a globalization vaccine by uthaiwan kanchanakamol

A Vaccine for Globalization:

Through People-Led Health Promotion and Community Development

2004

Produced by:

Uthaiwan Kanchanakamol, Director of The Institute for Community Empowerment, Thailand

and

The Chiang Mai Health Promotion Network • Ban Mae Faek Mai • Ban Mae Huk • Ban Mae Jong • Ban Nong Wai (Muay Thai) • Ban Saluang • Ban San Pa Bao • Ban Sri Boon Ruang • Karen Hilltribes in Ban Mae Jaem • Karen Hilltribes in Ban Mae Pakee • Lahu Hilltribes in Pha Hom Pok Mountain • Society of Lanna Healers

Research and Editorial Assistance provided by:

Jennifer A. Meyer and Timothy A. Struna

A Vaccine for Globalization

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A Vaccine for Globalization: Through People-Led Health Promotion and Community Development ICE and the CBO’s hope that by documenting and sharing their experiences future public health and community development initiatives can build on their achievements and learn from their struggles.

2004

Produced by:

Uthaiwan Kanchanakamol, Director of the Institute for Community Empowerment, Thailand

And

The Chiang Mai Health Promotion Network • Ban Mae Faek Mai • Ban Mae Hak • Ban Mae Jong • Ban Nong Wai (Muay Thai) • Ban Saloang • Ban San Pa Bao • Ban Sri Boon Ruang • Karen Hilltribes in Ban Mae Jaem • Karen Hilltribes in Ban Mae Pakee • Lahu Hilltribes in Pha Hom Pok Mountain • Society of Lanna Healers

Research and Editorial Assistance provided by:

Jennifer A. Meyer and Timothy A. Struna


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Preface and Acknowledgments ince June 2001, the Chiang Mai area, Thailand, had been selected for a pilot project in which health-care was decentralized to local governments and S

community groups. Local area health-care was planned and programs implemented under the authority of provincial health boards consisting of representatives from local government, the communities themselves and the Ministry of Health. There was an urgent need to prepare the communities and their representatives to effectively participate in that new system. The participatory research project had been initiated in the year 2001, entitled” Challenges of health in a borderless world” under the support of Fulbright New Century Scholar program throughout the 2001-2002 grant years.

Within the broad range of research project, the critical aspect had been focused on increasing community capacity and empowering community members to improve the health and well-being of Chiang Mai hill tribes and low-income groups in three Thai districts. The proposed research was participatory action in nature, aiming: to determine how to improve implementation and effectiveness in promoting the integral development of youth, seniors and women in Hill tribes and low income communities while increasing community cohesion and collaboration through cultural, political, social and artistic activities; to determine how to improve implementation and effectiveness in promoting development of skills among sub-district administration / organization and municipality personnel in the area of community development; to determine how to improve implementation and effectiveness in promoting creation of community partnerships by local actors for health promotion. This involves providing incentives, skills and strategies to community members to enable their effective participation in designing and implementing new autonomous health care and social service systems that meet local needs. This was especially crucial for disadvantaged groups like the Chiang Mai Hill-Tribes and other low-income communities. Specifically, it was proposed that proven, effective participatory action techniques are utilized to educate, empowers, and involves members of these communities. These include training in the use of focus groups, Delphi methods, consensus development through negotiation/compromise techniques, participatory planning, needs assessment methods (with emphasis on "asset-based" methods developed by McKnight and Kretzman) and basic program participatory evaluation techniques. In addition, community organizations such as community hospitals, NGOs, local governmental groups were enlisted as collaborators in this learning process. Their involvement had the additional advantages of identifying issues early-on for discussion and resolution, enabling coalition-building and increasing trust between the three partner groups. In the year 2002-2003, the Thai Health Promotion Foundation provided funding for the strengthening Chiang Mai community health promotion network and monitoring and support for its project. The aim was to buildup a network of partners within an atmosphere of working cooperation characterized by solidarity. It was believed that this is partially attributable to the culture and traditions of Thai society, which are favorable toward working to build up health, together with the fact that the state is interested in

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health. Our participation in this study has led to an increased awareness of the dark side of globalization and the need to prepare the community people for building a community and social vaccine for combating those negative consequences. We believe that the social vaccine concept will help bring a multiplicity of perspectives and approaches to global health challenges and might be helpful to the south in setting priorities for defining the global health agenda in the future. Many people helped and encouraged us as we worked on this project. First we would like to thank all the community leaders, the brave and strong marginalized people who led health promotion and community development path by using asset-based, internally focused, relationship driven, including Mr. Intorn Kao-prated, Mr.Tanagorn Phomnuchanon,Mr.Preeda Thakrow, Ms.Phongpan Sakwongdaroon, Mr.Arnan Leraman, Mr.Adul Srisawat, Mr.Aphichart Chawwiang, Ms.Kommoon Intasit, Mr. Pa-ae Jalawpa, Mr. Pherapong Pattanaplaiwan, Ms.Prapai Armornsak, Mr. Phrommin Boacheanbaan, Ms.Sawart Jantalae, Mr. Sonthichai Somkate, Mr.Wasan Wiwatcharearn, Ms.Fongjan Wan-on, Ms.Narisa Pongsopa, Mr.Boonchoo Chantarabutr, Mr.Comchan Wichairat, Ms.Boonsri Chom-ngern, Mr.Boonmee Sangnoon, Mr. Decha Chotsooksiangwiwek, Ms.Boosaya Kunagornswat.Pra Pongtep Techakarugo We would like to provide special recognition to all the state and local public health leaders who have assisted us, including Dr. Amorn Nonthasute, ex-General Director, Thai Ministry of Health, Mr. Teerapan Techa, Ms. Nit Kao Sa-ad, Mr.Terdsak Seur-im. Within the academic community, we have many outstanding colleagues who have contributed to our work in a variety of ways. They include the 30 Fulbright New Century Scholars from all over the world especially Dr.Ilona Kickbusch from Yale University, the distinguished scholar leader, Assistant Professor Dr. Sasitorn Chaiprasit, Associate professor Dr.Songwut Toungratanapan, Assistant professor Vichai Wiwatkunuprakarn, from Chiang Mai University, Professor Dr.J.M.Navia and Professor Dr.David Coombs from University of Alabama at Birmingham. Finally, we would like to express our sincere gratitude to the Council for International Exchange of Scholars (CIES), The Fulbright New Century Scholar Program (NCS), Thai Health Promotion Foundation and colleagues, especially, Ms. Sirinapa Sathapornwachana whose tireless patient contributed this project, Mr.Chaiwa Sitkongtang, Ms. Jennifer A. Meyer and Mr. Timothy A. S. Struna who provided the fruitful research and editorial assistance.

Uthaiwan Kanchanakamol DDS, CDPH, MPH

Fulbright New Century Scholar 2001-02

Director, Institute of Community Empowerment (ICE), Chiang Mai, Thailand

Chiang Mai Health Promotion Coordinator 2002-03, Thai Health Promotion Foundation


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Abstract

In October 2001, the Institute for Community Empowerment (ICE) launched a Participatory Action Research (PAR) project. ICE used participatory techniques and Assets-Based Community Development (ABCD) strategies, for increasing community capacity and empowering community members to actively engage in a newly formed decentralized health care system. ABCD has been recognized by health and community development professionals as a valuable alternative to the traditional needs-based/deficiency-focused approach for health programming and community development. However, community members’ perspectives on ABCD are under investigated, and methods for evaluating the impacts of ABCD are only beginning to be addressed and analyzed. The purpose of this case study was two fold; first to build a more holistic understanding of ABCD programming by exploring community representatives’ perspectives on their own ABCD programs. And second to describe how 11 Community Based Organization’s (CBO’s) developed a method to identify and evaluate social changes within their communities by asking the question; “if the ABCD approach claims to lead to community empowerment and self-determination, as written in the ICE program ‘Increasing Community Capacity for Health Promotion and Well Being Project’ how can the participating CBO’s measure these potential changes in their communities?” Information for this case study was gathered over a four month period, December 2003 through March 2004, under the direction of ICE. The methods used to gather information were primarily qualitative including; document review, direct observation and participant observation. Community representatives described their experiences through a series of site visits, natural focus group discussions and semi-structured interviews. The results from this qualitative investigation indicate that the CBO’s in this case study expanded the standard process of building on ‘strengths’ (local assets, skills, local resources etc.), to also include cultural traditions (local music, dance and traditional healing methods). These cultural traditions go beyond traditional dance, health methods, and music to encompass a shared ‘way of thinking,’ living and viewing the world. It is here in the conservation of indigenous ways of thinking or being that we see the link to both health (physical, mental) and the environment (physical or social community development). Community members mentioned frequently one of their frustrations with health and community development programs in the past was they were limited to a specific age group, disease group, or gender. By mobilizing communities around shared traditional culture, in contrast to the standard approach of mobilizing around a specific problem or disease, more community members from all age groups came together for health promotion activities. Also, centering programs on their traditional/cultural ways of life was consistent with how individual community members identified themselves, thus


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reinforcing their collective identity and self-esteem. Additionally, when CBO’s reached out to local and external resources for partnership or support they did so with compelling concepts in hand, thus leveling the playing field, or power structure. To explore the second question, 11 CBO’s developed an evaluation method, based on the concepts of participation and empowerment, to translate what they ‘see happening’ in their community into ‘measurable variables and indicators’ of outcomes and impacts. The evaluation method was developed during a series of workshops facilitated by the director of ICE and attended by CBO representatives. Their 9-step method consisted of identifying, clustering, categorizing, prioritizing, rating and reflecting on ‘changes’ that had taken place within their community since they began their health promotion and community development activities. The evaluation was implemented in 11 different communities during a community meeting facilitated by the director of ICE and 1-2 CBO representatives. The evaluation provided quantitative information by using a number scale from 1 - 7 to rate each identified change, and qualitative information by including community member comments related to each rating. The results of the 9 - step evaluation will be used by the CBO’s to supplement quantitative reports submitted to funders to show evidence of the broad social changes taking place in their communities. Secondly, the stories shared by community members to define each significant change will be used to assist in the design and implementation of future health promotion programs. Thirdly, the 9 - step method developed by the CBO’s during workshops will be incorporated into a facilitator guide produced by ICE to assist in conducting future workshops and evaluations. This case study concludes there is evidence from the perspective of community representatives that supports the utility of an ABCD strategy for community development and health promotion. This observation also reflected the main themes revealed through qualitative data analysis (community pride, traditional culture, freedom, community dialogue, and community power). In addition, the self-identification and definition of community changes; unity, local wisdom, warmth, etc., elicited through the facilitation of community dialogue during each evaluation, reinforces the theory and adds to the conclusion that when community members develop and evaluate their own health promotion initiatives there is a stronger chance for sustainable community growth, motivation for future health promotion efforts, and the creation of self-sustaining capacity building initiatives. The director of ICE, Dr. Uthaiwan Kanchanakamol commented on these phenomena and explained that by practicing health promotion and community development through the conservation of indigenous knowledge and traditions the CBO’s are effectively creating a ‘vaccine against the ill-effects of globalization.’


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TABLE OF CONTENTS Preface and Acknowledgments 2 Abstract 5 Table of Contents 8 List of Figures 9 List of Tables 10 Glossary 11 Chapter I: Introduction 12 Thailand 13 Chiang Mai 14 ICE, Thai Health, and the Network 14 Purpose of Study 19 Chapter II: Literature Review 21 Community 22 Participation 22 Empowerment 23 ABCD 24 Appreciative Inquiry 26 Educational Pedagogy 27 Participatory Evaluation 27 Empowerment Evaluation 29 Chapter III: Community Perspectives 32 Chapter IV: Evaluating Social Change 55 Chapter V: Limitations 89 Chapter VI: Conclusions and Recommendations 92 References 96 Additional Resources 100 Appendix A: ICE Proposal 108 Appendix B: Overview of Project Operations 116 Appendix C: Example of Semi-Structured Interview 123 Appendix D: ICE User-guide 125 Appendix E: CBO Quantitative Evaluation Results 146 Appendix F: Time-Line 156


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LIST OF FIGURES Figure Number Page 1. Mae Chaem Rehabilitation and Development of Herbal Medicine Group 73 Variables of Community Change – Star Plot 2. Mae Chaem Rehabilitation and Development of Herbal Medicine Group 76 Indicators of Coordination – Star Plot 3. Frequency Graph 85 Summary of all identified ‘variables’


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LIST OF TABLES Table Number Page 1. Results of Step 1 – Step 5 65 2. Results of Step 6 69 3. Results of Step 7 70 4. Results of Step 8: Variables of Community Change and Central Tendencies 73 5. Cooperation Breakdown 74 6. Indicators of Cooperation 75 7. Mae Chaem Rehabilitation and Development of Herbal Medicine Group 76 Indicators of Coordination – Central Tendencies 8. Pile Sort 1 78 Summary of all identified ‘variables’ 9. Pile Sort 2 79 Summary of all identified ‘variables’ 10. Table of ‘Sorted Variables’ 81 11. Types of Community Development Approaches 102 12. Qualitative Inquiry Activities 103 13. Themes and Illustrations 104


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GLOSSARY ABCD: Assets Based Community Development AI: Appreciative Inquiry CBO: Community Based Organization DDP: Department of Drug Prevention GO: Government Organization ICE: Institute for Community Empowerment NFG: Natural Focus Group NGO: Non-Government Organization PAR: Participatory Action Research PHC: Primary Health Care PRA: Participatory Rural Appraisal SAO: Sub-District Administration Organization SBD: Strength Based Development ThaiHealth: The Thai Health Promotion Foundation UNAIDS: Joint United Nations Program on HIV/AIDS UNICEF: United Nations Children’s Fund WHO/SEARO: World Health Organization South East Asian Regional Office


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Chapter I: Introduction

Thai government is a constitutional monarchy, and the country has

ude a 92+% literacy rate for both men and women, with free

ompul

ently

health care system is based on the Western bio-medical model.

Also officially recognized is the Aruvedic based Thai Medicine, ‘MorPatPhanThai,’ and

Thailand

The

progressively moved towards democracy over the last thirty years. About 18% of the 62

million people in Thailand live in urban centers. Approximately 85% share a dialect of

Thai, in addition to 8% speaking Thai-Lao, found in the Northeast, and another 8%

speaking Northern Thai, commonly referred to as Lanna. Thai-Lao and Lanna share

some similarities linguistically, and in written form. The predominant religion is

Theravada Buddhism, practiced by almost 95% of the population. The majority of

Muslim’s live in the southern region and make up the next largest religious group at 3%,

followed by Christians (1).

Health statistics incl

c sory education up to grade six. Thailand is well recognized for a dramatic

reduction in their population growth from 3.1% in 1960 to about 1% today (1). At the

end of 2001, UNAIDS estimated that 1.8% of the adult population are living with

HIV/AIDS. This is one of the highest prevalence rates outside sub-Saharan Africa.

Thailand’s current health system offers universal health care through a rec

initiated policy known as the ‘30 baht program.’ Under this program, individuals can

receive any service at the local public hospital or health station for a 30 baht fee

(approximately 75 cents) (2). There is a specific list of drugs and services covered by

this program. Private medical care is also available in the provincial capitals. According

to Dr. Prawase Wasi (2000), a health care reform activist, Thailand has a sound health

care infrastructure. However, he calls for a change in the ‘ill-health orientation’ of the

disease control and prevention system to incorporate ‘good-health oriented’ systems of

health promotion as well as continued health care reforms based on improved national

health care research (3).

The government


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Lanna or Northern Traditional Healing based on the holistic concept of “enhancing happy

living through the spirit, the body, the community and the environment” (4). In the

North, traditional healers are referred to as ‘MorMuang,’ and practice at the community

level. Hill tribe groups also have local healers whose practices range from Shamanism to

herbalism and massage.

Chiang Mai

Chiang Mai, known commonly as “The Rose of the North,” is located 700 Km

kok. Northern Thailand shares borders with Burma to the west and Laos to

d in the mountains of the northern region and along western borders.

The Institute for Community Empowerment (ICE) is a Non-Government

r. Uthaiwan Kanchanakamol. The organization

omot

north of Bang

the east. The city of Chiang Mai is over 700 years old and was ruled by the Burmese until

1775. The provincial population is estimated at 1.6 million people, of which 160,000 live

in the capital (1).

For over two hundred years, semi-nomadic ethnic minority groups referred to as

hilltribes have live

Currently, their combined population includes approximately 550,000 people. The Tribal

Research Institute in Chiang Mai officially recognize 10 different hilltribes however,

there may be as many as 20 (1). In terms of linguistic groupings among hilltribes, the

most common are; Tibeto-Burman (Lisu, Lahu, Akha), Karenic (they refer to themselves

as ‘Ba-Kur-Yoa’, or Garieng) and the Austro-Thai-Chinese (Hmong, Mien). The Karen

are the largest group numbering around 322,000. In these high remote areas most people

practice subsistence farming, while a small percentage engage in ‘for profit’ agriculture

and recently, tourism. The predominant religions tend to be animist or ancestral worship,

unless influenced by missionaries or Buddhism (1).

ICE, ThaiHealth, and the Network

Organization (NGO) directed by D

pr es and practices health promotion through the concepts of Assets-Based

Community Development (ABCD). Their purpose is to facilitate the internal processes

of capacity building and empowerment among local communities through teaching the


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skills necessary to conceptualize, plan, implement, and evaluate health promotion and

community development programs. ICE works with 22 Community Based Organizations

(CBO’s) from three districts in the Chiang Mai province of Thailand. The 22 CBO’s are

located in city, suburban, and hill tribe areas all defined as low income or ‘marginalized’

communities.

In June of 2001, Chiang Mai and fifteen other provinces were selected as pilot

sites in which health care service decision making was decentralized to the local

E proposed

board development. However, ICE continued its work building partnerships

provincial government and community groups. Decisions were to be implemented under

the authority of newly created boards consisting of members from local government,

representatives from CBO’s, and Ministry of Health officials. This national initiative

recognized the need for not only the participation of health service professionals and

local government officials, but the popular sector as well (see Appendix A).

In order to prepare local communities, especially members of marginalized

groups and women, with the skills necessary to act within this new system, IC

a Participatory Action Research (PAR) Program entitled “Increasing Community

Capacity and Empowering Community Members to Improve the Health and Well- Being

of Chiang Mai Hill Tribes and Low-income Groups in Three Thai Districts” (see

Appendix A). The ICE staff includes a director and two assistants. Most of their

operations, including a community radio station focused on health promotion and

community empowerment, are operated by volunteers. ICE’s founder and director was

influenced by years of professional academic public health experience, environmental

activism, as well as fieldwork among marginalized communities. The central themes of

ABCD, or Strength Based Development (SBD), are present in the operations at ICE,

while conceptual frameworks of the approach have been adjusted to fit the Northern Thai

context.

Unfortunately, a number of factors combined to breakdown the proposed

Provincial

with CBO groups and assisting them in applying for health promotion program funding.

ICE continues to concentrate its energies on working with 22 local CBO’s assisting them

in moving through a relationship driven dialogue oriented process, in order to propose,


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conduct and evaluate their own community based health promotion and development

projects. (see Appendix B)

ICE was recognized by the Thai Health Promotion Foundation as a center for

teaching community capacity building techniques, with a focus on health promotion and

mmu

ds harmful products, resource depletion,

s

co nity development. The Thai Health Promotion Foundation, or ThaiHealth, was

established in 2001 as a state agency. This agency was created as part of the national

health care decentralization initiative to manage and distribute ‘sin tax’ money collected

from the two percent taxation of cigarettes and alcohol. ThaiHealth was set up to

encourage, support and fund health promotion activities for public health within the

concept: “All Thai People will have a better life and can earn their living with well-

being. This development will proceed through by the collaboration of all key factors and

a unified intension. Through this concept Thai people can live well and be happy by

relying on themselves.” (5). Operating dimensions emphasize healthy public policies,

issue-based programs, and holistic ‘setting’ approaches. According to the ThaiHealth

website, “Most of Thai people’s health problems and deaths result from their personal

misbehavior, misbeliefs and other preventable causes such as smoking, drinking alcohol

or traffic accidents.” They continue, “The World Health Organization (WHO) has

defined the aim of public health not only to eliminate diseases from human life, but also

to build up well–being for balancing the physical, spiritual and social health. Moreover,

the WHO has declared health promotion strategies through the Ottawa Charter, and

Thailand has responded by pushing the substantial movements for well–being of Thai

people. Thai Health provides catalytic funding for projects that change public values,

people’s lifestyles, and social environments” (6). The Ottawa Charter for Health

Promotion called for renewed commitment;

1. for the development of healthy public policy, and equity advocacy in all sectors.

2. to counteract the pressures towar

unhealthy living conditions, and environments, and poor nutrition; and to focu

attention on public health issues such as pollution, occupational hazards, housing

and settlements.


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3.

th produced by the rules and practices of these societies.

through

5.

and most importantly with

6.

