Community Development &

Partnerships

UNIT 1
 Learning Outcomes

At the end of the session learners will be able to

• Define Community, Community Development
& Community Partnerships
• Discuss key concepts in Community
Development & Partnerships
• Discuss different perspectives on health
Definitions of Concepts
Definition of Concepts: Group Activity
Divide into 3 groups and broadly define the following.
Group 1: Community
Group 2: Community Development
Group 3: Community Partnerships and benefits

After discussion each group will chose a presenter who

will share the outcome of the group discussion.
Community definition
A group of individuals, bound by common socio-
economic, cultural, or geographical conditions and
interests. A community can be built around space,
identity or interest.

A social unit with commonalities such as norms,

religion, values, customs, or identity.
Communities may share a sense of place situated in a
given geographical area or in virtual space through
communication platforms
 Community definition cont’d
• Members of a community have a sense of trust,
belonging, safety, and caring for each other.
• They have an individual and collective sense that
they can, as part of that community, influence their
environments and each other to improve their lives.
• People form and maintain communities to meet
common needs or achieve common goals
 Community definition cont’d
Community can also be defined by or define itself by
• Common cultural heritage
• Cultural/religious believes and values
• Shared interests
• Language
 Dimensions of Community?

Place

Population
“Community” must be defined so
Dimensions of
Community
Political system stakeholders can be identified
and appropriately involved in the
various stages of the community
Social organization development process.

Cultural system

Economic system
Dimensions of Community
• Place-geographical location
• Population- demographic, - size, etc.
• Political system- power, influence, allocation of
resources, leadership etc.
• Social organization – how society is organised, ways
people interact with each other and between each
other
• Cultural- the cultural practices beliefs, values and how
these affect members.
• Economic – opportunities available to better the lives of
communities
Place-Based & Interest Based Community
Placed-Based community:- refers to a geographically delimited population
e.g. block, rural village, town, district, municipality, university or city.
• Place based has an assumption that residents have some bonds as a
result of sharing a common local environment.

Interest –Based:- set of relationships and personal ties.

• Community of interest or identification e.g. religious group, Gay
community, student community, business community etc.

• Virtual-based:- bond by common interest, yet no face-to-face interaction

on daily basis just through communication.(through modern technology)

• (What common conditions and interest binds the IDM community)

