Participatory Learning and Action 16:
RRA Notes 16: Applications for HealthIIED, July 1992. 115 pp.
Guest Editor: Alice Welbourn
Out of print except as part of a complete set of back issues:
Summary
This issue of RRA Notes has resulted from a two-day workshop on PRA techniques in relation to health, held at the Institute of Development Studies (IDS) in November 1991, and hosted by Robert Chambers. The four key issues discussed at the workshop and here presented are: reflection on the relative values of qualitative and quantitative data; the position of ‘the community’ as subjects or objects of health service delivery; the importance of the process of community-based health and information collection, as opposed to a more conventional pre-occupation with the product; and the importance of the development of health worker skills towards learning and facilitation, as opposed to imperious superiority.
Scrimshaw and Hurtado’s work on Rapid Assessment Procedures for Primary Health Care (PHC) is mentioned by several authors in this issue and reflects a shift in approaches to community-based health studies. The articles here contribute to a highly topical debate within the health field as well as beyond.
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PART 1: Overviews
1. Rapid appraisal for health: an overview
Susan Rifkin
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Abstract
This paper examines the rapid appraisal approach -as opposed to the Rapid Assessment approach - and some of the issues it raises for health development. These issues are: 1) types of information collected; 2) community participation; 3) the information collection process; 4) information use.
2. Participatory Rural Appraisal: potential applications in family planning, health and nutrition programmes
Richard Heaver
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Abstract
This paper presents a review of PRA with specific reference to its potential for the India Family Planning, Health and Nutrition Programmes. In this context it examines the issues of PRA expansion, institutionalisation and quality control. NGOs are considered to be vital to institutionalise the PRA process. The speed at which governments are able to absorb PRA techniques will be determined by the rate at which suitable NGO support for the process can be made available.
PART 2: Discussions with communities
3. Qualitative methods for assessing the acceptability of immunisation in Somalia
Anne LaFond
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Abstract
Save the Children Fund and the Ministry of Health in Somalia used focus group discussions, key informant interviews and observation to identify factors influencing the acceptance of immunisation. Focus groups consisted of mothers of different ages, Mother and Child Health staff and Traditional Birth Attendants. Three researchers lived with families in the community for 12 weeks. The team found that there were widespread misconceptions regarding the Expanded Programme on Immunisation (EPI). All health campaigns were regarded with suspicion by the community because of the sensitive political situation. Suggestions are made for adapting future health messages to take into account local perceptions of disease.
4. Unemployment and health: the development of the use of PRA in identified communities in Staveley, North Derbyshire
Teresa Cresswell
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Abstract
The study took place in an urban area of North Derbyshire where unemployment rates were 40% higher than the UK average. Interviews were conducted with professionals in education, health, social services, police, clergy, housing sector and members of the community including children. Discussions (some of which were videoed for later analysis) focused around unemployment, perceptions of problems and possible solutions. The study identified 'the need for an informed, integrated, inter-agency approach with the involvement of unemployed people in order to be able to respond effectively to the problems of unemployment'.
5. Community-based information systems
Francesca Moneti
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Abstract
This article describes the objectives of UNICEF's 1990 Bamako Initiative. The initiative attempts to institutionalise the collection and analysis of health information by communities which it believes are a powerful mobilisation tool. The initiative aims to encourage decentralised community information systems of the type developed in Tanzania, Mali, Peru and Ethiopia. A number of countries are to be given direct support for the development of health and nutrition information systems that are community based. PRA is considered to have a valuable part to play especially in base-line studies.
PART 3: Illustrated Discussions
Asia
6. Training workshop on Participatory Rural Appraisal for planning health projects
Sheelu Francis, John Devavaram and Arunothayam Erskin
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Abstract
SPEECH (Society for Peoples' Education and Economic Change) conducted a series of workshops on PRA for NGO and Government officials in Tamil Nadu, Southern India. The workshop at Manavarayanenthal focused on health, 'to evolve new strategies in planning specific health projects'. Descriptions are given of each training activity, including materials used, and an evaluation of the training programme as a whole. Findings are analysed in terms of the different responses of the NGO group and women's group, showing clearly the value of the PRA approach in revealing the different kinds of knowledge and attitudes to health care.