(Ot

e and interested in funding

cal groups directly, bypassing the non-government organizations. Thus, it was

porta

otion and Well Being

to respond to the health gap within and between societies, and to tackle the

inequities in heal

4. to acknowledge people as the main health resource and find ways to support and

enable them to keep themselves, their families and friends healthy

financial and other means, and to accept the community as the essential voice in

matters of its health, living conditions and well-being.

to reorient health services and their resources towards the promotion of health;

and to share power with other sectors, other disciplines

people themselves.

to recognize health and its maintenance as a major social investment and

challenge.

tawa Charter link can be found at the ThaiHealth website)

The founding board of ThaiHealth was very progressiv

lo

im nt that these CBO’s learn to speak the language of the funder (and vice versa),

striving to bridge this standard communication disconnect. ICE receives only travel

reimbursement monies for their work from ThaiHealth, and all program operation

finances are transferred and managed directly by CBO’s. This decentralized approach

intended to give community groups the control to develop their own health promotion

programs, and to seek out the assistance of NGO’s or Government Organizations (GO’s)

to partner with, if appropriate. Prior to this paradigm shift, communities were dependent

on these NGO’s and GO’s to meet the needs of their community.

Recognizing the fundamental changes of this approach, ThaiHealth supported ICE

and its program, ‘Increasing Community Capacity for Health Prom

Program’. The goal of ICE’s project was to strengthen and empower communities to

meet this new challenge. ICE invited CBO members, considered to be ‘natural leaders’

of their respective communities, to attend workshops on how to conceptualize, plan and

implement local health promotion programs. There was no financial incentive for

attending the workshops; the only incentive was knowledge. The community analysis


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and program planning phases occurred over approximately nine months before the

CBO’s submitted proposals for funding and began implementation.

Each CBO is represented by a “natural leader,” sometimes more than one person,

and referred to throughout this document as a community representative(s). These

gs

unity level and

(Pe n

tatives met for monthly workshops at ICE

learn assets building processes and participatory action techniques. Some traveled up

leaders/representatives are not individuals who hold an official position in the community

necessarily, but they are the community members that seem to ‘get things done’. The

criteria ICE was seeking in a natural leader was someone who could;

• Facilitate group discussions

• Be a strong link between the community and resources

• Stimulate participation

• Catalyze and facilitate discussion

• Be at ease during trainin

• Comfortable working at the comm

• Effective in mediating conflict

rso al communication with ICE director)

Beginning in late 2001, CBO represen

to

to six hours one way to attend these sessions. During the first three months they learned

how to conduct assets mapping in their own communities. During the second three

month period they participated in future search conferences with local authorities from

their own communities in order to build participatory planning strategies. CBO

representatives learned about health promotion paradigms, advocacy, mediation

strategies, team building techniques, social action strategies, and communication for

social change. After workshops, these community representatives returned to their

community to facilitate a process with other community members in conceptualizing and

developing their own priorities, plans, methods, and budgets. During the second year

various health projects were implemented. Examples of some health initiatives include;

• Traditional exercise groups

• Family strengthening programs


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• Cultural conservation programs

and

ching, and promotion projects

tners formed the

ealth Promotion Network of Chiang Mai, and entered their second round of program

The aim of this report is to present examples of people-led heath promotion and

velopment programs, in a specific cultural context, using specific

problem as an under

evidence on the impacts of NGO

development projects and programs (7). The majority of evaluations focus on outputs

• AIDS/drug prevention programs

• Herbal medicine conservation, tea

During their second year, the CBO representatives and their par

H

proposals. The original participants of the workshops conducted in year one continue to

meet once a month to offer support, share their experiences and learn from each other.

Purpose of Study

local community de

strategies. Understanding the ABCD process, from the point of view of the community,

can provide insights into how applications in other settings might be coordinated,

supported, and directed toward improving the health of entire communities. By

describing one groups’ effort, the authors hope to shed light on how an ABCD approach

to health promotion programming is perceived by community representatives living,

learning and practicing the process in their own communities.

It is our perspective that the opinions of community representatives practicing

ABCD based programming are unheard. By framing the

investigated area, the results can act holistically by adding diversity to the dominance of

professional opinions about ABCD as an approach. The public health professional or

community development worker can benefit from the information presented by learning

more about how to support community based programs, and limit the difficulties

encountered for communities practicing ABCD. The other beneficiaries of this work

include ICE and the CBO’s, as the results obtained can assist in organizational and

program development, as well as lessons learned.

Despite the growing interest in evaluation, and the growing numbers of evaluation

studies, there is still a lack of firm and reliable


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achieved and not outcomes or broad scale impacts (7). Social, ecological, and cultural

dimensions of reality have been overlooked or undervalued systematically by

development professionals (8). Ideally, an evaluation includes an examination of the

micro and macro-conditions of social, economic, and political environments in order to

understand the constraints to development and identify possible actions to remove or

lessen these constraints (9).

The need to develop an evaluation method to explore these dimensions requires

an approach that respects the extreme cultural diversity of ideas and practices to be found

around the world. The challenge comes from acknowledging that culture will influence

g process’ many have concluded that based on its

O’s

ones view of the world; based on the metaphor that ‘culture is a pair of glasses through

which we see the world in a particular way – where the glasses are constructed of ones

ideas, values, rules, customs, knowledge, beliefs and laws’ – thus one must critically

question the utility of universal standards of acceptability, prefabricated variables and

indicators of outcomes and impacts.

Any development activity that seeks to improve the quality of life of marginalized

people is rooted in the process of moving from a state of dis-empowered to empowered.

In terms of evaluating this ‘empowerin

context specificity there is no universal model in which to measure this process (10).

ICE and 22 CBO’s located in Chiang Mai Thailand accepted the challenge of

developing a method to evaluate the potential outcomes and impacts of their ABCD

health promotion programs. This case study describes the efforts of ICE and the CB

in developing, implementing and reflecting on their evaluation method and results.


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Chapter II: Literature Review

There is an enormous amount of information available pertaining to development,

community health, empowerment, participat

study, and in order to understand the appro s are

defined and a short history of their use in the field of public/international health provided.

Community

The WHO defines community as: ‘a specific group of people, often living in a

defined geographical area, who share a common culture, values and norms, and are

arranged in a social structure according to relationships which the community has

developed over a period of time. Members of a community gain their personal and social

identity by sharing common beliefs, values and norms, which have been developed by the

community in the past and may be modified in the future. Community members exhibit

some awareness of their identity as a group, and share common needs and a commitment

to meeting them’ (11).

Participation

In regards to health, participation can be defined as a right and duty of people to

be involved in decisions about activities that affect their daily lives (12). The WHO and

the United Nations Children’s Fund (UNICEF) claim that participation enables even the

very poorest sections of the community to take part in improving the health services

available to them, and thereby create a precedent for their participation in wider

community activities (12). The WHO mentions that the level of community involvement

is an important indicator in attaining Health For All (13).

The WHO declared community participation as a people’s right and duty in 1978

with the Alma Ata conference and the introduction of Primary Health Care (PHC) (12).

Although the concept of community participation is universally accepted there appears to

be a wide variety of interpretations in term

ion, and evaluation. For the purpose of this

ach taken by these CBO’s - key term

s of its definition, practice, and evaluation


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(14). It seems the more one studies the concept of participation the more elusive it

becomes (15). However, st be defined as a multi-

imensional concept that takes on different meanings and significance in different

t

development initiatives has been an elusive priority in public

ealth for decades (19).

siveness of empowerment results from the countless factors of influence

isation or self-reflected critical

community participation might be

d

settings and circumstances (16).

Experience has shown that community participation in all phases of a project or

program – including evaluation – improves the quality, effectiveness, and is extremely

important for long-term sustainability of the particular development initiative (17, 18).

Empowermen

Empowerment can be broken down into processes and outcomes. Empowerment

is an enabling process through which individuals and or communities take control over

their lives and their environment in hopes of solving their own problems (19, 20). The

essences of development are dependent on these empowering processes (20). The

outcome of this process is empowered individuals and groups who live in an environment

that enables them to influence the path of their lives (19). Creating this environment that

frees individuals to learn, participate in, critically reflect on, and take action in

community health and

h

The elu

and their presence in several areas of development; including education, health, law,

science, government and economics (19). Additionally, ‘empowerment’ can mean

different things, at different times, to different people. It can occur at the individual,

community, and societal level. There are no fixed and final definitions of empowerment,

merely suggestions based on individual behaviors, community conditions and norms,

environmental changes, and long-term changes in population health (20). Most

importantly, problem-solving education, called conscient

awareness of ones social reality and ones ability to transform this reality by collective

action – must occur from within a person – it cannot be imposed from the outside (9).


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Development Approaches and ABCD

The type of program approach in public health, community and international

development have been passionately debated for decades. Methods for achieving various

2,

some exceptions, most development initiatives, have often increased the

he most vulnerable: The poor, the illiterate, the women, the children, and

e mar

uses of ill health (26). An alternative to this needs based

t,

ith needs that can only be met by outsiders.

visions of a better future range from those bound by romantic idealism, to those

pragmatically focused on hard economic realism. The past several decades of traditional

top-down and trickle down development programs, have yielded dismal results (21, 2

23). “Barring

vulnerability of t

th ginalized. Strident questions have been raised about development for whom, with

what purpose, through what means, and for what ends?” (24)

The dominant bio-medical approach has become systematized into local, national

and international development and public health initiatives. Often this approach refers to

the view that a community, or ‘target population,’ is lacking something, most of the time

it is ‘knowledge’ or ‘resources.’ Generally, this ‘deficiency’ orientation provides an easy

opportunity for ‘experts’ or professionals to confirm their authority, without much regard

for the practical experiences of that target group, and ignores the underlying socio-

economic and political ca

approach is the strength or assets based community development approach, which starts

with what is ‘present’ in a community (not absent), more specifically with the capacities

of its residents and builds on the natural associational base in a community (27).

An ABCD approach stands in contrast to the ‘deficiency-oriented’ approach based

on surveying ‘needs’ and ‘problems’ of communities, which often results in the building

of patron-client communities (27). “Public, private and nonprofit human service systems

often supported by university research and foundation funding, translate the programs

into local activities that teach people the nature and extent of their problems, and the

value of services as the answer to their problems” (27). In some extremes, the members

of patron-client communities begin to identify themselves as fundamentally deficien

w


25

Other authors have echoed similar concerns in the field of International

(1993) writes, “all too many development

new development program

omes

es and

se institutions (GO, NGO, donors and

academic researchers) have developed a systematized interest in maintaining this patron-

Development. For example, Burkey

professionals unconsciously believe that rural development will be achieved through the

efforts of government and development agencies. They do not reflect on the possibility

that sustainable rural development will only be achieved through the efforts of rural

people themselves working for the benefit of themselves, their families, and hopefully

their communities. Government and agencies can assist this process, but they cannot do

it themselves. Unfortunately, after decades of this type of paternalism (top-down) all too

many rural people have also come to believe - they have been told so many times - that

this government or that agency is going to ‘develop’ them. The result is apathy

interspersed with small peaks of expectation as one or another

c their way. Rather than promoting development such programs have ended up

developing dependency thinking.”

Kretzmann and McKnight (1993) point out that if the problem focused approach

is the only one available to communities, there is a clear risk for the unintended side

effect of further breaking down community capacities such as, problem solving skills and

self sufficiency. Communities depend on associations with ‘experts’ instead of building

relationships locally. This process can devalue, deconstruct and delegitimize local

wisdom, culture, and identity, by placing control outside of the community. Kretzmann

and McKnight (1993) are careful not to advocate complete rejection of the outside

resources, only a balancing of the equation by strengthening local resourc

associations.

Advocates for ABCD have increased over the last decade largely because

development workers are thirsty for an alternative to the needs-based approach (28). Part

of the attraction to ABCD is the central focus that the community can drive their own

self-reliant development by discovering and utilizing residents’ assets and resources (28).

ABCD is a response to the observation that communities are becoming passive

consumers of services instead of active problem solving citizens (27). Mathie and

Cunningham (2002) note that perversely the


26

client approach. ABCD is an effort to take back and build upon a community’s wisdom

and problem solving capabilities. According to Mathie and Cunningham (2002) ABCD

relies on in five critical elements;

1. Use methods to draw out strengths and successes in a community’s shared history

as its starting point for change (as in Appreciative Inquiry).

2. Pay particular attention to the assets inherent in social relationships, as evident in

formal and informal associations and networks.

3. Active participation and empowerment (and the prevention of disempowerment)

are the basis of practice.

4. A strategy directed towards sustainable economic development that is

community-driven.

5. Rely on linkages between community level actors and macro-level actors in

public and private sectors. Foster active citizenship to ensure access to public

einforcing shared meaning attributed to that reality. Communities that have

goods and services, and to ensure the accountability of local government. It

therefore contributes to, and benefits from, strengthened civil society.

Appreciative Inquiry

Appreciative Inquiry (AI) is important to define because it is part of the first step

in the ABCD approach. Its’ main purpose, according to author Charles Elliot, is to find

the necessary energy for change and its two main tools are memory and imagination (28).

“According to Elliot, AI assumes that reality is socially constructed, and that language is

a vehicle for r

been defined by their problems (malnutrition, poverty, lack of education, corruption)

internalize this negativity. What the appreciative approach seeks to achieve is the

transformation of a culture from one that sees itself in largely negative terms – and

therefore is inclined to become locked in its own negative construction of itself – to one

that sees itself as having within it the capacity to enrich and enhance the quality of life of

all its stakeholders – and therefore move towards this appreciative construction of itself”

(28).


27

AI draws on theories of empowerment, knowledge construction, and educational

psychology regarding sources of individual and collective motivation (28). The essence

of popular education practice rests on the concepts of learning from experience and

dial

and un ed by the dominant

ideo

can learn about their larger socio-political, cultural and economic environments. This

com

conscio ore in depth and reflective comprehension on the broad

soc

level of consciousness that leads to group self confidence, and eventually collective

acti (

Educat

h critical

onsciousness, participatory development also places people at the center of the process.

ent is based on the premise that the people in marginalized

ommu

entation, conventional evaluations were protested because the evaluations done by

outsiders failed to capture the specific meaning that the project (processes and results)

ogue (29). Freire (1970) argues that people have developed their own way of seeing

derstanding the world according to cultural patterns mark

logy. Through the process of coming together and reflecting on their lives, people

bination of learning as experience and dialogue results in the development of critical

usness, which means a m

ial, cultural, political and economic conditions in which people live. It is this raised

on 29).

ional Pedagogy and Participatory Development

Similar to Freires’ educational pedagogy and liberation throug

c

Participatory developm

c nities are not the target of development projects, but rather they are the ones who

determine, drive, and control the entire development process (30). Participatory

development starts from the assumption that marginalized and low-income people better

understand the problems they face, and how to fix them (29). For an overview of the

definitions, strengths and weaknesses of four types of community development

see Table 11.

Participatory Evaluation

There is an increased emphasis and a growing recognition that the evaluation of

community-based initiatives should incorporate the participation of beneficiaries (10). In

projects where participants took the lead in all aspects of program design and

implem


28

h its participants (31). This dissatisfaction stimulated the movement toward a

different approach to evaluation and has been explored throughout the nineties.

Participatory evaluations are typically done by community members, project staff,

or facilitators. At its most fundamental level, it is investigative, educational and capacity

building (32). It is a transparent process of self-evaluation using simple methods adapted

to the local culture to empower local people to initiate control and take corrective action

based on findings (33). Participatory evaluation embraces the concept of giving people a

voice and placing them at the center of all stages of an evaluation process. By assessing

the intended or unintended impacts of ones’ own program there may be a greater

potential to provide a more accurate representation of the values and concerns of the

multiple groups involved in decision-making, to promote the empowerment of

marginalized

ad for

groups previously left out of the process, and increase the utilization of the

valuation results through a sense of ownership of the results (17, 32, 34, 35, 36).

ing functions of participatory

icipatory evaluation process is in constant motion, taking paths that may

em uncharted, and is as diverse as the number of contexts in which it is applied (32).

ncepts, methods, and applications developed in hopes of

e

There are five general interdependent and overlapp

evaluation; impact assessment, project management and planning, organizational

strengthening or institutional learning, understanding and negotiating stakeholder

perspectives, and public accountability (10). With regards to an impact assessment of a

program carried out under the full or joint control of local communities, the community

participates in the definition of impact indicators, selecting and building methods,

developing the questions, collecting data, analyzing data, communicating assessment

findings, and designing actions to improve the impact of future development

interventions (10).

The part

se

There are a variety of co

engaging stakeholders to participate in producing useful participatory evaluation results

(10). The evaluation is built on the concerns, issues and problems that present

themselves through discussion, dialogue and interaction – which are considered the main

tools to active participation (9, 32). Participatory approaches require a commitment of

time and energy as conflicting perspectives can slow or stop the process. It also requires


29

a high level of trust and some consider the results less objective than traditional

evaluation as there are many barriers that could prevent the effective development of the

g by

rguments against the conventional evaluation includes; they are

process – political, academic, personal, environmental, financial, and cultural to name a

few (9, 17). Differences in opinion and confusion can occur early and often in the

evaluation process because it involves collaboration and negotiation among individuals

who may have not worked closely in the past. The effort requires patience and flexibility

in order for collective evaluation questions to take form.

One of the primary goals of a participatory evaluation is to share control of the

evaluation process, by placing control (power) in the hands of the community while

removing it from the outside evaluator (32). The premise behind participatory processes

is the progressive shift of power, with a sequence from control to empowerment (37).

The professional must talk less, dominate less, and control less, to empower and trust

others (37). Facilitating others analysis means disempowering ourselves, leadin

withdrawing, waiting while others think before they talk and act (37).

Participatory evaluations challenge conventional evaluation practices which were

founded on the tradition of scientific investigation. Conventional or ‘top-down’

approaches to evaluation can be broadly characterized as; focused on complex procedures

to measure cost and production outputs against predetermined indicators, oriented to the

needs of funders and policy makers to determine accountability and continued funding,

seeking information that is objective, value-free, and quantifiable, and usually contracted

and conducted by outside experts seeking to maintain a distance between evaluator and

participants (10). A

costly, fail to involve program beneficiaries, the outside evaluator is too far removed

from the ongoing planning and implementation of development initiatives, and the

emphasis on quantitative measures tend to overshadow the qualitative information which

tend to provide a deeper understanding of outcomes and processes (10).

Empowerment Evaluation

Community empowerment and participation are the twin pillars of health

promotion and defined as a process of enabling people to increase control over and to


30

improve their health (19). Empowerment evaluation is the use of evaluation concepts and

techniques, highlighting the importance of context – social, political, and value systems –

and incorporates it into the evaluation process (38). Empowerment evaluation embraces

the concept of sustainable human development – the strengthening of individual identity

and capacities to learn, adapt, and innovate along with the acquisition and internalization

of knowledge and information – must be part of any development process (8, 9). The

process helps beneficiaries by self-consciously guiding a program, rather than solely

mpower or gain

context-specific

efinitions of success to allow program or project participants to determine their own

evaluation embraces the concept that participants

judging its accomplishments (10).

The theory behind an Empowerment Evaluation, as defined by Zimmerman,

focuses on processes and outcomes. As stated earlier, an empowerment process attempts

to gain control, obtain needed resources, and critically understand one’s social

environment (39). The process is empowering if it assists people in developing skills so

they can become independent problem solvers and decision makers. Empowerment

outcomes are consequences or effects of interventions designed to e

control (39).

Fettermen adds an additional theoretical foundation of empowerment evaluation;

one that is based on self-determination, defined as the ability to chart one’s own path in

life (39). The empowerment theory consists of many interconnected capabilities; the

ability to identify and express needs, to establish goals or expectations and a plan of

action to reach them; to identify resources; to make rational choices from various

alternative courses of action; to take appropriate steps to pursue objectives; to evaluate

short and long term results, including reassessing plans and expectations and taking

necessary detours; and to persist in the pursuit of goals (39). If anyone of these links

break down it can reduce the likelihood of being self-determined (39).

Empowerment evaluation has its roots in community psychology and influenced

by action research and action evaluation (38). The purpose is to produce

d

standards (39). The empowerment

evaluate their own action and behavior according to the standards and values of their

setting, rather than judging according to outside criteria articulated by experts from a


31

distance (40). Defining success appears to be dependent on whom you ask. The question

of ‘who measures’ results and ‘who defines’ success is the critical issue addressed with

Empowerment Evaluation (10).


32


33

CHAPTER III: COMMUNITY PERSPECTIVES ON ABCD

Information presented in this section is in raw data format, including participant

bservation, community discussion and natural focus group results from four different

ommunities. Reflections from the qualitative researcher are also included. The purpose

is to give the reader a sense or glimpse inside how community representatives think about

their programs, the ABCD approach, and how it is similar or different to other

approaches they have experiences in the past.

Methods

Qualitative methods were appropriate for eliciting perspectives from CBO

representatives (informants), and community members. Data collection methods

included; participant observations, natural focus groups, and semi-structured interviews.

Participant observation was selected as a data collection technique in order to

engage in CBO activities, become familiar (thus reducing reactivity) and understand

more about the socio-cultural context. This process continued on a daily basis throughout

the entire three month study period.

The purpose of natural focus groups (NFG’s) was to build on what was uncovered

during participant observation. NFG’s occurred in community settings, and I was

frequently invited to CBO representatives’ homes. The ICE director was not present

during NFG’s, in hope of achieving a more natural setting for truthful responses. Usually

elders, youth, monks or others would join our discussions, and frequently offer

unsolicited commentary. These community visits allowed insight into how CBO

representatives interacted with their fellow community members. Four visits are profiled

to demonstrate the diversity of local settings.

