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References

1. Murphy J. Farmers' systems and technological change. In: Chaiken MS, Fleuret AK, eds. Social change and applied anthropology. Boulder, CO: Westview Press, 1990: 17-30.

2. World Bank, IFAD, FAO. The collection, analysis and use of monitoring and evaluation data. A joint World Bank-IFAD-FAO study. Baltimore, MD: Johns Hopkins University Press, 1988.

3. Casley DJ, Kumar K. Project monitoring and evaluation in agriculture. A joint World Bank-IFAD-FAO study. Baltimore, MD: Johns Hopkins University Press, 1987.

4. Murphy J, Marchant TJ. Monitoring and evaluation in extension agencies. World Bank Technical Paper No. 79. Washington, DC: The World Bank, 1988.

34. RAPing in Chad

Operational research programme
Projects begun in 1990 include the following:
Other studies under consideration included:
Initial resistance to RAP
Positive potential

By Carol Watson

Carol Watson was monitoring and evaluation officer with UNICEF, Chad.

The set of short synopses of completed, ongoing and planned UNICEF-supported studies described in this paper demonstrates a UNICEF programme of cooperation firmly committed to national research capacity building focused on high priority problems linked to child survival and development. This paper also provides an acute analysis of the organizational and professional constraints inherent in the introduction of a new qualitative methodology that requires a new way of viewing and working with communities. The succinct outline of problems, ranging from those with the donor, to those with government and with researchers complements the earlier paper by Murphy, from the World Bank. This paper, written from the perspective of a professional qualitative researcher and programme officer working for a major donor and living in a developing country, shows how quickly and how productively RAP can be introduced. However, researchers and donors alike are cautioned on important constraints that can be expected and overcome. - Eds.

IN THE SEARCH for relevant information on which to base the UNICEF supported Analysis of the Situation of Women and Children in Chad, it soon became apparent that both qualitatively and quantitatively the gaps in the existing data base are enormous. There are no reliable demographic statistics, as the country has had no census since the 1960s. Studies of an ethnographic nature are mostly outdated, recent sociological research having been interrupted during the protracted period of civil unrest characterizing the country virtually since independence.

The studies that do exist tend to concentrate on certain regions rather than others, often favour certain themes of purely ethnographic interest, such as religion, and do not always focus specifically on women and children. More recent operational studies commissioned or performed by international agencies in conjunction with humanitarian aid or development actions are scattered and often narrowly focused on a particular problem; the results are not easily accessible and are often of uneven quality.

In addition, research capacity in the country is poorly developed. University structures are weak, with most academic facilities destroyed or disrupted during the war, and many of the most qualified personnel of all disciplines have fled the country. With very little background data, the question UNICEF faced in the course of its planning for 1990-1994 was how to build relevant programmes of action in favour of women and children.

Operational research programme

One of the responses was to develop an operational research programme designed to collect relevant information on women and children's lives through support given over the next five years to local research institutions and individuals. The aim of the programme is two-fold: to contribute to the data base and to strengthen national capacity for research. With the Ministry of Plan as the coordinating ministry, contacts have been established with the University, the National Institute for Social Sciences (INSH), the Center for Applied Research (CRA), the Interministerial Office for Studies and Projects (BIEP), the Central Hospital of N'Djamena, and various ministerial departments, including the Center for Nutrition and Food Technology (CNNTA) of the Ministry of Health and the Division of Statistics of the Ministry of Plan.

Projects begun in 1990 include the following:

An investigation of traditional practices adversely affecting the health of women and children

In coordination with the National Committee on Traditional Practices, this study was led by a professor of law specializing in women and customary practices at the University of Chad, assisted by a lecturer in sociology at the National School of Public Health and Social Services. Field work began in 1990 in four regions of the country, seeking to establish a broad inventory of traditional practices, but focusing most specifically on excision. The aim was to identify those involved in the practice, examine causes and consequences, and investigate attitudes for and against the practice through questions asked a cross-section of the population, including male and female, the excised and the non-excised, traditional leaders, excisers, socio-sanitary personnel, political authorities, and others. The results of the study were intended to aid the National Committee on Traditional Practices in developing a programme of action focused on popular education and training.

