1. Introduction – four true stories about healthy communities
Story 1 : Betty says that everyone in Zambia knows her as a positive woman. In 2001, about 35 HIV-positive women and five men started meeting and contributing money. With their pooled funds, they bought three pigs. A chief gave them five acres for their efforts. The group has grown to 73 members, 25 of whom are bedridden. Many have died, and many left children. The group supports the orphans with the proceeds from raising pigs, though they also have to pay for anti-retroviral medicines. They opened a school for the orphans with the money they earned. They feed the pigs with food they grow themselves. Betty says that they can’t depend on donors, but work on their own.
Story 2 : Berwings Sambo is a 44-year-old farmer and father of eight in Traditional Authority Mabilabo in Mzimba, northern Malawi. He tested HIV-positive in 2004. At first, he was shocked and disturbed. But he accepted the results, began to live positively and became a living testimony that inspired many in Mabilabo.
After learning his status, Sambo broke the news to his wife and talked with her about going for testing. She also tested positive. They told their children: “… I called all my children and broke the news, and from there, I started teaching them more about HIV/AIDS. Until they came to fully understand what it means to be positive.” His children are always happy to remind him to take medication. He was asked why it was necessary to break the news to the children when he could have lived a life without their knowledge. Sambo responded, “I consider myself the living example and I would like to tell the world the truth about HIV and what it means to be HIV positive. I emphasize on prevention of the infection … I want my experience to save millions out there, but before I reach out to millions, I have to ensure that my family is knowledgeable about the reality of HIV, as charity begins at home.”
Sambo works to dispel the stigma and discrimination around HIV, including beliefs that those who are infected are lesser human beings or sinners. Many people still abandon and reject those that are infected, despite intensive campaigns against HIV-related stigma and discrimination in Malawi.
To encourage others to disclose their status as he has, Sambo and some friends who are also HIV-positive formed a group called Nkhongono AIDS Support Group. The group has been involved in HIV awareness campaigns. They are also seriously involved in income-generating activities like farming and making jam. They sell their proceeds, which helps them in their day-to-day life. With support from a local NGO, the group grows three acres of maize and has a grain bank for proper storage of maize.
From Firelight Foundation, News Flash, June 2009
Story 3 : Rose Thomas is a volunteer community health worker from Ngomano village in Kibwezi District, 200 km southeast of Nairobi. She is 49 years old, married and has four sons. She sensitizes mothers and educates them on the importance of ante-natal care, delivery at health facilities and immunization. Because of the efforts of Rose and others involved in this project, the percentage of mothers who have their babies at the health centre has doubled between 2005 and 2008, and immunization rates have increased from 89% to 100%.
Rose collects data from households. She enters the data into a computer, and produces summaries which she uses to develop action plans. She shares the information with the community and educates them on improving their health based on this information.
Community health workers like Rose work on a volunteer basis, receiving no payment. This can be discouraging as they have to walk long distances in the heat to make home visits and collect data. Distances between households are far in this semi-arid area, and covering ten households may take a whole day. In addition, some community members are not comfortable about disclosing health information to community health workers.
The collaboration and support of the provincial administration and the Ministry of Health give community health workers a sense of recognition and ensures the co-operation of the community members. The provincial administration assists them in calling meetings, and the Ministry of Health provides technical assistance and supervision.
The community and decision makers at health facilities and other levels are now using the information collected by Rose and other community health workers to monitor various health needs and activities. In addition, the community is able to follow trends in common diseases. For example, the percentage of new mothers who gave birth with trained health workers in Ngomano village rose from 35% in 2004 to 48% in 2008. The number of non-immunized children under five years decreased from 4% to 0% in the same period. The communities are now able to demand services from the government based on their needs.
Story 4 : On May 25, 2010, in Mbagne, a town in the southwest part of the Islamic Republic of Mauritania, a celebration was held to mark the abandonment of the traditional practices of female genital cutting (FGC) and child marriage or forced marriage. The event was organized by 78 regional communities.
Representatives from the Hassanya and Pulaar ethnic groups gathered to announce their commitment to protect the health and human rights of girls and women, and to set the stage for future abandonment declarations in the country.
More than three-quarters of women in the region have at least one daughter who is cut. The pledge reinforces the fatwa banning FGC announced by the national Imams in January 2010.
The declaration of abandonment was read aloud in three languages: Hassanya, Pulaar, and French. Through music, dance and theatre, youth groups highlighted the communities’ reasons for abandoning the practices and the challenges they faced. Important community actors who were crucial to gaining community consensus – including former cutters, religious leaders and community doctors – spoke and declared their commitment to protecting the human rights of women and girls.