Based on results of the participant observations, NFG’s and community visits,

questions for the 12 semi-structured interviews were formed. All but one of the

interviews occurred at the Expo, which was a two day event coordinated by CBO

presentatives in which CBO groups presented their work, shared and exchange ideas.

o

c

re


34

Therefore, CBO’s that did not attend the event were not interviewed. Semi-structured

proved by the director

C). Prior to asking questions, I explained I was interested in learning

er. During the translation process unclear

ords were reviewed with a native speaker, and final English transcription

ed by the director of ICE for clarifications. Afterwards, the transcriptions

respected, and well liked. Although some

interview questions were written in English and Thai and pre-ap

(see Appendix

about their opinions regarding the process they used for building their community health

promotion programs.

Data Management, Quality and Analysis

Responses to interview questions and two NFG’s were tape recorded and

translated from Thai to English by the research

or unfamiliar w

was review

were printed for coding by hand. Qualitative analysis was done using open coding by

two English speaking researchers. Results are presented using quotes and long narratives

in order to illustrate relationships between the data, themes elicited and remarks in the

discussion section. For a table of qualitative inquiry activities including respondents’

roles see Table 12.

Results

Participant observation

CBO representatives were observed during meetings, workshops, and when

interacting with others in their own communities. For example, the groups were

preparing for their exhibition at the end of 2003; however a very active member heading

up the planning for this event died suddenly, about three weeks before the event. The

CBO representatives, over 22 people, worked together to select new leadership and make

group decisions about new plans for the Expo. This was a difficult time as many

members were close to this individual; he was

CBO representatives were visibly upset during meetings, they successfully reorganize a

new Expo event within a six week period.

In another example, CBO representatives were in the process of reorganizing

themselves as a Network. This occurred because during the second round of funding


35

some groups had received approval for their requests, while others were denied. By

observing their reactions it was clear this was a significant blow to the group. During the

first year they had moved through the learning process together, built relationships, and

learned from each other. Now, it looked like they were breaking up into funded groups,

possibly funded groups, and non-funded groups. They had to reach a consensus

garding whether they would continue on as a Network, separate into clusters, or work

emain together and elected a Network leader.

ted that he did a number of things very effectively. For example, he

oke very little and never stated his point of view unless pressed by others. He spent

his time listening, and asking questions which kept the group focused. Often

pon them, he restated the question verbally or wrote the options

ere taped for assistance in writing up the

inute

re

individually. In the end, they decided to r

Group dynamics were also observed during Expo planning meetings. During

these meetings they debated the budget, organized the site and a schedule of activities.

Only one of these meetings was held at ICE, while the others were conducted at the Expo

site, in SanSai District.

During the participant observation process it was noted who was more active and

opinionated about certain issues, the researcher listened and made small talk during

coffee breaks, and started the beginnings of relationships with people. Observing the

director of ICE during these meetings was crucial for assessing how ABCD was being

facilitated. It was no

sp

most of

when disagreement was u

on a white board in order to help the group visualize what they were struggling with.

Overall, he was able to encourage dialogue by asking inquiring questions and assisted

with mediation when necessary.

Among CBO representatives some were more outspoken then others. Discussion

and decisions were conducted in a friendly professional manner. When decisions needed

to be made individuals voted by raising hands. Initiative leaders were selected through

nomination and voting. The person elected had the option of acceptance or not accepting

the position. A note taker produced meeting minutes for CBO representatives who could

not attend. Most of the time meetings w

m s. CBO representatives tended to arrive fifteen to twenty minutes late and dressed

casually.


36

Natural Focus Groups and Community Visits

There were four primary site visits in which NFG’s occurred. Selection of these

sites was dependent on invitation by the CBO representative, and the availability of

transportation. The site visits included four CBO’s:

1. Drug Prevention Demonstration Project (Rural, SanSai District), # 3 on Table 12.

2. Nong Hoi Community (Urban, Muang District), #12 on Table 12.

3. SaLuang (Rural, Hmong, Karen and low-land Thai), #11 on Table 12.

4.

Project

hem about the project. Later, the CBO representative and the two health

Karen Mae Chaem Group (Rural, Karen, Mae Chaem District), #1 on Table 12.

The following narratives are included verbatim in order to show exactly how

CBO representatives were describing what they were doing, and what was happening in

their communities. This was important for conclusions to be drawn about how ABCD

was taking place, what kind of participation was occurring, and what they thought about

the process. After presenting the prominent results from each of the sites the

researchers’ immediate interpretations from the field are also included, and written in the

first person.

1. Drug Prevention Demonstration

The first site visit was attendance at a village presentation for the Bangkok Department of

Drug Prevention (DDP). This village was selected as a demonstration site because of

their success in reducing the amount of drug trafficking, drug use, and improving

prevention and rehab activities. This project was spearheaded by the village headman,

who is also the CBO representative working with ICE. On display was an impressive

wall of posters and pictures describing their activities for drug prevention. I had a chance

to eat lunch with the CBO representative, the village health worker and his coworker, and

talk with t


37

workers addressed the representatives from DDP and community members in a common

rea located in from of the CBO representatives house.

uring discussions with the village headman and community health workers, they

689 persons in this village. One health

men’s groups) and talk it over, and

then

to ask the director if he has any good programs to strengthen the community.” Here I

con d formation,

sha g

lationships with internal and external resources, such as the health worker and ICE.

d and what would not be tolerated in their village. They also decided to

ave activities to “strengthen families.” When I asked him why he explained that the

e was becoming a problem because families

a

D

explained there were about 208 families and

worker stated, “The village leader would come to me often before this project and we

would exchange ideas about how to build a healthy community. He would go back to his

team (representatives from the youth, elderly and wo

he would come back to me with more ideas. The village leader also contacted ICE

clu ed this was a very active CBO representative who was seeking out in

ring it within the associational network of the community, and in the process buildin

re

I asked the CBO representative if he could tell me about how his community decided to

work on drug prevention he said, “There were people in the village addicted to drugs and

selling. The community ‘team’ met to discuss the problem, where does it come from and

how to work on it.” He explained that the results of their discussions were many

activities. For example, making community rules posted on a sign explaining what

would be tolerate

h

people in the community believed drug us

were breaking down. To counter this they decided to have an activity bringing the elders

of the community together with the children to teach them how to play traditional

instruments, thus strengthening family relationships. They also developed a system for

assisting addicts who returned to the community after incarceration or detox. This

process involved coordinating a system for returning community members to live with

someone other than their family for at least the first three months. This was an effort to

manage the tendency to fall back into old patterns and minimalize quarrel. He went on to

explain about the youth group activities, including a ‘friend’s corner,’ where the youth


38

could gather and spend time talking about drug issues with their trained peers and health

workers.

I inquired about how many people in the community were participating in project

activities and the health worker said he thought perhaps 60%. He explained, “If 60% of

the community participates then it is good enough, if there is more than we make merit.”

He also said, “You can say or write community participation, but if it is not in your heart

it won’t happen.” I asked what he thought of this project and he said, “It’s very hard

work and requires lot of meetings and discussions, but I am very happy. In my twenty

years as a health worker I have never seen anything like this.” At this comment I was

immediately struck by the sense that this health worker, who had been working at the

community level for over twenty years, thought what was going on here was different

then what he had been involved in previously. This significant statement was explored

rther in each of the semi-structured interviews. Then I asked him what made this fu

project work here, and he said, “The health worker (referring to himself) uses common

sense, and the village leader is interested.”

During the addresses to the community members and the DDP representatives the health

worker said, “This model of community development is strong and means bringing

different groups together to work. The villagers have done this themselves with the

assistance of the community health worker to advise them on understanding the current

problem. There is no end to this process. The community does not have to wait for the

government, they can do it themselves. The villagers here are very determined and happy

for your encouragement. We are proud of how we received the money. Every group here

knows how much money there is and what they have decided to do with it. We (the health

professionals) join with the community to eat and drink and discuss all of our ideas, not

just accept orders, we can dialogue together. I am very proud we can communicate like

this. I am an assistant only to the community.” The village leader/CBO representative

echoed these words by stating, “When we meet and discuss what and how to do things we

use the words “we will try” not “you should.” I observed consistency here in what the


39

health worker and the CBO representative were telling me over lunch, and what they later

told the DDP representatives and the 200 members of the general community also in

ttendance. a

I inquired about the role of ICE and they explained that both the CBO representative and

the health worker attended the workshops coordinated by ICE for learning community

development facilitation skills, and how to communicate and exchange information and

ideas with other CBO groups. They went on to explain that they had raised money for

this project from the Provincial Health Promotion office, DDP, and through village

donations, thus illustrating the multiple sources of fund gathering.

I noticed with this community, independence. For example, the CBO

representative had initially come to the health worker and ICE for “advice on how to

build a strong community.” Therefore, the capacity building instincts were already there.

They could have been quickly squashed had ICE and the health worker not possessed a

complimentary philosophy.

2. Nong Hoi Community

This community is located on the outskirts of the main city of Chiang Mai. In attendance

were two government health officers, a retired nurse, and retired teacher who help with

the project activities, two police officers and members of the youth and elderly groups.

They had just presented their work to some government officials who had already left

when our group arrived. They began with an introductory speech, delivered by the local

monk, and the CBO representative. The group was seated at a large table and had lunch

after the monk took his food, which is customary. The meeting was at the home of the

CBO representative. I was introduced as a student working with the director of ICE.

The monk began by explaining that in their community they have about 700 permanent

residents and 300 transitory residents. He spoke about the importance of working within

the three institutions of the community the temple, home and school. “The Temple is


40

very important as it is the center of moral and social development. Three years ago the

community headman was responsible for the community. Now the central government

has decentralized power, but the community is still unaware of their rights. They have no

presentation. Also, three years ago drugs started to enter the community and there was

For example, with

osquito prevention, we use a traditional method and have a contest for who can collect

spoke, “the concept is the facilitation of bringing multiple

ommunity groups together, and if we do this we improve the quality of life for our

nd learn about problems and solutions together through

We

ave to meet on Saturday or Sunday. We have to help people understand it is important

re

a need to help adolescents and witnesses to drug selling know what they can do. They

started to organize and promote activities, but they have no money. We try to use all

social structures in the community to get a wide picture of what was going on, and come

up with ideas to strengthen the community. We started groups for promotion of nutrition,

exercise, AIDS and drug prevention. We have a Little Doctor Competition to encourage

young people to become health promoters within their families.

m

the most (dead mosquitoes). We do this work because community members, police,

teachers and parents are closer to the villagers, and know the problems better, political

representatives only talk.”

The CBO representative then

c

community. We study a

community participation from different sectors of society. Our vision is to work together,

coordinate people, and not separate them.”

I asked if there were any problems while doing this program and the CBO representative

said, “Our community has no office for our work, we would like some money to buy land

so our children will have a place to continue conducting community activities. Also, they

(community members) didn’t know how to work together at first. They all have hearts,

but it is difficult to find time to talk together because people have different schedules.

h

to love themselves, love their families, and love their communities, if we don’t love our

community who will?”


41

The retired teacher explained, “In Thai society we don’t have a sense of teamwork. So

now we use activities like competition (little doctor) to create a sense of belonging in our

community, maybe this will start improving.” I tried to probe further by asking how they

will know if there is a growing sense of belonging. The CBO representative responded,

“The villagers think and try to solve their own problems. When we do an activity lots of

people come to see. Now more community members are presenting their ideas at

meetings. Before they were quiet, now they dare to share their ideas in the room. We

don’t say whether on is right or wrong, we say what everyone has to say is useful, and let

someone try their idea. For example, in the rural areas we have natural cures,

‘oopanya’ we are sharing this knowledge to promote health. We are manufacturing a

small amount to sell.” What I learned here was that through this community dialogue

process people had the potential to engage and share their own ideas as a member of the

community. I began to wonder what prevented them from doing that before.

I asked how will they see the benefits of your work. The CBO representative

better grades. The hardest part is getting

at initial financial assistance to start, and then you have to show people that you really

commented, “The drug problem has stopped, but we always have to keep our eyes open.

We have observed diabetes reduction and cholesterol reduction and less depression

among the old people. For example, some of them could not walk before our group

exercise program, now they are able to do more movement. Our younger generation is

studying meditation and now they are getting

th

mean what you say you will do, and that you are really interested in improving

community health and family. The beginning is the most difficult. We, are worried

about our future, we might get a little more money from the drug prevention department,

but what about all of our other work?” Here I observed the potential to measure the

effect of there programs based on bio-medical markers for example, blood pressure,

cholesterol levels, etc. Ironically, in the same breath the discussion turned to funding,

and concerns about sustainability of their programs.


42

Then the Monk followed up by explaining, “Number one, the community has gained

more knowledge about health, the environment and community development. Number

two, they own this problem and they know best how to solve the problem. Through good

participation they build a sense of belonging and care for each other. And three, they are

responsible as a group.”

In this community I learned that they were mobilizing resources and perspectives

from three segments of society, the temple, school and family. Building on multiple

points of view and community ideas they were selecting their own program activities.

They are excited about the results they are seeing. Some of the problems include,

funding, having space for a community center, and concerns about sustainability. How

they are going about their work is consistent with the ABCD model.

3. SaLuang

book for use by the community to

ncourage organic growing and conservation of traditional treatments for common

ailments.

On the day I visited the SaLuang District, about a half and hour from the city of Chiang

Mai, the community was celebrating Children’s Day, a national holiday. I had a chance

to join in those activities of music, games, eating, and comedy show. Additionally, I

stayed over night with the CBO representative and his family. Upon arrival, I spoke with

one of the natural healers working in an alternative health center built alongside the

government health station, and eat lunch with the director of the health station.

The CBO representative and the natural healer explained that three groups were in their

district; low-land Lanna/Thai, and the high land tribes of Hmong and Karen. The talked

about how representatives from these groups came together to discuss ideas and resources

for a health promotion project. It turns out there is concern among these groups about

pesticide contamination. Especially, for the low land people who eat foods irrigated in

mountain run off, which they think contains high amounts of pesticides. They decided to

combine their knowledge of herbal medicines into one

e


43

The CBO representative explained, “At first there was me, and our team included about

10 other people and the director of the health station, who you will meet in a little bit.

Our experiences before were always working with the communities all the time. Then we

got together and talked about our community. In our community, we saw that people

ere being exposed to a lot of chemicals. Like when they eat vegetables that have been

n the area; from the

al healer group in the sub district area here, and the adolescent group.” The Lanna

ned, “There are lots of different groups, the village leader group, and the

doctor

t the health station said she has a friend who is a coordinating work with the Office of

w

grown with a lot of pesticides. So then we sat together and talked about what we could

do to encourage our community to use herbal medicine and plant organically. If they do

this they don’t have to take the foreign medicine, or visit the doctor at the big hospital.

Our plan was to use herbal medicine and to help ourselves so we don’t have to waste a

lot of money or gold for the price of medicine. That was our idea, and that is what we

talked about together…. The ten others are from different groups i

loc

Healer explai

elderly group, the natural healers in all villages and the Community Development

Department workers. In these statements, there is evidence of local relationship building

and community dialogue.

I asked about how they learned about ICE and the Thai Health Foundation Funding. The

CBO representative responded, “we talked for a while here and there, and then a

a

Health Promotion who told her about the Thai Health Foundation. Our team of 4-5

came together to talk about how to put the project together so we could request funding,

We waited for 3 months for funding approval. And then we called our team of 10 people

to come together and talk. We explained we now had the funding to do this project, but it

was up to them to figure out how to do it. We had to figure out how to collect the

information about herbs from throughout the community. From the old books written on

bamboo, in the Lanna language. The old healers would write their knowledge down in

small books. ”


44

This group brought together interested community members including youth to visit

that are worth sharing.

natural healers in all three areas and collect information about the plants they use and

various formulas. The CBO representative explained the steps they took for the project.

“We collected information from throughout the villages by mobilizing the adolescent

group to travel around and write down the information from all those who had any. The

next thing we did was travel to the forests in the mountains with people who knew where

to find the plants and photograph them. After that, we brought together all the

information we had collected from all the local healers, and typed it into a computer,

then we had it printed into a book. But we did not have them printed to sell. The books

are available throughout the community at schools, temples and all the local healers

have one. We had the book printed in Thai script but here are Karen and Hmong words

included. For example, if you look here we have the name for this herb in four different

languages, Hmong, Karen, Thai, and the English scientific name.”

In addition to discussions with the CBO representative about the project, I also had the

chance to stay with him and his family and discuss his views on development. He had

many insightful comments

“The community became tired of outsiders coming in and taking information from us,

then writing something and getting famous, while not doing much for the community.

These outsiders tend to do things for a short period of time and then leave. They are not

doing the work honestly. We realized over time, that it is much better if we do it

ourselves. If we do it ourselves we know that we are doing it for the love of the

community, and not for any other reason.”

“Outsiders think they know how to change things for the better, but we the local people

know better. It’s like trying to tell someone how to move around in their own house, it is

my house, who knows better where all the windows and doors are but me.”


45

“The only thing the community learns when programs come from the outside is to wait,

wait, wait for the next program to come and give you something. We have forgotten how

to think for ourselves.”

I asked him to comment on the ABCD approach, he said “With this approach the

community gets to use their own thinking, and the development worker becomes the

coordinator. Often the weakness in the community is that they have lots of ideas, but

don’t know how to coordinate things to make it happen.”

“One of the problems with the way things were done in the past is that when the funding

for the project ended, so did the project. With this new approach the projects don’t end

with the funding cycle. The project will continue because community members came up

with the idea, they believe in it and will try to find money from other sources, maybe even

cally. I think this would be the best way anyway, if the money came from local

r funders like in Bangkok or other

ountries, what do they want to see in evaluations?” He said “We usually have to do an

l get this type of evaluation. Sometimes I feel

we meet half way, 50% what they want and 50% what the community wants that is

ht impact the

eedom we need to make the project appropriate for our own community. When they get

lo

sources.”

I asked him “when you get money from outside

c

evaluation that follows this long process and ends up not meaning very much to the

community. It is very confusing for us and very difficult trying to give them what they

want. I think it is better to evaluate a project using the communities own words, very

simply and summarize easily. That is how I do my evaluations. Sometimes I have to

explain to the funder why this is important for the community, and I make them

understand before I get money that they wil

if

usually the best.”

“When doing a community project we have to be careful about 2 things: 1. who we get

the money from, and 2. what kinds of rule or limits with they make that mig

fr


46

money from far away, follow up is difficult. To call Bangkok can cost 100-200 baht per

phone call, and that is a lot of money for rural people.”

He explained that when he found out that the Thai Health Promotion Foundation did not

and to show the benefits of this

ind of work. I told him he has never even been to our community to see whether or not

We did not have any freedom in what to work on or how to do things and this

a very limiting approach to working in our community. Now, the communities are

and cons of the different approaches to community development.

the three different groups (low-land Lanna, Hmong and Karen) came together to work on

have their names on the list for next year he and seven other representatives from

different Chiang Mai CBO groups went to Bangkok to, “pound our fists on his desk” and

talk with the health promotion representative for 2-3 hours. We had to, “make him

understand what and why we were doing things this way,

k

the program has been beneficial or not, so he can’t pass judgment on it without even

visiting once.” He explained that later they heard the proposals for 8 groups have passed

the first tier for approval, now they are waiting for final approval.

“In the past the government in Bangkok would write a program and tell us the top

priorities.

is

writing the programs and sending the proposals to the government which allows for

much greater possibilities in terms of projects.”

I asked him this new way of doing things works better then the old way of doing things.

He said, “this new way works ‘because we see it’, and we don’t have to wait around for

someone to do it for us.”

Based on our discussions, it appears this CBO representative and community

members are critically reflecting on their social assets, how to mobilize them, as well as

weighing the pros

During this site visit I was able to capture more about how this CBO was operating in the

community, how they viewed their roles, how they thought the ABCD process was

affecting their community. For example, the CBO representative explained that because


47

this project together, members of the high land groups are much more likely to come

down and join in community events these days. The statement, “this new way works

ecause we see it” implored me to wonder what else he meant, and how he could

”

d the CBO representative’s house, and

as joined by a few other community members including 3 elderly men, 3

natural focus group. I did not have any specific questions

repared, and I didn’t anticipate the discussion to include 10 people. The Karen speak

b

illustrate to others the changes they were seeing. Additional awareness was raised about

the concept of freedom, and it became more obvious how adapting projects locally is

crucial to community success. The issue of passivity vs. pro-activity was also

prominent. For example, “we don’t have to wait around for someone to do it for us.”

Sustainability issues were explored in the statements, “One of the problems with the way

things were done in the past is that when the funding for the project ended, so did the

project. With this new approach the projects don’t end with the funding cycle. The

project will continue because community members came up with the idea, they believe in

it and will try to find money from other sources, maybe even locally.

4. Mae Chaem - Karen Group

This village is located about five hours from the main provincial city. I was

invited to visit during the Christmas Holidays. The missionaries were active among the

Karen groups and in this village and they had a mass attended by 100-150 people. After

a community breakfast on Christmas day, I visite

served tea. I w

adult men and two adult women. Their roles in the village were not identified, but they

knew about the work of the health promotion program. The conversation was tape

recorded and resembled a

p

their own language when talking to each other. Most of the men can speak Thai, and

some women. Young people of both sexes have been schooled in Thai and shift easily

back and forth. I asked questions in Thai and they were translated into Karen by one of

the adult men. In this setting I learned how they viewed ABCD, how it compared to

other health promotion work they had seen in community, how they viewed their medical

system, and the health status of their own community. The health promotion program in


48

this community was centered on restoring and promoting native Karen wisdom about

herbal medicine.

