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Final Assessment: Engaging Communities for RH/FP
Thank you for completing the course Engaging Communities for Reproductive Health and Family Planning. Below you will find the final assessment. Click the final assessment link to get started.
Phase 3: Explore Assets & Barriers and Set Priorities
Learning Objectives
Upon completion of Phase 3, you will be able to:
Adapted CAC – Phase 3: Explore assets & barriers and set priorities
The Explore Assets & Barriers and Set Priorities phase is the third phase of the Community Action Cycle (CAC) and is articulated around four key steps:
- Step 1 – Explore the issue(s) with the community core group.
- Step 2 – Explore the issue(s) with the broader community.
- Step 3 – Analyze priorities.
- Step 4 – Define key determinants to address.
This phase provides an important opportunity to initiate community conversations around the RH/FP issue(s). The process supports community reflection and analysis on how RH/FP issues affect their lives, and that of their children, family, and community at large. By applying various participatory tools in this phase, first the core group, and then the broader community, will explore the issues at hand, prioritize those to address and realize positive change, and explore the root causes or determinants of the prioritized issues. This phase also fosters exploration of community assets to identify feasible solutions.
Paula Bronstein/Getty Images/Images of Empowerment
Key to exploring RH/FP issue(s) with communities is engaging members of the community core group in participatory exploration that creates two-way community dialogue, promotes a common understanding of the issues, strengthens skills, and builds relationships between individuals and groups who are most affected by and are interested in solving RH/FP issue(s). When carried out in partnership with community members, this exploratory phase fosters community ownership and creates an impetus for change by bringing together and mobilizing key actors.
The key expected products of this phase are a list of prioritized RH/FP issues and a list of their determinants or root causes. Both will be used to establish a plan for local solutions. The Community Mobilization Team will help facilitate this process using participatory tools described in greater detail in this session.
Phase 3: Explore Assets & Barriers and Set Priorities
Step 1: Explore RH/FP issues with the community core group
The exploration phase begins with an in-depth examination of the RH/FP situation. Core group members learn as much as possible about current feelings, knowledge, practices, and beliefs related to the issue and their capacity to address their needs. This first step is usually carried out in one or several meetings with core group members and health facility workers. The number of sessions dedicated to this internal exploration of RH/FP issues will depend on:
- The level of trust and confidence established within the group and with facilitators.
- Participants’ availability to meet, donor constraints, and CM team members’ availability.
- Tools used: Some tools employ several sessions and in-depth analysis, which may require training of community members over a period of time.
- Logistical concerns: Geographic access, seasonal concerns (e.g., rains, planting, harvest), transport, other community activities, etc.
- Who facilitates the exploration process, i.e., you may need time to train new facilitators. Are the CMT members competent enough to facilitate the exploration or will you call upon different expertise?
- Session length: If participants need to discuss the topic with their families, friends, or others before they set priorities, they may prefer several sessions. Attention span and information processing time should also be factored. People can get tired or preoccupied with other things that they need to do if sessions are too long.
Communities can use many different participatory tools and methods to gather information and or identify priority RH/FP issues. These participatory exploration tools include but are not limited to:
- Appreciative inquiry (interviews and/or focus group discussions (FGDs) with appreciative questions)
- Picture cards
- Mini drama
- Score card
- Social Norms Exploration Tool
- Community Resource Floor Map
The Community Mobilization Team and the community core groups do not need to apply all the tools. One or a combination of two tools will suffice. Select the tools based on certain factors, such as the nature of the issue(s), the availability of data and information, and the level of literacy required to be able to use a particular tool. The descriptions of the tools may help you decide which tool is most appropriate for your context.
Participatory Exploration Tools
Appreciative inquiry (interviews and/or FGDs with appreciative questions)
Conducting interviews and focus group discussions provides key information to help communities identify issue(s) and set priorities. The main task here will be to design interview/focus group questionnaires for different individuals affected by RH/FP issues, including women of reproductive age, husbands, and other influential family members (e.g., mothers-in-laws and grandmothers), community- and facility-based providers, and religious and community leaders.
The most useful questions are appreciative ones:
“A question that seeks to uncover and bring out the best in a person, a situation, or an organization” (Whitney et al., 2002).
Appreciative interviews are designed to collect rich qualitative information in story form that carries a wealth of meaning, and sometimes a powerful emotional charge, rather than dry quantitative data consisting of figures and statistics. The story form tries to uncover motivations, priorities, facilitators, barriers, interests, perceptions, and experiences of community members about core program issue(s). Below are 2 examples of appreciative inquiry questions one may use:
- How did you feel when you visited the health facility during your ANC visit?
- Can you describe what made you happy last time you went to the health facility for family planning?
Picture cards
Picture cards can stimulate group discussion about key program issue(s) in the community and help to prioritize issues. This tool supports participation from those with low literacy levels and facilitates dialogue on the issue and ranks priorities.
Picture cards can be used in several ways. One way is described below.
- The facilitator lays out all cards representing RH/FP issues already identified on the ground and asks participants to choose one that they know about.
- The facilitator asks one participant who has chosen a card what the card represents and what they call it in this community.
- The facilitator can ask probing questions about the issue to ensure that core group and broader community members understand the nature and causes of the problem.
- The facilitator asks participants to add any other issues that may not have been captured.
- The facilitator asks the group to put the cards into two piles – one for problems they consider important or urgent to address, and the other for problems they don’t consider to be very important.
- The facilitator asks the group to prioritize/rank the pictures/issues from most to least urgent, important, and within their power to address. The pictures are ranked 3 times or more based on the number of criteria and the one that gets the highest rank is picked as the priority.
Mini drama
Mini drama is a powerful participatory and democratic tool for exploring issues—particularly delicate or sensitive issues in communities. After the mini drama, everyone has the power to talk because the discussion focuses on the mini drama and progressively generalizes what happened in the mini drama to the existing community context.
The mini drama is most powerful when community members perform it. Community members need about 30 minutes to rehearse and master the scenario. The mini drama, depicting a fictitious community with different RH/FP challenges, should be prepared before the meeting by volunteers with the support of the CM team and should not be longer than 10 minutes. After the mini drama performance, the facilitator should debrief the participants by asking a series of questions starting with the easiest ones to answer and ending with the ones that require more thought and reflection. For example:
- What have you seen and heard?
