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Participatory Learning and Action Participatory Learning and Action Techniques in Health in IndiaTechniques in Health in India

Presented byPresented by::

Dr. Y.L. TekhreDr. Y.L. TekhreAssociate ProfessorAssociate Professor

Department of Social SciencesDepartment of Social SciencesNational Institute of Health and Family National Institute of Health and Family

Welfare, Munirka, New Delhi-67Welfare, Munirka, New Delhi-67E-mail:E-mail: yade_lal@yahoo.co.inPh. [Resi.] Ph. [Resi.] 011-26161708011-26161708

(Office) (Office) 26107773 Ext: 384(Mobile) 26107773 Ext: 384(Mobile) 98681826969868182696

What I am going to presentWhat I am going to present FundamentalsFundamentals of PLA of PLA Applying the techniques of PLA Applying the techniques of PLA

for for CNA/Action PlanCNA/Action Plan and other and other purposespurposes

Listing out different PLA Listing out different PLA techniquestechniques

Developing certain PLA Developing certain PLA toolstools for for collection of datacollection of data

Special attention on Special attention on FGDFGD and and SociogramSociogram

FUNDAMENTALS OF PLAFUNDAMENTALS OF PLA

1.1. To work with To work with communitiescommunities2.2. To understand from To understand from their perspectivestheir perspectives what their what their

needs and concerns areneeds and concerns are3.3. To build on their To build on their local knowledge of their situationslocal knowledge of their situations

conditions, problems opportunities and expectationsconditions, problems opportunities and expectations4.4. To enable them to develop their To enable them to develop their local solutionslocal solutions to to

the problems they facethe problems they face5.5. PLA is a powerful means of PLA is a powerful means of enabling local peopleenabling local people

((the poor, illiterate, women and the marginalizedthe poor, illiterate, women and the marginalized) to ) to appraise, analyze, plan and act and empower appraise, analyze, plan and act and empower themselvesthemselves

66 Health professionals should assume the role of Health professionals should assume the role of helpers facilitatorshelpers facilitators and act as catalysts and good and act as catalysts and good listenerslisteners

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PRE REQUISITE OF PLAPRE REQUISITE OF PLA

It Requires Attitude FavouringIt Requires Attitude Favouring:: AT AT 3 LEVEL-3 LEVEL- individual, professional and institutionalindividual, professional and institutional

ParticipationParticipationRespect for community membersRespect for community membersPatience, enthusiasm, not rushingPatience, enthusiasm, not rushingHumility, good concentrationHumility, good concentrationListening, not lecturing - balanceListening, not lecturing - balanceFlexible planning, interact with othersFlexible planning, interact with othersCreativity in dealing with problemCreativity in dealing with problemShould always include women + children and Should always include women + children and community memberscommunity membersEnjoy itEnjoy itNobody is expert/perfectNobody is expert/perfectStrive towards a process of empowerment of Strive towards a process of empowerment of marginalised peoplemarginalised people

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Why we need PLAWhy we need PLACHANGING CHANGING GLOBALGLOBAL SCENARIO SCENARIO

Increasing influence of processes of Increasing influence of processes of globalisations, libralisation and marketization globalisations, libralisation and marketization throughout the worldthroughout the world

Paradigm shift in thinking of developmental Paradigm shift in thinking of developmental professionals and policy makers/researchersprofessionals and policy makers/researchers

Accountability, social audit, empowerment, human Accountability, social audit, empowerment, human rights, participation, partnership, social capital, rights, participation, partnership, social capital, sustainability, decentralisation, stakeholders, sustainability, decentralisation, stakeholders, transparency, convergence, equity, synergy, capacity transparency, convergence, equity, synergy, capacity building, sharing, client centered, area and need building, sharing, client centered, area and need basedbased

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WHAT IS PARTICIPATORY WHAT IS PARTICIPATORY APPROACH?APPROACH?

