District Health Promotion Using the Consensus Approach
Juliet Waterkeyn (2006)
The Consensus Approach is a training methodology that aims to develop functional communities by modifying the determinants of health to ensure long-term hygiene improvement through positive behaviour change. The process ensures that communities are not just a loose collection of households within a geographical area, but that they are strongly bonded neighbourhood, defined by a ‘common unity’ of understanding on health and most importantly, the households have the capacity to act together effectively to improve family health.
Basic Assumptions: Two important observations underlie the reasons for using this approach: 1. Most women are primarily interested in caring effectively for their family and will therefore be interested in the opportunity to improve their ability as mothers. 2. There is an intellectual starvation in developing communities, and many people have not had sufficient opportunity to learn, so they will respond to health information.
For whom? This manual is a guideline for those planners looking for a practical methodology for conducting a health promotion project at District Level.
For where? The focus is primarily on applying this approach to rural areas; however the approach is still applicable to an urban setting.
Thinking Globally – Acting Locally looks briefly at international efforts to engage countries in health promotion and focuses on the Millennium Development Goals (MDGs) as a target for halving the number of people living without safe water and sanitation before 2015. Having identified the main problem as the difficulty of getting people to change their behaviour, the text then outlines the Consensus Approach; a well-tried solution to this problem. A definition is given of Community Health Clubs, which is the main ‘vehicle for development’ using in this approach. The remainder of this section outlines the conceptual framework of the Consensus Approach, summarising core concepts such as the importance of ‘common unity’ as opposed to individual action, and the creation of a ‘culture of health’. It shows how health clubs can empower women through information sharing and participatory activities, which according to research do meet an identified cognitive need. Having introduced the participatory PHAST approach, it describes how this training has failed to alter behaviour to any degree, but how the adaptation of this method combined with a more structured programme in Community Health Clubs has produced significant results. The importance of the membership card is emphasized and a brief description of the six month health promotion programme is given. The section ends with some frequently asked questions, which may also be answered in Section 3 with concrete examples.
Acting Locally: District Health Promotion describes how to start up Community Health Clubs. It begins with a simple calculation to establish how to meet the MDGs in the district, halving the population without sanitation within 10 years. The four prerequisites to start the programme are then discussed in some length. This includes a discussion on which facilitators are the most suitable, the importance of mobility for field staff, the vital need for a pre-prepared toolkit of culturally appropriate visual aids, and the type of training that is needed to set up the programme. It then briefly describes the programme for a one year health promotion campaign. A final section is dedicated to the importance of monitoring and measuring behaviour change – given the dearth of well-reported studies available in the sector. It encourages districts to advocate at a National level using lessons learnt from the pilot project and provides rough guidelines to enable practitioners to publicise their findings internationally, so as to contribute towards more rigorous health promotion studies in the academic field.
Drawing on more than a decade of experience in the field in Zimbabwe, Sierra Leone and Uganda, this section presents 12 reasons why the Consensus Approach is a feasible health promotion strategy at District Level. It demonstrates that Community Health Clubs can prevent a range of diseases, address multiple risk practices and achieve high levels of behaviour change. The approach provides an effective way to disseminate knowledge and invariably produces a strong demand for sanitation. It can be extended to a further stage where water supply is managed by the health club, and if taken to its full potential can go on to alleviate poverty and deal with fundamental social needs such as illiteracy, social support networks and human rights. Extension workers have found the approach rationalises their work-load and provides an easy way to interact with the community. The Consensus Approach is particularly strong in measuring outputs in terms of hygiene behaviour change, as well as enabling performance monitoring of the facilitators in league tables, by their superiors at District Level. In areas where health clubs are densely concentrated and have been going for a decade, there are strong indications of reduction of diarrhoea, bilharzia, skin diseases, eye diseases and acute respiratory infections (ARI) as reported at local health centres. Most importantly, the Consensus Approach is able to prove its cost-effectiveness at between 35-66c per person over a two year programme, and can demonstrate value for money when compared to more vertical interventions.