determinism, by which a
bidirectional change results from interaction among people, communities, and
environments (U.S. Department of Health, 2005). CONFLICTS, MOBILIZATION AND
EMPOWERMENT IN PUBLIC HEALTH IN AFRICA Africa, particularly the region south of the
Sahara, has for decades suffered from protracted civil wars and factional and internecine
conflicts that have left thousands homeless or displaced. As reported by the United Nations
High Commissioner for Refugees (2006), 5 of the top 10 countries of origin of refugees are
in Africa. These are Sudan, Burundi, the DRC, Somalia, and Liberia. Also, 3 of the top 12
countries of origin of internally displaced people are African: Sudan, Somalia, and Liberia.
Interestingly, the continent also has 8 of the top 10 countries of origin to which refugees
returned in 2005, the other 2 being Afghanistan and Iraq. To the degree that such
displacement of citizens results from instability and conflicts, it takes its toll on health
programs that have been stretched to their capacity. The DRC is the archetype of a country
destabilized by lingering conflicts and civil wars; its two major wars (the first from 1996 to
1998; the second referred to as African World War, from August 1998 to 2003) led to 3.8

5. million deaths (Coghlan et al., 2004) and caused the displacement of some 3.4 million
people. Discussion: Strategies and Tactics in Healthcare PaperThe crisis in the Congo, which
is escalating as of this writing, has thus been described as ‘‘the deadliest anywhere since the
end of World War II, dwarfing Bosnia, Kosovo, Darfur and even the South Asian Tsunami’’
(Brennan & Husarska, 2006, p. B3). Between 1963 and 2002, at least 30 civil wars and low-
intensity conflicts occurred in Africa. They affected about 450 million people, approximately
60% of the continent’s population, directly and indirectly affecting health programs (The
World Bank, 2005). Indirectly, wars and conflicts serve to divert resources from the health
sector and are associated with increases in deaths from diseases and malnutrition (Kloos,
1992; Palmer & Zwi, 1998; Perrin, 1996; Simmonds, Vaughan, & Gunn, 1983). Directly,
conflicts deter health-service practitioners from delivering care to even the neediest,
particularly those in disputed territories, and they destroy the existing fragile health
infrastructure (Dodge, 1990; Levy & Sidel, 1997; Manoncourt et al., 1992; Palmer, Lush, &
Zwi, 1999; Reed & Keeley, 2001; Roberts & Zantop, 2003; The World Bank, 2005). Health
care is also hampered even when a truce is negotiated, or a compromise found—as was
done in June 2007 between representatives of the Ugandan government and those of the
rebel group, the Lord’s Resistance Army of northern Uganda. Similar situations prevailed in
2006 among tribal rivals in the western region of Sudan, in 2002 among warring factions in
2002 in the Congo, and in December 2000 between Eritrea and Ethiopia. And the effects of
wars that have resulted Mobilizing War-Torn Communities 375 in more than 4 million
deaths in the Congo since 1997 and an estimated 300,000 deaths and 2.5 million displaced
from Darfur since 2003 are still apparent on the well-being of all those nations. It is this
interface of health and security (e.g., Burris, 2006); violence and mortality (e.g., Toole &
Waldman, 1990); and conflict and extensive negative effect on health and health services
(e.g., Aluwihare, 2005; Médecins Sans Frontières, 1997, 2001; Toole & Waldman,
1993;Toole et al., 2006; Ugalde, Richards, & Zwi, 1999; The World Bank, 2005; Zwi, Ugalde,
& Richards, 1999) that provides the rationale for this article, which argues for a shift in
strategic approaches in communities where conflicts are rife and where health services are
particularly lacking. The effects of internal wars and conflicts in Africa suggest the need to
empower communities to play leading intervention roles in their health conditions. To
empower such communities requires effecting broad-based changes in health-related
behaviors. These can occur by providing support that helps them define their own health
problems, identify the determinants of those problems, and engage in effective individual
and collective action to respond to the impacts of those determinants (Beeker, Guenther-
Grey, & Raj, 1998). African communities, under peaceful conditions, boast a wide array of
institutional structures that provides governance at the local level, where chiefs and tribal
elders still wield enormous political clout in the decision-making process among their
subjects. In the DRC, for example, more so under wartime conditions, ‘‘‘tribal’ clientelism
provides a mode of access to state institutions; ethnic polarization a mode of exclusion of
‘the other’’’ (Englebert, 2002, p. 593). Such strategies pose a paradox. On the one hand, they
are still very much the channels for tracking community agendas. On the other, they ‘‘never
translate into a broader agenda of self-determination, as they enhance rather than challenge
the failed and predatory institutions they pursue’’ (Englebert, 2002, p. 593). Discussion:

6. Strategies and Tactics in Healthcare PaperArguments have been made for a shift from the
biomedical model of health care whose structural and cultural hegemony marginalizes
patients’ social concerns about their health status to one that recognizes the patients’ (e.g.,
war victims’) role and influence in health-related interactions (Sharf & Street, 1997;
Vanderford, Jenks, & Sharf, 1997; Verwey & Crystal, 2002), and to one that views disease as
a social and cultural construct (Jablensky, 2005). Such a shift affirms public health as not
merely the absence of disease but as the delivery of services that promote fulfilling,
satisfying lives. It is important to note that empowerment is predicated on three
assumptions: (a) that the health problems are multifactorial, (b) that communities must
participate in defining and responding to the problem, and (c) that the effectiveness of the
strategies depends on community’s self-efficacy. The empowerment must, therefore, take
place at two levels: at the individual level, by which people develop their health-related
competencies; and at the community level, by which additional resources and opportunities
are 376 C. B. Pratt and E. L. James developed (Beeker et al., 1998).This empowerment
approach is consistent with the theoretical foundation of this article. HEALTH-PROMOTION
STRATEGIES IN PEACETIME Donor-driven strategies tend to be used in promoting public
health during periods of relative stability. Indeed, international donor agencies, to the
degree that they fund much ground activities, require a level of accountability and
transparency that can only be achieved through a centralized model that calls for such
activities to be coordinated either at a headquarters or at regional levels. So, even if
international donors form partnerships with local agencies such as the Nairobi, Kenya-
based African Population and Health Research Center (APHRC), these agencies are still
largely responsible to their benefactors. Yet, oftentimes, benefactors’ ground activities are
not fully synchronized with those of recipients, regardless of the continent-wide leadership
role of APHRC in research in population and health issues and policy. A rationale for more
direct communal discourses and involvement in health projects is borne out by the results
of a study undertaken in southern Africa by Save the Children UK that showed that many
blockages and bottlenecks prevent the priority allocation of HIV=AIDS resources from
reaching communities (Foster, 2005). Discussion: Strategies and Tactics in Healthcare
PaperThat study also found that neither donors, government departments, non-
governmental organizations nor community groups could provide effective mechanisms for
channeling those resources to communities and households that respond to children and
that intermediaries are unwilling to empower community groups. Another characteristic of
these agencies is that they tend to adopt Euro-American centralized health-promotion
models. An example is the three-level, hierarchical network model whose basic design the
U.S. government adapted from a successfully implemented HIV=AIDS prevention model in
Uganda (Institute of Medicine, 2007). At the apex of the hierarchy is the central health
authority (in the case of the Global AIDS Initiative, it is the Office of the Global AIDS
Coordinator [OGAC]), which, depending on the specifics of the organization, is generally far
removed from the ground— inarguably an effective administrative approach to health
promotion in developed donor nations, but not quite as effective in the developing world,
where such structures inherently contradict dominant cultural practices and mores.
Granted, th Discussion: Strategies and Tactics in Healthcare Paper