PARTICIPATORY LEARNING AND ACTION PLA FOR COMMUNITY HEALTH

PARTICIPATORY LEARNING AND ACTION (PLA) FOR COMMUNITY HEALTH DEVELOPMENT DR. (MRS. ) RAJNI BAGGA ASSOCIATE PROFESSOR NATIONAL INSTITUTE OF HEALTH & FAMILY WELFARE, MUNIRKA, NEW DELHI - 110067. E-mail: nihfw@mantraonline. com & nihfw@delnet. ren. in Phones: 26165959, 26107773, Fax: 91 -11 -26101623

PARTICIPATORY LEARNING AND ACTION • • • INTRODUCTION CONCEPT &DEFINITION ORIGIN& EVOLUTION OF PLA PRINCIPLES OF PLA TOOLS AND TECHNIQUES APPLICATION OF PLA IN HEALTH RATIONAL POTENTIAL USE IMPACT & BENEFITS CONCERNS & CHALLENGES CONCLUSION

INTRODUCTION Participatory approaches like PLA developed in response to concerns regarding a top down approach to developing strategies for addressing local concerns These strategies have a much greater chance of success if local community is involved in the process from start to finish

PLA can empower women, poor and disadvantaged, giving them more control over their lives An explicit concern with the quality of interaction, including a stress on personal values, attitudes and behaviour as a prerequisite for effective work.

The use of open-ended, adaptable visual methods within a flexible, interactive learning process, rather than the use of set sequences of specific methods for preidentified ends; Generate important often surprising insights, which can contribute to policies, to serving the needs of the poor and marginalized section of the population It can challenge the perceptions of those in authority and begin to change attitudes and agendas

PLA methods are based on principles aimed at offsetting the deficiencies in the earlier investigative approaches in the health development and has over the years developed out of a dissatisfaction with common modes of investigation, formal questionnaires and surveys and rural development tourism

CONCEPT/DEFINITION Robert Chambers 2002 : “A growing family of approaches, methods, attitudes and behaviour to enable and empower people to share, analyse and enhance their knowledge of life and conditions and to plan, act, monitor, evaluate and reflect”.

CONCEPT/ DEFINITION Richard Heaver described PRA – (1991) has also “PRA embraces a series of techniques, many of them recently developed in India, for using local people’s knowledge and skills to learn about local conditions, identifying local development problems and plan responses to them

ORIGIN AND EVOLUTION PLA approaches have developed out of Rapid Rural Appraisal (RRA) techniques, which were first systemized in the late 1970 s. RRA techniques in turn developed out of: dissatisfaction with large scale questionnaire surveys which gave delayed results dissatisfaction with the unreliability of impressions gained during the field visits made by urban based professionals which came to be known as ‘RURAL DEVELOPMENT TOURISM’ For quickly gaining qualitative insights into a situation CONTD.

ORIGIN AND EVOLUTION FROM RRA TO PRA / PLA From 1970 onwards Participatory tools- for promoting and participation of the poor & marginalized in improving their wellbeing. These tools arose from two beliefs: Ø The knowledge & experience of poor and marginalized have value and not to be dismissed as irrelevant or wrong, Ø Poor and marginalized have the right to resources traditionally defined by them.

FROM RRA TO PRA /PLA Agha Khan Rural Support Programme (India) conducted participatory RRA in two villages of Gujrat, in 1988 Few of the Govt. organizations which got their staff trained and promoted PRA are: Dry lands development board. Karnataka Several forestry departments National Academy of Administration, Mussouri

In India PLA more popular in the NGO sector and particularly three NGO’s: Action Aid in Bangalore, MYRADA Agha. Khan Rural Support Project in Gujarat

FOR Nature of Process RRA Mode EMPOWERMENT PRA PLA Extractive Elicitative Participative Sharing Empowering Outsider’s Role Investigator Information owned, analyzed & used by Outsiders Facilitator Local People PLA has evolved from Rapid Rural Appraisal (RRA) and refers to a process that empowers local people to act upon, change their conditions and situations

PLA AND JOHARI WINDOW Information known to every one What we know and what they know Teach What we know and they do not know Knowledge belongs only to community and we do not know Learn Knowledge belongs only to professionals What they know Knowledge acquired by learning together What we do not know and they do not know

