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Community participation and nutrition: Some issues for consideration
Consultant, Community Participation and Family Life Programme Division, UNICEF, New York
WHAT IS COMMUNITY PARTICIPATION?
Community participation takes different forms in different situations. It includes, but is not limited to, receiving information and services and providing labour for the construction of the infrastructure required for carrying out development programmes. However, genuine community participation leading to self-reliance and continuity in community-based social services grows out of people's involvement from the first phases of problem identification and data collection, through programme design, to ultimate implementation, management, and evaluation. The ACC Task Force on Rural Development defines participation as "an active process in which the participants take initiatives and action that is stimulated by their own thinking and deliberation and over which they can exert effective control''(1). It also points out that "the idea of passive participation which only involves the people in actions that have been thought out or designed by others and controlled by others is unacceptable."
WHY IS COMMUNITY PARTICIPATION IMPORTANT TO NUTRITION?
Some common problems of centrally planned nutrition programmes are:
(a) lack of relevance of the programme designs to the felt needs of target groups,
(b) non-acceptance and non-utilization of programmes by communities, and
(c) lack of maintenance and continuity of programmes in communities. Experience shows that active participation in programmes can solve many of these problems.
There is increasing evidence of the inappropriate and often harmful effects of large-scale, centralized planning of nutrition interventions on local communities when such planning does not take into account the needs and resources of these communities . If an intervention is not designed to meet the felt needs of a community, it is unlikely to have much effect. For example, in the Bolivian government-sponsored Project for the Incorporation of Women in Development, in Chiquisaca, Bolivia, in which local women did not participate in identifying priority needs, government health workers trained them in environmental, sanitation, and health practices. However, the results of this training have been limited because the health personnel did not consider the women's financial constraints that prevented them from using services provided by medical clinics and from initiating and sustaining changes in their daily routines or improvements in the environment that could have resulted in better health. Consultation with the local women would have revealed initially what was later discovered: Their priority need was to increase their income, because they could make use of existing medical facilities and initiate improvements only if they had more money. Community participation is a means through which communities can identify needs and priorities.
If a programme addresses a need of the community identified by the community members themselves, it is more likely to be accepted and utilized. The genesis of the education programme of the Social Work Research Centre (SWRC), a non-governmental organization working on rural development in India, is a good illustration of this. Initially, education was interpreted by SWRC as literacy, and, accordingly, a "100 per cent literacy" programme was launched in 1973. Fourteen literacy classes were organized for boys and girls and men and women. However, the teaching materials were uninspiring, and the teachers were unable to motivate the villagers to learn. Soon, their attendance began to fall sharply, and most of them left before the end of the school year. Some time after this initial collapse of the education programme, a more realistic approach to literacy emerged. The women producers at the Tilonia craft centre, who had begun to earn money, started to take out bank loans, and, on being exposed to market mechanisms and prices, felt an interest in, and need for, knowledge of letters and numbers. The women who had been participating in the maternal and child care community health programme also recognized the practical value of literacy and skill with numbers. Consequently, literacy classes were started in response to their interest, and the women were clearly motivated to learn. it is evident that, unless a programme deals with a need that the participants perceive to be important and articulate themselves, it will not be accepted and used. Again, community participation is a means by which this can be accomplished.
In Nigeria, where the formal political ideology assumes and implies mass mobilization and popular participation in development, communities are mostly involved in providing labour for various construction projects such as building schools and dispensaries, but receive little or no financial or material support from the government.
Finally, maintenance and continuity of programme activities, even after outside assistance - government or non-government-is phased out, are more likely when the participants have played an active role in designing and implementing the programme. If they feel that the programme is important and they share the responsibility for making it work, they will ensure that the activities are continued. Participation is important to nutrition because experience in programme planning and implementation suggests that there is no better way of fostering cost-effective programmes than by building, supporting, and implementing programmes in a participatory manner. Cost-effective programmes are those that are relevant to the needs of the community, that are consequently well received and used, and that will be sustained.
Community participation can enhance the cost-effectiveness of nutrition programmes. However, exclusive emphasis on community participation as a means of nutritional development with no centralized planning is not an optimal strategy. Clearly, a balance must be found between the two. A means must be found of reconciling the degree of centralized organization and leadership necessary for equitable distribution of scarce resource and the implementation of large-scale efforts with the full local participation and responsibility that are essential to equitable programmes.
Nutrition planners suggest that a comprehensive nutrition policy must take into account the following three factors:
a. food demand, which relates to income, income distribution, subsidies, etc.;
b. food supply, which relates to food production and productivity, prices, food technology, exports and imports, etc.; and
c. the biological utilization of foods, which has to do with health, environmental factors, quality of foods, and variations in consumption by age and sex.
Some of these factors are more effectively dealt with through centrally planned policies, and some have been successfully dealt with through community initiative and action.
WHAT FACTORS AFFECT PARTICIPATION?
There are a number of factors that influence the extent and nature of people's participation in development efforts: environmental, organizational, and participant factors.
