ENGAGING COMMUNITIES IN

WHOLISTIC HEALTH DEVELOPMENT:

THE ‘THV MODEL’

INTRODUCTION

PURPOSE To collectively contribute to the improvement in the

quality of health care and life of the people of Burangi area in Malindi /Magharini district along the Kenyan coast by engaging active community participation in its own development in a model we call “Total Health Village.”

THE MAP/GENESIS PARTNERSHIP

WHY? “We are attracted and bound by absolute like

mindedness in

VISIONMISSION

AND CORE VALUES

THE MAP/GENESIS PARTNERSHIP

SIMILAR CORE VALUES• We are Christian with mirror visions and missions• We are driven by a holistic participatory approach

to health development emphasizing local sustainability

• We specialise in human health care• We prioritise reaching to the poorest, the

marginalised, and underprivileged in society

SIMILAR CORE VALUES• Our philosophy is anchored on realistic

empowerment of communities and individuals• Our inputs are low but our expected outputs are

high.....hence we support cost effective interventions

• Commitment to transparency and good stewardship of resources

SOME FEW HEALTH SECTOR INDICES FROM KENYA

• 5000 health facilities in Kenya• 4500 doctors; 1000 in public service. 50%

concentrated in Nairobi: Ratio 1 physician to 10,000 citizens (compared to 26:10,000 in US)

• 47,000 Nurses & other cadres of medical personnel (10:10,000)

• 4.6% GDP towards health financing ($29 USD per capita) far below the minimum $34 recommended for Africa by WHO. 40% of financing comes from Kenyan Government; 15% donors, rest by private sector

SOME FEW HEALTH SECTOR INDICES FROM KENYA

• 58% of health services run by private sector which caters to high income clientele

• 90% resources devoted to curative a service that only 10% of the population accesses.

• 90% of morbidity (and mortality) is caused by preventable infective diseases (and poverty)

Kenya HDI (Human Development Index) #147 (0.541)

(ranked out of 182 countries)Literacy Rate

(age 15 and over that can read and write) #107

73.6%

Infant Mortality Rate

(per 1,000 live births)

54.7 deaths/M

(2009 est.)

Life expectancy at birth

#152

53.6 years

Combined primary, secondary and tertiary gross enrollment ratio #138

59.6%

GDP per capita

#149

$1,542 USD Per Capita(2009 est.)

THE BURANGI PROJECT is a total health village (THV)

program

• The THV is a ‘low-input($15 pp/py), high-impact strategy for achieving the ‘Millennium Development Goals.’

• It is a cost effective community development strategy that is expected lead to Total Well Being by impacting a whole village of close to a thousand people through a facilitative and low input cost strategy.

• It is a completely participatory strategy where communities analyze their situation, and plan a response strategy, and implement it using Community’s Own Resources/Persons and engaging External partners only in a facilitative role where they have no capacity in solving their own problems.

WHAT IS A THV?

PARTICIPATORY METHODOLOGIES

How?

We have devised simple methods that can apply to any community (in any country).

Is the rallying point that initiates, stimulates and sustains

enthusiasm in participation.

THE TEN SEED (OR EQUIVALENT) TECHNIQUE

Why TST?•Win trust•Ice breaker•Neutralises threats of inferiority•Neutralises the threat of illiteracy•Stimulates thinking and visualisation (perception)•Is the tool for data collection

EXAMPLE OF A TST ANALYSIS OF PROBLEMS IN THE BURANGI COMMUNITY

OVERALL PROBLEMS MAJOR PROBLEMS

•Rampant diseases•Poor health care•No access roads•Drought•Poverty•High illiteracy•Lack of technology/communication•Floods•Wild animals•Poor leadership

Inadequate health Facilities

30%

Diseases 20%

Communications/Access Roads

5%

Floods 5%

Illiteracy 10%

Poverty and hunger 30%

• A ‘SWOT’ analysis

that uses information gathered through the TST.

