Closer to people's hearts: NGOs in action

World Health • SOth Year, No. 3, May-June 1997 27 NGOs in a,tion Closer to people's hearts Alok Mukhopadhyay A magician in the village. The show talks about health. Photo WHO/Voluntary Health Association of India It is essential for health education campaigns to be rooted in the needs of local communities. ealth education has tradition- ally been a one-way process, working on the assumption that local communities need to learn from "health educators". In devel- oping countries, their messages often have little to do with local practices which have evolved through centuries of trial and error. A process of imposed education of this nature usually ends in frustra- tion. We have also seen that these high-pressure and unempathic edu- cational processes lead to a gradual erosion of some good local health practices. For the Voluntary Health Association of India, therefore, health education starts with an understanding of local health tradi- tions, food habits and the habitat. This will ensure that messages conveyed will be understandable and acceptable to the local communities, and also that goals and milestones are set realistically. There is always a two-way process of learning from the local community as well as offering them information which has not hitherto been accessible to them. This process has led us to rediscover unrecorded knowledge about food habits, effective traditional medi- cines which have no harmful side- effects, and refreshing patterns of sustainable ecologically friendly living. We feel that the holistic health of a community should be based on that community's own health traditions, many of which make a great deal of sense within the given context and are truly sustain- able. We have equally found that current mainstream health education overemphasizes communicating though the print media, even though in most developing countries a very large proportion of the people suffer- ing from ill-health cannot read. On the other hand, these communities have vibrant, entertaining and ever- evolving methods of communication such as local fairs, festivals, pup- peteers, jugglers and magicians, and traditional theatre groups. After years of according too much importance to the role of print in communication, we are gradually realizing the incredible potential of all these other ways of communicat- ing that have never ceased to be popular in the community. Through our work with existing groups, we have seen how we can spread health and development messages among the people in a much more effective manner. We have also seen that these alternative media are much more interactive and closer to people's hearts. Traditional approaches In the last two years, thousands of people have formed a part of our health communication campaign through these traditional approaches. Since many of these art forms are dying out for lack of sponsorship, we have started the process of edu- cating the younger generation and encouraging youngsters themselves to keep them going. In the heteroge- neous society of developing coun- 28 World Health • SOth Yeor, No. 3, Moy-June 1997 A village elder storing herbal products. Health education is a two-way process that may lead to rediscovering traditional ways of protecting health. Photo W HO/Voluntary Health Association of India Vi/loge health workers performing in street theatre in Himachal Pradesh. Photo WHO/Voluntary Health Association of India tries today, considerable thought needs to be given to this whole area when health education strategy is being planned. This does not, of course, rule out the importance of the print media, or the incredible outreach of radio and television. By propagating the health message through popular film songs and the dialogue of commer- cial films , we have been able to reach millions of people in India. Radio and television channels are particularly useful for creating a favourable atmosphere to launch more community-based educational efforts. We had considerable suc- cess in taking up gender issues and dealing with the problems of adoles- cents as well as encouraging com- munity action through television. Similarly, our effort to reach young people with sex education through popular radio channels has proved to be highly effective. Rooted in the local needs All too often, health education efforts do not address the minimum needs of the community, but fulfil the objectives of a project or cam- paign. This approach is a non- starter. In an area where people are dying of malaria, it is completely insensitive to overemphasize the problems of eye care. Therefore, it is essential for health education campaigns to be rooted in the needs of local communities. Health educators need to under- stand how information is processed and recorded in traditional commu- nities. Overemphasis on written information and records is likely to prove irrelevant in these settings. The farmers there plan their next crop or estimate how much seed and fertilizer to buy or how much money to spend for the next festival and what should be the budget for it, without noting it down in a diary. Their own method is perfectly effi- cient as far as they are concerned. Consequently, expecting them to switch into maintaining family health records, growth cards and so on is usually unrealistic. We have to work out a system that is effective and possible within the existing format of information acquisition which is familiar to a given commu- nity. We must also think seriously about the whole concept of time, dates and venue when we seek to provide health education to societies in developing countries. The cycle of daily life in such communities moves according to the harvesting, seasonal changes, religious festivals and so forth. The concept of having a meeting at nine o'clock in the morning of every Sunday is some- what irrelevant in these contexts. The right approach is to let the community decide what is the best time for everyone to be able to sit together and share some of their problems. Equally, the venue must be the one which is best suited for all and is non-controversial for such a meeting. Not least, it is vital to make these gatherings truly partici- patory by ens4ring that the women and the people of humble origin are able to speak their minds. In short, the whole approach of health education needs to evolve a different paradigm if it is to reach out to all the people for whom it is meant. "Education is what survives when what has been learnt has been forgotten." • Alok Mukhopadhyay is Executive Director, Voluntary Health Association of India, 40 Institutional Area, South of /IT, New Delhi· I I O O 16, India.