In their view, the predominant mode of treatment for forest people is herbal medicine

cures that have been passed down from generation to generation. They commented that

western medicine came from the missionaries, and when the roads came people tried to

get the medicine from the ‘doctors’ at the government health stations, “Most of the time

they (their elders) would find herbal medicine in the mountains, they would boil the herbs

and use the Karen knowledge because most of the time the doctors in Chiang Mai don’t

come here. In the past for our parents, aunts and uncles, the roads did not reach here,

they couldn’t get here. It was very inconvenient… When people died they thought it was

because of a spirit (‘rok pee’) had entered their body and killed them.

vernment health stations arrived and one young man

mme

about herbs, massage, and poultices, ,,,we already have these true medicines, we don’t

About two years ago the go

co nted, “The patients should have enough medicine to cure their disease, but it is

not enough. By the time they need it the medicine has expired, like 6 mo or 10 mo or 2

years past expiration. That is one of the problems. They use medicine that has already

expired and it does not cure them. These days’ things are a little better, but the villagers

still need to use herbal medicine to supplement, a lot.”

In regards to the development of the program the CBO representative said they wanted

to, “improve the community by looking after the culture through the conservation of

herbal knowledge.” The CBO representative explained, “Using the medicine from the

hospital, it’s good, but there are side effects. If you take too much you have a problem, if

you don’t take enough you won’t get the curing effect of the medicine. In the past our

relatives used herbal medicine and they survived, and didn’t need to go to the hospital.

So for kids these days if they have a swelling or a cold and take the hospital medicine

sometimes they have problems. But with herbal medicine you can take a lot and it won’t

cause harm…. for our lives maybe we can use our local knowledge to teach our children


49

have to buy them or go to the hospital. Why do we have to do that? So, that is how this

project got started.” He went on, “what can we do is make sure that the next generation

use and conserve the herbal medicine cures that we used in the past.

tainability of the

rogram. But this type of program was concerned in doing whatever you want just

implement the program for the

ommunity…But, in terms of herbal medicine, I think that if we have knowledge about

knows how to

Before we didn’t have any hospitals around here or any doctors, and we survived, we

didn’t die, sometimes we died if it was a very difficult disease, or if we didn’t treat it in

time, but for treating common disease, coughs, colds, sore throats, headaches, and

rashes, we can use what we have always used…,”

I asked how this program was similar or different from others, one man stated, “It is like

this, the state programs are only interested in the outputs of their work. If they come and

test us they come once, this is not sustainable or useful. It is because the staff person is

only interested in the output of the work, not interested in the sus

p

please make it beneficial, and please make it sustainable in the community. It is different

because there is much more freedom. If it was a state program there would be many

limits and rules, and after the program it would be over, because the staff is only

interested in the outputs of the project, and not interesting giving too much else. After the

program it would end.” He continued, “If I look at the big picture, the state works health

programs and then it is up to the staff person to

c

herbal medicine it is good, because you can take care of yourself, this is much better then

waiting for some worker to come take care of you.”

I asked them to talk about how they thought this project was affecting their community.

At this the CBO representative said, “We see the villagers helping themselves, they don’t

have to always go to the health station, they know the plants and they know how to use

them. The students know. They don’t have to go to the hospitals and take the poisonous

medicine. We also see the students teaching other students. For example, if one of their

friends has a headache they show them which plant to use and how to make it.”


50

Form this site visit it started to become clearer how critical cultural identity was

for their programs. Not only were CBO’s moving and mobilizing local social assets in

the form of native wisdom, they were developing associations with other communities

through the vehicle of health promotion program for herbal medicine conservation. They

were engaging in community dialogue and discussion right there in front of me! There

were many breaks in the discussion in which different people disagreed with what

another was saying. The disagreement didn’t cause uproar or chaos, instead it appeared

stimulate more dialogue. Most importantly, they were reaching back to their own to

cultural identities and building from there.

Semi-Structured Interviews

12 semi- structured interviews were conducted with CBO representatives. After

analysis, re-reading and coding of transcripts, themes became salient and are presented in

Table 13.

In addition to the themes presented, a list of concepts that representative’s

mentioned during interviews regarding what they thought helped to make their programs

work, and what made them difficult was formed. These questions were asked directly

during the interview. Included in these lists are concepts mentioned by more than one

CBO representatives.


51

Issues that made ABCD for health promotion work:

1) The ability to think and do for oneself

2) Groups decision making

3) Multiple activities under one project

4) Having those activities firmly fixed in native culture/community identity

5) Inclusion of all age groups

6) Funding and support from local and external resources

Difficulties of ABCD for health promotion:

1) Time

3)

ram Writing and Evaluation

very far from the provincial center and ICE. Making phone

calls is very expensive and transportation can be long, uncomfortable, and costly.

Practicing mediation and consensus in decision making was also mentioned. The process

of reaching consensus and conclusions can be difficult if there were varied views among

community members. The issue of evaluation came up more than once. Some

representatives commented that they were interested in knowing more about evaluation.

There was frustration expressed over not being able to explain or show funders the “good

things” their programs were doing in their communities. The uncertainty of funding

resources was another major difficulty mentioned since the announcements of which

groups were funded and which were not was occurred prior to the expo.

Another representative expressed the “conditioning of NGO’s” as a difficulty to

over come. He noted in his community, “they are spoiled by the NGO, so all they

2) Communication

Group Decision Making

4) “Spoiled” by standard Development Approaches

5) Prog

One of the most frequently sited difficulties was the issue of time. Any effort to

gather community people together for community discussion was difficult secondary to

schedules, jobs, and family responsibilities. Other difficulties included communication.

Many communities were


52

(community members) know is how to do is spend money.” By practicing ABCD they

“have to learn how to plan, report and evaluate their work.” He also mentioned that the

project ideas and activities were too big and there was not enough leadership, negotiation

stra s. In the same case there was concern about

the munity

group. Interestingly, the individual in the representative position for this CBO has a long

30 ulty, because of his NGO

aining, and was planning to remove the difficulty by removing himself from the CBO

Dis

from the semi-structured interviews was consistent with

the the NFG’s. The semi-structured

inte f citing weaknesses and strengths of the process.

The NFG’s and participant observations provided more in-depth information related to

(capacities,

tegies or skills among the group member

ideas for activities coming from only one or two people instead of a com

year history in the NGO field. He sited himself as a diffic

tr

representative position.

cussion

The information elicited

information drawn from participant observation and

rviews were useful for ICE in terms o

socio-cultural context and insider perspectives.

Some initial assumptions were confirmed in the data and support its validity. The

consistent statements from community representatives, “we did it ourselves,” “it was the

ideas of the villagers,” “we are proud” and “they are proud of themselves” provide

convergence when triangulated with ABCD methods, and the theories of self-

actualization and self-sufficiency (41, 42). Based on the principles of ABCD and the

theoretical constructs of educational psychology, self-efficacy, and empowerment, the

themes generated from the semi-structured interviews are also consistent and

confirmatory.

The primacy of traditional culture and cultural identity appear to be critical pieces

of CBO program building, and provide evidence of a difference between the ABCD

processes as described by Kretzmann and McKnight, and the process being supported by

ICE. Kretzmann and McKnight emphasize the mobilization of resources

skills) and local relationship building. In this cases study there is evidence of resource

mobilization and local relationship building, with the explicit emphasis of traditional


53

culture as strength through which health promotion and community development are

taking place. Based on this observation, I believe what is happening among the groups in

this case study may be even stronger than the ‘standard’ ABCD approach. CBO’s are

conserving indigenous knowledge and traditions through health promotion and

community development programs, therefore preventing the identity destroying aspects

of rapid growth. As the director of ICE often stated, “what they (CBO’s) are doing is a

vaccine against the ill-effects of globalization.”

Additionally, by expanding the process of building on ‘strengths’ (local assets,

skills etc.) to also include cultural traditions (local music, dance, traditional healing

ethods) this allowed CBO’s to reach out to local and external resources with something

in hand, thus leveling the playing field, or power structure. Therefore,

individuals, identified themselves, thus

inforc

comfortably” or another “we are a typical Thai community, and the

m

compelling

through the ABCD approach, as practiced here, there was a better chance for more equal

partnerships between CBO’s and local and external associations. Mobilizing around

traditional culture brought more people together, from all age groups, since the focus was

not on a specific problem or a disease. Centering on traditional ways of life was also

more in line with how the community, and

re ing their collective identity and self-esteem.

These inferences were based on the interpretation of how CBO representatives

and community members described themselves, or in other words, an ‘emic’ perspectives

of their own community. Although these groups are considered ‘marginalized’ by

professional development standards (based on income access to resources, education

etc.), when they described their communities, none described themselves as poor, weak,

impoverished, or through a list of problems. For example, “we are Karen, we live like

Karen, we live

environment is good because we live out in the countryside” or “our community is in a

rural are and we live using the rural ways of life.” A similar phenomenon occurred

when trying to investigate community identified health problems. I often asked

community members to tell me what kinds of health problems there were, and most

frequently they responded by stating “we don’t have any.” This was also confirmed in


54

the evaluation report written by a contractor hired through the Thai Health Promotion

Foundation.

From a broad point of view, I considered whether Thai social systems were well

matched for an ABCD approach. For example, more than one group described the

importance of building their work on the traditional social systems of temple, school, and

village. Therefore, when thinking about what ‘strengths’ to build upon, they reached

back to the system of a traditional community. These community ties, they explained,

are the four things that combine

mak

had been breaking down secondary to shifts in the administrative structure, growth,

development etc. Part of their projects was to restore those relationships between

community resources.

Similarly, many of the projects focused on teaching and promoting traditional

health models. “Lanna health is focused on the four precepts for holistic health. A

‘happy life’ was to be achieved through the spirit, body, the community and the

environment. Through spirit a human could reach the supernatural. The human body is

described as containing the four elements; Earth, Water, Wind and Fire, and their balance

a critical. Herbs are a part of the environment that can be used for health. And in a

community people survive by helping each other. These

to e a healthy life according to Lanna principles” (4).

Therefore, both traditional Thai social structure and the traditional northern

healing philosophies include an emphasis on community relationships, which may have

supported the transition to an ABCD approach for health promotion and community

development.


55


56

Chapter IV: Evaluation

The purpose of this section is to address the question, ‘if the ABCD approach

claims to lead to community empowerment d self-determination, as written in the ICE

program ‘Increasing Community Capacity for Health Promotion and Well Being Project’,

than how will these CBO’s measure these potential changes in their communities?’

An answer is provided by describing the efforts of ICE and the 11 CBO’s in

developing an evaluation method. The evaluation method was based on the concepts of

participation, empowerment and suitable in their community for taking on the challenge

of identifying their program outcomes and impacts. For the purpose of illustration we

chose to highlight the specific effort of the MaeChaem community, whose project was

the Rehabilitation and Conservation of Herbal Medicine, to demonstrate how the

evaluation was implemented.

Development of the Evaluation

The 22 CBO’s were entering their third year of ABCD for health promotion

programming. They had already submitted project specific quantitative reports required

by ThaiHealth for justification of funding. However, the CBO’s had not learned

techniques to evaluate possible empowering or broad societal impacts in their

communities as a result of this new approach to health development. ThaiHealth was

anxious to determine if these changes were transpiring in the community and hired an

external evaluator from Bangkok to assess the situation.

The 22 CBO’s were exposed to an external process evaluation during the summer

of 2003. The purpose was to evaluate outcomes, the capability of CBO’s, their

effectiveness in modifying health habits, the capability of ICE, goal – objective –

indicator alignment, identification of best practices and motivate a system of future

evaluation among the CBO’s. Information collected was analyzed and each CBO was

then quantified into three categories; Good, Fair, and Needs Work.

an


57

Several CBO representatives felt the external evaluator did not spend enough time

in the community to gain a fu ey were doing and how they

ere doing it. Several CBO members expressed the potential of losing identity if

how

O’s involved in the development of the evaluation method

ere; Saluang Group, MaeHak Group, BanMaiJong School, Lahu Group, Muay Thai

Kee Group, SanPaBao Group, SriBoonRuang Group,

ible, however ICE felt it was

porta

ll understanding of what th

w

externally located NGO’s and GO’s used standards, based on their outside values, to

judge the worth of their programs. Members of the CBO’s claimed that there were so

many other things going on in their community that this externally conducted evaluation

did not reflect. They expressed frustration that they can see changes, but don’t know

to express it on paper for the funders to see as well.

Dr. Uthaiwan presented the idea of learning how to do participatory evaluations to

the 22 CBO’s at the December 28th Network meeting. He informed the Network that

these evaluations would supplement and not substitute their current program summary

reports submitted to ThaiHealth. In response to Dr. Uthaiwans’ request, 11 of the 22

CBO representatives volunteered to attend workshops in order to learn participatory

evaluation techniques. The CB

w

Group, Three Age Group, MaePa

MaeSa Group, and the Mor Muang Group.

Prior to the workshops, volunteer community representatives and ICE

collaborated on developing a User-guide (see Appendix D) to assist in facilitating the

evaluation workshops. The guide was based on participatory and empowerment

evaluation, in addition to the ABCD approach in order to be consistent with the CBO’s

health promotion program planning. It outlined a hypothetical path for developing and

implementing the evaluation. The guidelines were flex

im nt to put it on paper so the process was truthful and transparent. The guide was

not handed out to the CBO’s during the workshops because ICE intended that the CBO’s

would move through the process of developing a context specific and community owned

method.


58

Background information

The community of MaeChaem is approximately a 5 hour drive ‘up the mountain’

from ICE headquarters in Chiang Mai. There is one health post in the village that focuses

on primary care. There are a total of 60 families in the village, which is an increase of 20

families over the last few years. In the past, families clustered to form compounds that

tended to be far away from each other and scattered throughout the forest. Over the past

10 years, the village has gradually seen the development of roads and the introduction of

electricity. The community has both a primary and secondary school. The CBO

1.

nally, an Overall Summary of all Evaluation Results. All variables identified by

the 11 CBO’s who conducted the evaluation were complied through a qualitative

process of pile sorting. The process was repeated two times; once to sort

according to social, physical, and mixed capital; a second time according to

representative explained that the community has a strong local representation within the

government and there is much less foreign missionary work in the area as a result.

However, there are still strong ties with a Baptist organization that sends money into the

area. The church is currently constructing a new clinic in the village.

Analysis Plan

Data collected and analyzed is presented in a chronological format detailing the

evolution of the evaluation method.

A description of the Workshop; detailing the process of how ICE and the CBO

representatives worked together in developing the evaluation method.

2. A description of the actual Evaluation Method steps; detailing each step of the

evaluation as decided upon by ICE and the CBO’s at the workshops.

3. A description of how one CBO implemented, displayed and reflected on the

evaluation method during their Community Meeting. (This group was singled out

for description because an ICE coworker is from the community, they were the

last of the 11 CBO’s to do the evaluation and they were one of the few groups that

went deeper into the evaluation by defining indicators of a chosen variable.)

4. Fi


59

similar themes. The final outcomes of the variable summary displays were agreed

ograms.

The evaluation method required a mechanism for involving stakeholders in

fining and measuring variables and indicators. ICE recognized that

ial changes. However, they felt that community

volvement in variable and indicator identification needed to be developed and

neg

linkage stems in a

com

underst

can eva

activiti

They v

asked ‘ ther

que

resourc

underst

process

upon by a process of democratic consensus between the two researchers and ICE

staff.

Workshops

The evaluation method was developed during a series of workshops attended by

representatives of 11 CBO’s and facilitated by the director of ICE. Appreciative inquiry

was the tool to address the challenge which faced the 11 CBO representatives in

developing their own method, one that would best meet the needs of the community to

identify, prioritize, measure, document in a format to help reflect on what was done,

where they are today, which way they want to go, and how far they need to go and

demonstrate impacts in their communities as a result of their health promotion pr

recognizing, de

researchers and development workers have prefabricated long lists of variables and

indicators for empowering and soc

in

otiated based on indigenous and experiential knowledge, taking into consideration the

s between social, cultural, economic, political, and environmental sy

munity. ICE thought the process of identification would ideally lead to a better

anding of what caused the changes.

The workshop began by posing the question; ‘what are different things that we

luate in our community?’ The 11 CBO representatives listed several possibilities;

es, social changes, what works and what doesn’t, and a combination of all three.

oted on trying to evaluate social changes. Then the 11 CBO representatives were

what questions do we need to ask in order to identify any social changes?’ O

stions and concerns raised and addressed at the workshops included; availability of

es required of the community to design, collect and analyze the data, an

anding of the amount of time that they realistically had to participate in the

, as well as taking into consideration that people participate in diverse ways, at


60

differen

context

reflection would pass. How to assure that the process was not associated with fault-

r pointing, that people were not being monitored, if the findings will be

l with a pull toward just looking at activities, how much

form

ective and participatory, fostering self-

t times, with varying patterns, and through different structures within their

. Deciding how much time between information collection, analysis and

finding or finge

abused or not, how to dea

in ation is needed, how precise does it have to be, and how will the results assist in

creating common solutions and assist in bridging the communication gap between the

CBO’s and their funders.

The evaluation method slowly materialized over three workshops. Refinement

and ongoing revisions were made according to continuous and flexible spirals or cycles

of participatory learning; planning, acting, evaluating, and reflecting during the three

workshops and during actual implementation.

The resulting mission for the evaluation was, ‘To utilize an ABCD approach to

empower community members to identify and evaluate common and unique community

changes, secondary to their ABCD for health promotion programs.’ The final guidelines

for developing and implementing the evaluation method were;

o Communities will evaluate their own changes according to the values of their

setting based on local knowledge and ideas, rather than judging their approaches

according to outside criteria

o The entire process will be coll

determination, building capacity and putting control into the hands of the

communities by first identifying and building on existing community strengths.

o The evaluation method will be meaningful to the community, CBO members, the

Network, and funders.

o Methods will be sensitive to local settings, taking into consideration; time,

language, education, etc

o Methods will be adaptable for when perceptions and conditions change, and will

reinforce community competence

o Information will be collected in a collaborative manner


61

o Results will be both qualitative and quantitative because community perspectives

through experienced based stories are crucial in helping to explain the situation

behind the numbers.

o Results will be easily displayed, understood, relevant, and highly valued by the

community and their funders.

o Results can be used to guide future decisions and community action to increase

long-term sustainability of all health promotion initiatives, with hope of gaining

an understanding of social reality.

ndix A.

uld then ask everyone to

ink about what the community was like before this program. Everyone would write

thei

comfortable taking this approach because there would be enough younger community

mem

with th

allo f

concerned that by having such an open ended question, there was the potential to get

ans r

program hildren.’ Despite this concern, the group decided the

sim

Evaluation Method

The 9-step evaluation method developed at the workshops is described below for

comparison to the user-guide presented in Appe

Step 1: Before

The evaluation would begin by talking about the CBO’s program, framing

everyone’s mind set around what they did. The facilitator wo

th

r responses down, one thought per page.

Knowing that some community members can’t write, the group still felt

bers in attendance to assist. If this was not possible, responses could be taken orally

e facilitator writing them on a board.

The purpose of this step was to ask a simple and open question, one that would

w or responses to range from possible outputs to impacts. Some members were

we s that were not related to the project, for example; ‘I had only one child before the

and now I have two c

ple and open question would be the most effective first step and worthy of a try.

Step 2: Cluster


62

discuss

collectively arrange all responses into similar categories and stick them to the wall.

group d

up to think about what it is like now in the

o years after our program started (similar to Step 1). Everyone was

wn, one thought per page.

Again, the facilitator would collect all responses, read them aloud to the group,

when appropriate. The group would then

from; negative to positive scores.

The facilitator would then collect all the responses, read them aloud to the group,

each response and clarify meanings when appropriate. The group would

The basis for this idea came from a PRA method of pile sorting; however the

id this activity collectively.

Step 3: After

The facilitator would ask the gro

community, tw

instructed to write their responses do

Step 4: Cluster

discuss each response and clarify meanings

stick each response on the wall if they related to the clusters already formed, or they

would create new ones.

Step 5: Categorize

After all responses were clustered and stuck to the wall, the facilitator would

negotiate a process of categorizing and defining each cluster with a neutral key word.

The group felt it essential to use a neutral word so when it came time to rate the category

one would have a nonbiased range to choose

Step 6: Prioritize

Once all clusters were categorized according to a general consensus of the group,

they were each given two pieces of paper. The facilitator would then instruct each

member of the group to walk around, read the responses and vote by placing each paper

on the category that represented the most important change in the community.


63

The votes were tabulated and each neutral key word was listed in order of

priority, based on the outcome of the voting. The facilitator would then have the group

decide how many key words would be rated.

Step 7: Rate

n empty results form. Each member of the group

te each neutral key word

nd then justify their score with a personal story or experience written on the right side of

tar plot came from work by Rifkin and her efforts to evaluate

articipation, and the work of Chambers in his evaluation wheel (37, 43).

Uthaiwan.