Environmental factors include:
a. physical and biological factors (e.g., seasonality of production, concentration of settlement patterns),
b. economic factors (e.g., availability of land),
c. political factors (e.g., existence of a national political ideology supporting democratic procedures),
d. social factors (e.g., social stratification, ethnic and racial distinctions),
e. cultural factors (e.g., deferential attitudes toward authority, values discouraging conflict), and
f. historical factors (e.g., the nature of people's previous experiences with development efforts).
Organizational factors also affect participation. Organizational factors refer to both programme characteristics and the nature of national and international development agencies. Programme characteristics include:
a. the technological level of the activities,
b. resource requirements,
c. programme flexibility, and
d. the intensity of staff interaction with the local people.
In a Child Development Centre Project in Thailand, village-level citizens' committees are involved in all aspects of the centre's work, including the decision on the location of the centre, the development of cash and in-kind assistance, and the selection of youth to be trained as child-care attendants
FIG. 1. Schematic Representation of Fit Requirements (Source: ref. 2)
Certain characteristics of government and international agencies not only inhibit their capacity to promote effective community participation, but at times actually set up barriers to people's initiatives. These are:
a. centralized decision-making,
b. elite values and attitudes of personnel,
c. evaluation systems that emphasize quick results in centrally planned service provision activities, and
d. frequent transfer of personnel.
Finally, factors relating to the participants themselves have an important effect on the extent and nature of their participation in development efforts. These include:
a. the participants' degree of consciousness about their situation,
b. their level of organizational and technical expertise,
c. their general level of education, and
d. their work load, which determines the amount of time they have available to participate in development programmes.
The particular combination of environmental, organizational, and participant factors in a given situation will condition the forms of participation apt to emerge and influence the methods likely to be successful in eliciting and sustaining the full and active involvement of community members in development efforts. While it is true that no one method will necessarily work across different environmental and organizational contexts, the basic principles underlying a successful method of community participation can be delineated. Korten does precisely this in suggesting that the way in which community participation for rural development can be successfully generated is by a high degree of "fit" between programme design, beneficiary needs, and the capacities of assisting organizations (see fig. 1) (2).
The critical fit to be achieved between the intended beneficiaries and the programme is beneficiary needs, which are conditioned by the political, economic, and social context in which they live, and the resources and services resulting from programme activities. The fit between beneficiaries and the assisting organization refers to the means by which beneficiaries are able to define and communicate their needs and the processes by which the assisting organization makes decisions. Korten suggests that in order to achieve this fit, changes may be required at the community level in terms of developing a means by which the poor can express their needs, and at the level of the assisting organization in terms of developing ways to respond to such information. The fit to be achieved between the programme and the assisting organization is between the task requirements of the programme and the particular competence of the organization. Korten defines task requirements as the activities carried out by the assisting organization's members to produce and make available the programme inputs to the beneficiaries. He defines the competence of the assisting organization as the structures, standard operating procedures, and norms that govern the organization's functioning, as well as the technical and social capabilities it mobilizes to bring about the programme.
In a sub-regional project operation in four Central American countries-Panama, Costa Rica, Guatemala, and Belize-basic community needs are being determined through a survey process in which the community is actively involved in carrying out the survey, analysing the results, and defining priority needs.
In a nation-wide programme to support self-help activities for the underprivileged and economically disadvantaged groups, sponsored by the Department of Social Affairs in Indonesia, families organized in groups receive small cash or in-kind inputs for starting income-generating activities. This project is managed at the village level by men and women from the village who have been trained specifically for this programme.
The solutions to achieving the fit between programmes, beneficiary needs, and the assisting organization will vary substantially from one set of circumstances to the next. What is common to cases that have been successful in achieving this fit is the process of simultaneous, bottom-up programme and organizational development.
There is no doubt that promoting community participation in programmes is a labour-intensive proposition. Community level workers need to be trained and supervised and provided with logistical support; community people need information and training to make decisions and manage participatory organizations. The process of consciousness-raising and mobilizing the people takes time, and the achievement of quick results is unlikely. All this translates into money. Is this, then, a feasible strategy? Can governments afford to do this? There is not sufficient information to answer one way or another. However, where there is active participation by communities in programmes, the likelihood of the programme's success is enhanced. Success here is measured in terms of addressing the real needs of the community, building self-reliance, and promoting imaginative and low-cost use of existing local resources, both human and material.
Effective promotion of community participation also implies a reorientation of bureaucratic practices and procedures. This also requires money. However, if present top-down approaches to planning are continued, we will make no progress in devising measures to solve the massive problems in the Third World.
It is important here that we distinguish between short- and long-term cost. In the short term, the investment required to promote community participation may be large, but in the long term, it is likely that the investment will be paid off many times over as communities increasingly take charge of their own development.
Nutrition interventions represent an investment in human resources, a method of increasing human capital. Community participation also represents an investment in human resources. It is a method by which the poor and powerless can improve their life conditions and receive a fair share in the socioeconomic benefits generated by the development process.
1. ACC Task Force on Rural Development, "Report of the Third Meeting of the Working Group on Programme Harmonisation Rome, 26 January 1978" (UNTO/62 (c) Ext., pare. 9).
2. D.C. Korten, "Community Organization and Rural Development: A Learning Process Approach," Public Administration Review, Sept.-Oct. 1980, pp. 480-511.
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