- At what moment of the drama were you excited? Or unhappy?
- What key issues is the story about?
- What ideas from the story are very important for you?
- Do you experience the same issues in your community?
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Example Burkina Faso and Niger
Under the Sahel RISE II examples in Burkina Faso and Niger, Breakthrough ACTION applied a combination of mini drama, review of health facility data, and group discussions. The West Africa Breakthrough ACTION (WABA) project in both countries utilized a combination of “community dialogue” and “site walk through” to explore and identify the RH/FP issues.
Community Resource Floor Map
Community core group members create a map of their community by drawing or using locally available objects. Maps are drawn to reflect resources and services available to community members, as well as gain a better understanding as to whether these resources and services are used and why or why not. In addition, this mapping process seeks to understand what new services and resources may be needed, and by which groups (e.g., men, women, youth, etc.). Using the map, participants can show where individuals and families live, how many people live in each house, who has challenges accessing RH/FP services, and other such characteristics that relate to the health and wellbeing of communities.
Community Score Card
The Community Score Card is a social accountability and monitoring tool used by community core groups to track priority indicators they want to focus on. Communities can discuss the changes in their indicators and discuss together what they will do to improve indicators. The score card can motivate or incentivize community members to contribute to activities that address RH/FP challenges. Based on the RH/FP information generated by the primary health care center or community health workers, indicators such as uptake of ANC visits, facility deliveries, or use of FP methods are calculated and appreciated in terms of achievement compared to objectives/targets initially set. Communities, in partnership with health service providers, identify gaps, analyze them to find bottlenecks, and act to solve the identified problems.
Social Norms Exploration Tool
The Social Norms Exploration Tool is a table that community core group members can discuss and complete. It identifies social norms, specific behaviors associated with that norm, priority groups (e.g., the target audience), reference groups (e.g., influencers), sanctions and rewards for following the norm, whether the norm is public or private, and proposed actions needed to address the norm.
Step 2: Explore RH/FP issues with the broader community
In the second step, community core group members prepare to enter the community to learn about and facilitate dialogue around the RH/FP issue(s), as well as the experiences and priorities of those most affected and others who are interested in the issue. They repeat the activities in Step 1, involving the wider community members as participants.
By involving the wider community, the core group broadens its understanding of the RH/FP issues affecting the community and ensures that the perspectives of those most affected and people who have knowledge and experience in RH/FP are considered.
Core group members, supported by the Community Mobilization Team, will choose one tool from the list of participatory tools described above and use it to deepen their understanding of the RH/FP issues affecting the wider community. The tool will determine which questions they will ask people in the broader community, how they will ask them, what material they will use, if any, to stimulate discussion and/or record people’s answers. Core group members may decide to organize small groups to discuss the issues or do individual interviews. In the context of a primary health care center for example, core group members can purposefully select to conduct the exploration with communities that are geographically far from the health services and/or villages that are not using the services.
Step 3: Prioritization of RH/FP Issues
This step helps the core group select one or a shortlist of priority RH/FP issues to choose to address. The community core group should focus on what they can handle in a period of six months to one year.
Save the Children
Before determining priorities, the community core group should organize the information collected during the explorations with core group members and the broader community (Steps 1 and 2). Then organize a meeting in collaboration with health service providers, the core group, representatives of the most affected, and other community leaders. Facilitated by the Community Mobilization Team, this group will compile the findings and identify a comprehensive list of RH/FP issues. The group should then answer the following questions about the information collected:
- What are the most common themes in the results? (What phrases, attitudes, opinions, beliefs, values, and perspectives are repeated in the data?)
- How are these themes or perspectives the same or different depending on who is responding?
- What do these results say about people’s belief systems (not just individual practices but the interconnected “whys” behind them)? For example, what beliefs do young women have about how the reproductive process works?
- Are there any surprising results? Why are they surprising?
- What conclusions can we draw from the results?
Underlying themes discovered during the Explore phase help to focus on those social change issues that affect attitudes and practice. If the community mobilization issues relate to RH/FP, there will be many potential priorities to choose from. For example, if the community engagement goal is to reduce maternal mortality and morbidity, the community might choose from the following possible issues: low uptake of ANC in the first trimester, malaria, few health facility deliveries, low use of family planning methods, etc.
Participants need to examine the list of issues, compile the information gathered, and establish criteria to decide which issue to address first. Some suggested criteria to consider include:
- Severity – Is this problem life-threatening? Are there consequences later in life if it is left unaddressed now, such as poor performance in learning and achievement?
- Frequency – How often does the problem occur?
- Magnitude – How many people experience the problem or condition?
- Gateway problem – Would solving the problem resolve other problems?
- Feasibility of a response or vulnerability – Can the community solve the problem themselves? Have any effective responses to the problem been identified? Is financial, material, and resource support available? Do people possess now or could they develop the necessary skills and abilities to make a difference?
One way to systematically apply these criteria is to use the following matrix to rank the issues. In the first column, list the issues raised while exploring the issues. In the row at the top, list the first four criteria (severity, gateway, magnitude, and feasibility.
Ask participants to rank the problems across all the criteria, using a likert scale of 0 to 5 (0 being the lowest score and 5 being the highest). Once a criteria is picked, rank all problems based on that criteria before moving to the next criteria.
Ranking problems can create discussion and disagreement; however, eventually the group should come to consensus on the ranking given. Once each issue has been ranked, total the numbers and identify the top priority problems. Limit the number of priorities to two or three to focus the group’s effort.
This is an example from a priority ranking for RH/FP services in Niger.
| Problems Identified | Severity | Gateway | Magnitude | Feasibility | Total |
| High number of teen pregnancies | 5 | 5 | 4 | 4 | 18 |
| Very few health facility deliveries | 4 | 4 | 5 | 4 | 17 |
| High numbers of early and forced marriage | 3 | 5 | 5 | 4 | 17 |
| Very low uptake of ANC during the first trimester | 4 | 5 | 5 | 5 | 19 |
| Low uptake of family planning methods | 2 | 5 | 5 | 4 | 16 |
In this case for example, very low uptake of ANC was priority number one the communities decided to work on, followed by high number of teen pregnancies.
Other methods to set priorities or make decisions
- Voting – Core group members can vote on which priorities they wish to focus on.
