C o m m u n i t y - B a s e d
I n i t i a t i v e s
S e r i e s
8 WHO-EM/CBI/017/E/G Distribution: General
Frequently Asked Questions about Community-Based Initiatives
World Health Organization Regional Office for the Eastern Mediterranean
C o m m u n i t y - B a s e d
I n i t i a t i v e s
S e r i e s
8 WHO-EM/CBI/017/E/G Distribution: General
Frequently Asked Questions about Community-Based Initiatives
World Health Organization Regional Office for the Eastern Mediterranean Cairo, 2003
© World Health Organization 2003 This document is not a formal publication of the World Health Organization (WHO), and all rights by the organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes. The views expressed in documents by named authors are solely the responsibility of those authors Text prepared by Mubashar Sheikh and Mahmood Afzal Cover design by Suhaib Al-Asbahi Designed & Printed by DAT Document WHO-EM/CBI/017/E/G/09.03/2000
C o n t e n t s Preface ..................................................................................................................... 5
Frequently asked questions What is sustainable development? .............................................................................. 7 How can sustainability be achieved? ........................................................................... 7 How does health relate to development and poverty reduction? ................................ 7 Why is WHO advocating broader approaches to health development? ...................... 8 What is quality of life? ................................................................................................ 8 How can improvements in quality of life be achieved? ............................................... 8 What are community-based initiatives? ...................................................................... 8 What are the objectives of community-based initiatives? ........................................... 9 What are the strategies of community-based initiatives? ............................................ 9 Are there any community-based initiatives guidelines and tools? ............................... 9 How do the tools assist in community-based initiatives implementation? .................... 10 What are the links between community-based initiatives and national development agendas? .............................................................................................. 10 What is a basic development needs programme? ....................................................... 10 What is a healthy city programme? ............................................................................ 11 What is a healthy village programme? ....................................................................... 11 How do these three approaches differ from each other? ............................................ 11 What is meant by “women in health and development”? .......................................... 11 What are the structures of community-based initiatives? ........................................... 12 What is a social contract? ........................................................................................... 12 What are development packages? .............................................................................. 12 What is social development and how does it differ from economic development? ........ 13 Why is income generation undertaken? ...................................................................... 13 What is seed money? .................................................................................................. 13 What is a revolving fund? ........................................................................................... 14 What is a community development fund? .................................................................. 14 How does cost sharing differ from profit sharing? ..................................................... 14 Why is promotion and advocacy important for community-based initiatives? ........... 15 How can partnerships be developed and strengthened? ............................................ 15 Who are the major partners for community-based initiatives? ................................... 15 What is the role of the partners in community-based initiatives? ............................... 16 What is the role of the community in community-based initiatives partnerships? ....... 16 What is the role of intersectoral cooperation in community-based initiatives partnerships? ............................................................................................ 16 What is the role of WHO in community-based initiatives partnerships? ....................... 17
P r e f a c e
The international community has now recognized health as a major goal of development and considers it a universal human right. With this in mind, the Eastern Mediterranean Regional Office of WHO has developed an innovative strategy of community-based initiatives (CBI) for health and development in which emphasis is put on both economic growth and improvement in standards of living, health status and quality of life. The document provides simple and concise responses to the questions raised, over the years, by the people involved with CBI management at different levels. The readers will get a better understanding of the rationale, concept, methodology, implementation and monitoring of different initiatives. It is expected that, with a clear comprehension, these people will be able to advocate and manage the initiatives more diligently.
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FREQUENTLY ASKED QUESTIONS What is sustainable development? Development can only be sustainable if both the social and the economic dimensions are considered at all levels and stages. Health is a central goal, and one of the most important outcomes of development. Therefore, sustainable development should always be measured in terms of social indicators (mainly health), reduction of absolute poverty and improvement in quality of life.
How can sustainability be achieved? The following factors are essential for sustainability of local development: • demand and ownership from the community • feasible, needs-based planning • decentralization and transfer of responsibilities and resources • capacity building at local level and promotion of technical skills • political commitment and administrative support • conducive environmental and socio-cultural factors • use of appropriate technologies suitable for the local level • efficient and transparent financial management • effective monitoring and periodic evaluation. • political stability
How does health relate to development and poverty reduction? The reasons for and mechanisms leading to persistent inequalities in health are mainly poverty, limited resources, underdevelopment, illiteracy, overpopulation, poor sanitation and lack of awareness regarding health and basic needs. Health contributes to and results from social and economic development. The problem of poverty is deeply intertwined with national growth perspectives and quality of life, including the health status of the population. The links between health and poverty run in both directions: good health allows poor people the opportunity to participate in gainful and productive activities, while ill-health adds to their miseries and further reduces socioeconomic opportunities. Those living in absolute poverty have much higher morbidity and mortality rates compared to the well-off.