PRINCIPLES OF PLA ENTAILS SHIFT FROM Dominating Closed Empowering Open Individual Group Measuring Comparing Reserve Frustration Verbal Rapport Fun Visual

PRINCIPLES OF PLA Triangulation Optimal Ignorance and Optimal imprecision Direct contact, face to face, in the field Critical self awareness Changing behaviour and attitudes A culture of sharing Commitment Empowering Flexibility, Innovation, Improvisation Learning directly from, local people

PRINCIPLES, BEHAVIOUR & ATTITUDES DESIRABLE ATTITUDES RIGHT BEHAVIOUR OPTIMAL IGNORANCE - OPENNESS - CURIOSITY - HUMILITY - ACCEPTANCE - EMPATHY - SENSITIVITY - SHARING - EMBRACING ERRORS - FRIENDLY - LISTENING AND NOT - RESPECTFUL LECTURING AVOID COLLECTING UNNECESSARY DATA

PRINCIPLES, BEHAVIOUR & ATTITUDES COMMITTMENT - To equity -Empowering those who are marginalized, specially women, children and elderly CRITICAL SELF AWARENESS - About attitudes & behaviour - Embracing & Learning from error - Taking personal responsibilities REVERSALS Learning from , with and by local people directly and face to face seeking to understand their perceptions, priorities & needs

VISUAL TOOLS ØParticipatory Mapping DISCUSSION TOOLS ØFocus Group Discussion ØSemi- Structured Interviews ØInstitutional Programming (Venn Diagram) ØSeasonal Diagram ØDaily activity Chart OBSERVATIONAL TOOLS ØBody Mapping ØParticipant Observation – DIY, taking part in local activities ØPair wise Ranking ØTransect Walks ØTrend Analysis ØForce Field Analysis ØCausal Impact Diagram ØImpact Evaluation

TOOLS AND TECHNIQUES APPLICATION OF THE TOOLS DO NOT FOLLOW ANY FIXED SCHEME. IT IS VERY FLEXIBLE AND DEPENDS UPON THE EVOLUTION OF THE PROCESS, NEED OF THE SITUATION AND USER’S OWN BEST JUDGEMENT

TOOLS AND TECHNIQUES BUT MERE APPLICATION OF THESE ARE NOT SUFFICIENT UNLESS THE FACILITATOR / USER HAS THE DESIRABLE ATTITUDE AND BEHAVIOUR AND THE USER MOVES FROM TALKING TO DOING & FROM DOING TO BEING

TOOLS AND TECHNIQUES TOOLS CAN ALSO BE CATEGORIZED AS PER THEIR USE AND SEQUENCE IN WHICH THEY ARE USED TOOLS FOR EXPLORATION AND IDENTIFICATION OF PROBLEMS TOOLS FOR PRIORITIZATION OF PROBLEMS TOOLS FOR ANALYSIS TOOLS FOR SOLUTION / IMPLEMENTATION

In 1978 at Alma-Ata, Primary Health was defined by WHO & UNICEF as : “Essential Health care universally accessible to individuals and their families in the community by means acceptable to them, through their full participation and at a cost that the community and the country can afford”

RATIONALE FOR CONDUCTING PLA IN HEALTH Both Primary Health Care and Community Development recognizes that the process of achieving the goal - through the development of Local Initiatives, Participation, Self-confidence, Self-reliance and Cooperation - is more important than the achievement of the goals and objectives HEALTH IS NOT THE RESPONSIBILITY OF THE HEALTH SECTOR ALONE, BUT IS AFFECTED BY THE DEVELOPMENT ACTIVITIES IN OTHER SECTORS SUCH AS EDUCATION, HOUSING AND SOCIAL SERVICES. HENCE A NEED EXISTS TO INTEGRATE ALL SUCH DEVELOPMENT ACTIVITIES THROUGH PLA.

RATIONALE FOR CONDUCTING PLA DEVELOPMENT OF SELF-RELIANCE AND SOCIAL AWARENESS THROUGH CONTINUING COMMUNITY PARTICIPATION IS A KEY FACTOR IN IMPROVING HEALTH. IF HEALTH CARE IS TO IMPROVE IT IS ESSENTIAL THAT COMMUNITY SHOULD DEFINE IT’S NEEDS AND SUGGESTS WAYS OF MEETING THEM. DECENTRALIZATION IS NECESSARY IF COMMUNITY NEEDS ARE TO BE MET AND PROBLEMS SOLVED. LOCAL COMMUNITY RESOURCES, FINANCIAL AND HUMAN, CAN MAKE AN IMPORTANT CONTRIBUTION TO HEALTH AND DEVELOPMENT ACTIVITIES.