- Pair-wise ranking – Participants take two problems represented by two picture cards and decide which of the two is most important. They put the least important card in a pile on the ground and take the next problem card and compare it with the one that was most important in the previous ranking. Continue comparing cards until the exhaustion of cards and retain the card that was found to be the most important.
- Picture cards – When the group has identified all potential priorities related to the CM goal, members can develop picture cards representing each problem, condition or issue for ranking and pile sorting. To encourage full discussion and greater participation of each group member, divide the core group into smaller groups of three to five people each. Give these smaller subgroups a copy of the cards to help them sort their priorities. Individuals can rank their priorities using the cards and then share their priorities with other subgroup members. Pile sorts can help the group organize the cards. Cards not deemed priority by all group members can be set aside, while others can be sorted and discussed using the criteria (above) to arrive at a consensus on the top priorities.
- Pile sorting – It is a systematic data collection technique used to further explore a topic of interest by allowing informants to group together items according to their own system of categorization. Informants are asked to sort cards on which relevant items are written, drawn, or attached. They are then asked to explain the basis on which they sorted the cards (WV, 2000).
Step 4: Define key determinants to address
The fourth step is about finding root causes or identifying determinants to address. Now that the community core group has a list of prioritized issues, further analysis is needed to identify determinants to address in the planning phase.
A determinant describes any factor that strongly influences and affects a behavior. This factor produces a desirable or undesirable behavioral effect. Community members should be encouraged to work on factors they have control over.
Communities in the Niger example in Step 3 identified fear of stigma and criticism from relatives and friends as the main barriers to uptake of ANC in the first trimester.
Different tools exist to explore the determinants of an issue or to conduct a root cause analysis that include the “problem tree”, the “three whys”, and social norms exploration tool.
Example: Using the Problem Tree Methodology
In the context of low literacy, core group members often use the problem tree to examine key factors that contribute to the main issue identified. In the case of Niger, the core group used the problem tree to identify the root causes that contribute to low uptake of ANC in the first trimester.
To create a problem tree related to low uptake of ANC in the first trimester, ask group members to draw a tree with roots, a trunk and branches. On the trunk, write the problem: low uptake of ANC in first trimester.
Then you ask group members to think about why the uptake of ANC in the first trimester is so low. Write every response on a root. Then keep asking “Why does this happen?” for each thing written on the roots to get deeper and deeper into the roots, until the responses end.
Then do the same thing for the branches, only this time ask, “What happens as a result of low uptake of ANC in the first trimester?” Every response becomes a new branch. For each branch, keep asking, “What does that lead to?” In the end, the community will have painted a full picture of how low uptake of ANC affects maternal health, families, and their community.
Regardless of the tool used, take the root causes or prevalent behaviors and match them to one of the four determinants from the SBC framework presented in the Introduction, namely, behavior, resilience, community capacity, or service delivery.
Key Takeaways
Explore Assets & Barriers and Set Priorities is the third phase of the CAC.
Check Your Understanding
Thank you for completing the fourth lesson of Engaging Communities for Reproductive Health and Family Planning. Next is an ungraded quiz to test your understanding of Phase 3. Click the Knowledge Check button to get started.
Phase 2: Organize for Collective Action
Learning Objectives
Upon completion of Phase 2, you will be able to:
Adapted CAC – Phase 2: Organize for collective action
This session explores how communities can organize themselves around focused RH/FP issues to increase the participation of those most affected and excluded, and enhance broad engagement at community, institutional, and policy levels.
Organize for Collective Action is the second phase of the Community Action Cycle and it is articulated around four steps:
- Step 1 – Visualize positive change – community orientation and partnership.
- Step 2 – Build relationships, trust, credibility, and a sense of ownership with the community.
- Step 3 – Invite community participation.
- Step 4 – Identify and strengthen a core group in the community.
Communities need to understand who is excluded and address barriers to participation to ensure that the most affected and interested in the specific RH/FP issues have a voice, play a central role, and benefit from the outcomes.
At this stage of the CAC, the Community Mobilization Team will have already met informally with community and faith leaders to learn more about the community history, gender and social norms, values, formal and traditional social structures, decision-making power, and male engagement in RH/FP issues. The Community Mobilization Team will have also already gathered information from health facilities, national databases, and other sources on the magnitude of the issue being addressed as mentioned in Phase 1.
Using the data and information gathered from the situational analysis carried it out in the prepare to mobilize phase, the Community Mobilization Team will now support communities to articulate a vision for positive change and formalize community partnerships and ownership, and engage all relevant multi-sectoral government and civil society partners to support the mobilization goal through a series of of orientation and partnership visualization meetings that you will be studying now.
The two key expected outcomes of the Organize for Collective Action phase are: (1) community buy-in and (2) the formation/identification of a community core group.
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Phase 2: Organize for Collective Action
Step 1: Visualize positive change – community orientation and partnership
An essential step in the Organize for Collective Action phase is planning for a series of broad-based community visualization and orientation meetings to begin a dialogue related to RH/FP goals (e.g., increase uptake of antenatal care during the first trimester of pregnancy, reduce adolescent childbearing and early marriage, increase access to contraceptive services, etc.). Community visualization and orientation meetings create ownership and invite participation.
Save the Children
Determine who will convene the orientation meetings at the community level to reach those most affected by, and interested in the issue and include those most often excluded. Prepare trusted leaders to support the orientation process within their own communities. Consider that individuals often decide to attend a meeting based on whether or not they think they belong at a meeting, not because of the subject.
Ensure that respected formal and informal community leaders are prepared to bring together the broader community and facilitate the community visualization and orientation process. Trusted community leaders need to own the process! External partners can co-facilitate during community orientation sessions to bring additional data and information that highlight the severity and facts related to the issue.
Example Burkina Faso and Niger
In Burkina Faso and Niger, the orientation or community entry was organized in three (3) meetings:
- Community leaders meeting
- Village meeting
- Community leaders feedback meeting
The community leaders meeting was attended by the comité de gestion (COGES) or health facility management committee members, representatives of women’s groups, farmers’ associations, religious leaders, etc. This discussion was introduced by a mini drama depicting early ANC attendance challenges in the community. After debriefing the mini drama, the midwife presented the RH/FP indicators of the health facility for the community leaders to better understand and appreciate their own situation.
Visualization meetings
Who might be invited to a community orientation session?