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Why is WHO advocating broader approaches to health development? Health and development are intrinsically linked and mutually reinforcing. Development in all spheres of life, including the political, cultural, social, economic and environmental spheres, affects the health of the people. Health is a sensitive and vulnerable component of life that is influenced by any challenge to the human environment. Therefore, it can only be achieved by addressing its multi-dimensional determinants through advocating and supporting collective measures for sustained and holistic development.
What is quality of life? Quality of life must be considered in the context of local development and human needs. It is a subjective evaluation of the situation of a person or group of people and is affected by a range of factors such as those determining health and happiness (including comfort in the physical environment and a satisfactory occupation); education; social and intellectual fulfilment; freedom of action; justice; and freedom from oppression. This concept is the composite measure of physical, mental and social well-being as perceived by each individual or group of individuals.
How can improvements in quality of life be achieved? Improvement in quality of life can be achieved as the result of a set of multisectoral actions considered essential for human rights and needs. The following are key examples: • providing equitable primary health care services with accessibility to each component; • ensuring accessibility to safe water, a healthy environment and better housing; • raising the standards of life through multisectoral interventions benefiting each person; • reframing social goals and policies.
What are community-based initiatives? Since the 1980s, the Regional Office for the Eastern Mediterranean of the World Health Organization (WHO) has been advocating poverty reduction as the most potent strategy to facilitate equitable development for achieving health related goals. This strategy is consistent with the millennium development goals set by the United Nations and the priorities identified by many international forums and organizations. In support of this strategy, the Regional Office is actively promoting community-based initiatives (CBI) among countries of the Region. These include basic development needs (BDN), healthy cities programmes (HCP), healthy villages programmes (HVP) and the promotion of women in health and development (WHD). These initiatives are managed by the organized, empowered and actively participating communities, supported through coordinated intersectoral action.
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What are the objectives of community-based initiatives? • Facilitating the integration of health policies and programmes in the national strategic development agendas; • Improving health and environmental conditions; • Reducing poverty; • Promoting equity, gender mainstreaming and enhancing the role of women in health and sustainable development; • Achieving a better quality of life.
What are the strategies of community-based initiatives? The implementation of community-based health and development initiatives varies according to the prevailing situation. Each country will have to adapt these approaches to suit the local conditions and introduce the most modest interventions according to the ground realities and the priority needs of the communities. The Regional Office provides technical and conceptual support. The following is a set of key strategies which will ensure uniformity and effective implementation of CBI: • generating and disseminating information on links between health and development; • supporting the countries of the Region to develop a shared vision in formulating national strategies or focusing on the health of the poor through dynamic intersectoral collaboration; • helping in empowering communities with particular emphasis on the role of women; • creating partnerships advocating the centrality of health in development policies and programmes; • assisting countries to incorporate community development approaches in their national poverty reduction policies.
Are there any community-based initiatives guidelines and tools? To facilitate the process of planning and implementation of CBI, uniform, user-friendly guidelines have been developed along with a set of technical/administrative tools1 (although only BDN is mentioned in the guidelines, these can be utilized for other CBIs as well). This is an attempt to address some of the most important comments concerning CBI which have been put forward by various sectors and agencies. They are by no means exhaustive or rigid, and require adaptation by each country. The government, WHO and other contributing agencies should refer to these guidelines when evaluating their plans. When assessing the inputs, processes and outcomes of national CBI programmes, these guidelines should be used as the reference material. The guidelines and tools are generic in nature and can be adapted to all CBIs to tie in with national or local situations and requirements. 1 Guidelines and tools for management of basic development needs, Cairo, World Health Organization Regional Office for the Eastern Mediterranean, 2003 (unpublished document no.WHO-EM/CBI/004/E/G)
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How do the tools assist in community-based initiatives implementation? CBI tools assist in the following functions: • • • • • • • • • • planning organization human resource development community survey and prioritization project preparation and implementation supervision and monitoring financial management documentation and reporting promotion and advocacy programme evaluation.