7. Trends in health care
Alok Kumar
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Abstract
PRA was conducted in Ambari village, Meghalaya. The importance of diseases was symbolised by stick length and pie diagrams. Recall was used to compare treatment strategies in 1920 and 1990. Seasonality was charted. A causal model was constructed which showed the link between a lack of safe drinking water and disease. A model of the causes of child mortality was built. Health and wealth ranking took place. Illustrations are included of each method.
8. Participatory Rural Appraisal in identifying major illness, healthcare providers and costs
Sam Joseph
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Abstract
A five day PRA exercise and training session was conducted by ActionAid with the dual purpose of 1) training members of the Comprehensive Rural Health Project (CRHP), 2) generating information on the health care system in Jamkhed. Team members were paired so that non-literates were placed with literates. Methods used included: focus group discussions, preference ranking, seasonality diagrams, village transects and a flow-process analysis to understand who gets sick.
9. A little experience of a PRA exercise conducted at Mecluskigang
Mahadeo Sahu and Ranjan Tirkey
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Abstract
A brief report of a PRA exercise carried out to analyse the effects of alcoholism in a tribal area of India. Causal diagrams were produced of drinking habits and of women's status, showing the different consequences of birth of a female child as compared to a male child.
10. Extract from ‘Participatory Rural Appraisal for Nepal: concepts and methods. A guide to the slide presentation’
Lorna Campbell and Gerard J. Gill
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Abstract
This article is an outline of a slide presentation on the use of PRA in family planning in Nepal. A time line was constructed of when different family planning methods arrived in the village. A pie diagram was used to show preferences for family planning methods. Vasectomy was the most popular. A matrix was used to rank the reliability, availability, simplicity and side effects of each method.
11. Participatory methods for research on women's reproductive health
Elizabeth Tolley and Margaret E. Bentley
Africa
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Abstract
A workshop held in India revealed a number of ways in which PRA methods could be applied to research and programme development for health. A body mapping exercise was conducted with a group of traditional birth attendants to discuss their concepts of reproduction, contraception and nutrition. A village mapping exercise led later to construction of pregnancy time lines and information on family planning.
12. Body mapping in health RRA/PRA
Andrea Cornwall
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Abstract
Body mapping (pictures of the perceived working of the female reproductive system) was conducted with women in southern Zimbabwe. The study aimed at bridging local knowledge and western medical explanations of non-indigenous contraception. Maps were drawn on the ground with a stick. The use of body maps helped to generate discussions from which an understanding of local idioms and ideas of contraception emerged.
13. Notes from a food and nutrition PRA in a Guinean fishing village
Judith Appleton
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Abstract
This report of a PRA exercise held in coastal Guinea focuses on methods which can be used to highlight food security issues and health problems in a community. It notes that the PRA experience 'left the whole team with a critical awareness of our own outsider judgmental attitudes, and increased our understanding of constraints on livelihood improvement and our respect of fisher household decision-making'.
14.A note on the use of disease problem ranking with relation to socio-economic well-being: an example from Sierra Leone
Alice Welbourn
South America
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Abstract
An RRA training exercise was conducted by ActionAid staff in a Sierra Leone village. People were divided into separate groups of old men, young men and women, then sub-divided into "better-off" and "worse-off" using groups of well-being ranking . A disease problem ranking by the women revealed very different results between the groups of poor and richer women.
South America
15.Exploring the potential for primary environmental care: rapid appraisal in squatter communities in Salvador da Bahia (Brazil)
P. de Colombani, G. Borrini, M.C. Meira de Melo and M. Irshaid
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Abstract
This paper discusses the methods of collecting information in a field study carried out in Salvador da Bahia (Brazil) a suburb of Salvador. The study was part of a training exercise for students of the 'International Course for Primary Health Care Managers at District Level in Developing Countries' based in Italy. The study also aimed to explore the potential for Primary Environmental Care (PEC) and identify ways by which the local health district could support squatter communities.
16. Actual or potential uses of RRA/PRA methods in health and nutrition
Robert Chambers
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Abstract
This is a list of potential practical applications of PRA methods to health and nutrition. Several applications are listed for each method.
Saboteur
Alan Margolis
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