UNIT 21 ORGANIZING SUCCESSFUL

NUTRITION AND HEALTH

PROGRAMMES : SELECTED
PROCESS MODELS
Structure

2 1.1 Introduction
2 1.2 What's Success?
21.3 Levels in Organizing Nutrition and Health Programmes
21.4 Level I : Conveying Suitable Messages to Selected Target Groups
21.5 Level I1 : Multiplying Message Reach and Population Coverage
21.6 Level I11 : Promoting and Sustaining Community ActionPractice
21.7 Level IV : Helping the Community to "Take Over"
21.8 Let Us Sum Up
2 1.9 Glossary
21.10 'Answers to Check Your Progress Exercises

21.1 INTRODUCTION
In this last Unit of Course 5 we take a good look at ideas about organizing
successful nuuition and h e . education programmes. You already know much of the
theory and practice from your study of the previous units and the practical activities
you have conducted. But how do we integrate all this in order to promote and sustain
community action? In fact, how do we ultimately help community members to "take
over" a programme?
We must realize that there are no ready-made recipes for success. A strategy that
works in one situation may fail in another. We are using the term "process model"
here to indicate a flow chart or sequence of steps which could help us to achieve a
particular aim. The processes are organized according to different levels of involve-
ment with the community. The more our involvement with the community, the more
we let'them control the process. As you will find on reading the unit, we have given
examples of Levels I to IV. Try to put down examples of programmes working at
these levels from your own experience. Or alternatively gather information from field
level functionaries in your area. This should help you to arrive at some ideas how you
can organize a good nutrition and health education and action programme.

Objectives

After studying this units, you should be able to

e differentiate between levels of community involvement in nuuition and health
education and action programnles
list ways in which to increase involvement of community members
describe strategies for sustaining community involvement

21.2 WHAT'S SUCCESS?

Before we proceed with any analysis of processes in health and nutrition education
programmes, we must look at this vital question: How do we define success?
Defining success is quite obviously related to our aims and objectives in interacting
with the community. Do we just want to convey a message to the maximum number
of people? Do we decide to explore the reactions of people to messages-are they
adopting it or not? Are we moving beyond this level and trying to actually promote
and sustain action?
It is now widely recognised that programmes launched by "outsiders" (i.e. people
who are not members of a community) often ignore the importance of community
participation. This obviously reduces chances of success. On the other hand.
programmes managed by insiders (i.e. community members) may be unsuccessful
because they may cater to certain vested interests or influential groups only.
Hence organizing a successfd programme often begins with an outside agency
spreading a message in a particular rural or urban area and then evolving an action
plan with members more affected by a problem. The next phase involves encouraging
people to act in order to overcome their own problems. Do you remember the
concept of self reliance and independence we discussed in Unit 19? Community
participation is a key indicator of this. In other words we should not define success
merely as the number of people covered by a programme but rather by whether the
community can initiate and sustain action using their own resources or with help
from outside agencies.
Obviously this is difficult to achieve and takes time and effort. But there's no doubt
that it can be done! Experience has shown that programmes tend to be successful
when they:
begin small and then grow, yet retain the involvement of local people in decision
making
enable the target group particularly the poor and disadvantaged among them to
participate in determining priorities and taking action.
a do not stick to a pre-determined plan but remain flexible and open to change.
are lead by people who are committed to solving the problems of the poor and
disadvantaged community members. -
adopt a holistic approach in improving the entire "way of life" rathtr than just
concentrating on one aspect (rather like the concept of integration we talked about
with reference to ICDS).
These points have been drawn from the introduction to the book "Helping Health
Workers Learn" by David Werner and Bill Bower.
May be you could add a few points of your own in the space given.