- Leaders (formal and traditional)
- People most affected/excluded
- Grandparents, aunts, and uncles
- Men and boys
- Women and girls
- Faith-based leaders
- Community media outlets
- Government extension workers (health, nutrition, child protection, education, etc.)
- Community-based organizations (e.g., youth-led, women-led)
- RH/FP service providers and administrators
Figure 5. Socio-ecological model depicting how factors at various levels reinforce or impact a given normative or social challenge, including reproductive health and family planning issues.
Community engagement for SBC requires broad base support. Do not limit community orientation and visualization sessions to groups that might appear to be aligned to the RH/FP issue being addressed. For example, if the focused issue is low uptake of antenatal care (ANC) visits during the first trimester of pregnancy, invite a wide range of participants beyond women of reproductive age, such as men, husbands, mother in laws, grandmothers, etc. Other social issues, as depicted in Figure 5, may be causing the poor uptake of early ANC, such as social norms and fear of criticism. Thus, it is critical to involve the wider community, including internal and external stakeholders, such as traditional leaders, women’s groups, and local institutions.
When will the meetings take place?
The visualization-orientation meetings might be organized around other events that are taking place in the community, such as traditional community events, development activities (e.g., nutrition demonstrations), women’s groups meetings, national celebration events, and human rights activities (e.g., women’s day, youth days, etc.).
What topics should be included?
Plan for these meetings with key community stakeholders. Identify topics to cover, organize an agenda, and identify who can best speak to the different topics. Most visualization-orientation sessions include:
- Welcome by community leaders
- Community participants and the Community Mobilization Team introduction
- External partners introduction and overview of their roles and responsibilities
- Discussion on the focus FP/RH issue (e.g., teen pregnancies)
- Sharing data on the issue, soliciting community views and priorities
- Presenting the mobilizing goal
- Exercise to visualize positive change
- Forging a respectful partnership that promotes co-learning and ownership
- Presenting community-led development, and the CAC
- Recognizing community strengths and needs
- Inviting participation, including those most affected, discriminated, and excluded
- Discussion on how the community has worked together in the past, and what are some next steps
Presenting data on the RH/FP issue can be extremely helpful during community visualization-orientation sessions to raise awareness of hidden issues related to gender norms, stigma, or attitudes that might prevent change. Using culturally appropriate ways to present data such as mini drama, role play (rather than lectures), as well as information from recent situational analysis, local government monitoring systems, or research can be helpful.
Step 2: Build relationships, trust, credibility, and a sense of ownership with the community
Every time you follow through on a promise, others learn that you can be trusted. It is a deposit in an “emotional bank account” (Covey, 2020). Every time you break a promise or mistreat someone, you make a “withdrawal” from your emotional bank account. If you are new to a community, you will begin with no “money” in the bank, so you need to establish a positive balance in community members’ emotional bank account.
You can build trust among community members you wish to work with by:
- Establishing convenient meeting times based on community members’ availability and creating safe meeting spaces, where participants can express themselves freely and confidentially.
- Learning about and accepting where individuals and community groups are in their own realities, skills, and understanding and organizing around community strengths.
- Being honest and transparent. For example in the West Africa Breakthrough ACTION (WABA) Project, they fostered honesty by first separating like groups (e.g., youth, religious leaders, men, women, service providers) to discuss FP issues, and then brought all groups together for a facilitated conversation to ensure the tone stays safe and solution-oriented.
- Ensuring that all members of your CM team communicate consistently with community members, which means all team members embrace the community engagement principles and philosophy, are well informed about community engagement activities, and can explain them to community members.
- Calling community members’ attention to times when they do not fulfill their promises and commitments, in a respectful way that promotes reflection and fosters greater accountability.
- Apologizing and accepting responsibility when mistakes are made or promises are broken.
- Identifying an activity that community members enjoy, such as a sporting event or a community fair, and working with the community to help organize action around existing activities to leverage time and resources.
Step 3: Invite community participation
Early in the Organize for Collective Action phase, invite individuals most affected by and interested in the mobilization goal to participate. Children, women, minority groups, those with disabilities, and others who are often excluded from participation and decision-making are frequently the ones who experience the problem most directly and need to participate in finding appropriate solutions.
Consider how developing RH/FP activities that target men and boys as partners who grow and nurture their families alongside female partners, and serve as social activists in their communities will complement and strengthen existing RH/FP programs and promote gender equality (Hook et al., 2021).
Who participates?
Participating in community engagement for SBC often starts with a small, committed group. However, who participates, and how, is related to whether individuals feel they have the right to participate, and the power to overcome barriers to participation. Who holds power is related to issues of gender, race, ethnicity, sexual identity, and economic status, amongst other factors. Make sure that those most affected and often marginalized have a voice in the community engagement process.
Each society has its own exclusionary processes, and yet some groups are excluded from many societies across the globe. The most prevalent excluded groups in the context of RH/FP typically fall into the following categories:
- Rural/pastoral, poor women and families
- Women with disabilities
- Refugees, migrants, and displaced women and households
- Girls, especially those married early
- Women and families affected by disaster or living in disaster-prone areas
- Ethnic or religious minorities
- Women from households that are distant from health facilities
The “60/40 percent rule” draws attention to the balance of power and voice in community decision-making. True representation of the voiceless requires that at least 60 percent of participants come from the groups most often discriminated against and excluded from community structures.
Identifying and overcoming barriers to participation
While working only with people who respond to a general call to action (i.e., inviting those who are often included) is easier, this strategy will not be most effective if you truly want to reach priority groups. Those most affected by the issue often face the greatest barriers to participation even if they genuinely wish to participate.
Community mobilizers are critical for identifying and overcoming barriers to participation. Knowing about these barriers and devising ways to overcome them can yield obvious benefits. This also relates to youth participation. Often programs are planned and implemented without young people’s insight, contributions, or active engagement.