 Community Perspective
It is also important to understand how communities define themselves
and what makes them a community.
Below are some questions to consider when defining a community.
•How does the community view themselves?
•Who are the community representatives?
•Which individuals or groups have influence in the community? What is their
sphere of influence?
•Are they resident in the community or do they operate from outside?
•Who in the community has time, resources and flexibility to attend
community activities?
•Who in the community is defined as an outsider and should not be involved
in community activities?
Community Development
Community Development: is the process that increases
choices. It means new options, diversification, thinking
about apparent issues differently and anticipating change
(Christenson et. Al., 1989)
• CD involves change, improvement and improved
participation, flexibility, equity, attitudes, the function of
institutions and consequently quality of life of people
• It’s creation of wealth – the things that people value not
just money.
Primary outcome of CD is “Improved Quality of Live” and
Health
Community Development
A process whereby people come together to take
collective action and generate solutions to common
problems
• Community Development should be a long term
endeavour
• Well planned
• Inclusive and equitable
• Holistic and integrated
• Initiated and supported by community members
• Be of benefit to all members in the community
Community Development cont’d
Process of improving the quality of all human lives in
three important areas:
1. Raising peoples’ living levels, i.e. incomes and
consumption, levels of food/food security , health
services, education economic opportunities etc.
2. Creating conditions conducive to the growth
of peoples’ self-esteem through the establishment of
social, political and economic systems and institutions
which promote human dignity and respect and their
participation in the development processes
3. Increasing peoples freedom to choose
 Some examples of Development (cont’d)
o Advances in telecommunication(handheld devices,
internet and digital devices).
o Increased mobility and ease of travel have resulted
in loss of community
o Individuals are much more independent now than
before
o Sense of community diminished people more
individualsitc
o Because of the above changes which have a bearing
on the community structures, its now takes specific
skills to organize the community to act for the
collective good.
Community Development
Community Development is a process of actively
involving and enabling people to enhance their
capacity to play a role in shaping the society of which
they are a part.
• It is a process where community members are
supported by agencies to identify and take collective
action on issues which are important to them
• Community Work underpins an approach to tackling
health inequalities and is crucial to long term
outcomes and progress.
Community Development
Community Development defines the inter sectoral
approach adopted at local level to address health
issues to.
• enable groups and communities to articulate their
needs and viewpoints
• work collectively to influence the processes that
structure their everyday lives
• take collective action that will contribute to making
real, positive and lasting change in the community.
Community Development
Principles of Community Development
• Promote active and representative citizen
participation so that community members can
meaningfully influence decisions that affect their
situation.
• Engage community members in problem diagnosis
so that those affected may adequately understand
the causes of their situation.
• Help community members understand their
economic, social, political, environmental, and
psychological impact associated with alternative
solutions to the problem ( Health determinants)
Principles of Community Development
• Assist community members in designing and
implementing a plan to solve agreed upon problems
by emphasizing Shared Leadership and active citizen
Participation.
• Seek alternatives to any effort that is likely to
adversely affect the disadvantaged segments of a
community.
• Actively work to increase leadership capacity, skills,
confidence, and aspirations in the community
development process.
Community Partnership
 Community Partnerships
What is Community Partnership?
A community partnership is a working
relationship between communities and
individuals and/or organizations working
together for a common goal on an issue of
importance to the community.
It consists of a mutually beneficial relationship
where all parties have shared responsibilities,
privileges and power (Connors, 2003)
Purpose of Community Partnerships
Partnerships are intended for 
– Joint solving of problems,
– Resource exchange or sharing,
– Cooperation,
– Coordination and coalition building.
– Capacity building
The relationship among partners can be temporary
(local bodies, including government, grassroots NGO's)
or permanent.
Community Partnerships
Community Partnerships;
• Take time, skill and effort to develop – on all
sides.
• Power sharing is necessary in partnerships
• Some autonomy may be lost in process of
developing partnerships
• Partnerships have to beneficial to all partners
involved.
Key Principles in Community Partnerships
• Have members who share a common vision, mission,
goals and values.
• Has a genuine interest in and commitment to the
community.
• Shows mutual trust and respect for partners.
• Recognizes the strengths and contributions of all
partners.
• Shares leadership, decision-making power,
resources and credit among its members.
• Ensures that each member of the partnership is
treated equally.
 Principles in Community Partnerships
• Fosters a safe environment for clear and open
communication that values feedback from all partners
• Values the knowledge and expertise of all partners.
• Believes community input is essential.
• Is community driven.
• Values diversity and inclusivity.
• Understands that relationships take time to develop
and that they change over time.
Benefits of Community Partnerships
• Ensures greater success by involving people most
affected by the problem.
• Creates a collaborative environment and a chance
to get to know and network with new partners.
• Fosters an environment of mutual learning and
understanding of members’ strengths, assets and
limitations.
• Provides credibility that may come from working
with other partners.
Benefits of Community Partnerships
• Fosters sharing of resources and creative ideas to
develop programs to address community needs.

• Reduces the amount of competing and fragmented

services.

• Increases financial and other resources to the

whole partnership or certain group members.

• Builds community capacity through training and

professional development.
TYPES OF PARTNERSHIPS
Collaborative Partnership
Collaborative: is a group of community
leaders who use an inclusive strategy to
establish shared goals and agree to use their
personal and institutional power to achieve
them.
 Advisory Committees

