WATER, HEALTH AND EMPOWERMENT
PHC Principles for Strength
By Phil Bartle, PhD
Dedicated to Andrew Livingstone
If the community wants a water supply system
Justifying Acquisition of a New Water Supply:
Let us say that you are a community mobilizer in dialogue with a community, and the issue of potable (drinkable) water supply comes up. Community members say they want a water supply.
Ask them what is their justification for getting a new (or for improving an existing) water supply system. In simpler terms, "If the water supply is the solution, then what is the problem?" Community members may or may not have thought it through. It is your job to encourage them to look at all the reasons and consequences, and to guide them through their own analysis.
If community members suggest that they want to be modern, or that a neighbouring community has a water supply system and they want one too, then you need to tell them that they have chosen an expensive way to satisfy pride. (You may have to explain how those kinds of reasons reflect pride and jealousy, not the best reasons for an expensive project). Perhaps there are cheaper ways.
There are two main problems that a reliable water supply system can solve. One of them is that it will reduce the time and energy of those responsible for collecting it. As an investment, that reason is discussed more in "Water as a Community Investment." Perhaps the most valid justification is that clean drinking water is an important (but not the only) factor in maintaining health of the people in a community – preventing disease.
A Review of Primary Health Care (PHC):
They are as follows:
Not only should you as a mobilizer know about these strategies, you need to devise ways to incorporate them into your methods of empowering communities.
The key to your methodology is to devise ways to provide these perspectives to community members as part of promoting their own decision making, without dictating, without preaching, and without lecturing the community members. Encouraging them to set their own priorities, based on your common observations of problems (Participatory Appraisal), yet challenging them to defend their decisions, is the overall approach.
It is up to you, based on your detailed and intimate knowledge of the community, to devise ways to make that happen. See: Participation in Appraisal. When you encourage and guide a community to choose the rehabilitation of an old water supply system, or construct a new one, your work is best done in the context of these PHC principles.
Disease and Empowerment:
In the principles document, The Five Factors of Poverty, disease was identified as among the big five that contribute to the continuation of the social problem of poverty.
When members of the community get sick, they stop being productive members of the community and divert the time and energy of others who care for them. They are also of greater risk of dying, which removes their productivity from the community.
Maybe all of us, including ourselves and community members, often make some assumptions about health care. We see someone get sick, then we seek medicine and other treatment to make them well again. That could be called the "disease" model of health care.
A more productive approach would be to see that we all can contribute more to our community (not only paid employment but all our contributions, domestic and other) if we are healthy and strong. We have limited resources, and if we channelled them into prevention against disease, rather than waiting for disease and then spending those resources on curing it, we would be using our resources more effectively.
So if the community decides that its priority would be a clinic, for example, challenge its members by asking what problem does it solve. If they say there is much disease, ask if much or at least some of that disease can be prevented. That would avoid the negative effects of having some members sick, and reduce one of the major factors of poverty. A preventive approach makes a much more efficient use of resources than a curative approach.
Community members must not only know what they are doing, they need to know why they are doing it. Your efforts at empowering the community must include providing information and challenging them to think through their decisions.
If, in your sociological observation of the community, you notice that many members reject the germ theory of disease, and prefer the witchcraft theory, let them know that the two theories are not mutually exclusive. Both can be used to explain at the same time. The germ theory simply tells us how the mechanism of disease transmission works, while the witchcraft theory explains why some members and not others get sick.
Your job is not to fight against prevailing religious (worldview) beliefs, but to assist the community to become empowered by managing its resources more effectively.
Water Alone is Not Enough:
Earlier, this document mentioned that a clean water supply system is one factor in reducing disease and improving the health of a community. One of several. If the community has decided that a water supply system is justified by the goal of reducing disease, then it must be accompanied by other actions. Clean water coming out of a pump or a pipe will not magically, by itself, cause disease to be reduced and health to increase.
While malaria, caused by the feeding of mosquitoes on humans, may be the biggest killer in the world, the second most important, and perhaps the greatest cause of debilitating sickness as well as death, especially among children, is a collection of water borne diseases that cause diarrhoea. These are parasites such as e-coli (escherichia coli), amoebiasis, giardia lamblia and others which are carried by faeces into the water supply.
You do not have to remember the fancy names to be a good mobilizer, but you need to know they are invisible in the water, cause disease, and the community members must learn about them. See: Diarrhoea , e coli, amoeba, amoebiasis, digestive disorders, diarrhoea, giardia.