21.3 LEVELS IN ORGANIZING NUTRITION AND

HEALTH PROGRAMMES
We have just reviewed the meaning of success in the previous section. Now we come
to the point of how to help people to decide on their own course of action and how
to actually facilitate community action that would help the community members.
In this unit we will be talking about four process models corresponding to Levels I to
IV. These are as follows:
Level I : Conveying Suitable Messages to Selected Target Groups
Level I1 : Multiplying Message Reach and Population Coverage
Level I11 : Promoting and Sustaining Community Action/Practice
Level IV : Helping the Community,to "Take Over"
 Organislug S u c d l Nutrition
Look at these levels carefully. You would realize that many programmes function at and Halth Regrammu :Selected
Levels I and 11. Reaching Level IV is in many cases not even thought about. When hvmr Mdelr
you consider programme constraints you might find the answer to why this is so.
Time and money both may be limited. The staff involved may not be in a position to
understand a particular area and its problems because they don't have the time or
inclination or may be because they are just told what to do.
As you look at Levels I to !I1 you would also realize that how a programme is
actually implemented and the attitude of people involved can make all the difference.
For example, take Level I. In this case how is a suitable message identified? Is it
predetermined or is it evolved after discussions with community members? You can
appreciate that the degree of participation of the community is quite different in these
two situations. We will elaborate on the aspect of community participation and control
in our discussion on Levels I to IV.
Before we move on to the next section, a few points about Level IV. This is where
our own attitudes may prevent the target group from gaining control over a
programme. Do we as people with expert knowledge want to let the community take
over? Difficult though it may be, we have to shake off the idea that we always know
best. Our role should always be that of facilitators or helpers not controllers. This
does not mean that we should not intervene and try to convince people about scien-
tific facts if we find they are moving on the wrong track. This is particularly true of
area.. in nutrition and health where there often are deep rooted prejudices, superstitions
and facts related to food.
Now let's begin with Level I.

21.4 LEVEL I :CONVEYING SUITABLE MESSAGES

TO SELECTED TARGET GROUPS

In any nutrition/health education programme it is extremely important to identify suit-

able messages for a particular community. We must remember that different messages
may be relevant for different groups within the community. For example, messages
relevant for a group of young women would be quite different from those for a
preschoolers' group. Of course the form in which a message is presented would vary
too. Presentation can be positive or negative. A positive message for a group of poor
preschoolers would he-eat greens to keep your eyes healthy. An example of the
same message in negative form could be-Eat grcens or you'll go blind.
Now what is the process involved in
a) identifying a suitable message for a particular thrget group and
b) conveying the message through selected communicators and channels of
communication?
Look at the process model illustrated in Fig. 21.1. It begins with identification of the
target group and relevant message in Step 1. How is this done? Information is
collected about the community as a whole through interviews with field level workers
and community members. A group of community members can also do a self survey.
In other words they can map out the area in which they live using stones on a piece
of land or chalk on a hard floor or pen and paper (see Annexure I for details). As a
result they may point out a group of people in the area who are particularly affected
by a nutrition or health problem e.g. families with very thin and ill infants. The group
must of course be drawn from different sections of the community or the results
would not be reliable. Listening to discussions would also bring out aspects Of*
problem or may indicate the need for talking to more people.Keeping community
priorities in mind is important.
At the end of this process of interviewing and discussion it would become possible to
identify the target group and their problem area i.e. the most important problem being
faced by them.
Nutrition Programmes Conveying Suitable Messages to Selected Target Groups

community members Community self survey

field level workers

4 L
.

Identification of target group 1.1

L
and message

Selection of sample based on

Choosing approaches,
tKAF' studies

Identifying communicators and

channels for communication

1
Finali sing message presenta-
tion (including pretesting)

I Conveying the message to the

target group I
Analysing Impact (including
tKAF' studies '

Feedback to programme

Fig. 21.1 Level 1 :Process model for conveying suitable messages to

selected target groups

Let's take an example.

