PARTICIPATORY LEARNING AND ACTION (PLA)FOR COMMUNITY HEALTH DEVELOPMENT

DR. (MRS.) RAJNI BAGGAASSOCIATE PROFESSOR

NATIONAL INSTITUTE OF HEALTH & FAMILY WELFARE, MUNIRKA, NEW DELHI - 110067.

E-mail:nihfw@mantraonline.com & nihfw@delnet.ren.inPhones: 26165959,26107773, Fax:91-11-26101623

PARTICIPATORY LEARNING AND ACTION

• INTRODUCTION

• CONCEPT &DEFINITION

• ORIGIN& EVOLUTION OF PLA

• PRINCIPLES OF PLA

• TOOLS AND TECHNIQUES

• APPLICATION OF PLA IN HEALTH

• RATIONAL

• POTENTIAL USE

• IMPACT & BENEFITS

• CONCERNS & CHALLENGES

• CONCLUSION

INTRODUCTION

Participatory approaches like PLA developed in response to concerns regarding a top down approach to developing strategies for addressing local concerns

These strategies have a much greater chance of success if local community is involved in the process from start to finish

PLA can empower women, poor and disadvantaged, giving them more control over their lives

An explicit concern with the quality of interaction, including a stress on personal values, attitudes and behaviour as a prerequisite for effective work.

The use of open-ended, adaptable visual methods within a flexible, interactive learning process, rather than the use of set sequences of specific methods for pre-identified ends;

Generate important often surprising insights, which can contribute to policies, to serving the needs of the poor and marginalized section of the population

It can challenge the perceptions of those in authority and begin to change attitudes and agendas

PLA methods are based on principles aimed at

offsetting the deficiencies in the earlier

investigative approaches in the health

development and has over the years developed

out of a dissatisfaction with common modes of

investigation, formal questionnaires and

surveys and rural development tourism

CONCEPT/DEFINITION

Robert Chambers 2002 :

“A growing family of approaches, methods, attitudes and behaviour to enable and empower people to share, analyse and enhance their knowledge of life and conditions and to plan, act, monitor, evaluate and reflect”.

Richard Heaver (1991) has also described PRA –

“PRA embraces a series of techniques, many of them recently developed in India, for using local people’s knowledge and skills to learn about local conditions, identifying local development problems and plan responses to them

CONCEPT/ DEFINITION

ORIGIN AND EVOLUTION

PLA approaches have developed out of Rapid Rural Appraisal (RRA) techniques, which were first systemized in the late 1970s.

RRA techniques in turn developed out of:

dissatisfaction with large scale questionnaire surveys which gave delayed results

dissatisfaction with the unreliability of impressions gained during the field visits made by urban based professionals which came to be known as ‘RURAL DEVELOPMENT TOURISM’

For quickly gaining qualitative insights into a situation

CONTD.

ORIGIN AND EVOLUTION

FROM RRA TO PRA / PLA

From 1970 onwards Participatory tools- for promoting and participation of the poor & marginalized in improving their wellbeing.

These tools arose from two beliefs:

The knowledge & experience of poor and marginalized have value and not to be dismissed as irrelevant or wrong,

Poor and marginalized have the right to resources traditionally defined by them.

Agha Khan Rural Support Programme (India) conducted participatory RRA in two villages of Gujrat, in 1988

Few of the Govt. organizations which got their staff trained and promoted PRA are:

Dry lands development board. Karnataka

Several forestry departments

National Academy of Administration, Mussouri

FROM RRA TO PRA /PLA

In India PLA more popular in the NGO sector and particularly three NGO’s:

Action Aid in Bangalore,

MYRADA

AghaKhan Rural Support Project in Gujarat

FOR EMPOWERMENT

Mode Extractive Elicitative Participative Sharing Empowering

Outsider’s Role Investigator Facilitator

PLA has evolved from Rapid Rural Appraisal (RRA) and refers to a process that empowers local people to act upon, change their conditions and situations