Advisory Committees: respond to

organizations or programs by providing
suggestions and technical assistance.
 Commissions
Commissions: consist of citizens appointed
by official bodies to develop or review
policies.
 Consortia and Alliances
Consortia and Alliances: are semi-official
membership organizations. They typically have
broad policy-oriented goals and may span large
geographic areas.
They usually consist of organizations and
coalitions rather than individuals.
 Consortia and Alliances
• Alliances involve more formal relationships among
organizations and usually focused on a particular
issue or mission.
• There will be clear expectations around task
performance, contributions and conduct.
• Alliances are often formed as a means of influencing
policy; either to formulate a strong response to a new
policy that is seen as detrimental, or to advocate for
the development of a policy.
Networks
Networks: are loose-knit groups formed primarily for
the purpose of resource and information sharing.
• Members of a network have informal ties to each
other and non-hierarchical relationships.
• There are few expectations of members and no
official obligations
• Networks may emerge simply due to the clustering
of people and activities.
• But are deliberately established to promote the
sharing of information, tools and resources among
individuals and organizations with similar interests
Networks
Networks have many benefits; they can:
• enhance communication, co-operation and mutual
support among organizations and community
members
• raise the standards and quality of services;
• encourage the development of new models of
service; and provide opportunities to form strategic
partnerships
Task Forces
Task Forces: come together to accomplish a specific
series of activities, often at the request of an
overseeing body i.e. government department, NGO,
other institutions
• The government generally appoints special teams
to investigate critical issues like epidemics,
mortality, terrorist attacks etc.
• The task force explores all the possible reasons
which led to a severe problem and tries to resolve it
Coalitions
Coalitions: are organizations that are made up
of various organizations working together for a
common purpose.
• This is formal relationship among more than
two organizations and perhaps involving
individual members as well, which enables
them to work together on a specific issue or
project
 Coalitions
Have its own funds and staff, either allocated from
members’ own organizational budgets and human
resources, or funded by an external source. 
There are three main types of coalitions: 
• Grassroots coalitions formed in times of crisis
to pressure political decision-makers to act i.e.
organized by volunteers and are political,
controversial and short-lived.  
Professional Coalitions

• Professional coalitions formed in time of crisis or

as part of a long-term strategy to increase their
power and influence.
• Often lead organization is established that
contributes significant staff and financial resources.
Community-Based Coalitions
Community-Based coalitions have broad
community representation i.e. professionals and
volunteers/grassroots leaders.
• They focus on positive action to improve
conditions in community, worksites, schools or
other local institutions.
• Often one agency takes a lead administrative
role and funding to support
Community-Based Coalitions
Community-Based coalitions have broad
community representation i.e. professionals and
volunteers/grassroots leaders.
• They focus on positive action to improve
conditions in community, worksites, schools or
other local institutions.
• Often one agency takes a lead administrative
role and funding to support
Different Perspectives of Health

Health is viewed different by

different people
Health - Professional Point of View

Health: “as a measure of the state of the

physical bodily organs, and the ability of the
body as a whole to function. It refers to
freedom from medically defined diseases”.
Health -Lay Person Point of View

Health: “Persons are healthy when they are

doing their activities with no apparent symptoms
of disease in them. The New oxford Dictionary
of English describes health as ‘the state of
being free from illness or injury”.
 Health: (WHO)

Health: “ A state of complete physical,

mental, and social well-being and not merely
the absence of disease or infirmity”.
 Health – WHO
The above definition describes health as multi-
dimensional.
o Physical health: is concerned with anatomical
integrity and physiological functioning of the body. It
means the ability to perform routine tasks without
any physical restriction. E.g., Physical fitness is
needed to walk from place to place.
o Mental health: is the ability to learn and think
clearly and coherently. E.g., a person who is not
mentally fit (retarded) could not learn something
new at a pace in which an ordinary normal person
learns.
 Health – WHO

o Social health: is the ability to make and maintain

acceptable interaction with other people. E.g.
to celebrate during festivals; to mourn when a close
family member dies; to create and maintain
friendship and intimacy, etc.
o Emotional health: is the ability of expressing
emotions in the appropriate way, for example to fear,
to be happy, and to be angry. The response of the
body should be congruent with that of the stimuli.
 Health- WHO
o Emotional health is related to mental health and
includes feelings. It also means maintaining one’s
own integrity in the presence of stressful situation
such as tension, depression and anxiety.

o Spiritual health: Some people relate health with

religion; for others it has to do with personal values,
beliefs, principles and ways of achieving mental
satisfaction, in which all are related to their spiritual
well-being.
 Community Health
• Community health activities are aimed at protecting
or improving the health of a population or
community.