Twenty-four community members attended the meeting and participated in the

evaluation. The age of participants ranged from 11-75, slightly over half were teens and

The facilitator handed out a

filled out the left side of the form with the prioritized neutral key words. The facilitator

would negotiate the meaning of each number on the rating scale from 1 to 7. Once a

consensus was reached on the scale, each participant would ra

a

the form.

Step 8: Display

Once all the scores were tabulated and averaged, they were displayed on a star

plot. The idea for the s

p

Step 9: Reflect

The star plot was displayed for the group and the facilitator asked participants to

comment on what they were looking at, what they thought of the process, and what they

can use the results for.

Community Meeting

The MaeChaem evaluation was conducted at the residence of the head CBO

representative. The two CBO members who attended the workshops were running the

local elections at the school and were not able to attend the meeting. A third member of

the CBO, a local teacher, facilitated the meeting with assistance from Dr.


64

young adults. There were 8 men and 16 women (1 older man, 2 teachers, and 4 married

older women).

The teacher opened the meeting with introductions and the community members

rticipated in singing a song. Dr. Uthaiwan and the local teacher explained that today

ey will together think about their community, what it was like 2-3 years ago and what it

ed by thinking about the CBO program they were

ing the time when the government cracked down on opium growing by

ields. At that same time, NGO’s were invited by the government

lternative income generation activities. They said

acilitators then

arted the evaluation method developed at the workshops (See Steps 1 – 9).

p what it was like in the community ‘Before’ their

d KurYo means ‘live easy/simply’) is how they refer to

emselves, as well as Karen. The responses were read aloud and discussed. Then they

sensus into similar themes and posted on the wall. When

pa

th

is like now. The discussion start

involved in and other projects that were implemented in their community the last few

years. Initially they could not think of any other besides their own program. Then, one

woman said there was a CARE project in the area that worked with the housewives group

to assist with income generation projects. Another woman said that in the past a religious

organization had a drug detoxification program nearby. They remembered the program

started dur

burning all the opium f

to work with local groups to develop a

the detoxification program lasted about 2-3 years, but was no longer running. They said

they would like to transform the now unused site into an herbal garden area as an

extension of their health promotion program. After this discussion the f

st

The facilitators asked the grou

program started. The facilitator asked them to think about it while he passed out blank

pieces of paper. Responses were written in both Thai script and in BaKurYo. BaKurYo

(Ba means ‘people’ an

th

were clustered (Step 2) by con

this process was finished, the second question (Step 3) was asked relating to what it is

like in the community ‘After’ this program has been running for 2 years. The responses

were again read aloud, discussed and clustered (Step 4) into similar themes – using

clusters already on the wall or adding new ones when necessary. The facilitator then had

the group take each cluster and categorized (Step 5) or labeled them by consensus. Table

1 lists an example of what resulted from the first 5 Steps of the evaluation method.


65

Table 1: SummaStep 1 - What wa

rized Results of Steps 1-5: s it like ‘Before’ the project?

Step 2 - Clustering similar themes. Step 3 - What is it like now or ‘After’ the project has been running for 2 years? Step 4 - Clustering similar themes. Step 5 - Categorizing all responses. *(number of times mentioned in brackets) Steps 1 and 2 -Before Steps 3 and 4 -After Step 5 “We did not have any development activities” (2) “There were no changes in the village” “We did not have any development work, and don’t have any roads”

“The village development is better” “We know more about development work” “The village has more development activities”

DEVELOPMENT ACTIVITIES


66

Table 1: (continued)

Steps 1 a Step 5 nd 2 -Before Steps 3 and 4 -After

“In the vcooperat“We others” “We had(4)

eration - for example building a

cooperation - for example groups eration, and we have sports

e operation for example

COOPERATION illage we had no “Now we have coopion” new house and other activities like during Christmas never helped time”

no cooperation” of housewives work in coopactivities”

“Now we have more

“Now wat new

can see clearly better cors” yea

“Now we h“Now we c

ave more cooperation” ooperate better”

“Health w(3) “We did nabout hea

erve and preserve our traditional make conservation of herbal medicine and d take care of our health” now about curing health”

ave better health” (2)

HEALTH as not good” “The SSS do activiti

ot have growth lth”

culture andmassage an“Now we k“We h

project we cooperate and know more and we es and cons

“We did not have unity in Ban Jam Luang, we did not have unity together” “Little mouse thinks we did not have unity ka” “Not have much unity”

“We have more love and unity because we have a group” “Our village knows unity more than before” “Now know unity more” “Have more unity” (2) “Have unity together a lot more than before”

UNITY

“We did not have activity of conserving herbal medicine” “In the past our village did not know how to use herbal medicine” “We did not have any conservation activities of herbal medicine”

“We know more about herbs” “Make everyone learn about herbal medicine” “Health is better, not have pain and illness and know about how to use herbs more” “Know more about herbal medicine more and make not buy medicine” “Health is better and don’t have pain or illness” “Everyone learns a lot more about herbal medicine and we have more unity” “We have opportunity to use herbal medicine more and to massage and not have to go to the doctor far away” “Know more about herbal medicine” “Know about herbal medicine more” “Program led to knowledge and ability more for example knowing more about herbal medicine and having more unity” “We help preserve and conserve herbal medicine” “These days most of us use herbal medicine first” “Have more knowledge and have understanding and everyone knows about herbal medicine more” “Can conserve herbal medicine” “Have knowledge about using herbal medicine more” “Have use of herbal medicine more”

CONSERVE HERBAL MEDICINE


67

“Have activities of planting herbal medicine in the forest”

about many kinds of “We have belief and knowledgeherbal medicine”


68

Table 1: (contin

Steps 1 and 2 -Before Step 5

ued)

Steps 3 and 4 -After “The village was not growing” “We did not have any growth”

GROWTH

“We had little knowledge and ability”

“Now we have more knowledge” “Now we can have more knowledge about many things” *(I probed to find out why they thought they had no knowledge in the past, they responded by saying, “before we had no roads - no way to get information, now our kids are going down to schools, and now we have our own schools.)

KNOWLEDGE and ABILITY

“Love and happiness was only a little” “We did not have love for each other, now we have more love for each other, much more”

“Have unity and love a lot more” “Have love a lot”

LOVE

“Travel was very inconvenient and made us not able to visit each other”

ROADS and TRAVEL

“Now we have massage for health” MASSAGE “Now we have conservation of traditional culture” TRADITIONAL

CULTURE “We have more fun and amusement” AMUSEMENT

After each response was discussed, clustered, and categorized; the facilitator

handed out two pieces of paper (cut into the shape of hearts) to each participant. The

facilitator instructed each person to take their paper and stick it on the most important

change (Step 6) that has taken place in the community since the program started. The

facilitator explained to not vote according to what was the biggest or most significant

change, but the most important change. The group walked up to the wall, had some

discussion and each person voted by placing their piece of paper on the wall over the

most important change for their community. Table 2 lists the results of Step 6.


69

Table 2: Results of Step 6 - Prioritize all Categorizes identified through Steps 1 -5: (number of votes given to each Category in brackets):

Development Work

Herbal Medicin

Knowledge and AbilityLove and Happiness (2) Travel

After the vo and asked the group to rate,

ity was doing in regard to these changes

e facilitator negotiated a definition for each number (1-7) and when the

c nsensus, they voted on the top 5 changes and were instructed to write a

re to justify their response.Table 3 lists the results f

of Step 7 - Rate the top 5 Categorizes followed by personal story to e:

*(score in brackets) *[number of times mentioned in brackets] COOPERATIO (5) “When we ha ers work together”

ration not a lot and not a little because we don’t give too much cooperation to have work we help each other”

4) “H

(6) “Building a church and a school” (7) “It is the best thing” (7) “It is the most important for Karen” (5) “In village development”

* Growth Cooperation (12) Health Unity (8)

e Conservation (1)

Massage activities Traditional Culture Amusement (1)

ting, the facilitator handed out a blank form

on a scale of 1-7, how they thought the commun

today (Step 7). T

group came to a

story next

h

o

to the s o

Table 3: Resultsjustify each scor

c rom Step 7.

N

ve Christmas activities all of the villag(4) “Have coope each other.”(4) “Because we( ave cooperation when we play sports” (6) “Help each other cooperate” (6) “Help to do” (5) “Help each other work” (6) “Cooperation for example when we build churches and schools” (5) “Cooperation have more” (5) “Working together” (5) “Work to build church and school” (6) “We have cooperation a lot better for example, working in groups” (5) “Because we have good cooperation in building houses and working in the field” (6) “Cooperation together for example building church and school” (5) “For example in working to build the church and houses” [2] (5) “Building a church and a school”

A Vaccine for Globalization Table 3: (continued) UNITY

month we have group villag yone has a lot of

vities and building new homes we have good unityctivity we have unity more ever

ave sports we have good unity” ve unity”

orts activities” (5) “For example the meeting on the 18th was very interesting”

many activities”

y”

(5) “On the 25th of the e meetings and we see ever unity” (5) “New Years acti

e have an a”

(5) “If w y time” (5) “If we h(4) “We help each other survive and ha(5) “Help each other do activities” (6) “We play sp

(7) “We have more unity” (7) “We all have to have unity together” (6) “In the meeting everyone shows their interests in the community” (3) “For example in the meeting we have only a few people” (4) “Working in groups have unity” (5) “Our meetings every month show the interests of the community” (5) “In the village meeting the community is very interested” (4) “For example at Christmas we have good unity” (6) “We work together” (5) “We have unity in(6) “We know each other more” (6) “Unity of the community is better, love and unity together is better” (4) “Have more unitLOVE (4) “When one person in the village does a good thing we all see and are glad and let them know” (5) “We understand each other” (5) “Peek at love” (6) “Love each other a lot”

her in the comm(5) “Love each ot unity” sharing and love”

(5) “Have active compassion(5) “Getting along well, show our affection for each other” (5) “We have more love”

or us” (5) “Love is beneficial f(5) “Have love for each other” (3) “Love not a lot because not have enough knowledge” (5) “Love for each other” (4) “We help each other” [2] (5) “We help each other” [2] (6) “We help each other” (5) “Makes us know and endure more”

ge is better” (5) “The love of the villa

70


71

Table 3: (continued) CONSERVATION OF HERBAL MEDICINE WISDOM

edicine (in the forest)” e forest”

e should conserve herbal

e”

use herbal medicine”

for the kids and relatives because it is

ke more” erbal medicine for the benefit of all of us and all of our kids and

cine” n they take herbal

tter” will conserve herbal medicine”

) “Conservation of herbal medicine is very important for the people who are far away from

e conservation of herbal medicine to be sustainable” and want it to be sustainable”

(5) “Conservation of the herbal medicine for example making a place for the conservation of herbal m(5) “When we make a space and study herbal medicine conservation in th(6) “If we are not comfortable we can use herbal medicine, w medicine” (6) “Because we don’t have to go buy medicine” (5) “Conservation of herbal medicin(7) “Herbs are medicine” (4) “It is medicine we can eat” (5) “Now we know how to (4) “Conservation of water and the forest”(6) “Development activities of herbal medicine” (6) “Using herbal medicine is very beneficial us” (4) “We need to conserve herbal medicine beneficial/useful for use” (3) “Activities to conserve herbal medicine” (5) “Conservation of herbal medicine to save and ma(5) “We are conserving h relations always” (5) “Conservation of herbal medi(4) “Some people take medicine from the hospital and don’t get well, the medicine and get be(5) “We(6 the doctor” (6) “Want th(5) “Want to use herbal medicineAMUSEMENT (FUN)

upport”

ootball”

as we have sports”

(5) “Makes us happy - think well of each other” (4) “Christmas and sports” (5) “Play sports and Christmas”

(3) “When we have sports we go to give s(5) “For example playing sports is having fun” (4) “For example we play sports and have fun” (4) “Help each other play f(7) “Play sports” (4) “Play sports” [2] (5) “Plan activities all kinds” (4) “For example takraw” (5) “Play sports” [3] (5) “Play sports is a lot of fun”(5) “For example at Christm(6) “We have fun always” (5) “Christmas and sports” [3]


72

The facilitator collected and tabulated all the scores. Table 4 depicts the central

tendencies of each prioritized change. Each change identified through the first 7 Steps of

t

p les’ and

with the help of some participants displayed the results on a star plot (See Figure 1).

The facilitator asked the group if th interested in taking one of the identified

changes and repeating the evaluation process to further understand what the identified

c

he evaluation method were determined to be the ‘variables’ of changes that had taken

lace over the previous 2 years. The facilitator took the five prioritized ‘variab

ey were

hange means to the community.


73

Table 4: MaeChaem Rehabilitation and Development of Herbal Medicine Group Variables of Community Change Measures of central tendency and variability for ratings

Concepts Mean Median Mode Range (min-max)Cooperation 5.25 5 5 4-7 Unity 5.04 5 5 3-7 Love and Happiness 4.75 5 5 3-6 Conservation of Herbal Knowledge 5 5 5 3-7 Amusement 4.75 5 5 3-7

Variables of Community Change Star Plot

Figure 1: MaeChaem Rehabilitation and Development of Herbal Medicine Group

Amusement

Conservation of Herbal Knowledge

Cooperation

Unity

4.75

1

Love and Happiness

7

7 7

77

5.25

5.04

4.75 5

A Vaccine for Globalization The group decided to explore deeper into the category of ‘COOPERATION’ by

dapted to have the context of ‘COOPERATION’ in mind. The evaluation was adapted a

ess orally. The facilitators wrote the

pa of

thi

able 5: Cooperation Breakdown by repeating Steps 1 and 3

repeating Steps 1-8. The ‘Before’ and ‘After’ questions regarding the program were

a

second time and the facilitators conducted the proc

rticipants responses on a piece of paper stuck to the wall. Table 5 lists the results

s process.

T

COOPERATION

Step 1):

force to meetings’ ‘People did not come on time to meetings’‘Before we were not brave to present our opinions at the meetings’ *(this was probed further to get thresponse that they did not have any information and less schooling so we were s so thing) ‘Wmaking a group together‘We were isolated from each other’ ‘People didn’t go to visit each other before because travel was very inconvenient’ ‘People didn’t go to funerals because they are afraid of ghosts’ ‘People move around’

After (Step 3):

ore, and more ormation and ideas

at meetings’ ‘Everyone came together to build the natural irrigation system in the community

rest’ ‘Everyone can say good ideas in the meetings and some times it is hard to get people to stop talking’ ‘Have the activity of organizing groups’ ‘Travel is more convenient because of the roads and people can visit each other regularly’ ‘People go to funerals more because we have electricity so we are not afraid to walk at night’ ‘We don’t have gambling and also have songs, “utaa”-usually sung by the elderly, some drinking depending on religion’ ‘We go to work in the city and kids go to study in the city so they bring back information’ ‘We have active conservation of herbal medicine and use herbal medicine, planting at home and at school and in the

Before (‘People in the community did not come in ‘Everyone goes to church m

willing to exchange inf

e fo

hy to say e did not have an introduction to

me

’

forest’

74


75

The facilitator then negotiated a ‘neutral key word’ to describe what linked the

categories of ‘Before’ and ‘After’. Each term identified was determined to be the

‘indicator’ for ‘COOPERATION’. Table 6 lists what resulted from this process.

Table 6: Indicators for Cooperation

3. Come together as a group ide together

6. Think/make/do/decide and use beneficially together

1. Coming together in force 2. Brave to express

4. Think/do/dec5. In the habit of visiting each other

a

currently. Scores were given to each indicato

n

the central tendencies of each indicator.

r

The facilitator repeated Step 7 of r ting where the community felt they were

r on the same scale of 1-7, but the group did

ot write comments to justify their scores as they were running out of time. Table 7 lists

A star plot was also displayed for group

eflection (See Figure 2).


76

Table 7: MaeChaem Rehabilitation and Development of Herbal Medicine Group

Concepts Mean Median Mode Range (min-max)

Indicators for Cooperation Measures of central tendency and variability for ratings

To attend in force 5.13 5 5,6 2-6 Participation 4.96 5 5 1-6 Dare to express/Brave to perform 4.67 5 5 2-6 Come together as a group 5.83 5 5 3-7 T 4.75 5 5 2-6 hink/Do/Decide together Visiting each other as habit 4.88 5 5 3-7 W f the co

5.17 5 5,6 2-6 orking together for the benefit ommunity

icators for Cooperation tar Plot

Figure 2: MaeChaem Rehabilitation and Development of Herbal Medicine Group

InS

d

To Attend in Force

Community Participation

Working together for the benefit of the community

Dare to express/ Brave to perform

Come together as a group Think/Do/Decide together

Visiting each other as habit

7

7

7 7

77

1

7 5.13

4.88

4.75

5.83

4.67

4.96 5.17

A Vaccine for Globalization At the end of the meeting the facilitator hung both Star Plots on the wall and

esults of the evaluation. The local teacher commented that the process was “not all easy

ead on our own”. Another teacher in

the re

wh as going, but in the it g e her n creat deas for doing

thi an fro ho ewives oup co ented that “we

ne before, it is t od.” nothe ember of the participants

sto s uch

different than someone coming here and saying this is bad or that is good - today

veryone learned something.” Another member of the group said “now we can see

ooperated much, now I see and want to do more, I heard many

ings today, it gave birth to much imagination. I believe our community will be strong.”

e 22 CBO’s participated in implementing the evaluation method

created during a s s of workshops. Th CBO individual resu a ed in

appendix E for review. All variables of community change, identified during the

implementation of the evaluation, were pile sorted into Social, Physical and Mixed

capital. This procedure was done by three members of ICE’s evaluation team. The three

members of the evaluation team compared results and came to a democratic consensus.

Table 8 lists the results of this process.

completed the evaluation methodology by having a reflection (Step 9) on the process and

r

and not all hard, but now it is enough for us to go ah

group said she listened to what was happening and in the beginning was not su

ere the process w end av ew ive i

ngs in the community. A wom m the us gr mm

ver did anything like this oo go A r m

od up and said “everyone is very sati fied with what happened today, and it is m

e

ourselves - it is very good - and we can see in the future where we should go and how far

- for myself I have not c

th

Overall Summary of Evaluation Results

Eleven of th

erie e 11 lts re display

77


78

Table 8: Pile Sort 1 – All ‘Variables’ pile sorted into Social, Physical and Mixed Capital (number of times mentioned by a CBO in brackets) Social Capital Unity (8) Participation (2) Cooperation Participation/Cooperation Community Power Togetherness Know Friends Thinking and Deciding Together Wisdom of Local People Self-care with old wisdom Hill Tribe Culture Culture Conservation of Herbal Knowledge Self-care with Health Leadership in Group Health Status Physical Health

Physical Capital Place to Play Resources (Funding) (2) Local Growth/Development (2)

Mixed Networking (2) Decreased Illness Economic Situation Decreased Stress (2) Stop using Addictive Drugs Using Free Time Gangs

Community exercising groups Sports Strong

hysicMental Health (2)

Community Relations Family Life (2) Strength Revitalization Education Knowledge about Health Interest in Learning Learning Knowledge about Drugs Knowledge Drug Prevention Responsibility by Community and Family

Interest Health

P al Exercise

Strong Community Family Warmth (2) Active Compassion Compassion Kindness Human Relationships Love and Active Compassion Happy, Joy, Gay (2) Love and Happiness Amusement


79

Each member of ICE’s evaluation team (3) pile sorted all variables from the 11

C t any restricti embers of the evaluation team compared

results and came to a democratic consensus. Table 9 lists the results of this process.

T ‘Vari e* entioned by

g (2)

ity Relations

Family Warmth Active Compassion Compassion Kindness Love and Active Compassion Happy, Joy, Gay (2) Love and Happiness Family Life

BO’s, with ou on. The three m

able 9: Pile Sort 2 – All a a CBO in brackets) bles’ pile sorted into similar th mes

(number of times m

Unity (8) Community Power NetworkinTogetherness Know Friends Strong CommunityCommunHuman Relationships Strength

(2)

Wisdom of Local Pe old wi

ople sdom

re

ledge Health

Education Knowledge about Health Interest in Learning Learning Knowledge about Drugs Sports Interest

Self-care withHill Tribe CultuCulture

f Herbal KnowConservation oSelf-care with Health Status Physical Health Community exercising groups

Resources (Funding) (2) Local Growth/Development Community Development Economic Situation Decreased Illness

Strong Health Mental Health (2)

Stress (2) Participation Cooperation Participation/Cooperation Thinking and Deciding Together

DecreasedRevitalization

Leadership in Group mmunity and Family

Outliers: Amusement Drug Prevention Use of Addictive Drugs Place to Play

Responsibility of Co

ere then compiled into a chart, based on the result of the final

pile sort, to display the frequency of similar identified ‘variables’ from all 11 CBO’s.

The quantitative results were then averaged to provide a display of scores given to each

o ommunity change. Table 10 lists the results of this process.

R ll the CBO’s identified ‘variables’ were then graphed, based on the final pile

All ‘variables’ w

f the 9 identified themes of c

esults of a


80

sort, in order to visualize similarities and frequencies of identified changes and their

current self-assessment score among all CBO’s participating in ABCD for health

promotion (See Figure 3). See Appendix E for individual quantitative results for all 11

CBO’s who participated in the evaluation.