What are the links between community-based initiatives and national development agendas? Potent strategies for achieving equitable development at the local level are made available by employing CBIs. These strategies involve utilizing a combination of measures which address all determinants of health; they also support underprivileged communities in attaining self-sufficiency and self-reliance to boost development. With the common objectives of social well-being and community development, different sectors work together to support local health and social conditions in line with national strategies and agendas.
What is a basic development needs programme? A basic development needs programme uses an integrated socioeconomic approach which is aimed at enhancing quality of life and improving health outcomes. It promotes holistic development focusing on the principle that health should be pursued using all available means. In this approach, the basic needs of each community are addressed and prioritized in order to achieve sustainable development with health as the central goal. The basic development needs approach intends to achieve the following objectives: • • • • mobilizing and organizing communities and capacity-building; implementing bottom-up and needs-based socioeconomic interventions; promoting partnerships and developing effective intersectoral coordination; integrating health services at community level in order to reduce the burden of disease and promote healthy lifestyles; • encouraging self-reliance and self-management for sustainable development.
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What is a healthy city programme? A healthy city programme is concerned with the physical, social, economic, and spiritual dimensions of urban development. The programme works on the principle that health and quality of life can be improved by modification of conditions in the home, the school, the workplace, the city and other places or "settings" where people live and work. It addresses issues such as upgrading health services, water supply, sanitation, pollution, and housing in the urban setting. It can also focus on promotion of healthy life styles, providing a helping hand for projects and activities that can generate income, improving education, addressing women’s issues and children’s needs, and enlisting the support of volunteer groups.
What is a healthy village programme? A healthy village programme is an approach to enhance and accelerate the process of achieving health for all. In this process, priority is given to creating a supportive environment with a focus on village development for improving the health and wellbeing of the people. Provision of a potable water supply, sanitation, solid waste removal and village cleanliness are major components of such an environment. For achieving these targets, organized participation of communities and strong intersectoral collaboration at all levels are considered essential. A healthy village programme offers health professionals and community leaders a unique opportunity to adapt health activities to local circumstances.
How do these three approaches differ from each other? All CBI approaches have the common objective of achieving health for all through health and development interventions. Basic development needs and healthy village programmes are implemented primarily in rural areas following common objectives, structures and process. A healthy city programme works in the urban localities, especially in the underprivileged suburbs for improving environmental conditions and bringing health onto the agenda of local development.
What is meant by “women in health and development”? This includes any endeavour which aims to facilitate the development of gendersensitive policies and programmes in order to improve the socioeconomic status of women. The Eastern Mediterranean Regional Office of WHO has integrated gender considerations in all facets of its work, supporting Member States to promote the proactive role of women in health and development issues. They are also encouraged to enhance of the role of women in CBI. The objective is to mainstream gender in CBIs and other WHO programmes as central to all efforts for achieving sustainable development.
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What are the structures of community-based initiatives? The structures in basic development needs and healthy village initiatives are almost identical in composition. They include: •a community development committee •a cluster representative from each cluster of the locality • technical committees and groups for health, environment, education, financial management, women and youth • a programme manager and intersectoral technical support team at programme level • a national focal person at country level • intersectoral councils from national to district levels (desirable). In a healthy cities programme, the implementation structures include: • a steering committee at city level, comprising members of the various organizations involved in the programme and chaired by a leading authority of the local government • programme office • working groups for specific plans and actions related to different sectors • a city health forum consisting of health related individuals and stakeholders. Promoting women in health and development initiatives is implemented by organizing women’s committees and integrating women’s development activities in other CBIs.
What is a social contract? The CBI approach works through the joint collaboration of the community, intersectoral technical teams, programme management and other stakeholders, including WHO. In order to formalize these partnerships, a social contract is agreed upon by all partners at the start of the programme implementation in each area. The social contract contains key targets to be achieved within a specified period and describes the roles of each partner for achieving the desired goal. The contract keeps the partners, especially the communities, accountable for the set of targets determined and provides a broader base for programme implementation.
What are development packages? In order to better achieve the targets agreed in the social contract, development packages related to components of the health, social and economic sectors have been produced. These packages are intended as a guide for the communities and the technical support teams. Health should be the main focus, and actions should be carried out bearing this in mind, irrespective of the priorities defined by the communities. On the other hand, interventions related to the social and economic sectors should be needsbased and subject to practical and financial considerations.