• Examples blood drive, fun-run and health and

wellness campaigns.
 Community Health
The WHO defines community health as:
availability of environmental, social, and
economic resources to sustain emotional and
physical well being among people in ways that
advance their aspirations and satisfy their needs
in their unique environment.
What characterises a Health Community?
Healthy Community
The total well being of a group of people
occupying a particular geographical location;
Community is considered healthy when
• Diseases and poverty are eliminated
• There is adequate accessible health services
• There is established atmosphere for good living
• Their basic needs are met
• There is adequate safe drinking water
• There is adequate food and nutrition
• There is good communication
• There is decent shelter etc.
• There psychosocial support etc.
• Strong community health requires communities to
look beyond themselves and take “collective
responsibility,”
• A healthy community benefits every person in it and
community health is one means of achieving a
healthy community.

• Socio-cultural factors, including the beliefs, norms

and traditions of a place, shape attitudes toward
health and influence the habits that contribute to
healthful practices or detract from them.
• The foundations of community health include the
understanding of history of community health
practice, factors that affect community and
population health, and the tools of community health
practice.

• These tools include epidemiology, community

organizing, and health promotion and disease
prevention planning, management, and evaluation
• Working with communities requires understanding of
all these
 Public Health Defined
• Public Health is defined by the American Public Health
Association (APHA )
(1) “the practice of preventing disease and promoting good
health within groups of people” and
(2) the research and surveillance conducted to better
understand the health issues facing a group and, in turn, to
craft good health policy.
• Successful public health activities and initiatives can save
money by promoting healthy living and prevention, thus
reducing healthcare costs and disease burden.
Relationship
Personal/Personal Health

Family Health

Community Health

Public Health
Factors that Affect Health of a Community
(Determinants)
Physical factors Social and
cultural factors

Health of the
community

Community Individual
organisation behaviors
 Physical Factors
Physical factors:- they include the influence of geography,
the environment, community size, and industrial development.

Geography:- a community’s health problems can be directly

influenced by altitude, latitude, climate e.g. tropical climate were
warm, humid, and rain prevail throughout the year parasitic and
infectious disease are the leading community health problem
and in temperate climates with fewer parasitic and infectious
diseases and more than adequate food supply, obesity and heart
diseases are important community health problems
• Environment or climate change:- uncontrolled
population growth and depletion of non-renewable natural
resources makes our communities less desirable e.g. soil,
water and air pollutions

• Community Size:- the larger the community, the grater

the range of health problems and the greater its number of
health resources. For example large communities have more
health processionals and better health facilities than small
communities. The amount of refuse/litter generated by
Gaborone is more than the one generated by Sua township.
• Industrial Development:- development like size above
can have either positive and negative effects on the health
status of the community.
• Even though industrial development provides communities
with resources for community health programs it may bring
with it environmental pollutions, occupational injuries and
illness. Palapye is a case in point: Mega-projects, BUIST,
Moruple B Expansion, Police Station and Glass
Factory……..think about the effects of the rapid industrial
development on the environment and health of the
community.
• How can communities such as above regulate the
effects of the rapid industrial development?
Social and Cultural Factors
• Social factors:- are those that arise from the interaction of
individuals, or groups within community e.g. town life has
high rates of stress-related illnesses than rural communities
and on the other hand rural communities would not have
access to quality health care such as hospital or medical
specialists.
• Cultural factors:- they emerge from guidelines(explicit and
implicit) that individuals “inherit” or “learn” from being a part
of a particular society. “Culture teaches us what to fear,
what to respect, what to value, and what to regard as
relevant in our lives”.
Beliefs, Traditions, and Prejudices:- all these can affect
the health a community e.g. the beliefs in some specific
health behaviour such as exercises and smoking.
 Economy
• Employers usually find it hard to provide health
benefits for the employee as their income drops