Each society has its own exclusionary processes, and yet some groups are excluded from many societies across the globe. The most prevalent excluded groups in the context of RH/FP typically fall into the following categories:
| Common barriers | Strategies to overcome barriers |
|---|---|
| Limited physical access to meeting sites. | Hold meetings close to where people live and work to maximize chances for everyone to participate. |
| Cultural limits to mobility and participation (e.g., religious and social practices of secluding women, caste structures, age). | Consider meeting marginalized or vulnerable groups separately or even form a group with them while working with leaders and the broader community for more support. |
| Time constraints due to responsibilities at work or at home with caring for children and household chores. | Work within the timeframe and the calendar of the community. If there is no time or it is an emergency situation, some tailoring can be made, e.g., by doing home visits, etc. |
| Family members or social structures that prohibit someone’s participation (e.g., husbands may initially object to their wives participating in meetings because they may not see the benefit, particularly if no tangible incentives are provided.) | Work with formal and informal leaders to find ways to progressively develop trust and increase participation. |
| Perception that the meeting is for others, particularly if the individual has never been invited to participate in community meetings or has been actively discouraged from participating. | Engage with local leaders and other influential community members to help encourage all individuals to participate. Use participatory tools such as games or drama so that anyone can relate to what is being presented. |
| Opportunity costs ( e.g. “If I attend this meeting, I will not be doing something else that may be more beneficial to me or my family.”) | Work with influential community members over time to help build trust and demonstrate that there are benefits and something to gain in solving RH/FP issues. Establish feedback loops through which successes will be shared with everyone. |
| Low self-esteem (e.g. “I don’t have anything to contribute.”) | Ensure that the activities start with and build on people’s direct personal experience with the issue. |
| Lack of identification with other participants (e.g.“My needs are different and they won’t understand.”) | Find activities to strengthen group cohesion, bonding, and identification with the issues that will be addressed. Separate meetings for subgroups of people can be held initially. Meeting outputs can then be synthesized later when groups meet together. |
| Fear of group processes (e.g. “Must I speak in front of a group? I do not like speaking in front of others.”) | Maximize the use of participatory tools and techniques, like mini drama and small group work, and encourage all participants to contribute. |
Create awareness for the issue
Jonathan Torgovnik/Getty Images/Images of Empowerment
When people are aware of and concerned about a particular issue they are more likely to participate in finding solutions. Create awareness and invite participation by doing the following:
- Identify and invite individuals and groups that have the most direct experience with the issue, even if only a small number want to participate at first.
- Use this small group to launch a general awareness campaign using local media, community meetings, enlisting respected leaders as spokespeople, and so forth.
- Advocate with local leaders about this issue using research data, so that local leaders put the issue on their agenda.
- Share comparative data on the prevalence of the issue in the community to emphasize the need for action.
In the context of the Sahel RISE II program presented above, women of reproductive age using RH and FP services as well as their husbands were identified in collaboration with health workers to join the various orientation meetings so that, through experience sharing, other community members could better appreciate the issues that were being addressed.
Step 4: Identify and strengthen a core group in the community
Community organizing for collective action can involve organizing groups in various configurations—small groups or large coalitions— to address the drivers of RH/FP issues, reach those most in need, link to internal and external resources, and advance broader support systems. Women’s and men’s support groups, youth-led groups, community health committees, and care groups are a few examples. Understanding local government organizations and processes that link community-based groups to local planning, budget, and advocacy systems is also important.
Community core groups
A community core group is a group of 15-20 community-based individuals most interested and most affected by the issue who will work together to achieve positive change. At least 60 percent of the members should come from the most affected/interested to ensure their voices are heard. The community core group:
- Acts as the engine to mobilize the broader community around the issue
- Is responsible for advancing the CAC
- Monitors and shares results with the broader community
Working with an existing group or a new group?
As a Community Mobilization Team, you must facilitate discussions to help communities decide whether to work with an existing group or to form a new one. Existing core groups might include traditional leadership structures, faith-based groups, informal women’s groups, parent teacher associations, community health committees, etc. It will be important to use the information gatherers during the prepare to mobilize phase to discuss with community leaders the relevance of working with existing community groups or forming new ones.
Sometimes, a core group might exist in name, but does not function or include those who need to participate. Strengthening this group’s capacity is important as you work to support community-led action. The table below outlines the advantages and disadvantages of working with existing groups.
| Advantages to working with existing groups | Disadvantages to working with existing groups |
|---|---|
| Avoids start-up delays. You do not need extra time to organize new groups and wait for members to become acquainted.
Group cohesion has usually been established in existing groups. The group is usually stable, with defined teams, and can turn its attention to new topics. Trust. After working together for years, group members develop a common bond and learn to trust each other. This trusting relationship creates space for them to have a more open discussion about the realities of their lives. Altruism. Group members have demonstrated their interest in supporting others. |
Inflexibility. Some groups may not be open to taking on new issues or different approaches.
Dependence on incentives. Groups formed to receive some tangible benefit, such as food supplements, may not be motivated to attend group meetings without concrete incentives. Dysfunctional structure. Some groups may be structured in ways that discourage the active participation of all group members and that restrain members from divulging personal information. Unequal structures. The existing group structure may perpetuate inequities. When minority subgroups do not participate in existing groups, their issues are not included on the community agenda and their needs remain unarticulated and unmet. Same old solutions. Existing groups may exhibit patterns that discourage new ways of thinking and problem solving. The group arrives at solutions in the same way and when they are not effective, the group is unable to generate new ideas. Changing the group composition and dynamics may help the group function better. |
Selecting the core group
Communities must decide if a new or existing group will be the core group to advance the mobilizing goal. Sometimes subgroups are formed under an existing umbrella group to take on the role of a core group to focus on the issue. It is important to explore how the existing group is perceived by the community and government systems, and to determine if they are likely to repeat previous patterns in their decisions and actions. In the case of the Sahel RISE II project in Burkina and Niger, communities decided to reinforce the existing health committees (COGES) and support them to carry out the community action plan.
Strategies for identifying and recruiting core group members
Recruit core group members from those most affected and/or interested in the issue. Remember the 60/40 percent rule mentioned earlier to ensure that those most excluded have a voice! Some tactics for creating functioning core groups are:
- Self-selection – Ask people to divide into small groups based on people with whom they are comfortable working with. Women who know and trust each other may be more comfortable participating in group discussions and more willing to provide assistance to other members. When the topic is highly personal, for example, RH/FP, some members may prefer the anonymity of a group composed of relative strangers, if possible.
- Common characteristics – This could be a group of teenagers, religious leaders, or a group of pregnant women who can support each other.
- Recruitment by volunteer leaders – Identify volunteer leaders and ask them to form groups. Volunteer leaders can inspire people to join their groups.