81

Table 10: All ‘Variables’ identified by the 11 CBO’s and their average ‘Score”

Community Groups 1-11 Concepts 1-9 1 2 3 4 5 6 7 8 9 10 11

1. Unity

o Unity (8) o Community Power o Networking (2) o Togetherness o Know Friends o Strong Community o Community Relations o Human Relationships o Strength

x 4.11

x x 4.38

x 6.63

x 5.41

x x x x 5.73

x x 5.48

x x x 6.49

x x 5.55

5.04

x

2. Warmth

o Family Warmth (2) o Active Compassion o Compassion o Kindness o Love and Active

Compassion o Happy, Joy, Gay (2) o Love and Happiness o Family Life

x x 4.39

x x 5.68

x 4.67

x 5.71

x x 5.57

x 4.75


82

Table 10: Continued m

Com unity Groups 1-11 Concepts 1-9 1 2 3 4 5 6 7 8 9 10 11

3

. Local Wisdom

eople old

ure

bal

x 6.63

o Wisdom of Local Ptho Self-care wi

wisdom o Hill Tribe Culto Culture o Conservation of Her

Knowledge with Health o Self-care

x

4

x 4.88

x 6.64

x5.73

x 5

4. Education

alth

x x 5.2

.77

x 6.08

.09

o Education o Knowledge about He

arning o Interest in Leo Learning o Knowledge about Drugs o Sports Interest

x x5

x 6


83

tinued

Community Groups 1-11

Table 10: Con

Concepts 1-9 5 6 7 8 9 10 11 1 2 3 45. Physical Health

o Health Status

ealth

x 4.55

.14

.11

x 6.29

o Physical Health o Community exercising

groups o Decreased Illness o Strong H

x x 6

x 5

6. s

Resources (Funding) (2)

Growth/Development

2.88

x

x 4.82

.27

Re ources

oo Local

o Community Development

o Economic Situation

x x

x 5

7.

Mental Health (2) o Decreased Stress (2) o Revitalization

x 4.45

x 4.44

x x 6.11

x 6.23

Mental Health

o

A Vaccine for Globalization Table 10: Continued

84

Community Groups 1-11

Concepts 1-9 1 2 3 4 5 6 7 8 9 10 11 8. Participation

CooperationDeciding

4.44

x 5.35

x 6.18

5.25

o Participationo Cooperation o Participation/o Thinking and

Together

x

x

9.

nsibility of unity and Family

x

71

5.4

Leadership

o Leadership in Group o Respo

Comm 3.

x

Ou r AmDru PUs

la

tlie s

usement g revention

e of Addictive Drugs ce to Play P


85

Figure 3: Frequency of CBO identified and prioritized ‘Variables’ vs. the current ‘Score’

Outliers: Amusement Drug Prevention

Drugs Places to Play

Use of addictive

Variables of Change

Unity Local Wisdom

Phys. Health

Ment. Health Leadership

Warmth Education Resources Participation

X=frequency of prioritized changes as identified by the CBO’s

= frequency of current scores giv etermined by the CBO’s Y en to identified change as d


86

Evaluation Discussion

ICE and the 22 CBO’s wanted to develop an evaluation consistent with their

ABCD approach to health promotion. The workshops were designed to practice a

thinking process of participatory learning and collective decision-making by providing an

environment for dialogue. Some might cr e e f having the ‘ques -

makers’ also be the ‘question-answers’. w oint out that wh

community has the chance to examine itself through questions created and asked to itself,

there is potential to lead to a new consciousness of ones surroundings (9). This approach

taken by ICE opened the door for the discovery of new and innovative ways to evaluate

broad societal impacts, and assisted the CBO’s in explaining these impacts to outside

funders

ing the workshops health professional and non-health professional; native

Thai, English and Lanna speakers engaged in a discussion of local health issues and

evaluation techniques. Universal terminology was an obs e overc

example, the word ‘Empowerment’ is not a native Thai word. The as m de

regarding the meaning and possible translation of this word and others. The process was

slow, and at times appeared to move in circles, but in the end it contained a great deal of

potential for the CBO’s to take ownership in learning how to self-ex

The development of the evaluation method was a learning experience for everyone

involved in the process, from community representatives to workshop facilitators.

evaluation method developed at the workshops strongly resembles a six-

elem ocess for empowerment evaluation described by Fawcett et al. (19). These

steps include; determine where you are now, where they would like to go, how to get

ther itor to make sure you are on track and making progress, collect and analyze

data along the way so you can adjust course, and apply what you have learned to

strengthen the organization for the next program (19). It also relates to what Green and

Kreuter detail in the Precede-Proceed Health Promotion Planning Model, specifically

whe ing a social diagnosis (44). The social diagnosis phase of the Precede-Proceed

Model is the identification and analysis of social and economic conditions, perceived

quality of life or the aspirations of the target population (44). This phase is necessary for

any thorough health promotion planning process (44).

iticiz

Ho

th

ev

e c

er,

onc

othe

pt o

rs p

tion

en a

bate

.

Dur

The

t pr

on

rm

tacl to

re w

ome. For

uch

amine their situation.

en

e, m

n fo


87

The 9 steps developed by the CBO’s stands to be criticized for its lack of

y dependent on the facilitator. The specific skills of the facilitator directly

e and

easur

for discussion and action. Action

scientific rigor and objectivity. However, with regards to objectivity, it has been argued

that perhaps objectivity is gained not through detachment from the setting via an outsider,

but through intimate involvement in and reflection about the setting (19). Additionally,

the CBO’s felt a complex methodology with statistically measurable objective data

gathered solely through quantitative means, similar to their current summary reports,

would defeat the purpose of a community-wide, user-friendly and community-owned

process for evaluating broad scale societal impacts. Thus, the simplicity of the method

was its strength.

During the implementation of the evaluation method; the quality of the evaluation

was largel

reflected on each community’s results, the amount of reflection and the potential

utilization of findings. For example, the clustering and categorizing steps were easily

monopolized by a few individuals if the facilitator did not make direct efforts to bring all

community members into the decision making process.

A few CBO’s took the evaluation process further by repeating the 9 steps and

developing indicators for achieving one specific identified variable. This additional

process turned out to be one of the most enlightening phases of the evaluation. However,

to deeply explore into the meaning of each variable was time consuming and challenging.

It was initially the most confusing phase because they were attempting to defin

m e very intangible concepts, i.e. ‘COOPERATION’.

The process of gathering the qualitative data was essentially much more important

then the actual scores given to each variable. The results were completely community

specific and subjective. ICE is unable to generalize or compare results among different

communities because each community defined their own variables, indicators, and

standards of acceptability. This will also make tracking changes over time difficult

because the majority of identified variables were not static, i.e. love, unity, etc. The data

did provide answers to what the changes were, however an understanding of why the

changes occurred remains up to the participants of the evaluation to determine.

The CBO’s wanted the results to be put together in an easy and understandable

format. The displayed results would be a starting point


88

to either change the evaluation steps to meet their needs (i.e. writing down their answers

to the before and after questions or doing the process orally), to address areas of

identified importance for future projects, and to improve current efforts. The Star Plot

provided this, however some CBO’s decided that the next time they wanted to try to

display the results in a different format.

The intention of ICE was that the evaluation method would function as a

benchmark in which CBO’s can revisit and repeat independently. However, only 11 of

the 22 CBO’s participated in the workshops and implemented the evaluation in their

communities. The 11 CBO’s who did not participate in the process expressed concern

k meeting when the evaluation

nother community program,

that this author was going to ‘steal their ideas’ return to the US, patent them and leave

them empty handed. Despite ICE’s constant reassurances this was not the intention of

the author, some remained steadfast in their refusal to participate.

A representative from ThaiHealth was invited to attend the Network meeting

when the 11 CBO’s shared their evaluation results and reflected on the process. The 11

CBO’s who did not participate did not attend the Networ

results were presented. However, the participating CBO’s proudly discussed their results

and several different CBO representatives engaged in dialogue regarding what each

others definition of similar identified variables were. The ThaiHealth representative was

impressed with what the CBO’s had accomplished, and was glad to see a renewed

appreciation for evaluation among the CBO’s who participated. She was excited to hear

that one CBO had repeated the evaluation method with a

without the facilitation of ICE.


89


90

CHAPTER V: LIMITATIONS

Limitations

Overall, the study was limited by time, language, availability of CBO’s, and

personal bias. Race, gender and nationality ay have influenced how people responded

to questions, or how much they shared abou their opinions. Translation should also be

mentioned as Thai is not our first language for the assistant researchers; therefore errors

of interpretation may have occurred. The 3 months time frame limited the depth of

knowledge obtained by this study and limits the ability to analyze the utility of the 9-step

evaluation results, as this will be evident by future program proposal writing and

evaluation. Researchers spent only one or two days in different community settings and

recognize this provides only a glimpse into a communities’ reality. The primary

limitation for data collection was not being able to interview all CBO representatives.

The CBO’s moving through the ABCD based process for health promotion with more

success were more likely to be present at the Expo, meetings, participating in developing

and implementing the evaluation, and invited us to visit their community. Therefore, it is

possible we missed collecting information from groups that may have been less

successful.

It is impossible in qualitative research to remove every threat to validity (45).

Although we tried to construct an objective account, our personal views may have

colored the interpretation of the data. There is no guarantee that a different investigator

would have interpreted the data in the same way. Field notes and transcripts are available

for others to analyze.

Attempts to maintain internal validity were obtained by constantly reframing and

restating an interviewee’s words during the conversation, in order to confirm intention

and concept links, and by immediate transcription. External validity of the conclusions

could be increased by another study using the same methods under similar circumstances

in another location. The conclusions are not generalizable, they are only specific to the

groups encountered and addressed in the case study. However, the processes and insights

m

t


91

presented here may be easily transferable to another setting practicing ABCD based

approaches to health promotion and community development. Additionally, aspects of

the evaluation building proc ble to other settings.

ider Issues

ess and final steps may be transfera

Insider/Outs

As a result of the participant observation and NFG’s, community representatives

appeared to feel at ease, perhaps trusting, when talking with me about their work during

the semi-structured interviews. Many became excited and animated while telling the

story of how their community worked on their projects. They appeared comfortable with

my ability to speak their language, and ask questions about the projects with the same

words CBO representatives and community members used. As the researchers gained

acceptance into their group, reactivity declined. The participant observations and NFG’s

also helped shape the questions for the semi-structured interviews. This was fundamental

for gaining insight into how they viewed their work, where ideas came from, and how

they framed struggles and successes.


92


93

CHAPTER VI: CONCLUSIONS AND RECOMMENDATIONS

Conclusions

This case study has provided valuable information about community perspectives

related to ABCD approaches and a context ethod to evaluate social changes

among people-led community health and development programs in Chiang Mai Thailand.

The original purpose of this case study was two fold; first to describe one group’s effort

in hopes of shedding light on how the ABCD approach is perceived by community

groups, and the second refers back to the question, ‘if the ABCD approach claims to lead

to community empowerment and self-determination, as written in the ICE program

‘Increasing Community Capacity for Health Promotion and Well Being Project’ how can

these CBO’s measure these potential changes in their communities?’

Based on analysis of the data, every CBO who was part of this investigation

believes their ABCD based approach to health promotion and community development

is; leading to positive changes in their communities, and different from other health and

community development programs they were exposed to in the past. Perhaps this is

because they now have an alternative to hold up against the standard needs-based

approach, making comparison and contrast meaningful. Additionally, the resulting

evaluation method, based on the concepts of participation and empowerment,

incorporated social, cultural, environmental and political factors into the evaluation of

outcomes and impacts of their health promotion programs. Despite the lack of

generalizability, ICE and their research assistants pile sorted all variables resulting in 9

separate categories; unity, warmth, local wisdom, education, physical health, resources,

mental health, participation and leadership. When looking at the three most identified

changes; unity, warmth and local wisdom, which can be classified as social capital, can

we answer yes to the question; Does ABCD approaches lead to empowerment and self-

determination? We believe the answer is a resounding yes and will argue that the ABCD

approach does in fact lead to empowerment and self-determination as evidenced by the

top three mentioned variables; unity, warmth and local wisdom. Therefore, ICE and the

specific m


94

CBO’s were successful in developing a way to evaluate and translate what they ‘see

happening

The evaluation results will be used to supplement quantitative reports submitted

the purpose of showing evidence of the broad social changes taking place

ddition to being

The second purpose of this case study was to describe how ICE and 11 CBO’s

in their community’ into ‘measurable variables and indicators’.

to funders for

in their communities. The self-identification and definition of these community changes;

unity, local wisdom, education, love, etc., elicited through the facilitation of community

dialogue will be used to assist in the design and implementation of future health

promotion programs. The 9 – step evaluation method developed by the CBO’s during

three workshops will be incorporated into a facilitator guide produced by ICE to assist in

conducting future workshops and evaluations with local CBO’s.

The process of developing and implementing the evaluation has potential to lead

to improved future development practices because community specific, reliable methods

were created to gather data that is meaningful to the community, in a

respected by the ‘professional’.

Perhaps someday, overwhelming evidence will exist to shift the balance of health

services and community development initiatives from top-down, problem-oriented,

outsider defined, funded and researched, to a more local bottom-up, strength-based

orientations. Otherwise, institutions will continue to teach deficiency oriented methods

as the preferred approach for public health and community development, thus making

sustainable empowering community development an unattained dream for the majority of

the world’s people, most especially those groups considered marginalized.

Recommendations

Recommendations for ICE include focusing on the difficulties mentioned by CBO

representatives including the issues of time, communication, and evaluation.

Communication alternatives could be explored by rotating the location of the monthly

meetings. Coordinating the development of CBO and Network timelines detailing

upcoming deadlines might also be considered. Providing representatives with more

workshops on negotiation and leadership could also be explored. Many CBO

representatives stated program writing and evaluation were areas they wanted to improve.


95

successfully developed a method to identify and evaluate social changes within their

communities secondary to their health promotion programs. The CBO’s accepted the

’ or ‘marginalized’ is

in trying to balance the equation of inside and outside

oup co esion,

aintenance of cultural identity, sustainable social transformation, and increased quality

efforts should be made to balance the overwhelming dominance of

challenge of learning how to evaluate outcomes and impacts of their programs with the

hope of generating action to transform social structures and conditions that oppress them.

ICE could have easily compiled a prefabricated list of variables and indicators, based on

a literature review, and conducted an evaluation to identify outcomes and impacts with

the mindset of “Why do these CBO’s need to develop and implement their own

evaluation?” This author feels there are reasons, too many to count, for why these CBO’s

are labeled ‘marginalized’ and considered hopelessly stuck in the ‘vicious cycle of

poverty’. The most significant reason for what keeps them ‘stuck

their dependency on local and international ‘elites’ or ‘professionals’ (9). However, one

is naïve to think that global interdependence is not an inevitable fact of life. With these

factors in mind, ICE and these CBO’s collectively believed the key to stopping the

‘vicious cycle of poverty’ lies

responsibility in order to break the cycle. They understand that empowerment and

development cannot be transplanted from the outside, but instead must come from within.

This case study hopes to raise critical consciousnesses of health professionals,

both practitioners and community development workers in respecting people-led

processes, working to counter institutions and systems whose aims are to derail and

devalue the process, and recognizing that the creation of an environment which allows for

genuine dialogue, or two-way communication, holds potential to lead to gr h

m

of life. Additionally,

needs based public health programming by finding ways to include or collaborate with

those interested in ABCD based strategies. The process clearly takes time, as all are

engaged in co-learning; however, based on the case study presented here the benefits

clearly outweigh the investment. Continued efforts to make community representatives

voices, opinions, critiques and insights part of the community development and public

health dialogue are fundamental.


96

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Table 11: Types of Community Development Approaches: Definitions, Strengths and Weaknesses (Adapted from Castelloe and Watson 2002, and Mathie and Cunningham, 2002)

Community Organizing (Alinsky, 1973)

Popular Education (Freire, 1970)

Participatory Developmen(Chambers19

ssets BasMcKnight an, 199

A(

ed and Kretzm 3) t

97) Definition An outside organizer

enters a community, and mobilizes citizens around a particular injustice.

Involves education and dialogue based on interactive co-learning, resulting in raised levels of critical consciousness, leading to group action.

Community m

organize their development, ilcapacity and s i

t at e o ui n nss th b e l ooc h cori m an e x ge

mecontrol, develop and

thus buustainab

bers

own ding lity.

Scaanldd

arts with whmmunity by bd communityets (rather

eds). Internaal relationsven developpendency on e

is prlding o

an pro focus ips, ent,

ternal a

sent in aindividual

talents, skills and lems andn forming mmunity-d limitsncies

Strengths -Reaches out to citizens by forming a group. -Focused on building strategies for fundamental system change.

-Useful if groups already exist. -Dialogic co-learning promotes equity. -Group process as a focus. -Emphasis on analyzing broad social constructs that result in injustice.

-Uses PRA fo mplanning, imp ti-Control bycommunity. -Emphasis on th pof grassroots groups ieffort to nsustainability.

PhR e a V s r smbalances. A s ncy utE s ocal w c e

r assesslementa

e ca

e

ent, on.

the

acity n an sure

-s-c-i--e

rovides a meared meaning. ecognizes thpitol.alues strength

void dependempha izes lonomic developm

thod to construct a

of social

s of power

siders. orks for

value

egardle

on o netnt.

Weaknesses -Focus usually on only one issue. -Lack of focus on broad social issues. -Less emphasis on individual learning.

-Less emphasis on guiding how a project might flow. -Little discussion on actual group building.

-Rarely used t asocial, cultural, p ceconomic forces that rin oppression. -Varied definiparticipation. (*see appendix, C

L o actio tes e r. N sure clusi a al ups.

C rn part tion u ies. Need an g en menNo clea ion in termappens i eadership b

formalized.

o anoliti

tions

)

lyze al or esult

of

-r-m-c--h

evel f interourc s uncleaeed to enrgin ized groonce over ltural hierarch

enablinr direct

f l

n wi

in

icipa

viron

h external

on of

given

t. s of what

ecomes

102


Table 12: Qualitative Inquiry Activities CBO Inform

D s sand (IFGD)

isit e t ut ee d (s ir l t o

Participant Observation

al sioniscu

Site V SInRro

mi-Servispone in

ructw ent

he c

red

) amm

nd theunity

1. MChae

X e e x

ae X m

X Xteacom8 te

(2 CBchers

munens)

O rep ity a

s win nd

ho arth

appro

2.K

X

e nd 8 teens

Mee

ae Ba X x X Tea1

(2 cher

C

CBO of reomm

rlig

eps; 1 ion and

Dev Volunt er, a

3. NoYang

X B ep who is a im community w e

ng X X X (1Cpart thealth

O re

ork r) 4. Ban H

B e ho is a health uayBong

X x X (1 Cvillage voluntee

O r

r)

p w

5.W(m

ho is a ing

Ban ai uayth

No

ai)

ng

X x X (1 CBcoach of

O re Thai

p w box

6. Sr Lua

C ep who is a eiBau ng

X x X (1farm

BO rr)

7. BMaeJong

1 rep who is al of the teachers)

an X x X (the schoo

CBO principl and 3

8. anHFellowship

ep who was f the Lanna wship)

eale

Lr

na X x X (1 Cthe le

e

BO rader o FH aler ello

9. BinDok

reps; 1 an and 1 mmunity

Ban X Xvillactme

(2 age hive mber

CBO eadm

co

10ofHealers

who is a

. Socie Lan

ty na

X x X (Lan

1 CBna H

O repealer)

11. SaLuang X X X X (2 CBO reps; 1 Lanna Healer and 1

omm Dev Worker) C12. Nong H

X X X oi

13 ri Po X (2 CBO reps both teachers, and 8 teens)

. S om X

(The small x refers to visiting that site, but with the purpose of doing a different activity.)

103


104

Table 13: Themes with illustrations Themes Exampl ns intere (I1, I2 mea view one, interview two etc.) Independent Ideas

p from the ideas of the community, they wanted to do this. It is the thinking of “It is the ideas of the villagers, they are the ones that decide what to do and they talk to understanfrom the top (upstairs), no one is gointhey think by giving us a project, we ether to do this the way though we sh ld, and we

(freedom-‘eesalaa’)

“The roject came the villagers” (I1)

d the problem. It is not g to make us live the way came tog

we ou did it together…”(I2) Co-operation (‘quamruammeugan’ directly translated

ll together)

“Many groups came together to dwomen…”(I1) “we accept anyone who is interesting in doing something…”(I2) “All hearts together and all thinking can’t live together.” (I7)

means, a feeling f ahands

o

o this, youth, elderly,

together, if we don’t we

Acceptance

“no one is left out…”(I6)

System reversal (examples here are

icro

“The vi agers used to a ept progratime…now they think themselves andtop.” (I1) “If we don’t begin to do this, we would not be able to get anyone together in order to think ab rrent problems, and the problems will stay.” (I2)

macro I1 and I2)

m

ll cc ms from the top all the propose programs to the

out some of our cu

Pride/Esteem (pride-‘poomjai’ jai is

art, ull

n, so together l rted

“They are proud of themselves, they did not think they could to it…now they can see it with theicommunity can do it…The work they do leads to peace and pride for the community” (I1) “If it is their own thinking they will be proud of themselves, and they will have the experience of pbe a fire and let them to do good ththey encounter a difficulty they will be able to use the experience for solving problems.” (I5)“…we (the community) feel proud, proud, proud, they (the members of the community) feel thteach others and help their families (

the word for poom is similar to for swolle

he

is means a fulfeeling.)

hea

r face and eyes that the

roblem solving, this will ings in the future, when

ey can help themselves, using herbal medicine).”

