Class Exercise

Volunteers for Focus Group Topic: security issues on campus

Requirement: that you have some concerns

Social Mapping divide people into 3 groups, one who mostly is on

upper campus, other in HSL

International students together

draw map of Health Sciences Center (bring in large sheets of paper & marker pens, just hand it to people in groups and ask them to draw a map, don’t explain what to put on it)

Participant ObservationHand in

Comments???

RAP developed in late 1970’s, early 1980’s out of dissatisfaction

with large scale questionnaire surveys which gave delayed and

questionable results

concern that RAP was an extractive process

History of PRA1980’s, group working in rural India

developed methods by which community members could express complex information about their homes, environment, work & lives

results obtained were faster & cheaper than previous methods, & had greater range of information & greater accuracy

Definition of PRA“organized common sense”

a family of approaches and methods to enable rural people to share, enhance and analyze their knowledge of life and conditions to plan and to act

defined as “semi-structured process of learning from, with an by rural people about rural conditions”

Resource for reading/manualFreudenberger, K. S. (1999). Rapid Rural Appraisal

(RRA) and Participatory Rural Appraisal (PRA): A Manual for CRS Field Workers and Partners. Baltimore, Catholic Relief Services.

http://www.catholicrelief.org/what_we_do_overseas/RRA_Manual.pdf

http://www.catholicrelief.org/what_we_do_overseas/RRA_Case_Studies.pd

Readings on reserve in library on health applications

Principles of PRAlearning rapidly & progressively with: flexible use of

methods,

improvisation

iteration,

not following blue printed program, but adapting in learning process

offsetting biases of rural development tourism,

not rushing, but relaxingbiases include:

– spatial, – project, – person, – seasonal, (Nepal 1995 eval. not during monsoon)– professional, – diplomatic, etc.

learning from and with rural people, directly, face-to-face

development workers to act as: facilitators,

rather than dictators about community needs

triangulating

optimizing (don't try to find out everything- Benjamin's law)

link information with – decision making,

– decentralized local planning,

– allowing those who manage programs to collect the information

critical self-awareness, reflecting on what is seen & not seen,

Components of PRA “use your own best judgment at

all times” is one sentence manual

orientation from verbal to Visual

Contrasts bebal and visual modes (Chambers 92, Pg 43)Verbal(interview, conversation)

Visual(diagram)

Outsider's roles investigatorq initiator and catalystOutsider's mode probing facilitatingOutsider's interventions continuous and maintained initial, then reducedInsider's roles respond presenter and analystInsider's mode reactive creativeInsider's awareness of outsider high lowEye contact high lowThe medium and material are those of the outsider insiderThe poorer, weaker, and women can be marginalized empoweredDetail influenced by etic categories emic perceptionsInformation flow sequential cumulativeAccessibility of information to others low and transient high and sem-permanentInitiative for checking lies with outsider insiderUnity for spatial, temporal and causal information,relations, analysis , planning and monitoring

low high

Ownership of information appropriated by outsider owned and shared by insider

Methods: VISUAL SHARINGmapping

transects & group walks

workshops & brainstorming

diagrams

rapid report writing in the field (& feeding back)

View video of Indian PRA

health mapping: models of

– houses, – wells, – hand pumps, – temples

arranged by villagers in correct positions could color code houses for various factors

(non-literates, infants, pregnant mothers, cattle ownership)

code can be for targeting activities can serve as monitoring vehicle as well

MARK ON: Peoplecensus-type information:

– men, women, children, age cohorts

(Key) informantsHealth specialistsSocial groups (ethnic, caste, clan, etc.)Household characteristicsHandicappedSick (by types of illness)pregnant women & month of pregnancy (one seed per month)

alcoholic husbands

widows

Users/Non-Users e.g.– children who do (not)

go to school– women who do (not)

go to the clinic

child marriage

deaths, by category

malnourished children

Social/Utilization | Natural Resourcesdowryownership of assetswealth/well-being statusmarriage from outside village who uses health services, where they liveimmunization status of childrenFP statuswho receives assistanceparticipants in program, those targeted

community natural resources

land use

Facilities | Hazards community facilities-schools, temples, churches

clinics, health posts

medical shops

water supplies

street lighting

communications (roads, paths, etc.)