• The unemployed and underemployed face

poverty and deteriorating health

• Thus, the cumulative effect of an economic

downturn significantly affect the health of the
communities
 Politics

• Politics can improve or jeopardise the health of the

community through the decisions that they make.
• The question then is to what extent should the
government be involved in the health care issues?
(Higher or lesser)
• Think of the influence that parliament and local
government councils have every time they vote on
health-related issues?
 Religion
• A number of religions have taken position on health
care and health behaviours e.g. limit on medical
treatment their members may receive, blood
transfusion, prohibit certain foods and use of
condoms
• Some religious communities actively address moral
and ethical issues such as abortion, premarital
intercourse and others teach health-promoting
codes to their members
• Thus religion can affect a community’s health
positively and negatively
 Social norms
• The influence of social norms can be positive and
negative e.g. smoking and alcohol
• Smoking was mostly done by men in all setting,
buses, trains, banks, then women gradually came
into the picture.
• Recently there is a decline or restriction of smoking
in public setting thus less socially acceptable. This is
a change in social norms which tries to improve the
health of the community
• Unlike smoking, alcohol has a negative social norm
in Botswana especially among the youth, it starts as
fun or cool
 Socioeconomic status
• Difference in socioeconomic status has a bearing on
health whether defined by education, employment
or income.
• Poor people experience adverse environmental
conditions in ghettos, farms. They also have poor
nutrition, less access to medical care and more
psychological stress
• On the other hand health care access, higher
incomes enable people to afford better houses, live
in safe communities and this increase the
opportunity to engage in health-promoting
behaviours
Globalization and Health
 Globalisation & Health
o Globalization is the process of increasing political
and social interdependence and global
integration that takes place as capital, traded
goods, persons, concepts, images, ideas and
values diffuse across the stated boundaries (Hurrel
&woods 1995).
o Globalization must ensure that people, particularly
the poor, enjoy better health that is the most
important factor in improving the economic
wellbeing of the population in general and in
reducing poverty in particular.
 Effects of Globalization on Health
o Externalities of some diseases due to increased
communication decreased human mobility

o Accelerated economic growth and technological

advances have enhanced health and life
expectancy in many population

o Increasing effects of international and bilateral

agencies (structural adjustment programs and
Global initiatives)
 Effects of Globalization on Health
Jeopardizing population health via erosion of social
and environmental conditions and exacerbating
inequalities
Other health risks of Globalization includes:
o Fragmentation and weakening of labour markets due to
greater power of mobile capital
o Tobacco induced diseases
o Food markets & obesity as well as chemicals in food
o Rapid spread of infectious diseases
o Depression in aged and fragmented population
o Adverse effects on the environment
Disease Causation Theories
 How disease is caused?
• Before the rise of modern medicine, disease
was attributed to a variety of spiritual or
mechanical forces, including:
A punishment from God for a sinful
behavior.
Weak moral character.
Witchcraft.
 Nineteen-Century Models
Each effort to prevent disease in the 19th century was
based on one or the other three theories of disease
causality. These are:
o Contagion theory

o Supernatural theory

o Personal behavior theory

o Miasma theory
 Contagion Theory
This theory was common at the beginning of the 19th century.
Most official disease prevention activities were based on the
hypothesis that illness is contagious. It required:

o Keeping sick people away from well people.

