Community Conversations: An Innovative Approach to Engaging Communities in Healthcare

By Andiensa Clotilda (CAGEAD) and Okwen P Mbah, Effective basic Services (eBASE Africa)

Identifying and handling health issues in Cameroon have remained very complex and challenging. An interplay of culture, behavior, and lack of knowledge has made health issues to either have a stigma, taboo or traditional belief associated with it. This has affected demand for orthodox healthcare by community members and more so in villages, rural and peri-urban areas.

Identifying real health issues plaguing a community is a fundamental step for everyone who intends to carry out interventions in a community. This requires relevant and context-based communication between well-informed decision makers, community leaders, service providers and community members. This communication must be mutual, it must be able to make community members develop a vision, identify a leader and communicate with established authorities. Unfortunately, this does not always happen and as such real community issues, especially in terms of health and other basic services, are usually not identified and so not properly handled. This is why diseases and other related issues still plague most of our communities. Health issues like menstruation, abortions, family planning, HIV/AIDS, epilepsy, diabetes, maternal and child mortality, sickle cell etc are hardly discussed among community members. As such these issues are usually not adequately handled and access to health services is equally very limited.

The Center for Advocacy in Gender Equality and Action for Development –CAGEAD and eBASE Africa have in the last 12 months piloted an innovative approach in community dialogue titled “COMMUNITY CONVERSATIONS” in 14 villages in Boyo division in the north-west region of Cameroon.

Using a theory of change, the project brought together in every village 20 - 30 participants who were selected in an inclusive approach. These provided an opportunity to hold a frank conversation on issues affecting their health and to also propose how they would like them to be addressed. In some instances, we had only women and in some mixed i.e. both men and women. During these meetings, we collected their views on just every health issue they wanted to talk about. The figure below demonstrates how community conversations could change community perceptions and mitigate stigma towards PLWHIV.

Sometimes it is necessary to have separate conversations with women before bringing in the men. This facilitates women to build confidence on issues relevant to women. In our experience, women had difficulties discussing family planning issues in the presence of men. This was so because men will not want their wives to use family planning meanwhile the women wanted to control their births. The reasons for this difference were quite complicated, especially as men believed that family planning causes promiscuity.

Some women were so excited with the meetings that they confessed it was their first time of having a real conversation on issues affecting their health. Most men also confessed that were it not for such meetings they would never understand what their women go through in terms of the health risk as they hitherto associated most of the women’s health issues to witchcraft or taboos.

CAGEAD and EBASE intend to continue these discussions with other communities in Cameroon.