Haiti Sit Rep 3. Promoting Community Participation and Ownership in an Emergency

Young Kids in Auto Mecca.

This Finn, is a bit of a personal bee in my bonnet and in truth, you may find this less than enthralling, but if any of this sort of public health stuff interests you as much as it does me, well…..

You see I really think that this is not only absolutley possible, if not right from the beginning of an emergency, certainly once populations have settled, but also makes for far better and more accurately targetted program responses.

Latrines draw a crowd….participation should be more than this

This means that if we involve local communities in designing our response as early as possible, they get to gain more control, sooner, our inputs are more relevant to their needs/culture and we begin to rebuild community esteem, control and capacity, at a time when these things have generally been massively compromised, that being the nature of emergencies.

However, more often than not, traditional emergency response is characterised by external decision making that is, of necessary made with a sense of urgency, but that, nonetheless, frequently fails to consider local involvement as anything other than fodder for building, lugging or mainly meanial tasks.

Obviously, the very nature of an emergency, where there has generally been large scale population displacement and a loss of control, often requires urgent decision making. But, personally, even here, once a situation has moved out of the first phase, we should be working to re establish local partnership at least and ownership as an aim. That’s what I think.

La Piste SC Planning Meeting (Mr Haiti’s on the right)

Thus the time I’ve spent trying to develop capacity at la Piste, which although severely compromised by the security and Mr Haiti, could have worked in that camp setting and might still.

Due to “les evenments” (which I’m afraid you’ll just have to wait for the details for) I’ve recently been focussing on Auto Mecca. This is a a totally different environment to work in. A much smaller population (15,000), systems of latrine and bin management that are working relatively well, including teams of cleaners that have been selected due to their proximity to latrines and who really do do their job….the latrines are generally spotless.

AM Latrine cleaner and water collection.

However despite this, we have had relatively little dialogue with the Sanitation Committee, that already exists, and almost none with the communities themselves. Thus we’d previously started handwashing education programmes, without even finding out if this was necessary. Yes, of course in an emergency, there’s a need to reinforce these messages, but my point is, we need to engage more and quicker.

We had designed, and translated in to Creol, a baseline Knowledge Attitudes and Practices (KAP) study. We were ready to go, identified the research team, had a training and trial in place as well as sample size numbers and gridding. But then the Organisation got wind of it and we were told not to do it as it had to be uniform all along the whole organisation.

We’d have had the results now, could have fed back strengths and weaknesses and had our own results from our own initiatives. But the Rc is not a place for initiatives. Too many cheeses in the same place here and thus the route to the top of the stairs and the landings necessary to get you there, stymie anyhting that could be a rapid or innovative response!

Am I moaning? Oops!

Anyway, thus we’ve started in Auto Mecca to develop the basis for a Community Action Plan (CAP) and have already completed a series of Focus Group Discussions (FGD) on malaria, that will inform our emergency preparedness and response to the threat of both malaria and Denge fever, both of which will be rampant from now on and in to the rainy season.

Focus Group Discussions in Auto Mecca.

The FGD should give us an idea of what actions and information we should priotitise, notably re how many nets to distribute. In Mozambique whilst working with SCF and distributing UNICEF nets (both agencies targetting youths and children) we discovered that after a family mosquito net distribution of one net per family, that this was generally taken by the adults, notably the father, and the children generally, but especially older children, slept without nets.

Here we’re pushing for at least two nets to go out per family, but we’ll know more tomorrow when we go through the results of these FGDs.

But back to the CAP. Here we’ve now undertaken another series of mapping exercises, but in Auto Mecca, down to the zone level and within these we’ve asked community members, zone heads of sanitation and the sanitation committee (SC), to identify major riskj factors in their areas.

Today we asked representatives from all these zones, totalling over 40 people, to meet to analyse this information and to begin to prioritise activities that will improve the sanitation and hygiene situation.

Grouping Community Problems.

Thus risk factors were clarified within zonal groups and then presented in a muddle of post it notes, placed chaotically by all groups on a large sheet of paper. At this point the zonal groups joined in to one group and then grouped the post it notes as they saw fit.

Ultimately this lead to 13 different groups of issues relating to anything from security to smelly latrines.

Obviously we needed to prioritise which of these issues we could or should address first and as such we undertook a (pairwise) ranking exercise, in which communities discuss and ultimately vote to select which issues they would prioritise in a series of discussions about pairs of alternatives (i.e. reducing fly/mosquito breeding areas or building more showers). This eventually builds a image of preferences and also requires extensive dialogue and discussions, all of which are noted by local staff and reflected upon as an infoemation capturing exercise.

A Community Ranking Exercise at Auto Mecca..what is your priority.

The results of this exercise will now be shared with our technical team to see what they feel that we can do and this will be fed back to the community.

As such we will have a series of targetted objectives linked to community needs and the reality of their lives and our capacity to respond. The next step is to build a Community Action Plan where by we agree that there are areas of the plan that the local community can respond to themselves (such as increasing the number of times bins are emptied, to reduce overflow and increase vector (flies/rats etc) control.

Within this we’ll need to assess steps to addressing each problem and the risks or opportunities that may exist for each.

In this way we ensure that communities own and participate in the design of their services, we learn more about the communities and thus are able to be more accurate in the program design decisions that we make, and ultimately we develop a happier and healthier emergency response. As I said before, hygiene promotion is about reducing barriers that block healthy decision making or healthy environments as well as promoting the heaqlthiest decisions possible, even or especially in an emergency.