Labor Visions

Neighborhood based Community Health Workers

Pattern ID: 
913
Michael O'Neill
Healthy Living Collaborative
Version: 
1
Problem: 

Fragmented systems of service delivery that are intended to deliver health, social wellbeing, and safety are in need of course correction to address severe disparities in health and welbeing that exist.  The mandate of health care reform from the Affordable Care Act is to improve care, improve population health outcomes, and lower costs. In Washington State the timeline to accomplish this is five years.

 

How can organizations that have traditionally delivered units of care shift towards providing access to wellness for a population which creates health equity, increases local capacity, and transforms payment and delivery systems?

Solution: 

Community Health Workers are an emerging solution to this problem as shown by a case study of the Healthy Living Collaborative project in Southwest Washington and other similar projects which it is modeled after.  Community Health Workers (CHWs) are trusted community members among the people they serve who can fill a variety of culturally appropriate roles.  These roles increase access for the CHWs friends, family, neighbors, and peers to resources, knowledge, and skills that promote wellness.  CHWs are a credible voice for the lived experience of local needs and play a critical role in translating this information across cultural, social, and organizational boundaries.

Verbiage for pattern card: 

Community Health Workers are an emerging solution to this problem as shown by a case study of the Healthy Living Collaborative project in Southwest Washington and other similar projects which it is modeled after.  Community Health Workers (CHWs) are trusted community members among the people they serve who can fill a variety of culturally appropriate roles.  These roles increase access for the CHWs friends, family, neighbors, and peers to resources, knowledge, and skills that promote wellness.  CHWs are a credible voice for the lived experience of local needs and play a critical role in translating this information across cultural, social, and organizational boundaries.

Pattern status: 
Draft

Community Animators

Pattern ID: 
752
Pattern number within this pattern set: 
102
Justin Smith
The Public Sphere Project & St. Mary's University
Version: 
2
Problem: 

Development professionals often find it difficult to adequately assess the broad spectrum of problems a community faces, as well as grasp and utilize the various assets the community has to work with. The lack of grassroots knowledge has proven problematic in that development schemes are often mismatched in scale and relevance to the community’s needs, abilities and liabilities. Thus the conceived solutions for encouraging community capacities and livelihoods fall short of their objectives.

Context: 

Through their lived experience, community members trained in assessment techniques and information gathering can provide contextual understandings of the assets and liabilities a community possesses that would otherwise go unnoticed to the outside professional. Similarly they can act as agent for the process of conscientization and subsequent mobilization for peoples to pursue change and empowerment.

Discussion: 

In response to the failures of 'top-down' approaches to development, a shift towards emphasizing participation and empowerment have begun to make their way into the mainstream of development practice. This move toward "bottom-up," "farmer-to-farmer," and "grassroots" communication has been a fundamental reorientation. Following, the 70s and 80s, years often associated with the dark ages of development a new light has come about through alternative practices that seek to employ the community’s themselves in defining their needs, mapping out there assets and coming to terms with their own liabilities.

Through a variety of participatory processes both community members and development professionals have had the opportunity to jointly design community improvement schemes that are both appropriate to the community's needs and wants, as well sustainable and empowering.

As a result of relative success, the role of the community animator has become an increasingly important component for enabling this process of cooperation and participation between the development practitioner and the community members themselves. In some ways the animator acts as both initiator and on-going advocate for his or her community's development through regular open communication with both community members and the representative staff working in the area.

In the past highly educated teams of researchers and development field workers would enter a community and employ any number of assessment tools to identify community needs. Some of which were participatory in nature (see Power Research pattern). Upon return to their offices these assessments would be used to design various projects ranging from indoor lavatories, to treadle pumps, to community telecenters. In many cases it was shown that these projects failed to support the kind of long-term growth in people’s livelihoods they were thought to bring. Rather than looking at what the community wanted or needed from their cultural and social point of reference; these professionals designed projects relative to their point of reference.

Instead of persisting with this paradigm, NGOs such as the Institute for Integrated Rural Development (IIRD) have pursued vigorous development campaigns in Bangladesh. In this example the community animator has become a central agent for helping to identifiy and express the needs and desires of a community, as well as initiating and supporting change to include, informal education, ideas for micro-enterprise, and even supporting the creation of women’s self-help groups that have enable a number of women in rural areas to gain access to credit and thus empower them to pursue economic generating activities.

Here organizations such as IIRD would send exploratory panels out to the communities, as a "get to know you" campaign. Over a period of time they would identify predominately young men and women that they would sponsor for further education. The pool of students would often serve as the primary group that would go on to perhaps become powerful community animators.

Not only were they given a valuable education they still retain those familial bonds to their community that often gives them an immediate advantage in having the lived experience of their particular area, as well the rapport of being a community member.

However, problems of jealousy and apprehension can be potentially problematic and it is important that groups and agencies that do seek to draw advocates from the field they seek to assist find ways to mitigate the potential social conflict that might arise. Unfortunately, it may not be possible to completely eliminate it. But it is perhaps a far better approach than previous alternatives

Solution: 

The community animator can act as a critical link between the community and any NGO Collaborator. It should be noted that by those in the field for social change that local citizens and activists can often better activate a community’s sentiments and bring about awareness for the possibility to realize change than an outsider who may be perceived to have little understanding of the real issues at stake.

Beyond the processes of concientization that a community animator can bring to the process; NGOs can also assist these community members in training for information gathering and needs assessments to help refine the basic kinds of projects and programs that might be of benefit to a community.

Verbiage for pattern card: 

Development professionals often find it difficult to adequately assess the broad spectrum of problems a community faces — or the various assets the community has to work with. This often means that development schemes are mismatched with the community's needs, abilities and liabilities. Community Animators can act as critical links and local citizens can often better activate a community to realize change than an outsider.

Pattern status: 
Released
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