A process through which the A process through which the stakeholders influence and stakeholders influence and gain control over gain control over development initiatives, development initiatives, decisions and resources decisions and resources which affect themwhich affect them

(WORLD BANK, 1994)(WORLD BANK, 1994)

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A multidimensional and A multidimensional and multifaceted construct – for multifaceted construct – for developmental professionals developmental professionals – not only actions and – not only actions and orientations by local people orientations by local people but also professionals, but also professionals, experts and outside agenciesexperts and outside agencies

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WHAT TO DO IN PLAWHAT TO DO IN PLA

Look, listen and learn, don’t lecture, Look, listen and learn, don’t lecture, create mutual trustcreate mutual trustBe sensitive, humble, nice, and Be sensitive, humble, nice, and transparenttransparentLearn and share together, not to Learn and share together, not to interrupt, avoid leading steps, be self interrupt, avoid leading steps, be self critical, unlearncritical, unlearnUse your own best judgment at all Use your own best judgment at all time, optimal ignorance, accepting or time, optimal ignorance, accepting or embracing errorembracing error

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Allow sufficient time for team Allow sufficient time for team interaction for – changing the interaction for – changing the agenda, discover + investigate the agenda, discover + investigate the unexpectedunexpected

Everyday schedule time for writing Everyday schedule time for writing field notes, think about how and in field notes, think about how and in what form the results will be usedwhat form the results will be used

Show interest in learning from the Show interest in learning from the people, respect the community people, respect the community members, ask for their advicemembers, ask for their advice

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Treat ordinary people as Treat ordinary people as equal partnersequal partners in in learning processlearning process

No touch and goNo touch and go, get rid of superiority , get rid of superiority complexcomplex

Team composition: Team composition: willingness to workwillingness to work with teamwith team

Assign Assign each team membereach team member a role for a role for presenting the findings of PLA, make the presenting the findings of PLA, make the presentation interestingpresentation interesting

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SIGNIFICANCE OF PLA TEAMSIGNIFICANCE OF PLA TEAMThe different viewpoint of team The different viewpoint of team members will complement each-members will complement each-other and will provide a more other and will provide a more comprehensive picturecomprehensive picture

Multi-disciplinary team have different Multi-disciplinary team have different skills and backgroundsskills and backgrounds

Method which empower community Method which empower community members to express, share, enhance members to express, share, enhance and analyze their knowledgeand analyze their knowledge

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VARIOUS VARIOUS METHODS/TECHNIQUES OF PLAMETHODS/TECHNIQUES OF PLA

Transect walkTransect walk

Resource mappingResource mapping

Matrix rankingMatrix ranking

Seasonality diagrammingSeasonality diagramming

Causal diagramCausal diagram

Focus group discussionFocus group discussion

Venn diagramVenn diagram

Daily activity chartDaily activity chart

What I am going to What I am going to present within the FGD?present within the FGD?

What is Focus Group DiscussionWhat is Focus Group Discussion Why we need and how to conduct itWhy we need and how to conduct it

– PreparationPreparation– Piolation/how to carryPiolation/how to carry– Report writingReport writing– Sociogram Sociogram

Demonstration Demonstration Sociogram Sociogram For whom FGD is more usefulFor whom FGD is more useful

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Objectives

Identify the :

Purpose, uses, and limitation of FGD as a method of data collection in research, monitoring and evaluation.

FOCUS GROUP DISCUSSIONFOCUS GROUP DISCUSSION

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WHAT IS FGD

A FGD is a group discussion of 6-12 persons guided by a facilitator, during which group members talk freely and spontaneously about a certain topic

Characteristics:Characteristics: Group situationGroup situation Limited member (6-12)Limited member (6-12) Participants talk with each otherParticipants talk with each other Guided by facilitator +RecorderGuided by facilitator +Recorder Members Members stimulatedstimulated by the by the

comments of otherscomments of others Make difference with (Make difference with (PPPPPP) )

purpose, process and people.purpose, process and people.

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Why we need FGD?Why we need FGD?