A study of the socio-economic aspects related to the return of refugees to Chad, with a focus on the situation of women and children

As part of a larger, multi-country study programmed by the U.N. Research Institute for Social Development (UNRISD), the study in Chad focused on five zones that have seen massive influxes of refugees returning after the period of hostilities. National policies and programmes are examined in the light of problems encountered by refugees on their return. A special case-study approach was taken with women. The aim was to document experiences in order to provide policy recommendations for national and international leaders.

An investigation of girls' school attendance and dropout rates

Statistical information drawn from school attendance records exists to indicate a major problem in girls' educational attainment in Chad. The aim of the study was to flesh out the statistics with qualitative insights into various cultural perceptions of, and reasons for, the situation. Investigators are drawn from the Ministry of Education. Field studies were sited in four regions of the country where the presence of UNICEF area-based service programmes provided scopes for eventual pilot programmes to enhance girls' educational opportunities based on the study's findings.

Ethno-linguistic research into common childhood illnesses and traditional remedies

Led by two linguists from the University of Chad working with key informants from two ethno-linguistic communities in the capital and selected resource people, the study aimed at recording popular perceptions of diseases through precise transcriptions of terminologies used to describe them, and to establish a comparative tri-lingual lexicon useful for health-workers operating in Chad's multi-cultural setting. Offshoots of the study so far include a video on certain traditional practices affecting children's health, such as removal of the luette, and a classification of medicinal plants and herbs from the region surrounding N'Djamena.

A study of village-level economic resources and community priorities in a region in the south of Chad

This project evolved as a response to difficulties encountered by UNICEF and National Water Office personnel when visits of prospection for provision of water services failed to elicit community support in areas where water was plentiful but of poor quality and water-borne diseases were prevalent. As government policy was to ask communities to participate financially ($275) towards the cost of installing village pumps, the question was: "Was refusal to participate due to limited resources on the part of community members or to non-perception of the problem? The study begun in late 1990 coordinated by the Economic Research Unit of the University (BEC), with input from the Statistical Division of the Ministry of Plan.

Other studies under consideration included:

• An investigation of cultural preferences on the part of certain Muslim parents to school their daughters through the traditional Islamic system of "madrassa" rather than through the public school system.

• A study of fever cases at the Central Hospital of N'Djamena, which aims to combat the tendency to misdiagnose and therefore mistreat all fevers as symptomatic of malaria.

UNICEF also aided in an earlier study which was an evaluation of the impact of rural radio programmes in four representative areas of the country. The study was conducted by two Chadian sociologists.

All of the studies were led and conducted by Chadian nationals - a conscious choice having been made to avoid calling in outside "experts" in order to build up local-level expertise in research activities. UNICEF's contribution was financial, conceptual, managerial, and technical with participation in all phases of project design and implementation. It must, however, be added from personal experience that everyday office time pressures and multiple responsibilities constantly threaten to reduce the role of UNICEF staff to that of mere administrators.

Initial resistance to RAP

While not all of these studies lend themselves in the same degree to all aspects of RAP methodology and approach, an attempt was made, through projection of the RAP video, discussion of RAP techniques, and participation in the development and testing of data-gathering instruments, to initiate the different research teams and participating UNICEF staff members into the spirit of RAP; i.e. to instill in the investigators an anthropological approach to information-gathering. There has been no assessment as to the extent to which the results reflect these efforts. The following comments are offered as observations on some of the difficulties encountered in the process.

The quantitative/qualitative quandary

For the most part, UNICEF staff members are charged with furnishing headquarters, with numbers, working with government officials most at ease with statistics, and with researchers most comfortable with neat tableaus of countable responses. RAP's emphasis on the need for qualitative assessments of situations was difficult to assimilate and left most participants uneasy. The solution, of course, is to offer RAP as an alternative approach, complementary to other statistical surveys. But when research funds are limited and other initiatives rare, it is difficult to insist on the importance of quality over quantity with persons conditioned to demand quantitative data.

Depth or breadth?

A related problem was resistance to basing an analysis on responses of a few members of various population groups interviewed in depth rather than on a broad survey of larger population samples. The question inevitably raised was, "Can talking with a few key informants at length give you as much to go on in pinpointing problems and planning programmes as covering entire communities with a questionnaire?"