- Nominations by community leaders – Ask community leaders to suggest candidates for core group membership. To avoid favoritism the nominees must be approved at a general community meeting.
- Public promotion – Hold a public event and recruit group members from among the attendees. However, since this approach opens up group membership to a diverse audience, finding common ground may be more difficult.
Creating a common purpose in the first meeting
Help a core group achieve its mobilizing goal by creating a clear foundation of purpose and identifying what the group has in common at the first meeting.
- Establish the group’s purpose so all members understand the mobilizing goal they wish to achieve.
- Ensure group membership roles, responsibilities, and norms are clear.
- Help group members express why they are interested in the mobilizing goal/issue.
- Encourage members to get to know one another and share stories about how the issue affects them.
- If the group is shy, the facilitator should share a real story from the community on how the issue affects individuals and families.
Establishing core group roles, responsibilities, and norms
Establishing norms for working together is essential. Group members will want to discuss:
- How to make decisions (e.g., consensus, vote, leaders decide).
- How to assign roles and responsibilities and whether to hold elections.
- How to communicate with each other and how often to meet.
- What role members want to play.
- How core group members will document their meetings, activities, and results.
Effective and sustained community-led action requires organizing and strengthening groups in an ongoing, dynamic manner. This capacity strengthening occurs throughout the CAC.
Groups need to assess their own progress over time. In general, discussions are richer when members first assess the group’s capacity individually and then share their observations with the others in the group. In session 6, tools for assessing community groups’ capacities are shared and can be also used at this stage. The CM Team can also observe the group’s progress and provide feedback to the members.
Key Takeaways
Organize for Collective Action is the second phase of the CAC.
Check Your Understanding
Thank you for completing the third lesson of Engaging Communities for Reproductive Health and Family Planning. Next is an ungraded quiz to test your understanding of Phase 2. Click the Knowledge Check button to get started.
Phase 1: Prepare to Mobilize
Learning Objectives
Upon completion of Phase 1, you will be able to:
Adapted CAC – Phase 1: Prepare to mobilize
Prepare to Mobilize is the first phase of the community action cycle (CAC). The four steps in this phase focus on strengthening a Community Mobilization Team’s skills and abilities to foster and respect community-led action. External organizations working with communities or communities themselves can apply the following steps:
- Step 1 – Select the issue to be addressed and define “community”.
- Step 2 – Develop a Community Mobilization Team.
- Step 3 – Gather information about community resources and constraints.
- Step 4 – Develop a community mobilization work plan.
Prepare to Mobilize consists of all the activities that need to happen before initiating interventions within the communities. The key outcome of this phase is a well-prepared team equipped with a written work plan to engage communities to address the RH/FP challenges they will be prioritizing.
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Phase 1: Prepare to Mobilize
Step1: Select the issue to address and define community
The first step in any community mobilization effort is selecting the issue around which the community will eventually mobilize.
Selecting the issue
Ideally the community itself selects the issue, but in the real world of international development assistance, the issue is often pre-selected by donors and government counterparts or by external organizations depending on country RH/FP indicators. Often, this occurs with little or no consultation with communities.
Also, consider whether the issue is the result of another underlying problem and whether it will be necessary to mobilize around the underlying factors in order to see a change. For example, women’s RH/FP challenges, such as maternal mortality or morbidity, may be a reflection of women’s low status in the community. Will you mobilize communities around women dying or elevate the value of women? First, articulate the issue, then you can design a program around that issue.
Finally, defining an issue too broadly could overwhelm community members to the point where they might feel they cannot possibly tackle it, and therefore decide not to participate. A well-defined, focused issue and corresponding goal are critical at this stage and throughout the community mobilization process. In general, if you have limited time and resources, community engagement is more effective when the issue is more narrowly focused. For example, tackling low antenatal attendance is more focused than tackling high death rates amongst women.
Defining “community”
Community engagement refers to “community” in its broadest sense. In the changing context of migration, urbanization, and globalization, the concept of community has evolved significantly beyond just a group of people who live in a defined territory. Today, community also refers to groups of people who may be physically separated but who are connected by other common characteristics, such as profession, interests, age, ethnic origin, a shared health concern, or language. Thus, you may have a teachers’ community, a women’s community, or a merchants’ community; you may have a community of women of reproductive age, displaced refugees, teenage boys or girls, or men with sexually transmitted infections. You may be in a position to work with the district health team to choose from several communities, in which case you will need to establish selection criteria.
In selecting the community, you should also consider issues such as:
- Is there strong or weak identification among members of the community?
- How and whether minority voices are being heard?
- Which sub-groups or individuals within the community are most directly affected by the issue, facing discrimination and inequalities, or have limited access to information and services?
Example Burkina Faso and Niger
In Burkina Faso and Niger, BreakthroughACTION through its community engagement activities which aim to address barriers to RH/FP service uptake, applied the geographical definition of “community” but combined it with audience segmentation. Working with the communities and the district-based multi-sectoral Community Mobilization Teams, the primary health care center was identified as the unit of implementation of the community collective action. Therefore, all people living in that catchment area comprised the “community” with the facility’s health committee being the community core group, or community action group, to drive and coordinate the community collective action for uptake of RH/FP services. However, to be very precise in their intervention, the health committee identified women of reproductive age as the primary segment of the community to cover and engage. Their partners and families were also identified as a secondary segment to address, but actions were needed primarily to address women of reproductive age in the selected health catchment areas.
Step 2: Develop a Community Mobilization Team
Before you begin working with communities, you will need to put together the team of people who will support the community engagement initiative. The Community Mobilization Team plays the following role:
- Helps define the issue and community’s focus
- Learns about the communities
- Develops and implements the broader community mobilization (CM) plan or framework
- Facilitates quality CM process through applying the community action cycle (CAC)
- Supports monitoring, documenting, and accountability of community-led efforts
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Who should be on the team?
The Community Mobilization Team should be multi-sectoral, if possible, as the underlying determinants for change can stem from various cross-sectoral factors. The Community Mobilization Team may include local government and district staff, community leaders, and project or partner NGO staff. In the context of RH/FP, the Community Mobilization Team may include:
- District health communication or health promotion officer
- District community health officer
- District family health officer
- Local municipality community development officer
- Gender and women affairs officer
- Agriculture extension worker
- Community leaders and champions
- Among others
The Community Mobilization Team composition may change as you move through the various stages of mobilization, with different skills needed at different times.
