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Inclusive decision-making and community empowerment for health and well-being: The Health Promotion and System Strengthening Project in Tanzania

Author(s) Kate Molesworth1, Ally-Kebby Abdallah2
Affiliation(s) 1Swiss Centre for International Health (SCIH), Swiss Tropical and Public Health Institute, Zürich, Switzerland, 2Health Promotion and System Strengthening Project (HPSS) Field Office, Swiss Tropical and Public Health Institute, Dodoma, Tanzania.
Country - ies of focus Tanzania
Relevant to the conference tracks Advocacy and Communication
Summary This presentation aims to show how participatory techniques can be effectively embedded within government health and community development structures to successfully support community action for health and well-being and at the same time contribute to broader positive social change and equitable access to health services.
By using participatory techniques and at the same time mainstreaming gender, HIV and social equity, within the project itself, as well as at the community and government levels, the Health Promotion and System Strengthening Project (HPSS) takes a broad human rights, equity and inclusive approach, to improve the health and well-being of all members of the community.
What challenges does your project address and why is it of importance? The HPSS Project aims to improve the health status and well-being of all members of a community through innovative approaches, with a particular emphasis on the support of vulnerable people, such as women, children, elderly and socially disadvantaged. A special focus is to ensure that all aspects of project implementation and information will maximize the potential to include all sectors of society in community health promotion and address existing inequalities. However, most often communities - and in particular vulnerable groups - do not have an arena in which to raise their voice and address their health concerns, while the possibility of involvement is low.
The project therefore aims to empower communities and their members to identify and express their health needs and demand equitable access to appropriate health care and social services. By addressing local needs and supporting community action for health, the projects aims to establish sustainable community mechanisms and strongly link them with government and non-government structures for sustainable results that contribute to improve health and well-being of all people in the region.
How have you addressed these challenges? Do you see a solution? This presentation will demonstrate how the project translates the Ottawa Charter onto the ground in the context of Dodoma Region and report on early operational research outcomes of the Regional pilot for health reform.
In adapting the health and community development systems to strengthen health promotion, the project has negotiated adapted terms of reference and trained-as-trainers Community Health and Development Officers (CHOs and CDOs) as well as School Health Coordinators (SHC) in community participatory techniques and cutting edge health promotion approaches. As master trainers, with support of HPSS District Coordinators, these government cadres have rolled out a tailored training packages to their assistants, Non-Governmental Organizations (NGOs), Faith Based Organisations (FBO), Community Based Organizations (CBOs) and communities themselves. Following consultative workshops, regional governments agreed to expanded health promotion roles of the Region’s 152 CDOs and their assistants. They work together with Health Officers to support communities, through participatory methods, to identify local health concerns, as well as resources and to plan solutions. In this process the trained government CHOs and CDOs and SHCs facilitate communities to identify their health concerns and solutions in a participatory meeting of peer groups - disaggregated by sex and age as well as by concern groups – such as the disabled. After initial community-led discussions, facilitators showed discussion groups how to quantify their priorities and the group subsequently voted for their primary health concerns. The results of the sub-groups were then presented by the facilitators to the whole community in a final meeting, emphasising the very different priorities of men and women, and different age groups in the same community. This usually resulted in a direct community discussion and debate concerning different perceptions on health and well-being issues within the community. Following this, the community as a whole, facilitated by their trained CDO, prepared a community health promotion plan for presentation to local councils for inclusion within and funding with the Council Comprehensive Health Plans.
How do you know whether you have made a difference? In the process Regional authorities have raised the importance and profile of inclusive, participatory approaches by adding these duties to government staff terms of reference. The strengthening of health promotion, gender and social inclusion approaches within community led-processes has not only improved grass-roots level dialogue and action on local health and social concerns but strengthened the capacity and networking of community-based organisations. This has also set in motion means by which communities can not only take action to address issues in the local context, but access existing funding lines for community health activities. The Participatory Rural Appraisal (PRA) process has been rolled-out to all communities in the 7 districts of Dodoma region. Even at this early stage of the project, PRA outcomes resulted in community health action plans, which have been inclusively developed in more than 200 villages. A total of 220 health promotion action plans have been developed by communities in this way, reflecting 16 priority health-related themes.
By taking an inclusive approach that sensitises government and non-government facilitators, the solidarity and empowerment of traditionally marginalised and stigmatised groups including women, the poor, people living with HIV and affected by AIDS and people living with disabilities has also been strengthened.
Have you or the project mobilized others and if so, who, why and how? Approaches chosen within the HPSS Project have mobilized people on several different levels. Primarily, government CHOs, CDOs and SHCs were trained-as-trainers in facilitating community participatory techniques and cutting edge health promotion approaches. This has led to their expanded health promotion roles in accordance with the regional governments. The master-trainers have rolled out these techniques to all government staff and community organisations in the region. Applying a bottom-up approach, government officers facilitate communities to identify their health concerns and solutions in a participatory manner.
When your donor funding runs out how will your idea continue to live? The HPSS Project, implemented by the Swiss Centre for International Health (SCIH)/Swiss Tropical and Public Health Institute (Swiss TPH) on behalf of the Swiss Development Cooperation Agency (SDC), is subdivided into three project phases, namely a pilot implementation phase from the year of 2011-2014, a consolidation and scaling-up phase between 2015 and 2017 and the completion of a nationwide scale-up in the years of 2018-2020.
By training a cadre of master trainers within government and non-government structures in the first phase of the project in Dodoma region, novel inclusive approaches have been rapidly cascaded to the communities for complete geographical coverage. The inclusive, participatory techniques used effectively advocate for the different health priorities of various groups within community’s debates, inclusive action planning and ensure that these actions are funded and realised.
As approaches have been embedded in the skills and responsibilities of government staff, this allows the direct involvement of community members, in particular giving voice to vulnerable groups. These inclusive, participatory techniques are likely to be sustained and replicated as a nationwide scaling-up of the HPSS approaches and activities in subsequent phases. Furthermore, the project has developed and launched a short course (in June 2012) on participatory techniques for inclusive community action for health promotion at the Zonal Training Centre. This will contribute to sustainability by providing focussed training of development and health staff in the coming years and act as regional resource centre for these activities.

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