Problems with the particular

In its focus on in-depth analysis of problems perceived by particular communities, the RAP methodology leaves many seeking to conceptualize and implement national programmes asking about its relevance to them. This is especially a problem in a multi-cultural setting such as Chad. The reaction of a UNICEF staff member and former Ministry of Health worker after viewing the RAP video was typical; shaking his head, he simply dismissed the possibility of RAP's being useful in his programming efforts with the government. What RAP might reveal about particular communities would most likely have little impact on national policy formation, so, some would ask, why do it?

Dealing with diversity

Bureaucratic problems particularly stemming from traditions of centralized planning leading to a heavy top-down approach to programming are often combined with political mistrust of diversity. In a country like Chad the idea of highlighting cultural diversities and adapting national programmes to such differences is often politically unacceptable, though the idea of regional development is gradually gaining currency.

Taking people seriously

At the heart of the problem is perhaps the failure on the part of government bureaucrats and technicians, UNICEF project personnel, and researchers alike to take people's perceptions seriously. Within the framework of authoritarian political structures, there is not much scope nationally for people's views to filter up. Government technicians, therefore, cannot be expected to accept that as their mandate. With UNICEF staunchly allying itself to government structures, UNICEF personnel working day in and day out with their government counterparts also risk assimilating this point of view and often lack the language skills necessary to approach "the people" directly. Researchers themselves, with an uncertain role in these societies, may not only lack the skills necessary to elicit people's opinions, they may also lack the power to do so.

In a recent attempt, for example, to encourage local journalists to document the Chadian people's experiences as they move out of a situation of war, drought, and the collapse of the cotton market, the journalist charged with reporting on agricultural problems went to the Ministry of Agriculture to conduct interviews with officials rather than to the countryside to ask questions of peasants. He served as the mouthpiece of government rather than as spokesman for the people.

Another apparent obstacle seems to exist at the societal level. Researchers are usually drawn from the urban elite and connected with government ministries. They seem to see it as a loss of face to go into the countryside simply to ask questions and listen rather than to give directives and offer solutions. In an early phase of the education project, for example, the researcher spent almost as much time in haranguing parents for not sending their daughters to school as in listening to their reasons for not doing so.

The fear of open-endedness

Even if the principle of taking people seriously is accepted, the techniques used to elicit responses are not always appropriate. Sociological research practices in Chad are generally rigid, based on fill-in-the-blank and yes-no type questionnaires, with little attention to formulating the RAP-type more open-ended questions that might allow real human perceptions and responses to filter through. Researchers have rarely received training in asking such questions or in recording people's responses in their own words. Difficulties in treatment and analysis of the data are also a discouragement to such an approach.

Formalistic frameworks

A related problem is that, since most of the research in Chad is so formalistic, it is difficult convincing researchers that informal interviews with friends and chance encounters are as valuable as formal interviews in yielding qualitative data of the type desired. Nor will they easily accept the idea that material from their own lives may add depth to the analysis of material drawn from the lives of others, since most of the topics under investigation touch them closely as members of the same societies. In the study of traditional practices, for example, the women researchers had similar experiences of female circumcision themselves or within their close families; yet they distanced the object of investigation as if truth were to be found in external objectivity and not in subjective experience.

Integrating observations

Related to the above are difficulties in linking observations to questionnaire responses in order to measure people's words against actions. On one occasion, a researcher interviewing a woman in her home recorded the response to the question of who took care of the household water supply as "the woman". Ten yards away in the courtyard, in full view of the interviewer, a young girl of about seven laboriously filled up a bucket from a deep well. This went unnoted by the researcher. The RAP approach stresses observation as well as open-ended questioning. On another occasion, in the investigation of the impact of rural radio, researchers carefully noted responses to questions concerning most popular listening times or possession of radios, but did not consider double-checking these responses with observations of times when people were actually listening to the radio or how many people in a particular village actually owned working radios. While, the rapidity of RAP might not allow room for the detailed and repeated observations that form the backbone of traditional anthropological fieldwork, even a little observation can go a long way. An underlying principle of RAP is "triangulation" - approach the same issue in several different ways.

Positive potential

In spite of these preliminary obstacles, there are many positive signs that resistance to RAP is being overcome and that the potential for imbuing ongoing operational research with the anthropological spirit exists. A major component of the Operational Research programme over the next several years is the training of national personnel. By having project leaders available with a solid background and experience in RAP and other anthropologically-oriented research techniques, many of the original difficulties encountered may be avoided in the future.