If there is'a high incidence of diarrhoea among infants mothers may have to be told
about ORS. That seems obvious. But again we have to discuss with the community
members. Who else looks after infants? What about older brothers or sisters? If they
too are involved, the messahe must reach them as well! So you can see that we
would have to choose between approaches, strategies and media. It's very useful at
this point to involve enlightened community members to discuss aspects and find out
more from their family, friends, community. Again their opinion can be sought for
identifying communicators as well as channels for communication (i.e. where and
how the message is to be conveyed). With the help of such community members or-
group leaders a pretest can be carried out on a sample from the larger target group.
On the basis of this the-final 'form of the message can be decided on. Then remains
the task of analysing impact. Free and frank discussion with the target group members Organking Sucoesshl Nutrition
can give useful information on how to modify the message or its presentation. A post Prosommca: Seiec*
Procfsl Modcls
test would also be of great benefit. Finally programme planners would be given
information about what happened and why so that the message is suitably modified
before being conveyed to a larger group.
One approach which has gained credibility in the health and nutrition sectors is called
participatory rural appraisal or PRA. It involves local people in identifying their own
problems and in planning how to resolve them. Mapping a village or a -geographical
area; ranking and scoring; listing local events in the order in which they happened;
making case studies of people or situations. PRA techniques tend to give a wealth of
information quickly without much expenditure. The information provided is accurate
in most cases. Using local materials people have shown the capacity to "map, model.
estimaic, rank, diagram and plan". This should not be surprising since they are more
familiar with local conditions than we are. There is also the advantage that as the
community undertakes a self survey, discussion ,place and information is collected
and cross checked at the same time.
PRA techniques may be routinely used for:
e group interviewing to get people's perceptions of the local health and nutrition
situation.
e village mapping to identify target groups, non-users of services and local health
care providers.
individual and group interviews to get qualitative feedback on how well a service is
provided or to assess effectiveness of a message.
e gaifiing knowledge of what went wrong in the case of deaths from preventable1
curable illnesd or malnutrition so that messages can be designed accordingly.
Perception of local people can be quite different from that of outsiders. Malnutrition,
for example, may not bc recognized or viewed as a major factor leading to illness and
death. The community may give priority to an illness aSsociated with fever, on the
other hand, because it prevents them from working and getting money or payment in
the form of goods. Such situations might be necessary to first address the problem
perceived by the people before they pay any attention to malnutrition, the "more
important problem" from our point of view-the one which is silently crippling them
without their recognizing it. Of course this has important implications for designing
nutrition and health messages that are relevant to the local situation. Community
members would be able to give detailed information, for example, about how family
food supply varies with seasons, or how incidence of a disease changes' with season.
They would also be able to relate this to demands on their labour in the fields. This
may tell us about the appropriate timing for a particular message.

PRA techniques may therefore be piiticularly useful for Steps 1, 3.4 and 7

Check Pour Progress Exercise 1 ' , .

1) List five ways in which you would encourage community participation in identify-
ing a suitable message for preschoolers at risk of suffering from malnutrition.
/

2) The process model given in Figure 21.1 mentions the use of knowledge, attitude
practice (KAP) studies. What technique would you use to collect information on
the knowledge, attitude and practices in the community group with which you are
working?
21.5 LEVEL H :MULTIPLYING MESSAGE REACH
AND POPULATION COVERAGE
Do you recall the case study we discussed in Unit 20? Starting with a group of
preschoolers the message reaches older children, mothers and staff working with
them. The case study illustrates how quickly a message can diffuse through a
community.
From this flows the point that Level I1 must follow Level I. Once we have been able
to design and test a suitable message we must decide on how to put it across first to
the maximum number of people in the target group and then to other community
members. Here "we" means us and the community.
Figure 21.2 illustrates a process model for "spreading a suitable message" to the
maximum number of people. Steps 4 and 5 need not take place in the order shown.
Both can take place simultaneously for example or the order can be reversed.
Some of the terms we have used in the flow chart need further explanation. In Step 1
we mention identifying the most cost effective channel of communication. As you are
aware. the term "channel" refers to all those means used to convey the message from
the "sender" to the "receiver". It is therefore inclusive of the media used as well as
location-specific details i.e. how and where is the message to be conveyed. In Step 1
you will be required to evaluate which channel would be the most effective for a
larger audience. While group discussions may be useful in small groups, larger
groups would require methods with which a greater coverage is possible. For
example, a larger group may be split into smaller groups and discussions conducted
with each group. In certain other situations mass media could play a key role e.g.
posters or pamphlets. TV or radio programmes.
In this context "cost effectiveness" becomes important. The actual medium you use
and your methodology would depend on the access you have to money. Some mass
media e.g. video programmes may be completely outside your reach whereas circula-
ting photostated copies of pamphlets with your original handwritten material or
pictures drawn by you may be possible. All this has to be evaluated within the
context of how you can create the maximum impact without too much expenditure.
It is a fact that using a combination of media can generate much greater impact.
But can you or the agency which you are working with actually afford to spend so
much more money? So resource considerations might encourage you to think more
closely about choosing a single medium supplemented by methods such as small
group discussions which may have no cost implications. Another way of reducing
costs is to consciously use and promote the diffusion of the message through the
network of community links such as those existing in mahila mandals or youth clubs
or wider networks over a larger geographical area. Identifying key people in the
community--people who are opinion leaders-is of great importance in stimulating
the process of spreading the message (Step 5)-What do we mean by the term
"opinion leaders"? This refers to people who can play a vital role in shaping the
opinions of others. A village head or sarpanch may be an opinion leader for example.
Opinion leaders can also be drawn from groups who hold no executive powers in a
community--their leadership is of a more informal nature. The next question is how
do you get them on your side? It might be a good idea to meet them individually
once you have identified them through interviews with field level functionaries or
community members. Once they are convinced, the diffusion of the message would
be quicker and more effective.
 Multiplying Message Reach and Population Coverage