The NGO, Tostan, began its Community Empowerment Program in Mauritania in 2007 in collaboration with international and national agencies. Since then, 30 villages in Brakna have participated in the program. These communities reached out to an additional 48 villages to share and discuss issues related to human rights, health, hygiene and the risks of FGC and child/forced marriage by organizing awareness-raising events, intervillage meetings and debates.
The events also unified two cultures that have sometimes experienced tension. It was a declaration that transcended these differences, demonstrating the power of human rights to unite communities for a common and positive goal.
2. Background information on healthy communities
What is a “healthy community”?
The concept of “healthy communities” combines a broad understanding of “good health” with a community approach to achieving it.
This way of looking at healthy communities considers health as part of general community well-being and community development.
The concept of a healthy community is similar to the concept of “community health.” Both phrases help us to look beyond health as a purely medical issue or solely individual concern. Health is then seen in a more inclusive, holistic way, as a community concern.
When we think about a healthy community, besides medical issues, we think about other, non-medical factors that influence individual and community health – for example, the environment, cultural customs and traditions, and the ability of people to make decisions that help them achieve good health and quality of life. Of course, we would also consider barriers to their ability to make those decisions.
In this sense, health is an integrated part of larger community culture, environment, governance, and development.
Rural communities face a unique set of environmental, economic and social issues. This script package explores the concept of healthy communities from a rural perspective and offers strategies that can be used to highlight positive responses which build healthy communities. The main aim is to see the many ways in which the overall health of communities can be improved through individual and collective efforts.
What components are included in a healthy community?
- Healthy environment: community solutions for environmental health, including sustainable land use, transportation, water, sanitation and waste management, and healthy home conditions (for example, reducing air pollution from cooking, and separating livestock and human living spaces).
- Agriculture and health: agricultural practices that help farmers contribute to a healthy community, such as controlled use of pesticides, and minimizing the impact of fertilizers on drinking water.
- Maternal health and family planning: community initiatives that promote maternal health and family planning.
- Access to information and health services: increased community understanding of health issues, and community health education and services on topics such as sexually transmitted diseases, for example, knowledge about HIV and care for people living with HIV and AIDS.
- Healthy living: healthy eating practices, treating addictions, addressing mental health issues.
- Equality and social justice: opportunities for women to make informed decisions about their health, promoting equal opportunities for marginalized groups.
- Community peace and safety: initiatives that enable people to live in peace; projects that help people resolve conflict; preventing work-related accidents.
Let’s start by looking more closely at some key terms:
“Health” is defined as a state of complete physical, mental and social well-being.
Good health enables people to learn and to work. It enables them to participate in community life. Health gives people the ability to manage and change their surroundings, As such, it is a vital part of what we know as “community development.” Finally, health is a concept which is strongly influenced by circumstances, beliefs, culture, and the social, economic and physical environment.
A healthy community is defined as one that provides peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity.
A community is a group of people with common characteristics: a common geographical location, ethnicity, age, interest, cultural group, etc.
“Community” also implies a collective approach. It might be a common approach to identifying, tackling, and solving problems. The word “community” carries a sense of people looking beyond their own interests to a larger group.
C. Healthy communities:
The concept of healthy communities takes a broad view of health. In other words, health is not simply a medical or biological condition. It also encompasses other factors that influence individual or community health.
Healthy communities are mindful of all aspects of health and endeavour to achieve good health for everyone. The idea of community implies that we are thinking about the community as a whole rather than simply each of the individuals in that community.
A healthy community is a community characterized by a strong sense of collective effort from individuals and from public and private agencies to protect and preserve the health of the community.
Examples of healthy communities:
Here are a few examples of healthy communities:
- A community where physical environments are planned to support healthy activities and social interactions. For example, a community that is addressing the issue of stagnant water as a source of malaria, contaminated drinking water as a source of water-borne illness, or safe environments for girls, women and elders.
- A community in which there is adequate access to basic health and other services. For example, a community in which all pregnant women have access to information about childbirth and access to health care, and where treated mosquito nets are available to everyone.
- A community with a sense of community safety – pollution-free, violence-free and crime-free. For example, a community that has addressed the issue of waste, found peaceful ways to resolve conflict, and enforces safe working practices for farm workers, for example, when working with pesticides.
- A community that informs its members about health issues and provides the means to deal with health problems; for example, community efforts to help young people learn about sexually transmitted diseases, mental health, family planning, and parenting skills.
- A community that provides opportunities for learning, skill development and participation in a healthy lifestyle, helping individuals and families to learn about nutrition, exercise and related issues.
What can individuals and groups do to promote healthy communities?