Already, through the various works-in-progress, several advances have been noted, with sometimes unintended positive benefits. The different project research teams meet regularly to discuss methodology, debate approaches, hammer out research instruments, and analyse results. These productive encounters of government personnel, UNICEF staff, and researchers help break down some of the barriers that tend to exist among personnel with different functions. It is as if the common search for truth unites us. There is a natural tendency towards multi-disciplinarity within the teams, which are composed of lawyers, sociologists, linguists, teachers, botanists, economists, health workers, and bureaucrats of various kinds.

The multi-disciplinary exchange of ideas when we come together is a welcome relief from the more narrowly focused sectorial approach to problems that characterizes much of our programme work with government structures. The programme has allowed UNICEF to expand its collaboration in the country to include non-habitual partners such as the University. This can only enhance UNICEF's intellectual base as it moves into the 1990s offering ideas and knowledge in addition to vaccines and ORS.

Certain discoveries have been made by the researchers during their investigations that further break down their resistance to RAP. In the study of girls' education, for example, researchers had originally intended to interview teachers, parents, and administrative authorities and had scoffed at interviewing the girls about their education. When more or less forced to conduct focus-group discussions with young village girls, they found the girls actually quite animated and vocal in expressing opinions. A similar discovery was made by the investigators of traditional practices who encountered women quite willing and able to discuss intimate aspects of their lives.

Experimentation with multiple forms of interview techniques is proceeding apace; the instruments, for example, which the traditional practice teams are now using are a far cry from the rigid, non-varying fill-in-the-blank type questionnaires originally proposed. The importance of observation has been accepted: in the girls' education study, observation grids have been elaborated to guide and systematize observations of girls' and boys' behaviours and interaction with others in the home, public places, and schoolroom. These have been tested and found useful by all involved in the study.

That UNICEF is taking evaluation research seriously is demonstrated by the availability of funding for the creation of the programme just described. It must, however, be noted that the particular anthropological approach to research as exemplified by RAP has not yet been institutionalized and still seems to depend very much on the willingness of individuals within the system to push it through, often under rather adverse conditions. This points to the continuing importance of gatherings such as this conference, and the need to create more support systems as well as to develop abundant training materials for a variety of field settings.

35. From qualitative community data collection to programme design: Health education planning in Niger

Data base for programme planning
Responsibility for data collection and programme planning
Contact between programme planners and target communities
Concept of the planning process
The Niger programme planning experience
Conclusions
Acknowledgements
References

By Judi Aubel, Mamadou Alzouma, Ibrahim Djabel, Sani Ibrahim, and Boubacar Coulibaly

Judi Aubel works as a consultant in Dakar, Sénégal. El Hadj Mamadou Alzouma, Ibrahim Djabel, and Sani Ibrahim are affiliated with the Ministère de la Sante Publique, Niger. Boubacar Coulibaly is affiliated with the Projet de Sante Infantile, Zinder, Niger

When the project focus is health education as in this paper, few would question the need to develop a clear picture of community behavior, attitudes, and knowledge on the project focus, in this case, control of diarrhoea. But as the paper indicates, more than information and a baseline behavioral set was obtained. This systematic, step-by-step description of the use of RAP in planning a health education programme demonstrates both the potential for bringing programme planners into the community as well as involving the community itself as a source of useful input into programme strategies. The paper details a multi-stage planning process that includes a feedback loop to the community during the planning cycle. The approach described appears to be equally valid for a far wider range of programmes than those dealing with health education. - Eds.

THE QUALITY OF community health education programmes depends in part on the process used to develop such programmes. There is a need for indepth, qualitative community data to be collected prior to developing health education programmes. This is often not done by most ministries of health. Three other aspects of planning closely related to the quality of programmes are: who is involved in both preliminary data collection and in programme planning; the extent to which planners have had contact with the communities they are planning for; and whether programme development is viewed as a top-down, mechanical process or as an iterative, problem-solving process.

The significance of these four aspects of the planning process is discussed below. A health education programme planning exercise carried out in Zinder, Niger is described. The planning exercise had two parallel objectives. The first was to develop a health education strategy appropriate for the socio-cultural realities of the Hausa communities in the area A second was to introduce an innovative programme planning methodology into the regional health education department.