pollution

zones of defecation

places where mosquitoes breed

drains

no go and problem urban areas

ghetto areas

street lighting

road-racing problems

Seasonal Analysis festivals, seasons, intervals

months represented by 12 stones

# of seeds or length of sticks as a HISTOGRAM

summer 1995 Nuwakot scheduled immunizations, no one came because were in high pastures with animals

crop/harvest

labor/time availability

food availability

illness by type & prevalence

gender perceptions of disease-prone periods

water supply

fuel sources

access to facilities

stress, happiness

BODY MAP

Walking transects of village with farmers as guides

Transects useful for:

timing of interventions with respect to variations in – migration– festivals– how busy/free people are– monitoring by them & by us– health workers’ & communities’ monthly monitoring

of biggest problems

Venn chappati diagrammingLocal ideas on causality

Venn chappati diagramming

Example of Participatory Diagramming of women's HIV

risk in ZimbabweKesby: Soc Sci Med (50) 2000

1723-41

Fig. 1. `Free flow' diagram of women's risk of HIV infection: Chiweshe group (quite farming township) Kesby 2000

Fig. 2. `Free flow' diagram of women's risk of HIV infection: Birchenough Bridge(busy service center on tarmac road) group. Kesby 2000

Fig. 5. `Closed scored' `tree diagram' of strategies to influence husbands sexual behaviour: Birchenough Bridge.Kesby 2000

Matrix Ranking and Scoring:types of illness vs access & utilization

scoring characteristics of health providers

scoring characteristics/effectiveness of types of treatment by types of illness

characteristics of diseases

food availability/food use: what is there vs what is used

health/nutrition problems

food preferences and characteristics

Matrix Ranking and Scoring:sources of credit & characteristics

sources of income & characteristics

reasons for needing credit (illness, funeral, hunger etc.) vs choices of sources (husband, sister, moneylender etc.)

areas according to health/disease status

patterns of health service usage

patterns of service supply/drug availability

vulnerability/debility (linked to income, food supply etc.)

World Neighbors PRA Vol 24 # 1E

Matrix scoring useful foranalytical process, including values placed on non-

tangible as well as physical items

people’s own analysis, sharing knowledge, etc.

people identifying & expressing priorities, and options for action

targeting and allocation of resources

Ranking of wealth and well beinguse slips of paper, one for each household,

– place in piles according to wealth or poverty,

– or well-being or ill-being, (depending on local criteria)

ask why each household is in the worst-off pile

determine criteria used by villagers to rank people there

useful for– targeting

– sampling

– research comparing different groups

– correlations between sickness & SE status

– identifying focus groups by wealth/wellbeing/health

Poorest of the poor Nuwakot 1995

Family genogram

Triangulation done by villagers themselves:

Discoveries of PRAvillagers knowledge & capabilities

– villagers have greater capacity to map, model, quantify and estimate, rank, score and diagram than outsiders have generally supposed them capable of

relaxed rapport established early in the process

traditional ethnographer feels this takes a long time

participatory diagramming and visual sharing is popular and powerful

Discoveries of PRAsequences are powerful and popular

several maps can be drawn, each more detailed

social maps can generate household listings, indicating many characteristics

transects can lead to identifying problems & opportunities…

Accuracy of information obtained is very high– high correlation with 'scientific' information

Training and orientation for some outsiders need not be long before they can

go off and practice

1 hour to a week is the range

Students in this class now know all they need to to do this

ReversalsOf modes

– from closed to open– from individual to

group– from verbal to visual– from counting to

comparing

Of Dominance– from extracting to

empowering

Advantagesfast and inexpensive

information it provides tends to be highly accurate– local people’s knowledge of local conditions is

greater than assumed, as is their capacity to map, model, estimate, rank, diagram and plan

– participatory approaches allow local people to discuss and cross-check each other’s knowledge on the spot

Advantagesplans drawn up in participatory manner by lower

people more likely to work than plans drawn up by outsiders

empowers local people, helps local people understand their problems and opportunities

Cautionsconcern that PRA will spread & be adopted too fast,

without changes in outsider’s attitudes & behavior, be discredited because of bad outcomes

PRA entails something of a revolution for– government, – bilateral – multilateral organizations– NGO's PVO's

PRA: Answer for decreasing poverty?

Based on your experience?

PRA: Answer for decreasing poverty?

Practitioners and participants:– Ritualistic processes that are manipulative or

harmful?

Participation as Tyranny?: – Tyranny: illegitimate or unjust use of POWER– (Cooke, B. and U. Kothari, Eds. (2001).

Participation: the new tyranny? London, Zed Books.)

