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Água, saúde e empoderamento
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Se a comunidade quer um sistema de abastecimento de água
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Justificando a aquisição de um novo abastecimento de água:
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Vamos dizer que você é
o mobilizador da comunidade em um dialógo com ela, a questão de água
potável vem a tona. Os membros da comunidade
dizem que querem um sistema de abastecimento de água.
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Pergunte a eles qual é
a justificativa para ter um novo (ou melhorar um já existente) sistema de
abastecimento de água. Em termos mais
simples, “Se o abastecimento de água é a solução, então qual é o problema?”
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Membros de comunidade podem ou não ter
pensado sobre isso. Community
members may or may not have thought it through.
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É seu trabalho
encorajá-los a olhar todas as razões e consequências, e para guiá-los para
suas próprias análises. It is your job to encourage
them to look at all the reasons and consequences, and to guide them through
their own analysis.
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Se os membros da
comunidade sugerem que eles querem ser modernos, ou que a comunidade
vizinha tem um sistema de abastecimento e eles querem um também, então você
precisa dizer à eles que escolheram uma forma muito cara de satisfazer o
orgulho.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.
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(Você pode ter que explicar esses modos
de pensar refletem orgulho e inveja, e não são os melhores sentimentos para
um projeto tão caro). Talvez
haja modos mais baratos.(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.
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Há dois proThere are two main problems that a reliable water supply
system can solve.
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One of them
is that it will reduce the time and energy of those responsible for
collecting it.
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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.
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A Review of Primary Health Care (PHC):
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The PHC (Primary Health Care) strategy of the WHO (World Health Organization) has several elements to
it.
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Among them
are several that are of immediate relevance to the community
mobilizer.
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They are as follows:
- If a society (in this case a community)
has limited and finite resources, it is more valuable to use them in
treating a small number of common diseases that affect the majority,
rather than treating many rare diseases that affect only a few
persons;
- Prevention is far more effective (and
useful) and much less costly than cure; and
- Inexpensive but widespread techniques of
health care, practised by many persons with limited education (so
called "barefoot doctors"), are more effective in
keeping a population healthy than expensive, complicated techniques
that can be practised by only a few highly trained persons on a small
number of patients.
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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.
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Having
expensive equipment and expensive specialists able to perform expensive
brain surgery operations may contribute to national pride on the world
stage, but it does little to keep the population generally more healthy,
relative to the PHC strategies.
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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.
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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.
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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 .
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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.
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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.
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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.
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They are also
of greater risk of dying, which removes their productivity from the
community.
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Maybe all of
us, including ourselves and community members, often make some assumptions
about health care.
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We see
someone get sick, then we seek medicine and other treatment to make them
well again.
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That could be called the
"disease" model of health care.
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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.
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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.
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So if the
community decides that its priority would be a clinic, for example,
challenge its members by asking what problem does it solve.
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If they say
there is much disease, ask if much or at least some of that disease can be
prevented.
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That would
avoid the negative effects of having some members sick, and reduce one of
the major factors of poverty.
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A preventive
approach makes a much more efficient use of resources than a curative
approach.
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Community
members must not only know what they are doing, they need to know why they
are doing it.
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Your efforts
at empowering the community must include providing information and
challenging them to think through their decisions.
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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.
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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.
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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.
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Water Alone is Not Enough:
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Earlier, this
document mentioned that a clean water supply system is one factor in
reducing disease and improving the health of a community.
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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.
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Clean water coming out of a pump or a
pipe will not magically, by itself, cause disease to be reduced and health
to increase.
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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.
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These are
parasites such as e-coli (escherichia coli), amoebiasis, giardia
lamblia and others which are carried by faeces into the water supply.
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A huge problem
is that these parasites are so small they can not be seen without a
microscope.
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Clean water
looks exactly the same as contaminated water.
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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.
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If the water
is clean where it comes out of the pump or pipe, it must remain clean all
the way to the mouth.
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The first
problem is that it is so very easy to contaminate that water during its
journey from the tap to the mouth.
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If it is
drank while contaminated, then disease will not be reduced.
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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.
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They are
unseen. They are washed to the nearest ditch, puddle or rivulet, and
eventually into the rivers and lakes.
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The water is clear and sparkling. It
looks innocent.
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It is deadly.
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Making that
contaminated water safe again is expensive and time consuming.
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It requires,
filtering, boiling, or adding chemicals, or a combination of them.
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Most groundwater (water from underground)
and rainwater is uncontaminated.
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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.
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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.
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That requires
behaviour changes among the community members.
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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.
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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.
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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.
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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.
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Consider some
of the barriers you face:
- People are often uncomfortable talking about
bodily functions, especially in public
- Many communities have taboos about discussing
human excretions;
- Community members are more willing to dig a
well than a latrine;
- People are more willing to contribute (cash
and kind) to a water source than to a human waste facility;
- Many people do not accept or understand
the germ theory of disease;
- No one wants to clean a public latrine;
- No one wants to accept responsibility for
cleaning public latrines;
- Private latrines are often reserved only for
important guests and VIPs;
- Even where latrines are available, they are
seldom used by babies and toddlers;
- Few people understand the links between open
air faeces and contaminated water;
- Few people know or understand that
clean-looking hands can be contaminated;
- Few people know how a bucket of clean water
from the well can easily become contaminated when being carried home; and
- Few people recognize the high degree of
contamination that is in surface water.
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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.
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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.
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Often, if you
are a careful and insightful sociological observer, you will find the
residuals fo previous campaigns in current behaviour, completely devoid of
the intended effect.
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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.
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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.
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The very act of covering the container
now contaminates the water inside the container.
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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.
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It must be a
conscious decision of the community development executive, based on a
thorough understanding of the nature of water borne disease prevention.
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The community
should choose to have a public meeting to discuss the campaign and its
reasons.
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The members
should devise various ways, including school children's essays, prizes and
their contributions read in meetings,
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Making and
posting of colourful posters (and other campaigns) should be
organized by the community.
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The reasoning
as well as the proposed behavioural change must be publicly discussed by
all members of the community.
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Visiting "experts" should be invited by the community to discuss reasons as well
as proposed actions.
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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.
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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.
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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.
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Remember the
basics of the empowerment methodology. See: Empowerment.
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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.
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That will not
strengthen the community; it will weaken it. See: Empowerment.
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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.
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Community
members may choose water supply as their first priority. Its primary
justification is that it can reduce disease and therefore poverty.
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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.
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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.
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