Here are some specific examples of initiatives that contribute to healthy communities. Please note that while most of these examples highlight projects with external funding, small or informal, grassroots initiatives are extremely important in all communities.
Neighbours promote healthy eating practices in rural Mozambique
In rural Mozambique, unhealthy infant and children feeding practices and illnesses caused by poor sanitation are key causes of childhood malnutrition. Cultural traditions can lead to deficiencies in children’s diets, even when healthy foods are available. For example, mothers normally feed plain porridge to young children, ignoring locally available vitamin- or protein-rich foods such as nuts or greens. In addition, strict traditional gender roles may prevent men from being involved in nurturing their children.
But today in four districts of Manica Province in central Mozambique, a donor-funded program run by the NGO Africare works with a network of volunteer “model families.” The program – called Crescer in Portuguese or “to grow” – selects parents whose children are better nourished than average. After training, the model families share their knowledge with neighbours. They conduct cooking demonstrations and lead discussions on choosing nutrient-rich foods, preventing diarrhea, and building latrines, which most rural households lack. Many use traditional methods of communication such as song and dance to reinforce the lessons.
The program and the volunteer groups have helped communities to move beyond strict gender stereotypes, with men now openly involved in caring for their children. Fathers attend cooking demonstrations and lead songs about enriching children’s porridge with sesame oil, greens, and eggs – something that was unheard of in rural Manica just a few years ago.
Phukusi la Moyo (Bag of life)
Malawi’s maternal and child mortality rates are amongst the highest in the world. Phukusi la Moyo is a community-based learning program that promotes community health in Mchinji District, Malawi. It was developed by MaiMwana, a community-based maternal and child health project, in response to a need for greater awareness and action on maternal and child health. The program promotes healthy communities by mobilizing women to identify maternal health issues, share experiences, and work collectively towards solutions. Some 200 groups with more than 6000 active members, mostly pregnant women and new mothers, have been established since 2004. The network covers approximately 350 villages across the district. In 2009, the women took their conversations to a wider audience by beginning a radio show in partnership with Mudzi Wathu, the local community radio station.
The project is reducing maternal and child mortality by increasing women’s knowledge of health and enabling collective action. Women are learning simple ways to promote safe childbirth and good health for themselves and their children. The project harnesses the power of shared experience to promote both individual and collective action, mobilizing women to take greater control over their own health care. The program has also generated greater understanding and empathy between health workers and communities.
Affordable health care made accessible in Senegal
Mariama is a spokesperson for the Women’s and Children’s Development Association of Kolda, in southern Senegal. For years, she and her friends observed that women had particular difficulties accessing and paying for health care. They realized the need for a mutual health organization (MHO). MHOs are not-for- profit, voluntary schemes whereby a group of individuals or households pay contributions to finance all or part of their basic health care services. With the help of a donor-funded health program, a community-based organization was set up to run the MHO. Other program partners trained the committee on how to organize and operate an MHO. Currently, the MHO has 650 members, each of who pays $2 US to enrol and 40 cents in monthly fees. The health scheme covers doctor’s consultations, dental care, hospitalization, laboratory fees, medication, and X-rays. MHO members pay 25% of the costs and the MHO covers the remaining 75%. The health centre committee gives MHO members a 10% discount on medication.
According to Mariama: “There were times when I was sick, and instead of going to get help, I just suffered through it.” Mariama recalled times before the MHO when money was in short supply. Like many others, Mariama sometimes went to see the marabout (religious leader) instead of consulting a nurse or doctor. But those days are over. Now, Mariama is excited about the new possibilities that the MHO brings to Kolda, and makes rounds in the neighbourhood to convince others to join.
Diane Sagbohan volunteers in anti-malaria efforts
Diane is one of only six women among the 265 spray operators who participated in Benin’s first insecticide residential spray (IRS) campaign in three decades. She is from Sèmè-Kpodji, one of the four communes selected for spray operations during 2008 and known for high rates of malaria transmission. Despite the fact that spray operators for IRS campaigns are mostly men from her community, she was eager to join the effort.
Her participation in the IRS campaign offers new opportunities for female leaders to combat malaria in Benin. In her community, she is viewed as a pioneer. She is an example for others to change their behaviour and adopt practices that prevent malaria.
3. Production ideas for broadcasters
There are many ways to create radio programming on healthy communities. Here are a few:
- Interview rural families in communities where health and livelihoods are threatened by lack of access to safe water, and thus water-borne diseases such as cholera, diarrhea, malaria and bilharzia. Also interview people in communities who have taken steps to ensure that drinking water is safe and/or have taken steps to reduce habitat for malarial mosquitoes, and thus address water-borne diseases.