Selection criteria
The Community Mobilization Team members are usually selected according to the following criteria:
- Have expertise in the issue.
- Have firsthand experience with the issue such as women, people with disabilities, and those who are most excluded.
- Understand the political, socio-cultural, and economic context, such as knowledge of the community and macro environment.
- Possess basic community mobilization skills, such as interpersonal communication and facilitation skills, program design and management skills, organizational behavior or group dynamics skills, capacity-building skills, planning and evaluation skills and/or knowledge of participatory methods.
- Possess attributes that inspire respect, such as openness, flexibility, patience, good listening skills, diplomacy, and most importantly, belief in people’s potential.
- Ability to communicate effectively in the local language.
The greater the variety of perspectives represented on the Community Mobilization Team, the less likely you will be to overlook important issues.
Skills of a mobilizer
Ensure the Community Mobilization Team is well prepared prior to initiating contact with the community. A bad first impression is difficult to overcome. What you wear, how you act, which language you speak, what you say, how you say it, even how you arrive – in a car, which almost no one in the community owns, or on public transportation which almost everyone uses – all these things will be noticed and discussed by community members when you leave.
You can talk with people who are working in the community or who know about local protocol to find out which people you will need to contact first, and what will be expected of your first visit.
As you prepare to mobilize, it is important to define the roles and responsibilities of each Community Mobilization Team member. Team members need to work together in the community to assure a unified approach. Here are some possible roles related to mobilizing the community:
- Catalyst/Mobilizer – Facilitates implementation of the Community Action Cycle with leaders and community groups to stimulate action on issues.
- Organizer – Forms new organizations/groups or brings existing organizations together around an issue.
- Capacity-Builder/Trainer – Helps to strengthen community skills to achieve community engagement goals.
- Partner and Coalition Builder – Complements local organizations in a joint effort.
- Direct Service Provider – Provides a health or education service.
- Liaison – Links communities with resources and partners, builds networks.
Step 3: Gather information about community resources and constraints
Situational analysis
A situational analysis can be a chance to learn more about:
- Community structures – How are communities organized?
- Formal and informal leadership – How are decisions made? And who makes them?
The Community Mobilization Team will need to know the answers to these key questions before beginning work with community partners.
A situational analysis process can be “one-way” information about the community and the issue at hand. In the case of RH/FP, you might gather information about local RH/FP service access, availability, use, and quality, among other information. You can also use additional formative research on key behaviors. It will be key to identify those most affected by RH/FP issues and why, as well as where these individuals live and their socio-cultural characteristics.
Tools to learn about communities
Learning about the community is a continuous process. Multiple tools, including a power and relation analysis tool, can be applied at this stage.
Depending on the time and budget you have and the type of data you want to collect, consider using outside expertise such as local NGOs and universities to help with some aspects of the situational analysis and gathering existing or new information about RH/FP.
Resources inventory
Now that you know more about the RH/FP issues and the community, you can create an inventory of the resources that can be leveraged to support the mobilization effort. Complete a simple worksheet where you list resources according to the following categories:
- Financial resources – project budget, local and national government budget, private sector support, coalitions, and non-profit organizations
- Human resources – existing community groups and leaders, collaborating partners and community members willing to address the issue, etc.
- Material resources – meeting space, supplies, meals, computers, vehicles, other equipment, office space
- Time – availability of community members, Community Mobilization Team members, core group members, time to achieve the goals of the mobilization effort
Also review constraints, which may include:
- Limited time to complete all the activities in the community mobilization plan
- Unskilled Community Mobilization Team members
- Limited financial or material resources (or excess budget with limited time)
- Limited geographical access during the year
Step 4: Develop a community mobilization work plan
Now that the Community Mobilization Team has a better understanding of the focus issue, the work setting, and community resources and constraints, it is time to develop a community mobilization plan. This community mobilization plan is not a community action plan that will be developed by communities themselves. This plan is a general description of how the Community Mobilization Team intends to work with communities.
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Community mobilization work plan elements
The purpose of the community mobilization plan is to define the overall goal and objectives of your effort and identify a process that you will follow to engage interested communities. As you create this plan, you should always keep the two overriding goals of community mobilization in mind:
- To create positive change around the RH/FP issue in focus, particularly for those most affected.
- To strengthen community capacity to address the RH/FP issue(s).
At a minimum, a typical community mobilization plan should contain the following seven elements:
- Background information – May include information about the RH/FP issues affecting the community, a description of the community (including size of the community, the make-up of the community, prevailing beliefs and cultural practices), the resources available to tackle the RH/FP issues and some of the constraints that the community may face).
- Program goal – The intended end result of the mobilization effort. This may include increased uptake of RH/FP services such as antenatal care attendance.
- Program objectives – The overall aims of the mobilization effort. For example support women to access antenatal care by providing transport for pregnant women.
- The community engagement process – The overall methods and steps you and the community will use to achieve the goal and objectives.
- The stakeholders and their respective roles – With whom you will partner, and what specifically they will do to address the RH/FP issue.
- A timeline of activities – a general calendar outlining what will happen when to address the RH/FP issue.
- A monitoring and evaluation plan – This might include what information you will collect, from which sources, to gauge during the community engagement process and at the end of your activity calendar to measure whether your efforts have been successful. The plan’s indicators should align directly with the program’s objectives.
Key Takeaways
Prepare to Mobilize is the first phase of the CAC.
Check Your Understanding
Thank you for completing the second lesson of Engaging Communities for Reproductive Health and Family Planning. Next is an ungraded quiz to test your understanding of Phase 1. Click the Knowledge Check button to get started.
Introduction: Engaging Communities for RH/FP
Learning Objectives
Upon completion of the Introduction, you will be able to:
In this session, you will learn key concepts and definitions to start you on your journey to work effectively with communities to mobilize for social and behavior change (SBC) around reproductive health and family planning (RH/FP), or social change in general.
There are numerous ways of effectively engaging communities, however there are fundamental values and principles you should recognize and adhere to in your work to achieve effective community engagement. Community engagement involves the following fundamental values and principles:
- Communities play a crucial role in addressing their own RH/FP issues.
