Mobilising resources within the community: ‘mobilising the unmobilised’
Every community has evolved ways of preventing and managing disease through its own understanding of the causes of illness. Health care is provided at many levels by many different groups of people. These include mothers and family members, traditional practitioners and private and public health workers. The contact between people and health workers through an equitable health system can lead to better understanding of the choices available to the people in addressing their health needs. It also offers an opportunity to improve people’s health. At every level the capacity of people can be enhanced and the range of choices they have to protect their health problems can be increased.
Access to health care
Many people lack access to health care and also lack the basic health-related knowledge which would allow them to control their environment and/or their behaviour in the interests of their health. As a result, preventable and curative health conditions frequently lead to death or disability and, even when they do not, are a common reason for poor families becoming even poorer and without hope. Women and children face considerable additional difficulties in receiving health care, compared with men, and also are frequently allowed only limited participation in decisions concerning their own or their family’s health. This has a significant adverse effect upon their health and upon their health-seeking behaviour. The problem is not that solutions are unavailable, but rather providing these solutions to individuals and communities who require them.
- Using existing community resources
Health issues are social needs which cannot be fully met through exclusively medical approaches. Mobilisation and better use of existing resources (human, social and financial) can lead to a significant improvement in health. The aim should be to empower communities with basic health knowledge (preventive and basic curative), so that they can make better decisions with regard to their environment and their health. Empowering communities may be done by working directly with all sections of the community or through the existing groups/institutions or through selected volunteers. In Bangladesh, Save the Children (UK) worked with and through men, women and children of the project area (see below). The International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), through its Chakoria project, worked through existing self-help groups (mosque committee, school committee, market committee, local youth clubs). Several government health care projects (Primary Health Care Intensification Project, Thana Functional Improvement Pilot Project) had experience of working through selected volunteers. The National Diarrhoea Control Programme uses Schools and scouts.The National Immunization Programme uses mosques and schools.
- Traditional practitioners
Every community has traditional practitioners. They are available, accessible, affordable and enjoy the confidence of the community. Some of their practices, however, may be harmful. When the health system recognises their strengths, works with them without ignoring them, their efforts will then support the health system. Thus, improving the existing indigenous resources of the community results in optimal use of resources for sustainable improvement of quality, equity, relevance and cost-effectiveness in health care. In Bangladesh, Save the Children (UK) working with the popularly known ‘Village Doctors’, demonstrated effective results. Also, the National Diarrhoea Control Programme and the Acute Respiratory Tract Infections Programme are working with them.
- Material resources
Material resources may also be mobilised within the community for health care. In Bangladesh, through philanthropic contributions (giving donations), several health facilities have been developed. If communities feel the need of health, they are willing and capable of arranging the resources required to deliver health care. The ICDDR,B’s Chakoria project has demonstrated that in Bangladesh. Several studies in Bangladesh have shown that even the poor people are capable and willing to pay for services, if these are perceived to be useful. A number of methods of mobilising finance for health care programmes have been successfully used in Bangladesh. These include lotteries, cultural shows, putting a levy on transport, cinema tickets, renewal of trade licences or fire-arms. Also, community medical funds, where each member contributes at a fixed rate on a regular basis and draws an interest free loan for medical expenses in the case of need, such as hospitalisation, has been made available in Bangladesh. ‘Zakat’ (where Muslims contribute at a fixed rate from their wealth due to religious obligation) is also not an uncommon source of funds in Bangladesh, to run health programmes or support individuals in case of their medical need.
Health care and medicine
Health issues need to get out of the narrow field of medical intervention alone. For social effectiveness, these need to be addressed by the broader society in all its interventions. Other development programmes need to integrate into health issues (preventive and basic curative) with appropriate back-up support from the medical programme. In Bangladesh, several micro-credit programmes (provision of low-cost loans) have successfully integrated the health component within their programmes.
Mobilising existing resources within the community – human, social, financial – and using these strategically will clearly lead to better health.