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What is social development and how does it differ from economic development? Social development is related to human well-being and improvement of quality of life; it allows people to live in a way that gives them a sense of satisfaction. They have access to the basic facilities required for sustaining life and do not feel deprived of opportunities or rights. Economic development, on the other hand, affects only one aspect of quality of life: it increases assets and incomes of individuals and communities. It is also essential for developing infrastructure and purchasing amenities. It should not, however, be the ultimate objective; rather it should be used as a tool for ensuring access to social services and improved quality of life of the population.
Why is income generation undertaken? Poverty as the root cause of social evils is a multidimensional issue affecting all aspects of life. Ill health and poverty are intrinsically linked, and mutually reinforcing. Ill health brings disastrous consequences for individuals and their families by shrinking household savings, reducing productivity and diminishing quality of life. It creates or perpetuates poverty. The poor, consequently, are exposed to greater personal and environmental risks. They are poorer nourished and have limited access to health care; therefore they are more at risk of illness and disability. At the same time, better health prevents poverty and generates wealth by building human and social capital and increasing productivity. The CBI programmes promote economic development and poverty reduction by supporting micro-credits and financing schemes for the underprivileged and poorest segments of the community in order to empower them and enable them to value and protect their health and productivity.
What is seed money? This is the initial monetary support extended by sponsoring agencies to initiate the development process and to enable communities to meet their basic needs. The seed money is utilized for loans for income generation schemes and grants for health and social activities. The seed money builds the capital assets of the community by directly supporting the projects and by serving as the basis of the local revolving fund. The disbursement and mangement of the seed money should primarily be the responsibility of the village development committee, whose members safeguard and guarantee the loans. This also encourages self-sufficiency and self-reliance among individuals, families and communities in sustaining and expanding local development.
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What is a revolving fund? Revolving funds refer to the amount collected through return of loans, community development fund contributions and other resources generated at the community level. The revolving fund aims at self-reliance through mobilization of resources and community management. It also assists in sustaining CBI areas following the initial support (seed money) from the sponsoring agencies. The revolving funds are deposited in a local account managed by the community development committee in collaboration with the technical support team. The funds are reinvested in new social and/or income-generating projects, multiplying the amount itself and also the number of beneficiaries.
What is a community development fund? The community development fund is a mechanism to strengthen the sustainability of the programme and encourage direct and indirect participation at local level through contributions and sharing of benefits among community members. The community development fund comprises part of the profit earned by the beneficiaries on income generation schemes supported by the CBI. At the time of approving any income-generation project, the community development committee and the technical support team, along with the beneficiary, determine the percentage of the contribution, depending upon the nature, feasibility and expected profit of the project. The community development fund contribution, therefore, will vary for different projects. If required, the community development committee may consider receiving community development fund contributions in non-monitory form, equivalent to the percentage agreed. The community development fund contribution is deposited in the revolving fund account and maintained locally by the community development committee. Both monetary and non-monetary community development fund contributions can be used to support community development activities, pro-poor actions, welfare initiatives, natural disaster expenditure and operational costs for maintaining the programme at community level.
How does cost sharing differ from profit sharing? All social and income-generation projects in the CBI are carried out on a cost sharing basis. The beneficiaries contribute the major percentage of the initial costs of these projects. The community also shares in social projects with their efforts, materials, space and even finances. They contribute the recurrent cost of project operation, maintenance and management. Profit sharing is the contribution of the beneficiaries from the earnings they gain from the implementation of CBI-sponsored income generation projects. This becomes the community development fund, and is used to support the underprivileged segments of the community.
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Why is promotion and advocacy important for community-based initiatives? Advocacy is the process of educating and convincing community leaders, decision makers, relevant sectors and agencies to accept, support and commit themselves to the CBI programme. It is a continuous process, starting before the initiation of the model phase, when political and administrative commitment is obtained in order to ensure the success of the programme, and continuing during the expansion phase to ensure and maintain national support and sustainability.
How can partnerships be developed and strengthened? Strong partnerships between the government and other stakeholders and civil society are required for the development of CBIs. This task of building such partnerships is achieved through continuous dialogue and the sharing of information, supported by explanation of the projects and their outcomes. The future potential for cooperation is explored in relation to common areas of interest and agendas. While advocating CBI programmes to attract new partners, adequate care should be taken to avoid conflict of interest and resistance to change.