- Write and produce a short drama about a farmer who spearheads the fight for safe drinking water after losing one of his children to a water-borne disease.
- Interview an expert on community health from a national or international health agency, a hospital, a university, or an NGO. Questions to ask include:
- What kinds of community projects do you think have the best success in improving the health of a community?
- What are the most important methods to protect infants and children from health threats such as water-borne diseases? What kind of projects are most successful at ensuring that these methods are widely used?
- What are the most important barriers to improving community health? How can these barriers be overcome?
- How can rural people best use traditional social structures and customary practices to address health threats and improve community health?
- Produce a call-in or text-in program. Invite community health experts to the studio, and invite callers to call or text questions or comments about addressing community health issues. The expert could be, for example, a health professional, an academic researcher, or an advocate from an NGO.
- Produce 4-6 radio spots which explain the importance of improving community health. Each spot could start with the same “punchy” lead line and discuss one important element of an integrated approach, including:
- ensuring access to safe drinking water;
- healthy pregnancy and childbirth;
- good nutrition for infants, children, adults and the elderly;
- integrating traditional and modern health practices; and
- healthy practices at work.
- Host or chair a roundtable discussion on emerging health issues in your area, and creative ways to address them. Invite representatives from various groups: civic and traditional leaders, leaders of women’s groups, educators, health professionals, NGOs, and concerned citizens.
- Interview members of nearby (or distant) communities that have successfully addressed community health issues. As well as information from health and development experts, it is essential to have local people share their experiences of health issues, positive and negative health practices, and the benefits and consequences. Follow up with a call-in or text-in program which considers whether these solutions would work for your community.
- Hold a poetry contest: invite listeners to submit poems about community health and offer a prize to the “best poem.” Read all the good submissions on the air.
4. Further resources on healthy communities
Some of your most useful resources will be local health professionals. It is extremely valuable for broadcasters to develop an ongoing relationship with local health professionals. These people can often offer locally relevant insight into healthy communities, and can refer you to other experts. As well, you can consult the following organizations, radio programs, and videos. Note that many of the organizations listed below have a wealth of documents and other resources on their websites.
- Africare: http://www.africare.org/
- AIDS and Rights Alliance for Southern Africa: http://www.arasa.info/
- AMREF (African Medical and Research Foundation):
- Cameroon Link:
- Canadian Physicians for Aid and Relief: http://www.cpar.ca/
- CAP AIDS: http://www.capaids.org/
- Care International: http://www.careinternational.org/
- Centre Régional pour l’Eau Potable et l’Assainissement à faible coût (CREPA): http://www.reseaucrepa.org/ (French only)
- Commonwealth of Learning: http://www.col.org/
- Family Health International: http://www.fhi.org
- Global Alliance for Africa: http://www.globalallianceafrica.org
- The Grandmother Project/ Le Grandmother Project: http://www.grandmotherproject.org/index.php (English) http://www.grandmotherproject.org/index.php?lang=fr (French)
- Inter-African Committee on Traditional Practices: http://www.iac-ciaf.net/index.php?option=com_content&view=article&id=52&Itemid=18
- International Community of Women Living with HIV/AIDS: http://www.icw.org/ (English, with some articles in French)
- International HIV/AIDS Alliance/Alliance SIDA/VIH Internationale: https://www.internationaldisabilityalliance.org/stakeholder/international-hivaids-alliance
- Johns Hopkins Bloomberg School of Public Health: The Center for Communication Programs: http://www.jhuccp.org
- National Empowerment Network of People Living with HIV/AIDS in Kenya: http://www.nephak.org/
- Network of Zambian People living with HIV/AIDS:
- Plan International: http://plan-international.org/
- Raising Voices: http://www.raisingvoices.org/
- Save the Children: http://www.savethechildren.ca/ (English and French)
- Sidaction: http://www.sidaction.org/ (French only)
- Sonke Gender Justice Network: http://www.genderjustice.org.za/
- Soul Beat Africa: http://www.comminit.com/en/africa
- Soul City Institute for Health and Development Communication: http://www.soulcity.org.za/
- Tostan: http://www.tostan.org/
- United Front Against Riverblindness: http://www.riverblindness.org/
- WaterAid: http://www.wateraid.org/
Resource programs and documents
- EAC Community Health Workers (Kenya): http://www.youtube.com/watch?v=d0RGMVzBYOY
- Videos on The Water Channel http://www.thewaterchannel.tv/index.php?option=com_content&view=frontpage&Itemid=1&lang=en
- AMREF: Better Health for Africa: http://www.youtube.com/watch?v=C8VQgFSXX7A