A huge problem is that these parasites are so small they can not be seen without a microscope. Clean water looks exactly the same as contaminated water. Since the micro organisms are invisible to the naked eye, talking about them sounds a lot like talking about magic, and natural scepticism is a feature of most community members.
If the water is clean where it comes out of the pump or pipe, it must remain clean all the way to the mouth. The first problem is that it is so very easy to contaminate that water during its journey from the tap to the mouth. If it is drank while contaminated, then disease will not be reduced. If anyone relieves herself or himself on the surface of the earth (roadside, bush, farm, urban back alley) faeces is deposited in the open air. Rain will dissolve that faeces, and any present parasites will enter that water. They are unseen. They are washed to the nearest ditch, puddle or rivulet, and eventually into the rivers and lakes.
The water is clear and sparkling. It looks innocent. It is deadly.
Making that contaminated water safe again is expensive and time consuming. It requires, filtering, boiling, or adding chemicals, or a combination of them.
Most groundwater (water from underground) and rainwater is uncontaminated. The vaporization and condensation of rain usually does not allow parasites to be carried along, and the earth provides a natural filtering of ground water. Rather than expensive treatment of contaminated water, it is more effective to find ways to keep uncontaminated water safe from the tap until it is consumed.
That requires behaviour changes among the community members. This is usually the least practised aspect of most water supply projects, and the one that, if not done, renders all the other efforts useless.
People will not change their behaviour unless they are well motivated to do so, understand the reasons for it, and are offered easy ways of doing so. This may be your biggest challenge as a mobilizer. It is more difficult than organizing a community to come together and construct a water supply system.
You can not dictate, preach or lecture, yet you must find a way of working with the community so that it collectively chooses to change everybody's behaviour, willingly and thoroughly (it only takes one person's faeces to contaminate a stream) with unseen parasites.
Consider some of the barriers you face:
You need to find strategies to overcome all of these barriers, and to find positive ways to encourage people to be willing to change behaviour (and attitudes) so that their clean water remains so from the pipe to the mouth.
Beware of a community or public campaign to change people's behaviour without it being accompanied by a clear understanding of the reasons for making the change. Often, if you are a careful and insightful sociological observer, you will find the residuals of previous campaigns in current behaviour, completely devoid of the intended effect.
A common one, for example is a campaign to have people gathering water at a communal well cover the containers of water as they carry the water home. No idea why. Five or ten years later, you will see community members covering the containers with dirty and much used cellophane, cloth or cardboard (usually the resident being quite aware of your visit to the well). No idea why. The very act of covering the container now contaminates the water inside the container.
If a campaign of behaviour change is necessary, it can not be organized by the mobilizer or any project team responsible for a water project. It must be a conscious decision of the community development executive, based on a thorough understanding of the nature of water borne disease prevention.
The community should choose to have a public meeting to discuss the campaign and its reasons. The members should devise various ways, including school children's essays, prizes and their contributions read in meetings. Making and posting of colourful posters (and other campaigns) should be organized by the community. The reasoning as well as the proposed behavioural change must be publicly discussed by all members of the community. Visiting "experts" should be invited by the community to discuss reasons as well as proposed actions.
The important thing is that you should use the same participatory methods for a campaign of behaviour change and awareness raising (about the health reasons for the change) as you would for any other community project that you stimulate. See: Mobilization.
The decisions to take action, the planning of the action, the implementation of the action and the monitoring of the action must all be made by the community as a whole, and details worked out by the community executive. Avoid doing; let the community do it.
List each of the barriers above (and any others you may discover) on the board with the community, and use brainstorm methods to develop a project of behavioural change, just as you would for any other community project. See: Brainstorm.
Remember the basics of the empowerment methodology. See: Empowerment.
If you do the work (decision making, planning, management implementation monitoring) for the community then you are like the coach who does the push-ups for the sports contestant. That will not strengthen the community; it will weaken it. See: Empowerment. Suggest, stimulate, organize and encourage, using the techniques of this site, letting the community be empowered (and the project be sustained) rather than it become more dependent.
Community members may choose water supply as their first priority. Its primary justification is that it can reduce disease and therefore poverty.
Water alone will not improve health; awareness of the water borne disease cycle and the importance of keeping water clean all the way to the mouth (requiring behaviour change) must accompany a water supply construction or rehabilitation.
This combination may be more effective in preventing disease and lowering poverty that the construction of a clinic or other choices the community members may assume will improve health.
Health and Hygiene Awareness Campaign:
© Copyright 1967, 1987, 2007 Phil Bartle