Data base for programme planning

There is increasing recognition of the need to base community health programme planning on an in-depth understanding of local health-related situations, beliefs and strategies [1, 2]. Similarly, there is a growing consensus that to plan health education quantitative survey data are insufficient, and that in-depth qualitative data on health-related phenomena are necessary [3-5].

The collection of qualitative data on community beliefs and practices, specifically on diarrhoeal disease, prior to the development of health communications and education activities has been carried out in a variety of settings [6-9].

Pacey [10] insists upon the value of rapid, cost effective informal data collection techniques to allow rural development planners to collect accurate information on community perspectives. He concludes, "Probably the most important information about rural situations is obtained by talking and listening to rural people."

In formative data collection efforts more attention needs to be given to specifying the information needs of programme planners and to defining how data will be used once they are collected, in order to decrease the gap between research and practice.

Responsibility for data collection and programme planning

Another related aspect of the programme development process is that of who is involved in formative data collection and who is responsible for programme planning based upon the data collected. The outcomes of the data collection and programme planning processes are significantly influenced by the training, values and experiences of those involved in those activities. Also, continuity in terms of the involvement of some of the same people in both data collection and programme planning is important.

Programme planners' backgrounds, values and attitudes are reflected in the programmes they develop and, therefore, determining responsibility for health education programme planning is of critical importance [11]. Programme planning is often done at the central level by programme managers who were not involved in collecting community data and who have only a superficial understanding of either community or service-provider perspectives on a given set of health problems.

To the extent possible, it is valuable for both programme managers and service providers to be directly involved in formative community data collection and in defining programme strategies. In the data collection phase, such involvement can: assure that programme planners' priorities are addressed; take advantage of service providers' greater understanding of community values and practices; foster learning and teamwork between service providers and programme managers; demystify the data collection process; strengthen health sector technicians' skills in community data collection; contribute to a sense of ownership of the study findings on the part of participants and of their commitment to using them in programme planning. In the programme planning phase, it is also valuable to elicit the participation of both health education programme managers and of service providers. The perspectives of the two levels of staff relative to a given programme area typically differ, and during programme planning it is beneficial to take those different perspectives into account [12]. Lastly, assuring some continuity between those involved in data collection and those involved in programme planning can contribute to a greater and more accurate use of formative data collection findings.

Contact between programme planners and target communities

The extent to which programme planners have contact with the communities for whom they are developing programmes is another important aspect of the planning process. Often those responsible for planning community health programmes have had little or no direct contact with the communities for whom they are designing programmes. Furthermore, the perspectives and values of health professionals and of communities regarding community health problems are typically different [13, 14]. The inherent gap between the culture of the health planners and the culture of the community, compounded by physical distance between the two, represents a serious obstacle to the development of socio-culturally appropriate programmes. In addition, evidence from various countries suggests that the attitudes of health professionals towards communities are often negative and condescending, particularly when those communities are poor and uneducated [15-17].

Direct contact between programme planners and target communities during the planning process is valuable. Pacey [10] argues that, if those responsible for developing community health programmes spend time in villages, and if they informally interact with, and collect information from communities, they may be more likely to develop programme strategies that take into account the community's point of view, resources and constraints.

Concept of the planning process

Two distinct approaches to programme planning have been identified: the "blueprint" and the "learning process'' approaches [18]. In the first approach, technical experts, at the national or regional level, design programme "blueprints" that are communicated to field staff for implementation. Such topdown planning seldom takes into account the concerns and perspectives of field workers and even less so that of communities themselves. In the learning process approach, the programme design and the capability to implement it are developed in consultation with community beneficiaries and programme implementors to take into account the concerns and priorities of each. In this approach technical experts acknowledge that their technical knowledge is necessary but not sufficient for programme planning, and that only through ongoing dialogue with the programme beneficiaries and implementors will they discover how to design more appropriate community programmes. In this approach, the programme plan remains flexible and as it is implemented, as feedback is received from community beneficiaries and field staff, programme managers are continuously learning how to modify and improve programme strategies. Relative to Korten's topology [18], it is argued that the planning process used to develop community health programmes should be participative, iterative and a learning experience for those involved. The following section describes a diarrhoeal disease health education programme planning exercise in the Zinder region of Niger in which particular attention was given to the four aspects of the planning process discussed above.

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