Challenges and difficulties of community health

Setting Up Community Health Programmes
By Ted Lankester
Macmillan

Reviewed by Claire Roberts-Lamont

There are many challenges and potential difficulties that exist in developing community participation in health programmes and Ted Lankester's second edition of Setting up Community Health Programmes outlines the components of setting up a successful health programme. The broad style lends itself to a detailed checklist for field workers who need a reference manual. Lankester also troubleshoots by gently drawing the reader's attention to the challenges and difficulties in community participation which is inherent to community health.

Lankester outlines the general components of health project management. He develops a community health model and then applies that model specifically to the common diseases affecting developing countries. These include nutrition, maternal health, diarrhoea, pneumonia, malaria, tuberculosis and Aids. Each section concludes with helpful references for further reading.

The challenges associated with community health work become clear when Lankester moves from the description of the ideology of community health to the practical tasks associated with carrying it out.

"It may be extremely difficult to find an individual who has the time and energy to take on the role of community health worker"

Negotiating the myriad of cultural and social issues in diverse communities is challenging. For example, the description of finding an appropriate community health worker illustrates the challenge of putting into practice the ideology of community health.

The community health worker should be "friendly, concerned about the welfare of others, uninterested in money, hardworking, respected and willing to visit any who ask her". It may be extremely difficult to find an individual who, on top of possessing these characteristics, also has the time and energy to take on the role of community health worker.

Although more than half of the book is devoted to treating the specific diseases common to developing countries, Lankester constantly refers to the importance of prevention which will enable people to achieve long term well-being. Lankester gives suggestions on how to help people who have been indoctrinated by a medical model of health to begin to accept a community health model.

The section "Setting up Public Health Improvements" give excellent examples of initiatives that will improve the quality and availability of water, aid in the disposal of human waste and improve hygiene. He addresses the potential cultural problems that may arise and offers excellent guidance on how to encourage participation and prevent conflict.

Lankester's use of cartoon drawings provide examples of the range of possibilities that the reader can use, while simultaneously making the book more accessible to readers in developing countries who do not have strong literacy skills themselves or do not have English as their first language. The reader can also use the cartoon drawings for teaching.

The book also covers the importance of monitoring, evaluation and of management styles. Lankester states that it is these most practical aspects of community health programmes that cause well-intended programmes to fail. The importance of careful people management is emphasised and models and guidelines for leadership including conflict resolution are suggested.

The reader is left with a clear picture of the dedication required from all parties in community health work. The treatment of disease and the provision of drugs are important but only within programmes that seek to meet a community's wider health needs. For unless those who are undertaking community health work are clear about these, any health work that is done will have to be done again and again. The cornerstones of sustainable community health work are time and participation - not abundant resources when the world, and funders, too often require immediate results.

Claire Roberts-Lamont has worked for community health projects in Canada, Mozambique and South Africa. She is currently the health promotion specialist for Shaftesbury Homes in London