PARTICIPATORY LEARNING AND ACTION (PLA) FOR COMMUNITY HEALTH DEVELOPMENT DR. (MRS.) RAJNI BAGGA

1. PARTICIPATORY LEARNING AND ACTION (PLA) FOR COMMUNITY HEALTH DEVELOPMENT DR. (MRS.) RAJNI BAGGA ASSOCIATE PROFESSOR NATIONAL INSTITUTE OF HEALTH & FAMILY WELFARE, MUNIRKA, NEW DELHI - 110067. E-mail:nihfw@mantraonline.com & nihfw@delnet.ren.in Phones: 26165959,26107773, Fax:91-11-26101623

9. PARTICIPATORYLEARNING 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

10. 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

11.  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.

12. 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

13. 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

14. 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”.

15. CONCEPT/ DEFINITION 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

16. 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.

17. 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.

18. FROM RRA TO PRA /PLA • 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

19. 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

20. FOR EMPOWERMENT RRA PRA PLA  Nature of Process Mode Extractive Elicitative Participative Sharing Empowering Outsider’s Role Investigator Facilitator Outsiders Local People Information owned, analyzed & used by 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

21. PLA AND JOHARI WINDOW Information known to every one Knowledge belongs only to community What they know andwe do not know What we know and what they know Teach Learn What we know and they do not know What we do not know and they do not know Knowledge belongs only to professionals Knowledge acquired by learning together

22. PRINCIPLES OF PLA PLA ENTAILS SHIFT FROM Empowering Dominating Open Closed Group Individual Measuring Comparing Reserve Rapport Frustration Fun Verbal Visual

23. 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

24. - OPENNESS - HUMILITY - EMPATHY - CURIOSITY - ACCEPTANCE - SENSITIVITY  DESIRABLE ATTITUDES   - SHARING - FRIENDLY - RESPECTFUL - EMBRACING ERRORS - LISTENING AND NOT LECTURING  RIGHT BEHAVIOUR  OPTIMAL IGNORANCE  AVOID COLLECTING UNNECESSARY DATA PRINCIPLES, BEHAVIOUR & ATTITUDES

25. - To equity -Empowering those who are marginalized, specially women, children and elderly COMMITTMENT CRITICAL SELF AWARENESS - About attitudes & behaviour - Embracing & Learning from error - Taking personal responsibilities Learning from , with and by local people directly and face to face seeking to understand their perceptions, priorities & needs REVERSALS PRINCIPLES, BEHAVIOUR & ATTITUDES

26. 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 • DISCUSSION TOOLS • Focus Group Discussion • Semi- Structured Interviews

27. 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

28. 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

29. TOOLS FOR EXPLORATION AND IDENTIFICATION OF PROBLEMS TOOLS FOR PRIORITIZATION OF PROBLEMS TOOLS FOR ANALYSIS TOOLS FOR SOLUTION / IMPLEMENTATION TOOLS AND TECHNIQUES TOOLS CAN ALSO BE CATEGORIZED AS PER THEIR USE AND SEQUENCE IN WHICH THEY ARE USED

30. 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”

31. 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.

32. RATIONALE FOR CONDUCTING 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.

33. Problem Identification Evaluation Monitoring ProblemPrioritization Implementation Possible SolutionIdentification Action Planning PLA FOR COMMUNITY HEALTH PROJECT HEALTH PROJECT CYCLE

34. 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.

35. PLA FOR COMMUNITY HEALTH DEVELOPMENT 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

36. POTENTIAL OF PLA • 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 • The participative nature of the process is a “ Development Benefit” in itself, in terms of empowering people • 6. Highly cost-effective

37. PLA FOR EMPOWERMENT •  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

38. CONCERNS & CHALLENGES OF PLA IN HEALTH SECTOR • 1. A family of approaches for reversing centralization, standardization and top-down development. • Biggest challenge includes achieving changes in our personal attitudes and behaviour towards • community & the disadvantaged. • Behaviour and Attitude: more important than methods

39. CONCERNS & CHALLENGES OF PLA IN HEALTH SECTOR • The need to recognize and work at personal responsibility, professional ethics, such • as developing self- critical attitude. • 4. To initiate and sustain process of change; empowering disadvantaged people & communities, transferring health services and reorienting individuals.

40. 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

41. CONCLUSIONS 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

42. 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.