Participatory (with comty+people)Participatory (with comty+people)

Qualitative methodQualitative method

Low costLow cost

Direct approach with civil societyDirect approach with civil society

Comparative ideas can be developedComparative ideas can be developed

Observation and non-verbal Observation and non-verbal communication communication

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UUSES OF FOCUS GROUP DISCUSSIONSES OF FOCUS GROUP DISCUSSION

Obtain Obtain in-depth informationin-depth information on on concepts, perception, ideas of concepts, perception, ideas of the groupthe group

Formulate Formulate appropriate appropriate questionsquestions for more structured, for more structured, large scale surveyslarge scale surveys

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Supplement information on Supplement information on community community knowledge, beliefs, knowledge, beliefs, attitudeattitude and behaviour already and behaviour already available but incomplete or available but incomplete or unclearunclear

Develop appropriate messages for certain programme including national health programme

Explore controversial topics

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HOW TO CONDUCT FGD

Preparation

Recruitment of participants

• Same socio-economic group/similar background, homogeneous group

• Each major category of man/women

• Participants should be invited at least 1 or 2 days in advance, and the general purpose of the FGD should be explained

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Physical arrangement1. Arrange chairs/seating

arrangement in circle

2. Area/place will be quite adequately, lighted, no disturbance

3. Try to hold FGD in a neutral setting – encourage for free

and frank expression, views, ideas.

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Preparation of a discussion guide• Written list of topics • Series of open-ended questions

Conducting the session• One member of the team

(research) should act as• ‘facilitator’ to stimulate + support• ‘recorder’ to unbiased systematic

recording

Functions of the Facilitator

• Introduce the session – purpose of FGD, kind of information needed

• Encourage discussion – be enthusiastic, humorous, encouraging

• Encourage involvement – avoid a Q. A. Session, importance of each participants

• Build rapport–observed non-verbal communication, body language, tone of voice etc.

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• Avoid being placed in the role of expert – you are not suppose to teach/educate counselling them

• Control the rhythm of the meeting – control the time, topic, discussion

• Summarise, check for agreement and thank the participants – any additional comments

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Function of the Recorder

Should cover content + emotional reaction

Item to be recorded

• Date, time, and place

• Names & characteristics of participants, group dynamics (level of participants, dominant participants, interested participants)

• Opinion of participants – own words, key statements, vocabulary used by them

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• Help in resolve conflict situation if any

• Support to maintain friendly and informal atmosphere

Number and duration of sessionsAt least 2 sessions for separate group

75 MIN. EACH FGD

Preparation of discussion guides (15 min.)

Discussion (50 MIN.)

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Analysis of Results After each FGD, both ‘facilitator’

+ ‘recorder’ review and analyse

Full report + comment on unclear aspects and controversial topics

Compare answer of different sub-group, any further suggestions

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Report Writing

o Decide to whom you are writing the report

o List of the topics guided by the objectives of FGD

o Composition of Groups of Participants (group dynamics)

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To To wwhom FGD is more usefulhom FGD is more useful

Developmental professionalsDevelopmental professionalsResearchersResearchersPolicy makers/decision makersPolicy makers/decision makersProgramme ManagersProgramme ManagersSocial reformers/mobilizesSocial reformers/mobilizesProgramme implementersProgramme implementers

Counselors and grassroot workersCounselors and grassroot workers

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Sociogram Sociogram A A sociogramsociogram is a graphic is a graphic representation of representation of social links that links that a person has. A sociogram can a person has. A sociogram can be drawn on the basis of many be drawn on the basis of many different criteria: Social relations, different criteria: Social relations, channels of influence, lines of channels of influence, lines of communication etccommunication etc

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Characteristics of SociogramCharacteristics of Sociogram

Social relationsSocial relations of individual in a of individual in a groupgroup

Understand the Understand the IPCIPC within the group within the group

Level of awarenessLevel of awareness on specific issues on specific issues

To know the To know the group dynamicsgroup dynamics

Group work method Group work method (action research)(action research)

Ways and means to Ways and means to resolve the resolve the conflict conflict

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Examples of sociogramExamples of sociogram(Pay and stay: high income group)(Pay and stay: high income group)

IssueIssue: : Relationship among the elderly Relationship among the elderly living in old age home.living in old age home.

