Creating empowering partnerships cross-culturally that are based on mutual design sounds easy, but nothing could be further from the truth. Mutual design based on community participation is one of the most difficult and complex aspects of designing and implementing global health initiatives.
Avoiding Manipulation in Community Development
If done well, the end result will be a facilitated form of community participation. If done poorly, it results in forced participation and manipulation. The book Two Ears of Corn by Roland Bunch shows this idea of harmful, forced participation. It is a classic development book that every leader of an international program should study. Although focused on agriculture, Two Ears of Corn demonstrates important concepts of community development that apply to all types of community initiatives.
So how do we create global health initiatives that are truly based in community participation and not forced or, worse, paternalistic? The answer to this rests in PRA (participatory rural appraisal) and PLA (participatory learning and action). These are very important models of community facilitation for anyone who works in global health projects and programs.
According to Chambers, “participatory learning and action” is a more accurate title for what practitioners of PRA do. However, PRA is the common term used to describe participatory programming. PRA is also used by some to stand for Participatory Reflection and Action, because at the center of PRA are “self-critical awareness, personal behavior and attitudes, and engagement with action.”
When conducting PRA, it is important to remember that “we are not teachers, transferors of technology, but instead conveners, catalysts, and facilitators” (Chambers, 2002). In using participatory methods, we have to learn to put our knowledge and ideas in second place. This is true from site assessment all the way to project implementation. In fact, the goal is always to “enable local people to do their own investigations, analysis, presentations, planning and action, to own the outcome, and to teach us, sharing their knowledge” (Chambers, 2002).
From the Insider Perspective
We must learn to move out of the driver’s seat and facilitate the community’s appraisal, presentation, analysis, planning, action, monitoring, and evaluation. You may have heard of RRA (Rapid Rural Appraisal). Nevertheless, there are clear distinctions between PLA and RRA. RRA is about data collection with the analysis done mainly by the outsider. PRA, which is an evolved form of RRA, is meant to be empowering: a process of appraisal, analysis, and action by local people themselves (Chambers, 2002).
Methods for RRA include observation and semi-structured interviews; PRA/PLA methods are done in groups and include participatory mapping, diagramming, using the ground in various ways, and making comparisons. The following is a list of methods commonly used by PRA/PLA practitioners. Most are applicable in community gatherings as discussion facilitators. They may or may not be applicable when working with medical professionals.
The essentials of PLA are attitudes and behaviors that say, I am here to listen and learn from you. Therefore, we need to develop what PLA practitioners call critical self-awareness. Chambers describes the important aspects of self-awareness as embracing doubt, learning from error, and continuously trying to do better; building learning and improvement into every experience; and taking personal responsibility. Again, this is an overview of these techniques as they appear in the World Vision supplementary resource guide on participation. Of course, they are not meant to replace formal training in participation. If you would like to see these tools in use, YouTube has many posted videos that demonstrate them.