- Communities themselves can lead social change and have the capacity to do so. They can also work towards strengthening their skills, when required.
- Recognize and build on existing community groups, structures, histories, and social networks to foster greater problem-solving community ownership and sustainability.
- Support dialogue, debate, and negotiation to identify issues that are important to community members, rather than focusing on persuading and transmitting information to communities as outside technical experts.
- Address individual RH/FP behaviors and the social norms, policies, culture, and environmental factors that influence positive social change.
- When individuals and communities most affected own the process of engagement, SBC for RH/FP is enhanced.
Definitions of Key Terms
In this section, we will review the globally accepted definitions of some key terms that we will use throughout the course.
Community Mobilization
Community Mobilization is a capacity-strengthening process through which community members, groups, or organizations plan, carry out, and evaluate activities to achieve a common goal on a participatory and sustained basis, either on their own initiative or stimulated by others.
Community mobilization is not a campaign or a series of campaigns. It is not the same as social mobilization, advocacy, social marketing, participatory research, or non-formal or popular education. Although community mobilization often uses these strategies, these terms are different.
*Please note that community engagement and community mobilization (CM) are used interchangeably throughout this course.
Community Capacity Strengthening
Community Capacity Strengthening is the process through which communities obtain, strengthen, and maintain capabilities to set and achieve their own development objectives over time. Community capacity strengthening and community mobilization are related terms, but they are not synonymous. Community mobilization is one of many approaches to strengthening community capacity.
The key to applying these definitions in your program design and approaches is recognizing that capacity already exists in communities and that your role is to further support and strengthen their skills and abilities.
Community Participation
Community participation is fundamental to community-led development and mobilization. However, the term “participation” is sometimes overused and not well defined. In the Degrees of Participation framework (Cornwall & Jewkes, 1995), we learn about different degrees of participation. At the lower end of participation, communities are sometimes “co-opted,” they have token involvement but no real power or input because external agencies control the development process. More meaningful participation can be found with co-learning and collective action.
Reclaiming the true meaning of participation requires external organizations and partners to shift power to communities from program design, beginning with a vision of participation focused on co-learning and collective action. As the Degrees of Community Participation diagram below shows, with increased participation comes greater ownership and the potential to sustain meaningful action.
Figure 1. Degrees of community participation
Social and Behavior Change
The purpose of community engagement is to achieve positive social and behavioral change, or the uptake of priority behaviors and shifting of cultural norms that directly improve the broader health of a community. Therefore, when designing for community-led development and mobilization, we do so with a vision of the change we hope to see.
Over the years, the idea that change manifests from one-off campaigns or one-way communication activities has shifted toward a more iterative process that includes multi-level action, including two-way communication. These multi-level SBC activities or approaches are grounded in several different disciplines, including social marketing, advocacy, community engagement/mobilization, behavioral economics, and human-centered design (Nancy & Dongre, 2021).
Social and behavior change (SBC) is an umbrella term encompassing social and behavior change communication (SBCC), community-led development, and community mobilization. Different tools and approaches are part of our SBC Toolbox (see Figure 2), including community engagement/mobilization. These tools can be combined to offer a comprehensive response to address a range of socio-cultural or health challenges.
Figure 2. Social and behavior change “toolbox”
The Community Action Cycle
Various methodologies exist to engage communities for improved RH/FP. This course explores the Community Action Cycle (CAC) as one approach. The CAC is a participatory, community-led process through which those most affected and interested organize, explore, set priorities, plan, and act collectively to achieve a specific goal. The process builds on community strengths and a social systems approach to achieve specific, measurable results and sustain collective action.
Figure 3. Community Action Cycle (CAC)
The 7 Phases of the Community Action Cycle
The CAC involves the following phases, and specific steps to foster community-led action. This course guides the learner through the seven phases:
- Prepare to Mobilize
- Organize for Action
- Explore the Issue and Set Priorities
- Plan Together
- Act Together
- Evaluate Together
- Scale Up
Each CAC phase has a series of related steps that guide communities and facilitate partnerships. These phases and steps draw from global experiences of quality, community-led action and mobilization. However, while these have been used successfully by multiple community-led programs, they should be used as a guide and adapted according to the unique context at hand.
The Adapted CAC Steps and Phases
As mentioned above, the CAC can be tailored to suit situations such as emergencies, single health topic interventions, or situations within which there is a necessity to build on existing investments. Under the USAID-funded Breakthrough ACTION project, the original CAC with its 7 phases has been tailored to 5 phases presented below. Each phase of the adapted CAC has detailed steps similar to the original. These can be integrated into the RH/FP program design, implementation, monitoring and evaluation cycle.
1
2
3
4
5
1
Phase 1: Prepare to Mobilize
- Step 1 – Select the issue to address and define community.
- Step 2 – Develop the Community Mobilization Team.
- Step 3 – Gather information about community resources and constraints.
- Step 4 – Develop a community mobilization work plan to guide the community engagement process.
2
Phase 2: Organize for Collective Action
- Step 1 – Visualize positive change – community orientation and partnership.
- Step 2 – Build relationships, trust, credibility, and a sense of ownership with the community.
- Step 3 – Invite community participation.
- Step 4 – Identify and strengthen a core group in the community.
3
Phase 3: Explore Assets and Barriers, and Set Priorities
- Step 1 – Explore the issue(s) with the community core group.
- Step 2 – Explore the issue(s) with the broader community.
- Step 3 – Analyze priorities.
- Step 4 – Define key determinants to address.
4
Phase 4: Plan Local Solutions
- Step 1 – Determine who will be involved in planning and their roles and responsibilities.
- Step 2 – Design the planning session.
- Step 3 – Facilitate the planning process to create a community action plan.
5
Phase 5: Act and Monitor Together
- Step 1 – Define your team’s role in accompanying community action.
- Step 2 – Strengthen the community’s capacity to carry out its action plan.
- Step 3 – Support community groups to monitor progress and use data to inform micro-planning and collective action.
- Step 4 – Problem-solve, troubleshoot, and mediate conflicts.
Figure 4. Adapted CAC
Key Takeaways
Check Your Understanding
Thank you for completing the first lesson of Engaging Communities for Reproductive Health and Family Planning. Next is an ungraded quiz to test your understanding of the introduction. Click the Knowledge Check button to get started.