(I10)


105

Themes Example (I1, I2 means interview one, interview two etc.) Community Dialogue

hese examples show lationship building,

e development of critical consciousness).

listen and

e think together, we want the home family and school to

e ave no right to be there, we are not the leaders of the village.

aboration is probably what made the program ork.” (I5)

his kind of work with your heart, and have nity in making a network for your project, the funding is

rk directly…”

People started communicating.” (I11)

(Trerecognition of social assets and th

W

“When they meet they are able to speak andexchange together…” (I1) “work together, (teachers, monks, parents, youth,) we all come together to discuss the current problem, where they come from and why…” (I5) “Working in the community is the most difficult because whCollaboration in our own villages can be a problem; (at the same time) collw “You have to do tuimportant we can’t do it by ourselves, villagers don’t have the money to support this wo “

Community Power mpowerment?) palang’ is the word r power, ‘chumchom

ns the

d for empowerment, the translation is ‘serm ang palang’, ‘serm’ eans fill or renovate

to build.

In the past the villagers did not know the power of ommunity, now they have a group that brings them

more power from pride, we can’t study very high, nd we don’t have a monthly salary in the 10,000’s we make

o the happiness of e people in our village, our friends, it is our happiness as

everyone, because it builds dividual and community power for health promotion and

(e(‘fomi palang’, meacommunity has power. There is no native wor

smand ‘sang’ is So, it is to renovate or build power that may already be there.)

“ctogether…everyone is accepted.” (I1) “we have aenough to keep our families, we want to use our time to work for others, and that we have a lot, this is our pride (motivation) and we can do it, this is what we want to dthwell. This is the kind of power that we have, and the power that we have not yet used.” (I2) “This is a good project forinbetter development…and the kids learn leadership skills…” (I10)


106

Themes Example (I1, I2 means interview one, interview two etc.) Traditional Culture (culture- watanatam”)

“The study of wisdom of the old culture is a big concern

ecause now everyone is studying high tech and the traditional

(to other health programs) because we are orking on issues like drugs, AIDS, and using time usefully,

gs.” (I4)

bwisdom is being lost, there is no school requirement for this.” (I5) “We are similar wbut different because we recognize that no one wants anyone else to know they are involved in something related to a problem. So, we look to our traditional way of life, see what we can learn from our culture, and build activities around those positive thin

Thoughts on Outsiders

so little, people here ave bad economic situations and only make enough to eat.

believe that we can do why is that? Why don’t they believe in us? That is the

ide, but I don’t want it, hy is it that our own country of Thailand is not helping

t,

“why don’t they (funders) support us why don’t they give it to us, in our village our own donations arehThe problem is they (the funders) don’t’iproblem.” (I2) “Maybe there is funding from the outswus.”(I2) “The only thing the community learns from programs coming from the outside is to wait, wait, wait for the next program to come and give you something. We have forgotten to think for ourselves.” (I7)


107

Themes Example (I1, I2 means interview one, interview two etc.) How do you think

uilding or renovating ower mpowerment)?

Because now we have friends that feel the same way we do,

olutely! From this experience students will have power in eir hearts and bodies for working in the community and

fficulty they will be able to use the xperience for solving problems.” (I5)

This process is empowering because people accept their own

ds the feeling of conservation and uses things at we already have for a benefit.” (I4)

h other and never had any coordinated activities to ise consciousness about nutrition and health” (I7)

rents, development workers, village headman) re working together honestly, and we all understand each ther better.” (I3)

your community isbp(e

“and we have a network for loving the environment, we can think and plan activities together…” (I4) “Absthsociety. They will have the experience of thinking for themselves, and doing things for themselves.” (I5) “If it is their own thinking they will be proud of themselves, and they will have the experience of problem solving, this will be a fire and let them to do good things in the future, when they encounter a die “problems, identify their own knowledge, set their purpose and goals, choose methods for problem solving and do by themselves. They have the experience from their efforts and they evaluate what they have done by themselves.” (I6) “Because it builth “it builds unity with nearby villages, before we were isolated from eacra “We show other villages the elderly group here, and they get excited and go to the office and make their own group.” (I11) “Because we (paao


108

A: ICE Prop T“

Appendix osal

he Research Proposal Challenges of Health in a Borderless World”

TITLE r Memb

Inc

easing Community Capacity and Empowering Community ers to Improve the Health and Well-Being of Chiang Mai

Hilltribes and Low-income Groups in 3 Thai Districts TYPE OF RESEARCH Participatory Action Research OVERALL GOALS • To determine how to im

development of youth, increasing community artistic activities;

• To determine how to im n promoting development of skills among sub-district administration/organization and municipality personnel in the area of community deve

• To determine how to icommunity partnerships

prove implementation and effectiveness in promoting the integral seniors and women in Hilltribes and low income communities while cohesion and collaboration through cultural, political, social and

prove implementation and effectiveness i

lopment; mprove implementation and effectiveness in promoting creation of by local actors for health promotion.

PROJECT SIGNIFICANCE Recently, Chiang Mai was chosen as the pilot coverage health insurance bhealth project, Chiang Mai p y, which form part of an initiative for health-care decentralization to local government and health-care reform. This project will be launched in October The innovation model of th of health local autonomy which called “ The Area Health The Area Health Board wgovernment organizations, society and representatives system reforms in Thailand desperate need to encourageempowerment given the pers Producing better health and improving quality of life at individual and collection levels need

uilding community capacity for action oriented at changing living conditions. Community participation is not possible in a vacuum, people need incentive to participate and the best incentive is to provide the opportunity to solve problems and issues that effective daily life. All activities in this project will be focused on inspiring experiences of community participation and empowerment of powerless and marginalized groups those who are in highland communities (hilltribes), sub-urban communities and urban communities. In working with communities to promote health, several abilities and skills from diverse disciplines and fields are needed. For example include advocacy, negotiation, policy formulation, strategies for community development of social networks, participatory techniques and social

AND HEALTH ISSUES INVOLVED

province from which to implement universal eginning June 1, 2001. Apart from this national innovation public ilot is one of 15 sites throughout the countr

1, 2001.

is health decentralization is establishing of the new formBoard or the Provincial Health Board .”

ill be comprised of 3 parties, namely representatives from local representatives from the popular sectors in communities or civil rom the ministry of public health. It means that the current healthf

need to be contributed by the popular sector. And yet, there is still a strategies of increasing and strengthening community capacity and istence of inequities in health.

b


action communication. Concentrating in the problem-solving capacities of communities is sential for obtaining success in participatory work.

ning community capacity will help powerless people to help themselves. local level but also address the complex subject of

uilding community capacity for action oriented at changing living conditions, producing better

ork has plications for the di ributio uction of

pts to upset the status quo and introduce edures necessitate active involvement in distribution of power, relation

etween social groups, and the production of knowledge.

esIncreasing and strengtheNot only addressing poverty and social need atbhealth and improving quality of life at the individual and collective levels. Recognizing almost all action as political, participatory action-research assumes that wim st n of power in society and that control of the prodknowledge is central to the maintenance of power. Attemmore democratic procb TH5. 1To

ancom

save

y Kretzman and Mcknight ent of

E SPECIFIC ACTIVITIES: How will the project be implemented? make communities get involved and develop their own capacity:

Participatory Action Techniques, e.g. focus groups, Delphi, consensus development, participatory pl ning, future search conference and logical framework etc., will be used to stimulate

munity participation, the focus to be maintained is the assessment of the situation and prioritization of needs and problems made by citizens. Identification of problems and needs is the be t starting point for community capacity building and the goal is the participation of those who

never had the opportunity of being heard; hA new strategy, “asset-based community development” developed b

993) will be used. It is an innovative methodology that “leads toward the developm(1policies and activities based on the capacities, skills, and assets of lower income people and their neighborhoods”. The map of community assets provide a tool for discovering individual and collective capacities and talent, as opposed to the usual practice: making an inventory of deficiencies of individuals or communities. It recognizes that each individual has talents, abilities, interests, and experiences that constitute a valuable arsenals that can e used for ommunity development. c

The “alternative path of asset-based, internally focused, and relationship-driven” map is a comprehensive inventory of all possible capabilities of a local community. The community assets map includes not only individual’s strengths but also citizen associations like churches, clubs, cultural groups, and local institution like schools, libraries, hospitals, parks, etc. Internally focused refers to concentrating on the problems solving capacities of the community. Together they provide answers for building or rebuilding relationships between and among individuals, local association organizations and institutions. The community epidemiology approach will be applied by using small communities/groups as the starting point to build larger and multi centric aggregates, where the individuality and cultural characteristics of a given group are not lost or subsumed. This approach allows moving progressively towards great integration between communities. All partners will be expected to

ach consensus and committed themselves to achieve their desired health goals. re Development of community partnerships. For the real approach to community participation, the commitments should be made for establishing “co-partnership” in health. This approach implies community involvement at high decision making levels in health service administration, in quality control activities and in establishing transparent financial resources management procedures at institutional levels.

109


110

At the community level, workshops and education activities for improving community organization and support, technical assistance for community groups and provision of appropriate

te NGOs and CBOs to

ilding will be trained as participatory ction learning.

dialogue and dissemination of

spaces for discussions, negotiation and consensus building will be implemented. Strategies, skills, and resources for working together; Health care institution like community hospitals and health centers will invijoin partnerships as “co-partners”. Workshops for health workers in community participation methods and strategies as a way to improve the health of the communities will be conducted. Skills such as advocacy, mediation, social action communication, negotiation, policy formation, abilities in resolving interest conflicts and consensus bua 5.2 How will the proposed activities promoteinformation about development ? By providing local-local dialogue meetings workshops, seminars and future search conferences participants will conduct 2 ways communications, participatory planning process and participatory action-learning which promote dialogue and dissemination of information about community development; 1-With culture and socio-political approaches, participants will gain the maturation of community participation process and strategies as a way to improve the health of communities; 2-It is believed that local-local dialogue creates awareness, develops communication and forges collaboration among local actors. In some cases, it can be described as a forum for conflict resolution, providing an opportunity to forge partnerships where mistrust and conflict have prevailed and to focus community action on issues that directly affect everyone.


111

5.3 Describe the project timeframe on how the it will take place? A one-year project timeframe in which the project will take place.

Month Activities 1 2 3 4 5 6 7 8 9 10 11 12

1. Asset-based community development - Develop the community assets map

in 5 sub-districts of Mae Cham district and 2 municipalities of Muang and Sansai districts.

- Community epidemiology approach.

2. Future Search Conferences among

- Two (3 days) meetings in Mae Cham

NGOs. CBOs, local authorities in participatory planning

district - A 3 days meeting in Muang District - A 3 days meeting in Sansai District

3. Training Workshop on: - Health Promotion: New Public

Health - Advocacy & Mediation - Team Building and Leadership - Social Action Communication - Community Radio (CR): How to be

the local DJ and produce good CR program

4. Coordinated Action by multiple actors, sectors

5. Monitoring and Evaluation by participatory ME Team

6. Evaluation Conference (2 days)

7. Reporting

5.4 Organizational Arrangement and Autonomous Provider Network:

6 TARGET • Twenty-one community based organizations in 3 districts will be setup.The youth, seniors

and women in low income communities would actively involve in public decision making processes to ensure that practical gender and group interests are adequately address to appropriate healthy public policies and programs conducive to their own positive health and quality of life;

• Five local administration organizations and 2 municipalities in 3 districts will be provided with training in principles of community development and health education. The Sub-district Administration Organizations (SAOs) and municipality members, community leaders include


youth, seniors and women would develop community capacity include community ulate values, sense of history,

sense of community, critical reflection, ability to bring in sources, skills, and ability to exert

• nated actions by multiple actors or t s il e r m A ol Os A ip t b , ut r and to influence healthy public policy t lo l a p

participation, leadership, rich social networks, ability to artic

power; Co-ordi sectors in 3

nddis

urictic

wli

l b m

pem

forrs

ed.o

t l work

cal evel, local actors which are CBOs, NG

et, oo

S Os a m n a y e e w ld aog her to improve the conditions of rural p

nd rovincial levels. ca

7 EVAL Wha e ese be tracked and measured? Describe who the activities will benefit and the expected impact of activities; Desc f your activities. SAO n e roject will gain skills and abilities necessary to identify a ze community problems; with particular concern to working plan training and using ev munity problems. C roject will directly ga L ve in the pro ct i acquire in rum ntsreduc th ocial exclusion. The e crete mechanism to energize social change. The most practical approach to success is to stimulate and support participatory movements at the comm s, and local authorities will create the right o n consensus building not only in health issue but also envi agement issues. I they

A h e F st, sh ul be as on the contextual s ted. In other words, there is not a unique list of indicators for evaluating cultural-socio-political processes. be p involved i the evaluation process. Third there is general

e both quantitative and qualitative. Fourth, this community-based project is given-short-term funding and in uff ie time to develop the groundwork. Just as the seeds for change are beginning to be established project money is withdrawn. It is important to find out appropriate criteria of evaluation of the effectiveness of the project activ

changes in community capacity is still many ways in their infancy. Anyhow, an

capExtDepModalities: in what ways do people choose to participate?

pSus

UATION

t ar the specific outcomes and how will th

ribe how you will measure the effectiveness o

s a d municipality members involved in thnd analy

p

d elopment program to help solve com

BOs members involved the pow co

l

in skills and experiences in working together. d in me and marginalized populations invo

e e burden of poverty and other causes of s je w ll st e to

exp cted impact of activities is con

unity level. It is expected that CBOrtu ities for participation, negotiation and

ronmental protection and resource manppo

t is rather difficult to measure the effectiveness of activities in this project because ultural-socio-political interventions.

are c

ny ow, several key aspects need highlighting erituation of each place where the project is implemen

h . ir it o d b ed

Second, evaluation should articipatory. Community should be gre ment that evaluation should be

na

s ic nt

ities. Measurement of attempt will be made to assess community participation, which illustrate enhanced community

acity: ension: who participate and who does not? th of intensity: in which type of activities do they participate?

Im act: what are the impacts of achieving health goals? tainability: how is better participation assured for the future?

112


113

Newoveincrdisc urturing and mapping of community assets,

all t Part type of evaluation are especially suited to the principles, goals and

ethods of community initiatives, all of which include collaboration and capacity building as

ide the framework the metaphor of the

rmation a long way so that the roject can adjust its course, if necessary in response to changing conditions or unexpected results

he ‘participant’ referred to have included volunteers, staff, organizers, and members of the

entory community asset needs rogram strengths and weakness. It is critical that the local community becomes involved and

ommunity meeting

reative brainstorming, sorting and categorizing of ideas critical discussion and rioritizing based agreed-upon criteria, and reach of consensus.

members develop a set of strategies for accomplishing project goals and objectives. t in the strategy development meeting, with detail

o we know we are on track? is needed to document progress

ward their goals. The team must develop monitoring systems that are realistic and make best

-conceptualizations of community building stress many of the same principle within an rall approach that focuses on community growth and change from the inside through eased group identification overy, n

creation of critical consciousness, oward the end of build stronger and more caring community

icipatory, empoweringmdesired out-comes. There is 6-element process for empowerment evaluation. These 6 steps provfor the following dissension of empowerment evaluation methodology, using process as a journey. Participants determine where they are now (Step I), where they would like to go (Step II) and how to get there (Step III), they monitor the journey to make sure that they collect and analyze making progress (Step IV). They collect and analyze new infop(Step V). Finally, they support what they have learned to strengthen the organization and prepare for the next journey (Step VI). Tcommunity active in the project and intended beneficiaries. Support team referees to the professional evaluators and related staff. Step I: Assessing community concern and resource. Where we are now? The support team assists local participants in doing and invpgains trust and ownership of the evaluation process during this initial period. Methods CFocus group Interview Survey Community mapping Step II: Setting a mission and objectives. Where do we want to go? Community members lay the foundation for evaluation by establishing realistic criteria for success and improvement. The principle activities if this step is a facilitated group meeting that includes cp Step III: Developing strategies and action plan. How will we get there? CommunityThe outline of action plans can be sketched oudetermined latter by smaller subgroups. Step IV: Monitoring process and outcomes. How dEvaluators help participants determine what type of evidence to


114

use of community resources. Documentation include periodic written activity logs or reports tracking of key events, port folios, interviews, surveys, observation and community data for change such as in the rate of disease or injury.

relevant audiences.

articipants and community at large can be engage in reflection, interpretation of meaning,

ntations at meeting coalitions and other forums.

ust be acted upon to be useful to the community. Evaluators help articipants use the lessons learned to strengthen future action. The support team uses

Step V Community information to Who need to be notified along the way? Pproblem-solving, based on evaluation data, to improve the project or take advantage of new opportunities. Communication method can include written reports, community meetings, newsletter, and prese Step VI: Promoting adaptation, renewal, and institutionalization. How can we use what we have learned to prepare for the next journey? Evaluation findings mporganization development, facilitation, and training skills to help strengthen its leadership and structure, integrate evaluation into ongoing operations. Building capacity includes striving for sustainability of hard-won improvements. 8 PARTNERSHIP TO IMPLEMENT ACTIVITIES Partnership to implement activities will comprise of NGOs, CBOs and local authorities in 3

ee for Local Autonomy (CCLA), the Pgazk’ Nyau ssociation for Social and Environmental Development (PASED), Institute of Community

ased Organizations

izations from 5 sub-strict and 2 sub-district in Muang District will take strong participation

nity. Even though they lack participatory experiences, poor organization etworking, and lack of collective initiative, activities in this project will help build

uild organization skill and build collective initiative.

lude members of CAOs from 5 sub-district in Mae Cham District and embers of municipality from sub-districts in Muang and San Sai Districts will participated in

gh they lack technical

districts of Chiang Mai Province. NGOs include the Campaign CommittAEmpowerment (ICE) and the Northern Co-ordination Center for Community B(NCCCBO) will link with networks and facilitate workshops and assist in technical skills. CBOs include members of youth, senior, and women community based organdistrict in Mae Cham Diand mobilize commuskills, poor nnetworks, b Local Authorities incmdecision making processes, implement project and sustain project. Althoucapacity, lack credibility with community activities in this project will help initiate dialogues, encourage co-operation with CBOs and NGOs. 9 EXPANSION After the participatory action process, participants will use the lessons learned to strengthen

hening networks among

f the possibilities for real community participation in the ture.

recognize

future action. Crucial future expansion of the project will be in strengtcommunities not only for health, but also for environmental issues and education. The success of this project in terms of concrete improvements in the health and educational status of community members will persuade popular sectors ofuAt the end of the one year program, it will be expected that grass-root groups wouldand develop their assets and abilities in order to participate in decision – making. Genuine


115

participation will in turn provide opportunities to choose healthy lifestyles and practical methods for developing programs to enhance community development. When a community shares ownership of goals, process, and skill, the loop of community capacity

plex problems with multiple interrelated causes

reasing community capacity nd community empowerment, best practices will be documented and replicated to hopefully

m opters” to help

begins to move like a spiral rotation creating accelerated movement. Community-wide initiatives and community organizing typically address comin a trial and error fashion. Success requires patience, persistence and compromise because multiple constituencies may be affected in multiple ways. With respect to the innovative aspects of this proposed project for incaprovide other communities with alternative models. After exchanging ideas and learning frothis project, other communities may adopt this innovative model as “early adthemselves in community development.


Appendix B: Overview of Project Operations Duration for all projects was May 1,2002-April 30, 2003 Data for this table was obtained from the translation of an external evaluation document compl u Foundation. Some data may be missing secondary to translation errors. Overall Summary of Projects and Activities Classification (topic focus) Number of Projects Budge o

eted at the req

t (40B=One d

est of the Thai

llar)

Health

Exercise Promotion 2 156,107B Health Education 8 764,170B Narcotic Prevention 3 337,115B Conservation of Local Wisdom 7 1,098,295B Community Care for Health 2 172,800B Total 22 2,526, 4.587B ($63,16 68) Classification (target focus) Traditional Medicine 5 Youth Group 7 Elderly Group 4 Tribal Group 4 Special Project 2 Project Name Location Budget

(40baht=$1) Activities Tar Aget Group ctual

1. Developing Potential among the Elderly for Health (578)

T. San Pa Pao A. San Sai

44,500 B, $1112.50

-Elderly meetings -Seminars -Income generation activities

60

persons 89-100 persons

116


117

get

Activities Target Group Actual Project Name Location Bud(40baht=$1)

2. Lanna Healer Community Health

romotion (561)

A. Muang 659,100B, $16,477.50

-Promotion of Fong Gern (Lanna movements) for exercise

330

200

P-Self and family massage -Health Care by LaWisdom -Teaching and LearnPromotion of Hethrough Lanna Wisdo-Herbal garden promotion. -Lanna Medicine Campaign -Lanna Medicine Quality Development -Study and breeding stock of rare herbs

28 villages, 532 Families no specific numbers available

80 25-30

(more than expected) in general numbers of men and women are about equal

nna 330 360

ing 250 alth m

30

3. Self Reliable T. HangDong 2.50 -Seminars for Traditional

onstrations

massage, compress making, herb use.