Nature of Process RRA PRA PLA

Information owned, analyzed & used by

Outsiders Local People

PLA AND JOHARI WINDOW

Information known to every one

Teach Learn

Knowledge belongs only to community

Knowledge belongs only to professionals

Knowledge acquired by learning together

What we know and what they know

What we know and they do not know

What they know

and we do not know

What we do not know and they do not know

PRINCIPLES OF PLA

PLA ENTAILS SHIFT FROM

DominatingEmpowering

ClosedOpen

Individual Group

Measuring Comparing

ReserveRapport

FrustrationFun

VerbalVisual

PRINCIPLES OF PLA

Triangulation

Optimal Ignorance and Optimal imprecision

Direct contact, face to face, in the field

Critical self awareness

Changing behaviour and attitudes

A culture of sharing

Commitment

Empowering

Flexibility, Innovation, Improvisation

Learning directly from, local people

PRINCIPLES, BEHAVIOUR & ATTITUDES

OPTIMAL IGNORANCE

AVOID COLLECTING UNNECESSARY DATA

DESIRABLE ATTITUDES

- OPENNESS

- HUMILITY

- EMPATHY

- CURIOSITY

- ACCEPTANCE

- SENSITIVITY

RIGHT BEHAVIOUR

- SHARING

- FRIENDLY

- RESPECTFUL

- EMBRACING ERRORS

- LISTENING AND NOT LECTURING

PRINCIPLES, BEHAVIOUR & ATTITUDES

CRITICAL SELF AWARENESS

- About attitudes & behaviour- Embracing & Learning from

error- Taking personal responsibilities

REVERSALS

Learning from , with and by local people directly and face to face seeking to understand their perceptions, priorities & needs

- To equity

-Empowering those who are marginalized, specially women, children and elderly

COMMITTMENT

DISCUSSION TOOLS

Focus Group Discussion

Semi- Structured Interviews

VISUAL TOOLS

Participatory Mapping

Institutional Programming (Venn Diagram)

Seasonal Diagram

Daily activity Chart

Trend Analysis

Body Mapping

Pair wise Ranking

Force Field Analysis

Causal Impact Diagram

Impact Evaluation

OBSERVATIONAL TOOLS

Participant Observation – DIY, taking part in local activities

Transect Walks

TOOLS AND TECHNIQUES

APPLICATION OF THE TOOLS DO NOT FOLLOW ANY FIXED SCHEME. IT IS VERY FLEXIBLE AND DEPENDS UPON THE EVOLUTION OF THE PROCESS, NEED OF THE SITUATION AND USER’S OWN BEST JUDGEMENT

TOOLS AND TECHNIQUES

BUT MERE APPLICATION OF THESE ARE NOT SUFFICIENT UNLESS THE FACILITATOR / USER HAS THE DESIRABLE ATTITUDE AND BEHAVIOUR AND THE USER MOVES FROM TALKING TO DOING & FROM DOING TO BEING

TOOLS AND TECHNIQUESTOOLS CAN ALSO BE CATEGORIZED AS PER THEIR USE AND SEQUENCE IN WHICH THEY ARE USED

TOOLS FOR EXPLORATION AND IDENTIFICATION OF PROBLEMS

TOOLS FOR PRIORITIZATION OF PROBLEMS

TOOLS FOR ANALYSIS

TOOLS FOR SOLUTION / IMPLEMENTATION

In 1978 at Alma-Ata, Primary Health was defined by WHO & UNICEF as :

“Essential Health care universally accessible to

individuals and their families in the community

by means acceptable to them, through their full

participation and at a cost that the community

and the country can afford”

RATIONALE FOR CONDUCTING PLA IN HEALTH

Both Primary Health Care and Community Development recognizes that the process of achieving the goal - through the development of Local Initiatives, Participation, Self-confidence, Self-reliance and Cooperation - is more important than the achievement of the goals and objectives

HEALTH IS NOT THE RESPONSIBILITY OF THE HEALTH SECTOR ALONE, BUT IS AFFECTED BY THE DEVELOPMENT ACTIVITIES IN OTHER SECTORS SUCH AS EDUCATION, HOUSING AND SOCIAL SERVICES. HENCE A NEED EXISTS TO INTEGRATE ALL SUCH DEVELOPMENT ACTIVITIES THROUGH PLA.

DEVELOPMENT OF SELF-RELIANCE AND SOCIAL AWARENESS THROUGH CONTINUING COMMUNITY PARTICIPATION IS A KEY FACTOR IN IMPROVING HEALTH.

IF HEALTH CARE IS TO IMPROVE IT IS ESSENTIAL THAT COMMUNITY SHOULD DEFINE IT’S NEEDS AND SUGGESTS WAYS OF MEETING THEM.

DECENTRALIZATION IS NECESSARY IF COMMUNITY NEEDS ARE TO BE MET AND PROBLEMS SOLVED.