Who are the major partners for community-based initiatives? The major partners of the CBI are the community and the government. The Eastern Mediterranean Regional Office of WHO is playing a proactive role to implement these approaches through technical and material support. Besides these, other potential partners include: • United Nations agencies such as the United Nations Development Programme (UNDP), the United Nations Children’s Fund (UNICEF), the World Food Programme (WFP), the Food and Agriculture Organization of the United Nations (FAO), the International Labour Organization (ILO), and the Arab Gulf Programme for United Nations Development Organizations (AGFUND); • development banks such as the World Bank, Asian Development Bank, Islamic Development Bank, African Development Bank; • bilateral donor agencies such as the UK Department for International Development, the Canadian International Development Agency, the International Fund for Agricultural Development, and the Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ); • nongovernmental organizations (national and international); • academic and research institutions.
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What is the role of the partners in community-based initiatives? • Assisting the preparation of national policies and plans; • Building the capacity of the national authorities and the communities; • Undertaking joint actions for technical assistance and financial support; • Fostering the flow of information, exchange of experiences and technical cooperation; • Marketing CBI approaches, creating linkages with similar approaches; • Supporting research and development of appropriate technologies.
What is the role of the community in community-based initiatives partnerships? • Manage the programme in order to meet the targets and goals; • Select the cluster representatives and community development committee to represent the area; • Conduct the survey, prioritize needs and prepare area development plans; • Motivate families to participate in the community development; • Participate in social development activities of the area; • Identify poor, needy, skilled and deserving persons for income-generation projects; • Implement the development packages to meet the targets agreed in the social contract; • Guarantee the loans and ensure recovery is on time; • Maintain project and financial records, including loan recoveries and deposits; • Monitor progress and evaluate outcomes; • Coordinate with the technical support team in the implementation and management of CBI in the area.
What is the role of intersectoral cooperation in community-based initiatives partnerships? The major determinants of health lie outside the health sector; therefore, health cannot be achieved in isolation from other sectors. It is therefore critical to involve health-related sectors in all stages of CBI management The intent of intersectoral cooperation is to: • mobilize, organize and assist the community in assessing its needs and priorities; • mobilize local and national resources, and promote intersectoral collaboration in support of the CBI process; • train the community in CBI methodologies and upgrade existing local skills; • supervise proper resource allocation for integrated community development; • assist in the search for, and transfer of, appropriate technologies relevant to programme activities; • take the necessary initiatives for the expansion of the programme.
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What is the role of WHO in community-based initiatives partnerships? The role of WHO in the implementation of CBI is catalytic in nature. At the country level, WHO and the Regional Office provide assistance in order to: • develop models of sustainable health as part of overall local development which will serve as examples and help to ensure equity; • prepare, in collaboration with countries, plans for launching the CBI in model areas, incorporating technical, financial, logistic and evaluation components; • support the building up of national capacities through orientation and training activities to manage and replicate the CBI; • encourage the development of strong intersectoral collaboration with communities, nongovernmental organizations and the private sector to promote the concept of health and equity as fundamental principles of development; • provide financial assistance as seed money for small-scale pilot areas, covering income generation and social sector schemes; • promote the community-based approach to other international organizations, as well as national decision makers; • support research and development projects in the countries of the region, with particular emphasis on economic profiles and sustainability; • enable national authorities to integrate and sustain CBIs in national development plans through gradual transformation of the role of WHO; this involves moving from active participation and financial contribution during the first phase of the CBI to mainly providing technical support to the government and people during the expansion phase.
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Investing in health, particularly that of the poor, is central to the achievement of the Millennium Development Goals. In support of this strategy WHO’s Regional Office for the Eastern Mediterranean is actively promoting in countries of the Region community based initiatives like Basic Development Needs, Healthy Cities, Healthy Villages and Women in Health and Development. These approaches are based on the principle that good health status—an important goal in its own right—is central to creating and sustaining capabilities of poor people to meet their basic needs and to escape from poverty. The Community-Based Initiatives Series is aimed at facilitating the management of such initiatives. Users of the series may include government authorities, community representatives, WHO and other international agencies and non-governmental organizations.
For enquiries please contact: Community Based Initiatives World Health Organization Regional Office for the Eastern Mediterranean P.O. Box 7608 Nasr City Cairo 11371, Egypt Tel.: +2 (02) 670 2535/276 5307 Fax: +2 (02) 670 2492/4 e-mail: CBI@emro.who.int postmaster@emro.who.int Internet: http://www.emro.who.int/cbi/bdn