Cautionsdominant medical value systems, with taught

knowledge of medical school, points away from rural life

INDOCTRINATION

Some Consider: indigenous technical knowledge is

– usually considered weaker in health – than in agriculture,

external scientific knowledge is said to be relatively stronger in health than agriculture

Schema of application

If you come here to help me then you are wasting your time, ... but if you come here because your liberation is bound up in mine, then let us begin

Lily Walkers, Australian Aboriginal Leader

For routine use in every villageClients’ perceptions of health/nutrition situation

Village mapping– identify clients for service delivery & education– target non-users of services– target high risk individuals or groups

Qualitative feedback on program performance

Verbal autopsies

Using PRA for program monitoring & management

Adjust local health care priorities

monitor service performance

Using PRA to facilitate research & development

e.g. gain villagers perspective on why obstetrical emergencies are referred too late

Resources• International Institute for Environment & Development

(IIED)• 3 Endsleigh Street• London, WC1H ODD• England• Phone 44-071 388 2117, Fax 44-071 388-2826• www.iied.org search Research Centre for Participatory

Learning and Action• www.oneworld.org/iied/resource/ • PUBLICATIONS MOSTLY HARD COPY TO DATE• www.parnet.org (much smaller)

History of Participatory Research Methods

BEHAVIOR

ATTITUDES

SHARINGMETHODS

• hand over the stick •"they can do it" •"use your own best judgement at all times" •sit down, listen, learn, respect •unlearn

•relax •embrace error

•vilagers share their knowledge •all share experiences •outsiders share their camps (invite, welcome others)

"THEY" • interview • map • model • rank • score • analyse • diagram • present • plan

PRINCIPLE COMPONENTS OF PRA

Participatory Rural Appraisal Focus

RRA is extractive (will talk about May 18),

PRA shifts presentation & analysis of information to “them” rather than “us”

good PRA implies radical personal and institutional change

Corrects two common errors

roles of teacher & learner are reversed, ‘“they” teach “us”– rural people own more of the process & output– appraisal & learning are not

• just by us from them, • but with them and by them

Corrects two common errorsrapport with villagers is primary

– requires reorientation & relaxation of outsiders & critical self-awareness

– ignorance of rural people a self-sustaining myth

Activist approachpoor people are creative and capable,

– can and should do much of their own investigation, analysis and planning

outsiders have a role as conveners, catalysts and facilitators

weak should be empowered

Need appropriate attitudes, demeanor & behavior

participation by outsider

respect for rural people

interest in what they know, say and show

patience, wandering around, not rushing & not interrupting

humility

materials and methods which empower villagers to express, share, enhance, and analyze their knowledge

Applications of PRA

General Principle

Listening

Clarification

Agreeing Interpretation

Feedback

Participatory mapping methods

health mapping

villagers use seeds, tikas, stones or other markers to indicate households with pregnant women, handicapped, malnourished children, widows, relative wealth and poverty– determine households, individuals at risk

health mappingmen tend to take over, so let them make

their own maps

body mapping

to explore people’s perceptions of a range of bodily processes and the effects of medical interventions in the body

Participatory Research MethodsLearning Objectives

carry out a social mapping exercise as a class

describe the history of participatory research methods

relate the principles of participatory rural appraisal in third world development work

Utilizationwho uses health services, where they live

immunization status of children

FP status

who receives assistance

participants in program, those targeted

Useful forestablishing rapport

starting point of entry with community

part of analytical process of better understanding the health/nutrition situation

demographic-census, hh survey, baseline

Useful foridentifying vulnerable groups

identifying health risk factors according to wealth/wellbeing/health

monitoring by community, graphical representation of changes in health/nutrition over time

Seasonal Diagramming: Useful for

awareness and planning, – esp. CHW, & health initiatives in relation to disease

trends, times of stress, etc.

Seasonal Diagramming Useful for:

timing of interventions with respect to variations in – water supply– disease– type & availability of food– income

Time lines & trendschanges in the composition of diets

Sequence Matricessequence of going for consultation & treatment

sequence of a disease with characteristics and treatments

Useful for– agency for discussion, participatory definition of

needs & services– learning how services can be improved

tracing sequence of disease & action taken at each stage

causal diagram-impact of a cash crop

food chain

what happened after immunization

sequence of weaning practices in relation to seasonality and food availability

Useful foranalysis of processes, sequences of action, causes,

choices & potential effects

planning sequences of shorter and longer-term actions

“what if” analysis before and after, understanding what has happened and what might happen

evaluation

Food charthistogram what currently consuming, etc.

Causal and flow diagramming

From Reserve to Rapport, from Tedium to fun

sharing in the culture and spread of PRA is important

Difficulties faced using PRA in women’s health efforts in India

barrier of participation, for centuries women contributed their labor, not their conscious thoughts, women see themselves as passive recipients of handed-down knowledge

devising suitable methods, need to be flexible

Food Pile SortsUnhealthy - salty (chips, pretzels...)Unhealthy - sweet (chocolate, cookies)Fruits (Apples, bananas, fruits)Unhealthy with a p (popcorn and pretzels)Unhealthy with a c (cookies and chocolate and chips)Healthy (fruits, nuts, apples, bananas, yogurt)Unhealthy (chocolate, pretzels, popcorn, cookies, chip)High fat (chocolate, nuts, chips?)Low fat (yogurt, pretzels)No fat (apples, bananas, fruits)Coffee was ALWAYS sorted independently.