Community Owns Its Own Health Matters through Dialogue

Author: Temesgen Afeta, September 20 2023 - I believe knowledge generation, development and regeneration is a social and never-ending process. Owned by human society, knowledge is shared across the globe without boundary. It never stops moving. Knowledge is our universal language and human race common identity. Knowledge moves across unlimited space and time between and among individuals, groups and society. Its purpose is human protection and wellbeing. Knowledge keeps generating and regenerating in our feelings, actions, interactions and relations with people and nature. Knowledge governs human behavior and guides functioning of human collective actions. As part of the knowledge dynamic and purpose, without which no one lives on our planet, let me share what we community members have been doing on education, health, solidarity, neighborhood power and family functioning. Knowledge building is central to the human race's collective purpose to enjoy peace, solidarity and justice for people in the ecosystem.    



From 2010-2012, I worked for CARE Ethiopia as Social Mobilization Coordinator on Communication for Change (C-Change) in West Shawa Zone, Oromia, Ethiopia. The approach used in applying C-Change in 54 local administrations and 162 villages extending for 100 km along Gibe River upper stream, one of the malaria hotspot areas in Ethiopia, was community dialogue. I learned that community owns everything through dialogue. Community dialogue is the vibrant and dynamic learning and decision making process in which all community members are equally recognized and heard. The process involves: taking action to improve the health of its members, monitoring the progress of the realization of what they decided, mentoring to develop local experience, and using best performing models to coach their neighbors in applying disease prevention mechanisms that are easily practiced in the daily life of household members and in the form of collective community actions.



The dialogue is the consensus, action and capacity building blocks to empower communities to respond to the priority issues set by their members. Community ownership is inclusive and never leaves its members behind. From the beginning, all community members - women, men, community and religious leaders - decide to participate in the dialogue. They collectively ensure the vulnerable and socially excluded groups are not ignored from the dialogue building process. The dialogue is designed and facilitated by community volunteers to create the opportunity for vulnerable and socially excluded groups; young men and women join the dialogue and get exposure to malaria information and skills to protect their family and neighborhood members. Community members facilitate and manage the decision and the participants' capacity building process of the dialogue. The participants enjoy shared vision, decision, action, relationship and impacts through saying what they feel and being heard. Community dialogue generates the initiation and determination of the community that transforms the local response, practiced for generations, on malaria prevention and treatment.



Community dialogue doesn't end up only transferring knowledge and discussing on malaria. It conveys the decision and commitment of participants to neighborhood and family members. Participants mentor one another on how to continuously apply the joint decisions and plans from the dialogue. This process transfers the dialogue decisions into the culture and daily life of community members and local networks. Community conversation is one of the key learning mechanisms in which community members move to share knowledge and common decisions that are geared toward actions and improving health and wellbeing individuals and groups. It creates a better opportunity for women and young people to express and present their feelings on how malaria affects women, children and family life. It creates organized and meaningful responses in which community members use their maximum aptitude and equally bring their potential and capacity to utilize in preventing malaria from afflicting their members. Community conversation is the capacity building process in which participants' interest, knowledge and skills are built by learning from one another and the local health service providers.



Community dialogue evolves the potential of people by enabling all community groups to freely present their knowledge and feelings about malaria. Dialogue participants decide to cascade their decision, lessons, information, skills (e.g., on bed net use, residual spraying, cleaning of mosquito-spreading areas), and motivation and support on treatment to neighborhood network and family members. The community dialogue enables participants to discuss and convince one another about the causes of malaria, as well as how to prevent and effectively use the treatment provided by primary health care. Those who participate get knowledge and skills and can take actions on malaria prevention and treatment. The community dialogue integrates malaria actions and enables community members to connect to the primary health care unit in their community. The dialogue paves the way for community-level health care workers to better understand the community and for the community to realize the available malaria services, as well as to make a determination to hear and trust health workers providing malaria treatment and information.



Furthermore, community dialogue enhances community capacity, motivation and commitment to work with health workers. It revitalizes the family and neighborhood energy to use malaria action and to strengthen the synergy between community interest and practice on malaria prevention and treatment. It encourages  government initiatives for malaria prevention as well as investments by donors and professionals in the process of developing a community culture of applying essential malaria actions in the household and at the family level. Community dialogue brings changes to family practices, to community attitudes, and to primary health care givers and service providers. It enhances the commitment and accountability of the service providers while increasing community members' demand for treatment - strengthening their collaboration and networking for the common goal, which is to sustain healthy community members.  



The community conversation we at C-Change conducted has had a great impact: reducing maternal and child mortality and morbidity, lessening the social and economic burden resulting from malaria, enhancing community seeking of treatment, stimulating the practice of frequent visits to health services when any family members get sick, increasing knowledge of the causes of malaria and its symptoms, and increasing the community's role, responsibility and actions in the prevention of malaria.



In conclusion, community dialogue can be understood as a capacity building and empowerment process that applies participatory approaches, ensures inclusion, mainstreams gender equity, and leverages community change agents for tangible impact by creating strategies, resources and community mobilization activities.



Image caption/credit: Community dialogue on insecticide-treated nets (ITNs) and malaria, Alemaya District, Oromia Region. ©UNICEF Ethiopia/2005/Getachew via Flickr (CC BY-NC-ND 2.0) 



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