PLA FOR COMMUNITY HEALTH PROJECT Problem Identification Evaluation Problem Prioritization Monitoring HEALTH PROJECT CYCLE Possible Solution Identification Implementation Action Planning

PLA FOR COMMUNITY HEALTH DEVELOPMENT 1. It has been recognized that for health services to be truly effective, potential recipients must be involved in every stage of the process 2. This project cycle is conceived as an empowering approach to enable the local community especially the marginalized and the women to review and articulate their own perceptions of need and identify them 3. Enables the local people e. g, women to reconsider their own belief systems, surrounding health and illness, exchange knowledge/ideas.

PLA FOR COMMUNITY HEALTH DEVELOPMENT 4. PLA broadens the lens of ‘health’ of local people to focus on the wider dimensions of well-being 5. It offers health professionals (outsiders) and local people an approach in determining priorities and developing strategies for action and improving well-being

POTENTIAL OF PLA Its Positive impact and benefits for Community Health Development : 1. Use and Application of PLA is wide spread 2. Generates rapport and forces outsiders to learn, listen and understand 3. It provide highly accurate information: Local people’s knowledge of local conditions is often greater than had been supposed 4. Plans drawn up in a prescriptive manner by local people are more likely to work than plans drawn up by outsiders 5. The participative nature of the process is a “ Development Benefit” in itself, in terms of empowering people 6. Highly cost-effective

PLA FOR EMPOWERMENT PARADIGM SHIFT TO RECOGNIZE THE ABILITY AND CAPACITY OF LOCAL PEOPLE– INNOVATION PEOPLE TAKE RESPONSIBILITY AND ACTION FOR IMPROVEMENTS EXPERTS NEED TO GIVE UP POWER AND CONTROL OVER PROJECT OUTCOMES – ROLES REVERSAL ‘BOTTOM UP’ APPROACH

CONCERNS & CHALLENGES OF PLA IN HEALTH SECTOR 1. A family of approaches for reversing centralization, standardization and top-down development. 2. Biggest challenge includes achieving changes in our personal attitudes and behaviour towards community & the disadvantaged. 2. Behaviour and Attitude: more important than methods

CONCERNS & CHALLENGES OF PLA IN HEALTH SECTOR 3. The need to recognize and work at personal responsibility, professional ethics, such as developing self- critical attitude. 4. To initiate and sustain process of change; empowering disadvantaged people & communities, transferring health services and reorienting individuals.

CONCLUSIONS 1. PLA, IS NOT A BANDAGE TO STICK TOGETHER OLD FAILING CONCEPTS AND APPROACHES. 2. RURAL DEVELOPMENT TOURISM HAS TO GO, INSTEAD LOCAL COMMUNITIES ARE TO BE INVOLVED FOR IDENTIFYING, PRIORITIZING, ANALYSING AND SUGGESTING SOLUTIONS TO THEIR PROBLEMS

CONCLUSIONS 3. UNDER RCH PROGRAMME, PLA CAN BECOME THE BASIS OF PLANNING AT THE MOST PERIPHERAL LEVEL WHEREBY THE HEALTH WORKER IS SUPPOSED TO FINALIZE THE PLAN AFTER DETAILED CONSULTATION WITH COMMUNITY AND COMMUNITY LEADERS, INFACT, CORRECTLY CARRIED OUT COMMUNITY NEED ASSESSMENT (CNA) IS AN EXAMPLE OF PLA APPLICATION 4. FOR EMPOWERING THE MARGINALIZED SECTION OF THE POPULATION WHICH INCLUDES WOMEN, CHILDREN, ELDERLY, PLA HAS LOT TO OFFER

CONCLUSIONS 5. WE HAVE REACHED A CRITICAL POINT IN THE HISTORY OF MANKIND. WITH GOVERNMENTS’ EFFORTS STAGNATING WORLD OVER, LOCAL COMMUNITIES ARE WHERE MANY OF THE CHANGES WILL HAVE TO START. THE PARTICIPATORY APPROACHES LIKE PLA CAN HELP TO ENABLE LOCAL ANALYSIS AND PLANNING, WITHIN AND BY COMMUNITIES.