In designing and planning global health initiatives, figuring out who the stakeholders are is a critical first step. Each community has leaders and influencers, and those involved in healthcare are critical for this kind of project. Partnership begins with identifying stakeholders and assessing their capacities.
Begin at the Beginning
Global healthcare projects are developed and designed by select individuals collaborating with the target community in advance of any groups arriving. This process may require a couple of visits to the community. Therefore, it is best to plan advance work to take at least one to two weeks. Meetings can be scheduled before the trip. Also, it is best to spend some time learning about the community and the context in which care will be provided both before and during the trips.
The following table includes the primary community-level assessment for evaluating any global health project site. It is an example of community assessment used by many Global CHE (Community Health Evangelism) Network organizations. The original authorship is unknown, but this form has been in use for some years. Clearly, it is by no means comprehensive. This is a starting point to learn about the community. It provides only an outline of key information we have used to start the community assessment process. It can be given to the individual or group who invited you to their community.
Preliminary Stakeholder and Community Assessment
|1.||Does your community have a history of self-help type projects?|
|List the projects that you are aware of, even if they were not successful:|
|2.||Has your community been established for at least 10 years?|
|3.||Are most of the people from one tribal group?|
|4.||Is there a central meeting place in your community?|
|5.||Are there definite boundaries to your community?|
|6.||Is there a local dispensary within 5 km?|
|7.||Does the dispensary have a mother-child health clinic?|
|(care of pregnant mothers, immunizations, family-planning services, etc.)|
|8.||How far is the nearest health center?||km|
|9.||How far is the nearest hospital?||km|
|10.||Is public transport available?|
|11.||If so, is it sufficient?|
|12.||Are there any community-based healthcare activities in your community
right now? If so, list them:
|13.||List three of your community’s problems which you think might be solved by
community health evangelism:
|14.||Are there other outside aid or development projects in your community right
now, such as World Vision, Feed the Children, Family Plan International,
|UNICEF, etc.? If so, list them:|
|15.||Check the box that most closely describes your community:|
|NOMADIC – Almost always moving||SEMI-NOMADIC – Moving back|
|with short stays. They do not grow||and forth once or twice a year.|
|crops.||They grow crops.|
|RURAL – Agricultural. They do not||URBAN – They live close to or|
|move. They grow crops.||within a town or city.|
|16.||Check the box that most closely describes the water situation in your community:|
|Almost always available.|
|Usually available but difficult to find every 3 or 4 years.|
|Difficult to find and not always available in this area.|
|17.||How far must you go to obtain drinking water?||km|
|18.||Check the box that most closely describes the food situation in your community:|
|Food is almost always available or easy to find or grow.|
|Food is usually available but sometimes hard to find or grow.|
|Having enough food is a constant problem.|
|19.||List the common foods grown in your area:|
|20.||Would you describe any of the following social situations as a major problem in
|List any other problems in your community:|
|21.||List the major health problems in your community:|
|22.||List the churches in your community:|
Next Steps in Partnership
Once this form is completed by the local partner, we can then work with them to ensure we have identified all of the local stakeholders and the way in which they will be impacted by any health programs that are developed. They can also arrange meetings and begin the participatory rural appraisal (PRA) processes in the community.
As an outsider who will be facilitating potential global initiatives, you cannot engage the entire community in PRA and PLA (participatory learning and action)-focused initiatives alone with the reality of needing to commute back and forth to your home country. Unless you are on the ground full-time, you will not be able to carry out the complete PRA process with the entire community leading to the design, monitoring, and evaluation of a health program.
Facilitating Participatory Design
However, it is feasible for you to use participatory approaches in partnership with those who invited you to the community. They are your link to the community. Furthermore, they have the trust and established relationships, and they had enough interest in facilitating health to contact you. Your role as an outsider is to walk them through the participatory design process. Your attendance at community meetings may be required, but ideally, those meetings will be facilitated by the person who invited your program to their community.
Those stakeholder meetings can be arranged over a one- or two-week period so you can be present to participate in the stakeholder analysis and program design. There are a number of resources listed here to assist your local partners so you can learn together what this process looks like. There is one important thing you need to remember in participatory approach application: You will make mistakes, lots of them. Embracing them openly and learning from them in collaboration with your local partner is essential.