Participation effect from water projects on EPI

doi:10.1016/0277-9536(90)90315-J

Social Science & Medicine

Volume 30, Issue 12, 1990, Pages 1349-1358

https://doi.org/10.1016/0277-9536(90)90315-J Get rights and content

Abstract

It has been hypothesized that in addition to the direct health and amenity benefits of an improved water supply, there are other, more subtle, benefits to communities who participate in community-based water supply projects. A detailed empirical comparison of villages with and without community-based water projects in Indonesia and Togo suggests that such indirect benefits are substantial. Between 25 and 30% more children are immunized in villages with community-based water projects than in comparison villages which either have benefitted from non-participatory water projects, or have had no water project.

From a comparison between the activities of villagers and workers in external agencies involved in water projects in the two countries, it is concluded that successful participatory water projects are best characterized as a partnership between the community and the external agency. Such projects require substantial inputs of time, resources, skill and persistence from both the community and the external agency. These inputs must be sustained by both parties in all phases—planning, construction and maintenance—if this partnership is to result in lasting improvements in water supply and other aspects of community life.

References (15)

Water for Rural Communities: Helping People Help Themselves
(1987)
J.A. Walsh et al.
Selective primary health care: An interim strategy for disease control in developing countries
New Engl. J. Med.
(1979)
The State of the World's Children
(1987)
J. Briscoe
Water supply and health in developing countries: selective primary health care revisited
Am. J. publ. Hlth
(1984)
J. Briscoe
Evaluating water supply and other health programs: short-run versus long-run mortality effects
Publ. Hlth Lond.
(1985)
D.A. Okun
The value of water supply and sanitation in developing countries
Annual Meetings of the American Public Health Association
(1987)
D. Blum et al.
Measuring the impact of water supply and sanitation investments on diarrhoeal diseases: problems of methodology
Int. J. Epidem.
(1983)

There are more references available in the full text version of this article.

Cited by (29)