Identifying most cost effective channel

of communication for a wider audience
(e.g. d l membcrs of the target group in
the community)

Identifying medialmedia combinations

for maximum impact (depcnding on
resources available)

1
Identifying strategies for diffusion of
message e.g. child-to child/woman-to-
woman

Using network of community links to

promote message

Getting the help of key pcrsons in the

community in reinforcing the message

Fig 21.2 Level 11: Process model for multiplying message reach
and population coverage

We've discussed the major steps involved in message diffusion across community
linkages. Now can you list strategies you would like to use in order to identify key
persons and get their help? Which of the strategies alteady mentioned in Course 5
would you find most useful?
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21.6 LEVEL I11 :PROMOTING AND SUSTAINING

COMMUNITY ACTIONIPRACTICE
In the previous section we have talked about how to spread a message in a community.
The role of opinion leaders and community networks has been emphasized. Fig. 21.3
NutrWn Pmgnmma gives you a bird eye view of the community networks in a villagePin Tamil Nadu for
example. Observe the intricacy of village institutions and interlinks as seen by people
themselves!

-
0 Individuals
Links between Individuals

Fig. 213 : Community institutions and networks (simplified and adapted version
of a map drawn by community members as part of a PRA exercise conducted
by an NGO called SPEECH)

The task of promoting community action can begin once a message has spread and
started to influence the knowledge and attitudes of people. You would have realized
by now that there are links between knowledge. attitude and practice.
There is a gap between knowledge and attitude for example. An individual knows
certain facts but has she or he developed the positive attitudes needed to actually put
the knowledge gained to good use? Further positive attitudes are not equivalent to
appropriate action i.e. there is a gap between attitude and practice. To put it another
way a person acts only after sufficient knowledge is acquired and a strong positive
attitude develops towards a certain practice.
So once a message has actually spread or diffused through a community we need to
carefully analyze the answers to questions such as the following:
Who will act?
Which individuals are most likely to initiate action (innovators)? What motivates
8
them?
Who would be most likely to follow the innovators Fust? Why?
Who is likely to resist any kind of change? What is preventing these individuals
from adopting a particular practice or course of action1
These questiombring out some important aspects we need to consider. In adopting a
practice the following situations usually arise:
I) A few community members begin a new practice (promoted by nutrition/health
education). Such people are called INNOVATORS.
11) Some other individualsfollow in the footsteps of the innovators and adopt the
practice as well. These are the EARLY ADOFTERS.
 III) People who are hesitating in adopting the practice but have a favourable attitudc. Organblng Sucaessf~Nutrltlon
and Halth Pr&ammcs :Selectfd
They exercise caution and prefer to "Wait and Watch". These are the SLOW Process Models
ADOPTERS.
IV) Then there are those people who resist change. They may be indifferent. On the
other hand they may even be hostile. These are the people you will have to
tackle with tact and persuasion. The innovators and early adopters can help.
But remembers to work out your strategies kceping the local situation in mind-
particularly local politics!
This analysis clearly shows us that we need to make special efforts to convince the
slow adopters and also to .cry and break down h e barriers which exist in the case of
those who reject a message,
The next part of the task of a community worker is to actually help in sustaining
community action. Are the people who have adopted the practice feeling satisfied? Is
it showing results? How can we keep their motivation high while they wait for their
action to show good results?
It is crucial to identify any problems that people may be facing. Again it is important
to let people speak out and encourage them to arrive at solutions to their problems.
You can help out if necessary.
Now lbok closely at Figure 21.4. Think of how you could use this process in your
own setting. Also consider how 'you might need to modify is to make it more
effective. Remember it's only one possible modcl. Feel free to develop your own!
Process model for promoting and sustaining community actionlpractice