E1

E2

E4

E3

E5

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Analysis:Analysis:E3 is social, having leadership qualitiesE3 is social, having leadership qualitiesE1 bedridden no contact with othersE1 bedridden no contact with othersE2 only talks and contact with E3E2 only talks and contact with E3E5 only talks and contact with E3E5 only talks and contact with E3E4 mutual understanding with E3E4 mutual understanding with E3

ConclusionConclusion: Loneliness within this group can be : Loneliness within this group can be taken care of, if the grup have a level of taken care of, if the grup have a level of interaction among themselves; where they interaction among themselves; where they can share:anxieties, problems or even can share:anxieties, problems or even solutions.solutions.E3 is more dynamic, can play a role as a E3 is more dynamic, can play a role as a leaderleader

Group activities were planed: lunch, TV etc.Group activities were planed: lunch, TV etc.

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The result of FGD after 20 daysThe result of FGD after 20 days

E1

E2

E5

E4

E3

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Progress in relationshipProgress in relationship

Small initiative brought a change in Small initiative brought a change in their loneliness as E2, E4 and E5 their loneliness as E2, E4 and E5 started communicating/contact with started communicating/contact with each othereach other

E3 became the Catalyst (E3 became the Catalyst (SutradharSutradhar))

More work is possible to improve the More work is possible to improve the relationship to avoid loneliness relationship to avoid loneliness among them.among them.

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Example 2: Moderate relationshipExample 2: Moderate relationship(Govt old age home : free)(Govt old age home : free)

E8

E10 E7

E12

E9E11

E1

E2E3

E6

E5E4

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Analysis:Analysis:

E10 has a E10 has a leadership qualityleadership quality

E12 is a E12 is a lonerloner

E2, E5, E1 and E3 has E2, E5, E1 and E3 has less interactionless interaction with others than E10with others than E10

Many Many behavioural problemsbehavioural problems identified, relationship is poor and identified, relationship is poor and less interaction among them etc.less interaction among them etc.

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Conclusion:Conclusion:

Suggestions:Suggestions:Effective Effective planningplanning for for improvement in their improvement in their interactioninteraction is neededis neededParticipation in Participation in group activitygroup activity is is requiredrequiredPossibility to Possibility to utilize their leisure utilize their leisure timetime in productive work etc. in productive work etc.

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Example 3: Excellent situationExample 3: Excellent situation(Arya Mahila Ashram)(Arya Mahila Ashram)

E10 E12 E7

E8

E6E3E5

E2

E11 E4E9

E!

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Analysis:Analysis:

The individual has The individual has less chances to be less chances to be lonelylonelyThe group is The group is well organisedwell organised and and concerned with each other through concerned with each other through multiple activitiesmultiple activities..All the individuals are involved in one All the individuals are involved in one or the other committee related to the or the other committee related to the functioningfunctioning of old age home. of old age home.Continuous communicationContinuous communication and and interaction exists among theminteraction exists among themClear and Clear and concreteconcrete relations relations

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Conclusion:Conclusion:Out of above 3 examples, the last Out of above 3 examples, the last one can be one can be analysedanalysed as role model in as role model in which every individual has a social which every individual has a social relationship in a group.relationship in a group.social environmentsocial environment may be a basic may be a basic reason for their group behaviourreason for their group behaviourSome of the characteristics of this Some of the characteristics of this group can be group can be replicated replicated in other old in other old age home, if possible.age home, if possible.

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Seasonal CalendarSeasonal Calendar

PURPOSEPURPOSE::– Changes during the year how to present informationChanges during the year how to present information

ISSUESISSUES;;– Climate: Rainfall + TemperaturesClimate: Rainfall + Temperatures– Crop – Cash + otherCrop – Cash + other– Live stock; Labour DemandLive stock; Labour Demand– Income Generation ActivitiesIncome Generation Activities– Marketing; Human diseasesMarketing; Human diseases– Social events (Marriage, festival, etc.)Social events (Marriage, festival, etc.)– Types and quality of cooking/heating fuel, diet, Types and quality of cooking/heating fuel, diet,

income and expenditureincome and expenditure

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HOW TO PREPARE SEASONAL HOW TO PREPARE SEASONAL CALENDARCALENDAR

– Use big size graph paper and draw 12/18 calendar Use big size graph paper and draw 12/18 calendar OR sit on the ground make the linesOR sit on the ground make the lines

