Taking health back into our hands

Us logoPresent by Stephanie Mooney, Programme Manager – Africa, Us

Hands on Health presentation

“Hands of health” programme –  is about how we strengthen our mutual capacity to stimulate the church for community engagement.

Mission hospital picture – still continuing the healing ministry of Jesus Christ. Historically responsible for the buildings and maintenance of mission hospital clinics. This can’t stay the same, Us is now trying to respond to perceived and actual needs.

Still committed to hospitals and clinics but is now supporting organisations to reach their communities, by empowering communities, to respond to challenges of health, access to water etc but also the challenges of people’s social, physical and spiritual capacities. Trying to bring about an individual ownership of health through facilitation and dialogue.

“Hands on health” programme is running in India, Lesotho, Malawi etc

Statistics  –

1.3 billion without access to healthcare , short of 4 million qualified health care workers; etc

A change of approach is required due to underfunding; drugs/equipment in short supply; difficult to retain qualified staff, particularly in remote hospitals; ongoing maintenance and upkeep of institutions; updating infrastructure – this is an unsustainable model.

However we are starting from a place of strength –  the churches have a long term presence in the local community; knowledge of local circumstances.

The principle of high quality of care – “outreach, equity, access” still fundamental to our work, Us is still providing healthcare and health education – introducing initiatives on malaria and HIV, as a result of their successes Us is before NGOs and government healthcare departments.

The aim is to rebuild trust in our healing mission – paradigm shift from hospitals to active intervention and community engagement, this is really key.  Revising primary healthcare as a joint enterprise, don’t want to see hospitals go away but give them a new identity, so that we achieve long-term sustainability.

Its based on simple principles – community engagement ; health facility adaptation in terms of culture, people being aware of what the problems are. But it’s often difficult for people to know what their strengths are, we are learning to focus on developing people’s strengths, and to reconnect what goes on within clinic/hospital with knowledge of local people – when people present themselves you see the issue, depression, illness, etc but its easy to lose sight of the person behind that.

Local churches have traditionally not been very proactive in everyday running of health facilities – we are trying to show them they can play a role in broking dialogue – to bring the hospital back to community, shared concerns leading to new solutions and ways forward.

2 elements to this – i) SALT = stimulate, appreciate, listen, transfer; ii) facilitated self-assessment.

How can we take more responsibility as individuals; communities; churches – to achieve a rebalancing between prevention and cure. Out-patient departments are full, when community care is empty – need to re-shift balance for sustainability leading to more confident, resilient communities.

Are services being provided in an accessible way for the community – let communities drive agenda rather than external agencies, greater unity amongst those partnerships.

SALT visit is a conversation at local community level made up of church, community and health facility. 3-5 people – in those small teams you don’t go in your role, you go as a person so environment is without paternalistic dynamics – to learn what that family is experiencing – to establish trust with them in their home setting – to learn what is driving the behaviour that is causing concern, and from there to go out into community, identify people’s strengths so that they can create change for themselves, they learn from the inside out – its about being proactive rather than reactive.

Self-assessment covers the core things about what makes health facilities work – tool which is done by community, church and hospital – so you can open up new perspectives for creating change. Its about using the conversation to create adaptation in the hospital and also for the community.

(photo) – Conversation in action  – MDT is essential, supporting programme design – you go back frequently to that home on an ongoing basis, to develop relationship. It changes the conversation when a health practitioner goes out and meets people in their homes/communities.

It also works to facilitate a wider range of responses to a disease – how can we explore solutions together to create ownership. It creates a change and shift in values/trust.

Effective responses rooted in communities and service providers and linkup. You cannot divorce hospitals/clinics from the community.

(photo) CEO talked about nets – why for fishing rather than to protect their health? Can’t compartmentalise the person. Most people we speak to know how to protect themselves but what will make them change their behaviour? How are they motivated to change?

Successes –

Reduction in Malaria rates; individuals being taught how to keep their compound clean, using nets as they were intended.

Trust – its about rebuilding trust, long-term health outcomes means people going to seek help at an earlier point. In 16 facilities in the “hands on health” programme’s 1st year we only expected to reach 36 communities.  1st year we actually engaged 54 communities, another 34k people were reached. Little interventions can go a long way.

Reflections – people expecting handouts rather than taking individual responsibility, about building and strengthening health systems. But it takes a long time, 25+ years, needs commitment. Need all partnerships involved for the long-term.

Challenge and hope – compliment government programmes, create a sustained local response which stands out. It’s about journeying to holistic health.

In a UK context – the word “community” means a relating group of people which acts for shared goal for consensus.  Applied in many contexts across world. Transferable. Care, Community, Change, Leadership and Hope. Language for sharing across differences. Builds trust.

Hands On Health – something which is going to grow. We will adapt and going back to who we want to be – long-term intervention, for church, community and health facility to work it out.

Questions

  1. Aren’t there some people who will say you are turning the church into an NGO? Not what church is for?

SM – leadership work is linked in to this. Because our mission is supporting training and development linked into community – our engagement with churches says they do not feel close enough to the community so that they can feel more relevant. They don’t feel that they know what is happening. It’s about enabling that holistic view of the role of the church, rather than turning churches into NGOs.

Does it increase bums on pews?

SM – yes – Sierra Leone – high Muslim community area, they were helping to build a church, to grow vegetables and digging graves to bury the dead. The church said they felt lethargic, but through this programme they felt renewed in their own walk of faith with God and there was an increase of 100 in numbers. No tension with Muslims.

  1. (comment) You did say it would take time and trust – culture also plays a key role. In the Caribbean people are private, healthcare is medically oriented, less trusting of people from churches coming into homes. People are private, will only tell the priest about their healthcare issues. To have people coming into homes you would have to scale up the home visits with training – will be significant, counsellors have to be trained. Have to have a lot of infrastructure. We have community medical clinics. Have to re-educate that health is holistic – training is massive.
  2. (comment) You can go fast with training if its focused on learning about culture – implicit in the discourse about the community is response by invitation. It’s not about imposition – its about how do you stimulate invitation into homes from the community themselves.  The skill is how to discern an invitation and recognise the ones that need to be followed up.

SM – Eg. sustained community contact in teams for a significant period of time – trust growing between the community and hospital. Church engagement takes repeated doses of stimulation. Beyond 5 years this is a turnaround of life culture.

  1. (comment) Over here I’ve found within the Methodist church that we are preaching it is a congregation of ministers, then it tends to flow over.
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