Discussing this problem with

innovators and early adopters

Arriving at common strategies

to convince slow adopters

working out solutions to any

i Fig 21.4 Level III :Process model for promoting and sustaining community
actionlpractice
Check Your Progress Exercise 2
1) Discuss the process model for Level I11 with any field level functionary or
knowledgeable person in your communitylarea of work. Now list the person's
comments with regard to

a) handling sources of resistance in a community

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b) encouraging innovators as opinion leaders in the community
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C) Now list your reactions totthese comments.

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21.7 LEVEL IV :HELPING THE -COMMUNITY TO

"TAKE OVER"

We return here to some basic issues in community work. It should be our aim to
indicate positive action in a community through nutrition and health education. After
desirable practices have started being adopted, it is best to let the community
members manage the programme on their own. This involvement and independence
of community members in doing their own planning, decision making and in taking
up collective action is the key to our success. The process is difficult sometimes
because it implies "loss of control" as some people may perceive it. However,
helping the community to manage a programme on its own is what participative
approaches are all about.
Experiences from many parts of the world indicate the benefits of community
involvement in creating change which is self-sustaining. Figure 21.5 gives you some
idea of how you can encourage the community "take over" a programme.
As we said earlier you must think more about the process model we have given.
Adapting it to your local situation is important. If you notice, we have mentioned the
points in the process where key persons and othe~community members would benefit
ftom training inputs. 1n~wps'2and 3, for example, key persons (i.e. people who are
receptive to education pkogrimmes and who help to shape community opinion and
action) have to be trained for their function of being leaden. Training is
indispensable during implementation as well.
 1
Group sessions with key persons
to discuss how the community
can run an action programme

Sessions conducted with commu- TRAINING

nity members by key persons

1
sibilities for themselves by

Planning resource allocation and

generating funds

i
Implementation of action plan TRAINING
by community

Fig. 215 Levd IV :Process model for helping the community to "take over"

Of course it is important to realize that Level IV cannot be achieved wi4mt interact-

ing with the community for a considerable period of time. It must be preceded by
Levels I to I11 for maximum impact and for ensuring better chances of success.

Check Your Progress Exercise 3

1) Identify six training needs for the key persons in the community where you work
or with which you are familiar. You can do this exercise in relation to any
nutritionhealth education programme being conducted in the' community y w
select.

21.8 LET US SUM UP -

This unit emphasizes the importance of using participatory approaches in programme

planning and implementation. Four different levels were identified at which
programmes can be organized. At the first level. efforts are made to design suitable
messages for target groups within the community. Organization at the second level
implie$ taking the message to as many people as possible. The next task is to promote
community action and to sustain it. In other words this is the third level. Finally the
fourth level involves training community members to handle an action programme on
their own with some outside help if they need it. From Level I to IV community
involvement increases steadily.
In rural settings the concept of participatory rural appraisal and its applications for
health and nutrition programmes is discussed. Local people can themselves assess the
health and nutrition situation and decide on what they want to do to improve num-
tional and health status. This has the potential of evolving better action plans keeping
local realities in mind and encomiging local people to become involved in
implementation.

REMEMBER TO MODIFY AND REDESIGN THE

MODELS WE HAVE GIVEN !