– Ask any alternative method local materialsAsk any alternative method local materials– Combine all seasonal patterns into one diagramCombine all seasonal patterns into one diagram– Cross-check and define the SCCross-check and define the SC

AREAAREA::Social events, seasonal diseases, malaria, Social events, seasonal diseases, malaria, dengue etc.dengue etc.Occupational diseasesOccupational diseasesMaternal deaths, industrial accident, etc. Maternal deaths, industrial accident, etc. Migration, export, import, crops, examsMigration, export, import, crops, exams

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CAUSAL FLOW DIAGRAM CAUSAL FLOW DIAGRAM (Child mortality Age 0-6 years)(Child mortality Age 0-6 years)

KanchanpuriVillageIn Delhi

4 died in1987

Nodeath

No death

One died In 1982No

Death

One diedIn 1995

One diedIn 1989

One died in 1989

No death

No No deathdeath

Nodeath

Malaria

Worm infestation Diarrhoea

Chickenpox

Scabies

Evil spiritNight blindness

Rheumatism

Typhoid

Malnutrition

Cough and cold

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Causal diagram OR impact diagramCausal diagram OR impact diagramARE useful to find out the inter-links between events ARE useful to find out the inter-links between events

and trace the cumulative resultand trace the cumulative result

Smoking

Time loss Work efficiency down

Prestige/insult

Habit

Health loss

Money loss

Peer grouppressure

Parents weresmoking

Enjoyment

Tension

Work situation

IMPACT

CAUSES

Area climate

Sleeping disorders

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MAPPINGMAPPINGVariety of mapsVariety of maps

SocialSocialMobilityMobilityBodyBodyHistorical etc.Historical etc.

Ask for previous map if any: Ask for previous map if any: select any topic:demography, select any topic:demography, social, residential, occupation social, residential, occupation stratification, field land use, stratification, field land use, water, literacy, natural, etc. water, literacy, natural, etc.

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Ranking Ranking

Ranking or scoring means placing Ranking or scoring means placing something in ordersomething in order

Pair-wise ranking, for example, helps Pair-wise ranking, for example, helps identify the main problems or preferences identify the main problems or preferences of individual community members and of individual community members and

Their ranking criteria, and enables the Their ranking criteria, and enables the priorities of different individual to be easily priorities of different individual to be easily comparedcompared

Useful for sensitive informationUseful for sensitive information

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Pair wise ranking matrix favorite pastimes

ModModee

TV RE SL MU SP Score/Rank

TV TV TV MU TV TV 3 BRE RE MU RE RE 2 CSL MU SP SL 0 EMU MU MU 4 ASP SP 1 D

TV= Television, RE= Reading, SL= sleep, MU= Music, SP= sports

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Overall preference for method of FP

Methods Temporary

Reliable Available Simple to use

Resistance to side effects

Condom

Norplant

Oral pill

Permanent

Vasectomy

TubectomyMax = 5 please give the marks according to your own feelings

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Treatment sequence matrixPlace of treatment

Home remedies

Medical shop

Govt. hospital

Private hospital

Prayers

Spiritual

Traditional methods

Commonness

Scabies

Headache

Skin

Stomach

Measles

ENT

STI/STD

Devil or

evil

Jaundice

1=Go first; 2=Go second etc. [what people actually do]

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How to prepare action planHow to prepare action plan55Ws and Ws and OneOne H H

WHATWHAT: the title, rationale, objectives: the title, rationale, objectivesWHEREWHERE: geographical area, population : geographical area, population coveredcoveredWHENWHEN: the time, frame breakup: the time, frame breakupWith With WHOMWHOM: staff, community/leader: staff, community/leaderWHOWHO: PLA team, consultant, : PLA team, consultant, representativesrepresentativesHOWHOW: intervention, methodology, tools : intervention, methodology, tools and techniques, qualitative Vs and techniques, qualitative Vs quantitativequantitative

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Thank youThank you