Arukah members TED LANKESTER, JUBIN VARGHESE and NATHAN GRILLS recently collaborated on the fourth edition of popular book 'Setting Up Community Health Programmes in Low and Middle Income Settings'. In this episode, they share stories and insights from the book, which you can buy or download for free here. You can listen to the episode above, or read the highlights below.
Their book describes “a gaping hole in global health, a giant jigsaw puzzle with the central pieces missing”. The missing pieces are the role of the community in planning and managing their own healthcare, rather than being directed by outsiders. Ted explained that the importance of the community as the “hub of the health system” is becoming increasingly clear, particularly this year. “With Covid, the community is suffering the most but also coming up with the most effective solutions.” Nathan added that community health and community development, which were traditionally seen as separate, are now understood to be intertwined.
Jubin used a story to illustrate how this works in practice. When she first started working at a community-based rehabilitation programme, she got frustrated when she found that a mother wasn’t following the home plan she’d been given for care of her child. Only later, Jubin learned that she had three other children, in-laws, and animals to look after, while her husband was struggling with addiction. It made it impossible for her to follow the instructions she’d been given – but, Jubin says, “I missed that entire story because I felt that I was the expert who knew what needed to be done… That's what happens when we miss community in our conversations about health and development.”
Covid-19 has impacted Jubin’s work. “We've had to rethink and rework how we interact with the community. But that has also been guided by what the community has been telling us.” It’s been more important than ever to listen, in order to learn about the complex and changing needs of different groups, as well as paying attention to their mental wellbeing. Similarly, Nathan’s experience of the pandemic is of the importance of a listening approach – “listening and doing a lot of community surveys, especially among marginalised people”.
Nathan warned of the dangers of ignoring “soft skills”. Skills like listening, learning from others and relationship-building – “we call it ‘soft skills’ like it’s almost easy, but I think they’re probably the hardest to do. They’re very difficult to develop and they’re often ignored in a community health and development programme”. Without them, policies or programmes that are developed won’t engage with people’s real needs – nor will they benefit from the expertise that already lies in communities. “If you don't actually listen to what their knowledge brings to the table… it's at our own peril really. It leads to bad decisions and bad policies if you don't listen.”
Jubin agrees that relationship is the foundation of her work. “It has to begin there, in terms of getting to know people but also being in the space where you are known by them as well.” Another way of describing these skills is with one word: “love”. Relationship-building can’t come from a selfish perspective of just trying to make a programme work: “it has to be a genuine engagement with and love for the community that we're working with”, Nathan says. This goes for relationships with other partners, like NGOs, government or service providers, as well.
The world has changed since the book’s first edition in 1992. Ted explained that there have been some improvements, such as in maternal and child health. But inequality has worsened, and 1.2 billion people – 1 in 7 – still live in absolute poverty. And Covid-19 has made things worse, delaying important treatments and setting back global health, Ted says, by five years. Setting Up Community Health and Development Programmes addresses these issues by not only highlighting the importance of community, but by offering practical guidance in setting up different programmes. It’s made to act as a handbook and guide for anyone who wants to put these principles into practice.
The book can stop people making mistakes that have been made before. Nathan it will help people to focus their passion and desire to help people, leading to better outcomes. Jubin agrees: the chapter she wrote “comes from a place of mistakes we have made and don't want other people to learn the hard way”. Ted hopes that its emphasis on community health workers will help to redress the problem of a global shortage of doctors, nurses and midwives.
Jubin also said: “All that we do is that we are learning to walk alongside each other. That's what community health and development is to me.”
Listen to other How To Build Community podcast episodes here.