• Analyses 3 components simultaneously

1. Problems2. Means of earning

livelihood3. Uncertainties

(W)HOLISTIC WORLD VIEW ANALYSIS:W(H)WVA

WWVA Explanation

Community Strengths

Community Weakness

Community Vulnerabilities

Lack

of H

ealth

Fa

ciliti

es

Outbreak of deseases

e.g Cholera

Prob

lems

Ram

pant

Dise

ases

Poor Roads

Wild Animals

Floods Tapping

(Traditional Licker

Farming

Empl

oym

ent

Cano

e Ro

win

g

Lack of

Education

Small Scale Businesse

s

Poverty

From: Uncertainty Analysis

From: Livelihood Analysis

From: Problem Analysis

Color code

PRIORITY SETTING

• There is a significant margin of statistical error being higher for quantitative data than for qualitative data compared to conventional statistical methods

• It has been tested that the perception results derived are reasonable enough to enable communities to analyse themselves and make informed plans that they can sustain

SHORTCOMINGS OF THE TST

POINT OF ENTRY THEMATIC AREAS FOR BURANGI THV

• HEALTH– Access to quality medical care through mobile and static

health clinics– Access to quality drinking water– Improved community, domestic and personal sanitation

• SUSTAINABLE DAILY LIVELIHOOD– Improved food security– Improved income generation

• Environmental preservation – Through tree planting and use of alternative renewable

sources of energy and others

EXPECTED IMPACT

• THE GOAL: Improved quality of life as measured by positive

changes in the human development index

• EXPECTED MAIN OUTCOME: A community empowered to take charge of its own

destiny

RESOURCES ALLOCATION

THE 50 | 40 | 10® PRINCIPLE• 50% TOWARDS PROMOTION.

– INVEST IN PEOPLE

• 40% TOWARDS PREVENTION. – INVEST IN SYSTEMS/STRATEGIES

• 10% TOWARDS PROVISION:– INVEST IN CONSUMABLES

WHAT ABOUT SUSTAINABILITY?• Involve the people right from the beginning

– Teach them to ‘learn how to learn“– To ‘learn how to dream constructively”– Elevation of self esteem and self confidence– “Doing with” rather than “doing for”

• Weigh when to give what…don’t interfere with their strength.

• Support their vulnerabilities and their weakness. Don’t do what they do well.

• Emphasize transferable skills and locally sustainable technology

WWVA Explanation

Community Strengths

Community Weakness

Community Vulnerabilities

WHAT ABOUT SUSTAINABILITY?• Involve local leadership from the start• Involve women and school children who provide

great potential as change agents• Understand and respect their culture and social

values; handle what you might think is retrogressive culture with tact.

• Don’t aim to make them a mirror image of your self. Let them discover their inherent ability.

• Enthusiasm is the driver of sustainability.

WHAT ABOUT SUSTAINABILITY?• Think “small,” think real, build on what they

know/have. Avoid ‘elephants with strange colors’

SIGNIFICANT PROGRESSTO DATE IN BURANGI

• Conducted Medical camps (April/August ’10/Feb ‘11)– 3800 people served with combination of US & Kenyan

medical professionals and community members

SIGNIFICANT PROGRESSTO DATE IN BURANGI

• Done a WWVA together that generated great understanding of group dynamics (August 2010)

• Construction of an access road though high level advocacy and community involvement

SIGNIFICANT PROGRESSTO DATE IN BURANGI

• Conducted a surgical camp in which 2 individuals with severe filarial morbidity

SOME OF OUR CURRENT WORK

PROVIDED NEEDY SURGICAL SERVICES

BURANGI CHALLENGES

The greatest challenge is adequate resources to facilitate this worthy cause

– Financial…extreme poverty (1/3 of average Kenyan daily earnings)

– Human….not labor but knowledge– Material…….technology

ACKNOWLEDGEMENT

• Tracy Haworth – Genesis Project Director• Dave Hall – Genesis Board Member

• Medical teams, background teams, donors and well wishers

OPEN INVITATION

– All of you– Health care professionals (and students)– Technical people in other areas– Any person with a heart for sharing or witness.– Any person who can donate a dollar or two (or

more) or any other gifts in-kind towards this mission

ABUNDANT BLESSINGS

THANK YOU