HE* BUT DON'T CONTROL. LET THE

COMMlJNITY DECIDE.

21.9 GLOSSARY
Diffuse Spread
Feedback Giving information and reactions to people who started the
programme
KAP Knowledge, attitude, practice
Key person Individual who can help shape opinions and direct the course of
action
NGO Non governmental organization
Process Model One possible list of steps involved in a particular process
Self S w e y A survey conducted by the community members about their own
community

21.10 ANSWERS TO CHECK YOUR PROGRESS

EXERCISES

All Check Your Progress Exercises in this unit are activity-based in the context of
the community in which you work or with which you are familiar. So answer on the
basis of your own experience keeping your local situation in mind.
 ANNEXURE I

,ACTUAL OR POTENTIAL USES OF PRA METHODS

IN HEALTH AND NUTRITION
1 ) Participatory Mapping and Modelling

This refers so far to maps made by people on paper, the floor or the ground. and to
three-dimensional models on the ground. Used or usable for identifying, presenting.
checking, analysis. planning and monitoring to cover the following, showing numbers
and locations:
- census-type information on men. women. children, age cohorts.
and compiling a community register
- key informants
- health specialists-TBAs, herbalists, traditional health
practitioners. therapists. etc
- social groups (ethnic. caste. clan etc).
- household characteristics
- handicapped
- the sick. by types of disease (TB. cataract. etc). by location and
social group
- pregnant women and month of pregnancy (one seed per month)
- alcoholic husbands
- widows
- children who doldo not go to school
- women who doldo not go to the clinic
- child marriage
- deaths. by category
- malnourished children etc etc
a Social - dowry
- ownership of assets
- wealthlwellbeing status
- marriage from outside the village etc etc
a natural - community natural resources
resowces - land use
a facilities - community facilitie~schools.temples. churches etc
- clinics. health posts
- medical shops
- water supplies
- sweet lighting
- communications (roads, paths etc)
a hazards - pollution
- zones of defecation
- places where mosquitoes breed
- drains
- no go and problem urban areas
- gheuo areas
- street lighting
a ufilisation: - who uses health services. and where they live
- immunisation status of children
- family planning status (sterilisation)
- who receives assistance
useful for: a establishing rapport
a starting point of entry with community
a part of analytical process of better understanding the health/
nutrition situation
a demographic--census, household survey. baseline etc
a identifying vulnerable groups
a identifying health risk factors according to household and area
a visible ranking of households according to wealthlwellbeingl
health
 ad hoc investigations in the community
identifying risk factors
awareness and planning by the community
participatory location of facilities
monitoring by the community, graphical representation of
changes in healthlnutrition over time
2) Seasonal diagramming and analysis
BY - rainfall
- labour in agriculture
- cropharvest
- food availability
- illness by type and prevalence
- gender perceptions of diseese-prone periods
- water supply
- fuel sources
- access to facilities
- stress, happiness etc etc
useful for: awareness and planning: community and health worker
awareness and planning for health initiatives in relation to
disease trends, times of stress, etc
timing of interventions in conjunction with variations of
i. water supply
ii. disease
iii. type and availability of food
iv. income
v. migration
vi. festivals
vii. how busylfree people are
monitoring-by them, and by us
health workers' and communities' monthly monitoring of
biggest problems
3) Matrix ranking and scoring
health care providers vs diseases
types of illness vs access and utilization
scoring characteristics of health providers
scoring characteristics/effectivenessof types of treatment by
type of illness
characteristics of diseases
food availability/food use: what is there vs what is used
health/nuuition problems
food preferences and characteristics
sources of credit and characteristics
sources of income and characteristics
reasons for neqiing credit (illness, funeral, hunger etc) vs
choice of sources (husband, sister, moneylender etc)
areas according to healWdisease status
patterns of health service usage
patterns of service supplyldrug availability
- vulnerabilityldebility (linked to income, food supply, etc)
usefrl for: part of analytical process, including values placed on the non-
tangible as well as physical things
people's own analysis, sharing knowledge etc
people identifying and expressing priorities, and options for
action
targeting, and allocation of resources
4 ) Sequence matrices
- sequence of going for consultation and treatment
- sequence of a disease, with characteristics and treatments
useful for: agenda for discussion, participatory definition of needs and
priorities
learning how services tan be improved
5 ) Casual andjlow diagramming
- tracing the sequence of a disease and action taken at each stage
- causal diagram-impact of a cash crop
- food chain
- what happened after immunisation
- sequence of weaning practices in relation to seasonality and
food availability
useful f w : analysis of process'es, sequences of action, causes, choices, and
potential effects
planning sequences of shorter and longer-term actions
"what if' analysis, before and after, understanding what has
happened and what might happen ...
evaluation