LOCAL COMMUNITY RESOURCES, FINANCIAL AND HUMAN, CAN MAKE AN IMPORTANT CONTRIBUTION TO HEALTH AND DEVELOPMENT ACTIVITIES.

RATIONALE FOR CONDUCTING PLA

PLA FOR COMMUNITY HEALTH PROJECT

Problem Identification

Problem Prioritization

Possible Solution

Identification

Action Planning

Implementation

Monitoring

Evaluation

HEALTH PROJECT CYCLE

PLA FOR COMMUNITY HEALTH DEVELOPMENT

1. It has been recognized that for health services to be truly effective, potential recipients must be involved in every stage of the process

2. This project cycle is conceived as an empowering approach to enable the local community especially the marginalized and the women to review and articulate their own perceptions of need and identify them

3. Enables the local people e.g, women to reconsider their own belief systems, surrounding health and illness, exchange knowledge/ideas.

4. PLA broadens the lens of ‘health’ of local people to focus on the wider dimensions of well-being

5. It offers health professionals (outsiders) and local people an approach in determining priorities and developing strategies for action and improving well-being

PLA FOR COMMUNITY HEALTH DEVELOPMENT

Its Positive impact and benefits for Community Health Development :

1. Use and Application of PLA is wide spread

2. Generates rapport and forces outsiders to learn, listen and understand

3. It provide highly accurate information: Local people’s knowledge of local conditions is often greater than

had been supposed

4. Plans drawn up in a prescriptive manner by local people are more likely to work than plans drawn up by

outsiders

5. The participative nature of the process is a “ Development Benefit” in itself, in terms of empowering people

6. Highly cost-effective

POTENTIAL OF PLA

PARADIGM SHIFT TO RECOGNIZE THE ABILITY AND CAPACITY OF LOCAL PEOPLE– INNOVATION

PEOPLE TAKE RESPONSIBILITY AND ACTION FOR IMPROVEMENTS

EXPERTS NEED TO GIVE UP POWER AND CONTROL OVER PROJECT OUTCOMES – ROLES REVERSAL

‘BOTTOM UP’ APPROACH

PLA FOR EMPOWERMENT

family of approaches for reversing centralization, standardization and top-down development.

2. Biggest challenge includes achieving changes in our personal attitudes and behaviour towards

community & the disadvantaged.

2. Behaviour and Attitude: more important than methods

CONCERNS & CHALLENGES OF PLA IN HEALTH SECTOR

3. The need to recognize and work at personal responsibility, professional ethics, such

as developing self- critical attitude.

o initiate and sustain process of change; empowering disadvantaged people & communities, transferring health services and reorienting individuals.

CONCERNS & CHALLENGES OF PLA IN HEALTH SECTOR

CONCLUSIONS

1. PLA, IS NOT A BANDAGE TO STICK TOGETHER OLD FAILING CONCEPTS AND APPROACHES.

2. RURAL DEVELOPMENT TOURISM HAS TO GO, INSTEAD LOCAL COMMUNITIES ARE TO BE INVOLVED FOR IDENTIFYING, PRIORITIZING, ANALYSING AND SUGGESTING SOLUTIONS TO THEIR PROBLEMS

3. UNDER RCH PROGRAMME, PLA CAN BECOME THE BASIS OF PLANNING AT THE MOST PERIPHERAL LEVEL WHEREBY THE HEALTH WORKER IS SUPPOSED TO FINALIZE THE PLAN AFTER DETAILED CONSULTATION WITH COMMUNITY AND COMMUNITY LEADERS, INFACT, CORRECTLY CARRIED OUT COMMUNITY NEED ASSESSMENT (CNA) IS AN EXAMPLE OF PLA APPLICATION

4. FOR EMPOWERING THE MARGINALIZED SECTION OF THE POPULATION WHICH INCLUDES WOMEN, CHILDREN, ELDERLY, PLA HAS LOT TO OFFER

CONCLUSIONS

5. WE HAVE REACHED A CRITICAL POINT

IN THE HISTORY OF MANKIND. WITH GOVERNMENTS’ EFFORTS STAGNATING WORLD OVER, LOCAL COMMUNITIES ARE WHERE MANY OF THE CHANGES WILL HAVE TO START. THE PARTICIPATORY APPROACHES LIKE PLA CAN HELP TO ENABLE LOCAL ANALYSIS AND PLANNING, WITHIN AND BY COMMUNITIES.

CONCLUSIONS