o The institution of quarantine of ships (the traditional period
was forty days la quarantine) during which time ships,
their crews and cargos waited off shores or at some isolated
islands.
o Setting up military cordons around infected towns
o Isolation of households if they were infected, and
o Fumigating or washing the bedding and clothing of the
sick.
 Supernatural Theory
o Proponents of this theory argue that supernatural
forces cause disease.
o Disease prevention measures based on this theory
were important to the religious people.
o The view among them was that disease is a
punishment for transgression of God’s laws.
o Because epidemic took a great toll on the poor than
the rich, the healthier rich can employ the super
natural theory as a justification for berating for the
poor for sinful behavior i.e. presumed idleness,
intemperance and uncleanness.
 Personal Behaviour Theory
o This theory held that disease results from wrong
personal behavior. It was democratic in intent since it
gave responsibility to individuals to control their own lives.
o In this formulation the source of the disease was not tied up
with the mysterious ways of God, instead people caused
their own disease by living fully unhealthy.
o Hence, improper diet, lack of exercise, poor hygiene
and emotional tension become the focus of preventive
actions. This theory does not blame the poor for the illness
and in many aspects; it was homage to middle-class life.
 Miasma Theory
o The word "miasma" comes from ancient Greek
and means "pollution".
o This theory argues that disease is caused by the
odor of decaying of organic materials.

o It dates back to the Hippocratic idea that disease is

related to climate.
o It contrasted sharply from the other three theories
since it conceptually separated the source of the
disease from the victim of the disease.
 Miasma Theory (Cont.)
• In the 1850s, miasma was used to explain the
spread of cholera in London and in Paris.
• The miasma theory was consistent with
observations that disease was associated with
poor sanitation.
 As a result of the miasma theory
1. Public health measure were concerned
with sanitation.
2. Focus was on disease prevention (causes
of diseases in population) and the health
needs of poor population.
3. The epidemiology were largely involved in
population-wide health improvement.
 Twenty-Century Models
Although economic and ideological considerations influenced
the 19th century disease prevention policy, sound research
determines policy today. The 20th century theory focuses
on:
o The Germ Theory

o Life Style Theory

o Environmental Theory

o Multi Causal Theory

 Germ theory
• Health problems were believed to be the
product of living organisms which entered
the body through food, water, air or the
bites of insects or animals.
• It was believed that each disease has a
single and a specific cause (mono-causal
approach).
 The result of the Germ Theory:
• Researches were moved from the
community to the laboratory and
concentrated on the identification of
agents for a given disease.
• Medical practice became devoted to the
destruction or eradication of the agent
from individuals already affected.
 Life Style Theory
o This holds that unhealthy lifestyles are causes for
diseases. This hypothesis blames stress, lack of
exercise, the use of alcohol and tobacco improper
nutrition for most chronic diseases.
o This theory rejects the notion central to the classic
germ theory, that a single disease has a single
etiology.
o Instead they emphasize the interrelatedness of
many variables in disease causality, principally
those under the control of the individual.
 Life Style Theory

o Nevertheless, this approach resembles the germ

theory, for it conceives of disease as an individual
event, the difference is that prevention, instead
of requiring physicians’ administrations, demands of
personal behavior change.

o The critics surrounding this theory state that the

change for lifestyle requires overall social change
 Environmental Theory
o Environmental theory explains that significant
number of chronic disease are caused by toxins in
the environment and it implies that disease
prevention, instead of requiring medical treatments
or personal hygiene, demands change in the
industrial production.
o The first aspect of the environmental hypothesis is
occupational hazards, the second concentrates on
toxic substances in the air, water and soil
(advocates of this theory places particular emphasis
on radioactivity)
o The third aspect focus on synthetic additives to
foods “organic foods”.
 Multi Causal Theory

o It is also called the web of disease causation.

o The theory express that there are multiple factors

for a cause of a single disease entity
 Web of causation/Multi Causal Theory
According to this concept, disorders are
developed through complex interaction of
many factors.
These factors maybe biophysical, social or
psychological and may promote or inhibit
the disease at more than one point in the
causal process.
Ultimately, they determine the level of disease
in a community.
 Cause

Cause
Effect \ Disease

Cause

Cause
 As a result of this theory:
• Based on this theory, it is believed that
prevention offers a better prospects for health
than cure, since many of these factors can be
modified.

Since several factors contributes to several

diseases, community efforts were shifted to
factors modification (prevention) rather than
disease treatment.
 Assignment

o Outline the strengths, weakness and the

preventative measures of the twenty century
disease causation models.

o Discuss how globalization has affected the overall

health of your country and explain how.