6 ) Chapati (Venn) diagramming

(Also "interviewing stones" used for individuals concerning family relationships. '

Rough, smooth, chirped, damaged etc stones. Therapist does her own stones first.
Very useful for personal interpretations of psychological problems. Could be used in
communities for how groups see themselves and others?).
- institutions and linkages
- access to linkages
- social groups, key individuals
- health service organisations, local health care providers (inside
and outside village) and which act on immediate causes,
which on longer-term
useful for: conflict identification and resolution
identifying sources of health advice and treatment etc

7 ) Case histories
- acutebonger maturing diseasestracking leprosy, TB etc
treatments, what done etc
- history of an illness in the area
- history of an illness episode and treatment in an individual
- history of drought and its after effects on particular families .
- project case histories from villagers' points of view
- status change in people working on projects
- verbal autopsies
useful for: learning about the above
communicating perceptions of illness
communicating to managers through quotations, recordings,
video.

8) Wealthlwellbeing ranking
- wealth or wellbeing ranking
- health ranking, leading to what is healthJmalnutrition (criteria,
characteristics) etc.
useful for: targeting
sampling
research comparing different groups
correlations between sickness and socio-economic etc status
identifying focus groups by wealth/wellbeing/health

9) Ti? lines and trend analysis

- time line of events to provide framework
- major changes in the past
- trends in time spent fetching water, fuelwood
- incidence of disease
- trends of epidemics
- changes in access to services
changes in environment
~utrltlonProgramma useful for: establishing rappok
building on previous successes/failures
helping people analyse and make sense of what has occurred
conflict resolution
identifying focus groups

10) Focus groups

- mapping/modelling
-
seasonal diagramming and analysis
-
perceptions of health and health problems
- mamccs
- chapatis etc etc
useful for enabling homogeneous groups, especially the poorer, more
deprived, women, etc to express and analyse their knowledge,
perceptions, problems, needs, preferences, priorities ...

11) Body mapping

- people draw or diagram "maps" of their internal organs
useful for: enabling people to show how they perceive their bodies leading
to more appropriate programmes (e.g. for family planning)

Combinarions and Sequences of Merhods

Combinations and sequences of methods can be strong. For example:
maplmodel leading to wealthhealth ranking on the map or
model
wealthhealth ranking leading to focus group discussions
leading to seasonal diagramming, causal diagramming, matrix
ranking and scoring, all leading through analysis to action
Dangers Putting practical people off. Long lists like these can
intimidate. They could inhibit practical people. But they are a
menu, not a syllabus. Practical people can pick and choose
what they want, and start, experiment, adapt, invert, and leam
to do better as they go.
Instant fashion. Donor agencies, Government departments, and
large NGOs are in danger of sudden, widespread adoption of
some of RRA/PRA approaches and methods. It is probably
better to learn piecemeal, to experiment and test, to allow and
encourage practical people to invert and adapt what seems to
fit local needs and conditions, learning from successes and
failures as they go.
Hopes that practical people in the field will be encouraged to try out
some of these methods and combinations, adapt them, invent
others, and share their experience.
that these participatory methods, such as diagramming and then
"interviewing the diagram", will be less intrusive and
disturbing than some others, will strengthen rural and urban
people's own analysis, and will help better communication of
their priorities and needs to managers.
Source : Note prepared by Dr. Robert Chambers, Institute of Development Studies,
University of S u ~ xU.K.
, based on sessions with IDS study course '20 and at the
IIEDflDS workshop held in November, 1991.