Learning from experience in the water sector to improve access to energy services
2018, Utilities Policy
Citation Excerpt :
This theme of participation has been explored, and is prevalent, in the water sector literature, which highlights that different types of participation will affect outcomes differently (Marks and Davis, 2012). Participation can be immensely beneficial and can lead to unintended outcomes as well (Eng et al., 1990). Participation of end users in decisions around water and sanitation access initiatives can increase ownership and pride in the technology and the project, and can increase the knowledge and maintenance capabilities of community members, leading to the sustained maintenance and upkeep of technologies (Manikutty, 1997; Gomez and Nakat, 2002).
Providing access to safe water in developing countries has stirred global attention for decades. This focus has not been paralleled in the energy sector, with access only recently receiving explicit mention in the Sustainable Development Goals. A framework applied to identify and compare trends occurring within these sectors suggests that there are areas for cross-sectoral learning, specifically around the emergence of market-based approaches to access and community engagement practices. Leveraging the lessons learned from years of development practice in the water sector could help avoid mistakes and improve energy poverty alleviation.
Community mobilization to reduce postpartum hemorrhage in home births in northern Nigeria
2012, Social Science and Medicine
Citation Excerpt :
As expressed in the Declaration, individuals and communities have a right and responsibility to play a role in improving their own health status (World Health Organization, 1978). The often untapped energy and resources of communities can make substantial contributions to the success of health projects (Chirowodza et al., 2009; Eng, Briscoe, & Cunningham, 1990; Minkler & Wallerstein, 2008; Rifkin, Muller, & Bichmann, 1988; Simon, Mosavel, & van Stade, 2007; Wallerstein, 2006). Community participation frequently is seen as occurring along a continuum and several useful models have been developed (see Arnstein, 1969; Draper, Hewitt, & Rifkin, 2010; Morgan & Lifshay, 2006; Rifkin, 1985).
The purpose of this study is to demonstrate the importance of community mobilization in the uptake of a health intervention, namely, community-based distribution of misoprostol to prevent postpartum hemorrhage. Community mobilization to increase access to misoprostol for postpartum hemorrhage prevention was implemented in northwestern Nigeria in 2009. Theories of community participation and the current near-epidemic maternal mortality conditions underpin an approach using modest levels of community involvement. The study was undertaken in five communities around Zaria, Nigeria. Community leaders and selected community members participated in a series of dialogs. Additionally, community education, information and dramas sessions were held. Twenty nine community oriented resource persons (CORPs), 27 drug keepers and 41 traditional birth attendants (TBAs) were involved in the intervention. Postpartum interviews were used to assess the impact of community mobilization efforts and to track use of misoprostol. Multiple logistic regression was used to examine the association between correct use and receiving information regarding misoprostol from TBAs or CORPs. A total of 1875 women were enrolled in the study in 2009. Most women delivered at home (95%) and skilled attendance at delivery was low (7%). Community mobilization efforts reached most women with information about postpartum hemorrhage and misoprostol (88%), resulting in high comprehension of intervention messages. Women identified TBAs and CORPs as the single most important source of information about misoprostol 41% and 31% of the time, respectively. Availability of misoprostol at the community level gave 79% of enrolled women some protection against postpartum hemorrhage which they otherwise would not have had. Although high level community participation in health care interventions is the ideal, this study suggests that even in circumstances where only modest levels of participation can realistically be achieved, community mobilization can have a significant impact on the successful distribution and uptake of a potentially life-saving health intervention, in turn helping promote policy change.
Social capital and health promotion: A review
2000, Social Science and Medicine
Interest in social capital and health has emerged at an exciting time. In public health, there is a renewed interest in mechanisms that link social inequalities and health. In epidemiology, there has been a critical interrogation of methods and a call for a more explicit use of theory. In health promotion over the last 20–30 years, social health interventions have been somewhat marginalised in an era dominated by interest in traditional cardiovascular disease risk factors. Now that social hypotheses are being reborn in health, there is a risk that the sophistication that has developed in social health promotion and the literatures that have informed it could be overlooked. In this paper, we present a brief history of social capital and how it has come into recent prominence through the debate linking income inequality and health. We present the background to this, the earlier literatures on social environmental influences on health and the possible processes thought to underlie this relationship. Social capital has relational, material and political aspects. We suggest that, although the relational properties of social capital are important (eg, trust, networks), the political aspects of social capital are perhaps under recognised. The paper also reviews how complex social processes at the community level have come to be operationalised by social theorists and intervention agents in other fields. We suggest that social capital research so far has inadequately captured the underlying constructs, in particular the qualitative difference between the macro/context level and the micro/individual level. While being cautious about the science, we conclude that social capital’s power as rhetoric and as a metaphor may be of value. We conclude by suggesting that the coalescence of interests in context-level influences on health now invites a revitalisation of theories and interventions inspired by diverse fields, such as geography and ecological community psychology.
Resource dependency and community participation in primary health care
1998, Social Science and Medicine
Great hope is accorded to community participation in health. A large number of potential benefits are attributed to participatory processes, including better addressing community needs through more locally adapted organizational processes and improvement in health outcomes. To this end, many governments around the world have adopted policies and programmes of community participation as part of their strategy to implement primary health care services. In Mexico this is, in great part, realized through the module programme of the Ministry of Health. A module is characterized by various village based health posts (casas de salud), each operated by a community volunteer and associated with a health committee, all of which are supervised by a nurse from a nearby health centre. The southern Mexican state of Oaxaca was chosen for a study of the module programme (during the period 1987–1992) to gain a better understanding of how organizational processes impact on the implementation and outcomes of community participation programmes in large institutions (i.e. the Ministry of Health). The resource dependency perspective formed the basis for the theoretical framework used. Some 75 towns and villages were visited and about 170 health related personnel from all over the state were interviewed to obtain data on the operation and impact of the module programme. As predicted by resource dependency theory, which postulates that organizations will react to pressures in their external environment to secure the resources needed for survival, the findings of this research led to the conclusion that the Ministry of Health had co-opted the resources of the communities it was involving in the module programme in order to meet its policy objectives, especially those related to expanding service coverage. Community participation in the module programme was found to have been implemented entirely for its utility in supplying resources and not for democratic or intrinsic values. This strategy, identified as the resource dependency approach to community participation, led to several flaws in the participatory process and resulted in far less than what could potentially have been achieved in terms of improving health outcomes. Ultimately, the participatory mechanisms became additional dependencies of the health system and not integral components of a process of community development. Large institutional programmes of community participation can benefit by understanding this approach and avoiding its inherent problems.
Health education to promote community involvement in the control of tropical diseases
1996, Acta Tropica
Health Education is any combination of learning activities that promote voluntary adaptations in health-related behaviour. In pursuing this definition, health workers generally work in two main directions, a community development approach and a behavioristic, communications approach. While Health Education in tropical, developing countries often takes the developmental approach with full community involvement, including the setting of programme priorities, Health Education for disease control has more often been characterized as the behavioristic mode utilizing simplistic, professionally determined messages and short-term campaigns to attempt to influence health behaviours related to disease transmission. Efforts in Idere, Nigeria, have tried to merge the two approaches building on community concern about one endemic tropical disease, Guinea worm. From this base, volunteer village health worker (VHW) training was developed. VHWs, once trained, developed their own association, which served as an organizational base for further health development programming, directed by the VHWs themselves.
Development sustainability through community participation: Mixed results from the philippine health sector
2018, Development Sustainability Through Community Participation: Mixed Results from the Philippine Health Sector

View all citing articles on Scopus

View full text

Participation effect from water projects on EPI

Abstract

Water for Rural Communities: Helping People Help Themselves

Selective primary health care: An interim strategy for disease control in developing countries

New Engl. J. Med.

The State of the World's Children

Water supply and health in developing countries: selective primary health care revisited

Am. J. publ. Hlth

Evaluating water supply and other health programs: short-run versus long-run mortality effects

Publ. Hlth Lond.

The value of water supply and sanitation in developing countries

Annual Meetings of the American Public Health Association

Measuring the impact of water supply and sanitation investments on diarrhoeal diseases: problems of methodology

Int. J. Epidem.