15

45

15

0 30elderly, 10 onks, 8 students,

government officers)

Community HealthDevelopment (570)

A. HangDong 105,00B, $26

Medicine exchange-Dem-Courses of instruction including;

30

7(m5


118

Project Name Location Budget (40baht=$1)

Activities Target Group Actual

4. Herbs for Health (573)

T. SaLuangA. MaeRim

610

00 00

104,400B, $2

-Village Meetings -Trekking to Survey Herbs in the Forest -Newsletter -Herb Text Book -Food Contesting

120 0 7

2500 00 1

150 00 1

250 00 1

5. Restoring Knowledge of using Herbs in the Family and Traditional Medicine Promotion (574)

T. SanSaiLuangA. SanSai

52,600B, $1315 lderly in

village, 25 the and

0 interested

rall more than -Seminars -Village Meetings -Herbal Book -Study Visits ily of

lderly,

5 e5

the amf

e1others

Ove100

6. Promoting, Restoring and Conserving Thai Traditional Medicine and Wisdom (575)

T. SanSai A. Prao

53,400B, $1335

s

8 -Study Tour -Student Training and Breeding Plants

60 0 6

14 village

72 3 9 villages

7. Creating Supportive Relationships for Health between Children, Youth and Elderly (576)

A. SanSai 104,112B, $2602.80 0

joined by W

0 youth 0 Families

0 oined by 5VHW

T. MaeFaekMai -Village Meetings -Elderly Group Meetings -Traditional MusicActivity -Family Camp

H 5V

485

31

485 j 50 youth 30 Families


119



8. Research for Health Promotion in School and Community

ents 50

mmunity

T. TaladYai A. Doisaket

80,000B, $2000 Stud Co1800

50 8001

9. Health Promotion in the area of Sri Boon

Luang Health Station

10. Promoting Exercise for Health andDevelopment of Learning Process Am

ong 3 age Groups

11. Building the

T. Mae Lao e

55,100B, $1377.50 -Village Meetings meetings for ges

Network now nects 48 villages Strength of Spiritual

Leaders Network“Dtala” among Lahu Tribe (580)

A. Mae Ey -Follow up

problem solving

26 Dtala from villa16 con

12. Restoring and Developing Indigenous Knowledge for Community Health Care (581)

T. Jam Luang A. MaeJam

60,845B, $1521.13 -Recover and Reinforce Elderly Wisdom -Transmit Wisdom to youth -Study Tour

Teacher 5 Student 17 17

eacher 5 tudent 20 5

TS2


120



13. Restoring and Developing Leadership Capability foComm

r A. Prao

unity Health Care

88 Fence building and trash disposal -Herbal Medicineinstruction Leadership development

among youth -Reproductive health ducation for youth

of MaeBaKee (582)

T. SanSai 62,555B, $1563. -

-

e

14. Herb Conservation and Caring for Health (583)

T. SanPA. SanS

aPao ai

63,000B, $1575 -Herbal Seminars

Survey

30 elderly, 60 housewives, 50 youth

-Trekking to Herbs -Use of Herbs Training

50 50-60

15. Encourage and Support for training

T. Mae

youth in Thai Boxing in order to opposenarcotics (584)

Fak A. SanSai

104,122B, $2603.05 -practice Thai Boxing

15/day

0 (6 female)

15/day

0 (6 female)

-morality camp 4

4

16. Lively Family Development for Strong Comm

T. NongYang

unity free from Narcotics (585)

A. SanSai 63,000B, $1575

icts

30

-Re-entry program for returning add-Village Standards

(208 Families)

youth 50


121



17. Glorification of Non-Narcotic Community (586)

T. NongYaai

ng 5 40

117 117

5-30 40 200 100 114 48 youth

A. SanS68,675B, $1716.86 -Practical Training

-Youth Training -Against Drug Sticker -Health Files

200

-Non-Narcotic Banner -Friends Corner

2 2

18. Life skills training

youth of Chiang Mai (588)

T. HarnKeaw 202,240B, $5056 skills

Camp Leadership

a fe

5-12

360 5-12

360 60

5Female/10male

nd 200M

for narcotic prevention and health promotion among children and

A. Muang -Teamwork and workshops First Camp -

-Development -Run Camp Two by

themselves Activities about Lann-

Traditional Ways of Li

3

98 5 4 6

75F a1

19. Modern Youth Caring for Health and Environment (589)

A. T. Sripoom

Muang 107,765B, $2694.13

20. Youth Network for Health (590)

A. Muang 150,000B, $3750

d DJ

-Radio Scheduling training -Web site development

000

200

0

0

000

200

-Summarize Lessons Learned -Radio Program anraining t

30 30 3 1

3 3 3 1


122



21. Strengthening Community Network of health promotionpersonal

by

Communication Media (593)

ing

g

dy 700

T. Nong Hoi A. Muang

119,950B, $2998.75 -Participatory Train-personal Communication trainin

ommunity -activities in c-observation and stutour

30 25 640

35 20 640- 100

22. Studying and Developing non-poisonous production of fruits and vegetables (596)

T. SanPaPao A. SanSai

144,300B, $3607.

50 -manure making, study, theory, and practice -youth camp -customer/consumer workshop

70 1

00 5

50-300 2


123

Appendix C: Example of Semi-Structured Interview

แบบสัมภาษณ การประเมินโครงการขวงสุขภาพ คร้ังที่ 2 ณ ขวงบาน ือง ต.

ทราย ให ที่ มกราคม 2547 Project: (ชื่อโครงการ) C unity: (ชื่อ ) W i le in t m ty? (ทานมีบทบาทอะไรในชุมชนของทาน ?) ( Health worker, Farmer, Leader…) P you ุมชนของทานมีลักษณะเปนอยางไร ?) H

ดานสังคม

nment ดานสิ่งแวดลอม Please tell me about you unity project? (โครงการสรางเสริมสุขภาพที่ทานทําอยูเปนอยางไรบาง ?) How is this project similar or different from community development/health promotion p e he past?(โ ตางจากโครงการสุข ือไม?) H

ศรีบุญเร เชียง

ปาไผ 24-25อ.สัน มวัน

omm ชุมชน

hat

leaseal

s y

e tellth, ดาน

ou

meสุขภ

r ro

aboutาพ

he com

r comm

uni

nityu ? (ช

So en

cial

viro

r comm

rojects don in tครงการนี้ แตก

ow?

ภาพอื่นๆ ในอดีตหร


124

(อยางไร?) Now that you have this project wh munity? เมื่อทําโครงการไปแลวมีอะไรเกิดขึ้

hat do you think helped to make the project work (or not work)? โครงการไปไดสวยหรือ…..ไมสวย ?)

hat do you think was the most difficult thing about doing this project?

hat has your group done to overcome this difficulty? ีมงานของทาน เอาชนะมันไดยังไง ?)

hat are the community plans for the future? ทานในอนาคต?)

ow do you plan to do that?

o you think that we are empowering ourselves ?

)

at has happened in your comนบาง ?

W(มีอะไรบางที่ทานเห็นวาไดชวยให How and why? (อยางไร และ ทําไม? ) W(อะไรที่ทานเห็นวาทํายากที่สุดในโครงการนี้ ?) W(ท W(ทานมีแผนที่จะทําอะไรในชุมชนของ H(ทานวางแผนกันยังไง?) D(ทานคิดวาเรากําลังเสริมสรางพลังของเราเองหรือไม)

ow ? H(อยางไร ?


125

Appendix D: ICE User-guide

PARTICIPATORY EVALUATION ON EMPOWERMENT

or:

POWERMENT ND OMMUNITY FACILITATORS

Participatory evaluations challenge conventional evaluation practices. Although a process, it has

munity or group to learn more about what they have This interest can lead to improved future

evelopment initiatives if community specific and reliable measurements can be

ated for use in facilitating a participatory evaluation of mpowerment by Community Based Organizations (CBO’s) affiliated with the Institute r Community Empowerment (ICE). The participatory evaluation guide is presented in

s and Tools

rocess and Reflection:

a) Phase 1: Establish Community Evaluation Team b) Phase 2: ICE Workshop for Community Facilitators

luation Evaluation Team – Reflection

3. Attachments

A User-guide for developing:

A F THE INSTITUTE OF COMMUNITY EMAC INTRODUCTION participatory evaluation of social changes (empowerment) is an unchartedthe potential to catalyze a comchieved and foster community consciousness. a

ddeveloped to gather data that is meaningful to the community.

The guide was cre efothree sections:

1. Background:

a) Definitions of Term

2. Planning, P

c) Phase 3: Community Meeting - Evad) Phase 4: Community

A Vaccine for Globalization Participatory evaluation asks one important and fundamental question: Whose questions are being asked and answered in the evaluation?”

. BACKGROUND

anding of some key terms used in participatory evaluation.

or process. In tion methods.

e facilitator must be genuinely committed to

aracteristics of a facilitator include;

iative Inquiry.

elegate tasks and responsibilities – once plans are crystallized make sure ibilities are equitably distributed among the group.

Add atalyst and a manager of the evaluation

without controlling the process. Their primary function is to release the creative portant role in assessing the levels

u its of participatory approaches, and promoting apacit ugh greater ownership of

the res create more effective future p

• Apprec human systems grow

persistently ask question about. This concept is paramount for the race if they are going to help a group navigate their way towards

positive change.

“ 1

a) Definitions of Terms and Tools

The following is a collection of brief definitions intended to provide a basic underst • A facilitator is a person who is knowledgeable about a specific topic

is case the facilitator is knowledgeable in participatory evaluathHowever, knowledge is not enough; ththe nature of participation.

Important ch

a) Create an environment of sharing and reflection – asking open-ended questions.

b) Encourage trust – validating everyone’s opinions and ideas, be non judgmental.

c) The capacity to listen – letting everyone finish thoughts without interrupting.

d) Help the group to ask key questions – see Apprece) Guide discussions – keeping the group focused on topics and mediating

conflicts. f) Plan actions to help bring together the viewpoints of the various

stakeholders. g) D

respons

itionally, the facilitator is both a c

energies within people. The facilitator plays an imof nderstanding, the perceived benefc y building among participants. This can be done thro

ults of the evaluation effort and use of those results to rogramming.

iative Inquiry (AI) is a process based on the idea that toward what theyfacilitator to emb

126


127

• A stakeholder is an actor that has a vested interest in a given project, activity, or

issue. Stakeholders may include groups affected by development actions, such as the kers, farmers or the community at large, as well as other actors that

can affect the outcome of a project, i.e., government officials, institutions, and project personnel. In participatory evaluations, stakeholders assume an increased role in the evaluation process as question-makers, evaluation planners, data gatherers and pro

Quantitative methods utilize numerical analysis to gather information from

• e the use of numerical analysis. Data collection methods

hniques such as; observation, semi-structured and open-conversation inte ormation from stakeholders.

• Baselinproject. Data collected later can be measured or compared against baseline data to assess cimportant factors or sources of information and the indicators required for measuring the resevaluations

• Triangu

check and cross-validate existing information. • A Beneficiary Assessment

plannedobservation y its principal

•

•

the method of learning. Preparation usually involves outlining the broad areas of inquiry, leaving specific questions to be formulated during the

poor, women, wor

blem solvers. •

stakeholders. Data collection methods include surveys, attendance records, statistical and epidemiological data.

Qualitative methods minimizinclude tec

rviews, testimonials and focus groups to gather inf

e data is a description of the conditions at the beginning of a program or

hanges. In a participatory evaluation, it is important that stakeholders identify

ults of their work. Baseline data serves as foundation material for future .

lation is the process of using different methods of data collection to cross-

involves the participation of beneficiaries in evaluating a or ongoing development activity and builds on the experience of participant

. Assessing the value of an activity as it is perceived busers, by letting beneficiaries' voices, values and beliefs be expressed. Methods include direct observation, conversational interviews, and participant observation. Beneficiary assessment is an approach to information-gathering that places the emphasis on the perceptions of the principal actors.

Direct Observation is a data gathering process where a person takes field notes while observing an activity without participating.

• Participant Observation is when an outsider lives and learns in a community for a

period of time ranging from several weeks to months.

A Semi-structured Interview are less formal than a structured interview and allow for conversation to be


128

interview itself. The questions should be sequenced with the easier questions coming

•

al issues and options. They are generally fairly small, with specific questions asked of participants. They can help you get a sense of what community

A Focus Group brings together a representative group of 10 to 15 people, who are

d clarifying key points.

•

cise and different gender interpretations of one's community is critical.

oject or its impact through the voices of participants and stakeholders. They can also help to corroborate other sources of

•

paper and given to participants, who are then asked to allocate the circles to different institutions, groups or

tions or groups.

This section provides general steps that a facilitator can use to build an evaluation

tp eRem

first and more difficult or personal coming later thus allowing the interview time to gain the confidence of the person being interviewed. The questions are open-ended and seek to collect in-depth information on attitudes, opinions, thought processes, and knowledge.

Listening sessions are public forums you can use to learn about the community's perspectives on loc

members know and feel about the issue, as well as resources, barriers, and possible solutions.

•asked a series of questions. A facilitator guides discussion. Focus groups can be used in the field to build project designs or help to assess project performance. They can be used in an evaluation as a means of starting a discussion, identifying needs an

Mind Mapping is a tool used at various stages of a project. It involves participants in drawing maps of thoughts, ideas, terms, definitions and concepts on the floor, ground or paper. Mapping can provide insight into the meaning of identified issues within the community. The importance of ensuring a good cross section of participants in a mapping exer

• A Testimonial records a person's thoughts, feelings and experiences in the first person

narrative style. It is a way of learning about a pr

data and information and provide a more personal insight into a project's achievements.

A Venn diagram, of usually circular areas, can be used to look at relationships within institutions or relationships between the community and other organizations. It illustrates different participant perceptions of access to resources or of social restrictions. Circles of various sizes are cut out of

departments. The larger the circle the more important it is. The circles may overlap, showing the degree of contact between institu

2. PLANNING, PROCESS, AND REFLECTION

me hod to measure social changes (empowerment) within the community. The section is

r sented in phases and steps, but this is not meant to show the process to be linear. embering that participatory evaluations and the nature of social changes


129

(emrecicomfacicom he flow of the meetings discussion.

The following is a visual aide to help conceptualize the section. Each phase is

powerment) within the community are context specific there cannot be one tool or pe, no strict course or syllabus that the facilitator can follow. The facilitator and the munity members invited are learning as they move through the process, but the litator needs to be responsible for altering steps according to the context of the munity and t

described in detail.


130

Establish a Community Evaluation Facilitation Team (CEFT)

(CEFT) attends a Workshop on Facilitating Participatory

Evaluations Workshop

provided by ICE

or

Facilitation Team and/or Community Members analyze the responses and plan how to communicate what they learned to the

community and other interested groups

Facilitation Team meets to reflect on the process, share lessons learned and discuss

recommendations for future plans with their communities, the Fellowship and IC E.

Workshop provided by experienced Facilitators

Make a plan to use the evaluation tool in the larger community to

collect responses.

Facilitators conduct a meeting with their community members/groups to build the

evaluation tools

Phase 1

Phase 3

Immediately collect evaluation tool responses at the

meeting

Phase 2

Phase 4


131

a) Phase 1: Establish Com Purpose: To identify a group of community members interested in facilitating a participatory evaluation of social changes (empowerment) within their community. This group will be called The Community ill be trained as evaluation facilitators. Objective: • Establish a community based evaluation team (4-6 members) Activities: o Make contact with community groups Identify and contact 4-6 representatives from different community groups in order to ensure an understanding of various community programs, the local power structures, and different socio-cultural group perspectives within the comm viduals will make up the Community Evaluation Team. o Invite them to the ICE facilitator workshop Materials: • None

b) Phase 2: ICE Workshop for Community Facilitators Purpose: The facilitator workshop will orient the group to the process of doing a participatory evaluation of social changes (empowerment) within the community. This team will be responsible for returning to their communities and facilitating a meeting to collaboratively make decisions about how the evaluation will be designed, conducted, analyzed and presented. Objectives: • Clarify roles of the facilitator.

munity Evaluation Team

Evaluation Team and w

unity. These indi


132

• hange knowledge regarding participatory evaluat Exc ions of social changes (empowerment).

Facilitators feel prepared to return to their communities to facilitate their own eva

Explain to the team why they are here and what they will do;

1. To do an evaluation of community changes that have occurred as a result of the

2. Sometimes these community changes are easy to see, but difficult to explain. gh this participatory evaluation process we hope to find a way to identify,

describe, evaluate, and share with others what has happened in our community. tand that there is no best model of doing a

participatory evaluation.

Get an idea of what the group knows about participatory evaluation;

1. Find out if anyone has experience in doing evaluations. have those with experience share their thoughts about the strengths and

weaknesses of the methods they used.

f the facilitator in conducting and finalizing a participatory evaluation: 1. Understand that the validation of community members’ experiences is the basis

building and conducting the evaluation. 2. Motivate community members to find solutions and act on them. 3.

ive identification for the focus of the evaluation. 6. Identify when training in data-gathering methods is necessary.

ate the collective date gathering process. 8. Facilitate the collective analysis of the data.

of resources for resolving problems identified during the evaluation.

10. Facilitate how to take collective action.

•

luation process. Activities: o

community driven development programs.

Throu

3. Make sure team members unders

4. Flexibility during the process is important. 5. The evaluation tools developed and the methods used will depend on the

communities’ interests. o

2. If so,

o Review the role o

for

Assess constraints and resources or enabling and inhibiting factors of conducting the evaluation.

4. Define parameters for the participatory evaluation (i.e., what can and cannot be achieved based on time and local resources).

5. Facilitate the collect

7. Facilit

9. Facilitate the coordination


133

11. Understand that a participatory evaluation is dependent on the skills and interest of the community team.

12. See Facilitator in Terms and Definitions for more information.

Review the following steps with the facilitator:

1. Planning the Community Meeting ent)

3. How to prioritize the identified terms

5. ese questions

7. o

tion Building Overal

easuring social anges (empowerment) within the community.

Ov l • xplain to the community members purpose of the meeting.

define social changes (empowerment). • • • Collectively develop an evaluation plan. • Delegate responsibilities to carry out the evaluation. Ov l • • • •

o

2. How to explore the meaning of Social Changes (empowerm

4. How to develop questions to identify each term How to develop a tool or method based on th

6. What is required to conduct the evaluation The importance of reflecting on the process once completed

Are we ready? c) Phase 3: Community Meeting – Evalua

l Purpose: This meeting will be held to develop the evaluation tool for mhc

era l Objectives:

E • Collectively

Collectively prioritize the top 2 or 3 terms.

Collectively develop questions to identify these changes.

era l Materials:

Meeting area Snacks and water Large pieces of paper Small pieces of paper


134

• • Nam• Board

t

1)

hanges are easy to see but difficult to a way to identify,

munity. veryone understands that there is no best way to show these changes,

ut we are going to take a collective attempt to do it. o d on our interests.

portant.

eeting.

t evaluations and if they consider them

important and if important, to who and why.

Objectives:

• Define evaluation.

• Who are the stakeholders in the evaluation.

• What will the evaluation results be used for.

Marking pens e tags (if appropriate)

Pins or tape •Ou line of Meeting:

Introduction

o ommunity changes that have occurred as a result of the community driven development p

We are trying to do an evaluation of crograms we have been doing the

last 2 years. o Explain that sometimes these community c

explain. Through this evaluation process we hope to finddescribe, evaluate, and share with others what has happened in our com

o Make sure ebThe evaluation tools or methods developed today will depen

o Flexibility during the process is im

2) Explain the role of the facilitator

o Give brief description of what your role will during the m

3) Get an understanding of what evaluation means to the group

Purpose:

Determine what the group knows abou


135

Activities: o Mind Mapping: Ask the question: “What does evaluation mean to our

” ill provide each member an opportunity to explain what it means

e up with a collective and working definition of evaluation-making sure everyone is clear)

o List on the Board: Ask the question: “Who wants to know the results of our

d who should be invited to future meetings)

luation)

• Large pieces of paper

4) Explore the meaning of empowerment or social changes within the community

e meaning of empowerment, or social changes in the community. The

cilitator directs the focus of the group towards defining and understanding this

bjective:

Collectively define empowerment, and identify important social changes ity.

his)

ples of things that have changed in our community since doing our projects?”

(Either break up into small groups of 4-5 or keep the group as one)

group? (This wand will allow the group to com

evaluation? (This will provide a list of stakeholders, and who the questions should

be asked to an

o List on the board: Ask the question: “Is it useful for us to observe or evaluate social changes within the community (empowerment)?”

(This will provide an understanding of interest in continuing with the meeting and a list of ways to use the results of the eva

Materials:

• Marking pens

Purpose:

Explore thfaconcept based on individual and community experiences. O •

within the commun Activity: (there are two possible ways to do t 1. Mind Mapping: Ask the question: “What are exam


• An example might look like this:

wed to a key term or word. The facilitatoiption of what they means by asking the questio

:

Group Discussion: The facilitator can ask the groupshare their ideas about each response. Then, eachnarrodescr

“Lets talk more about C and what it means?“How do we see C in our community?” “What are some examples of C in our comm

Materials • Large and small pieces of paper • Making pens • Pins or tape • Board

2. List on the board: Ask the question: “What was it lbefore this program, and what is it like now?”

Social Changes/

Empowerment

D

A

E F

C

p

r can ask for funs:

unity?”

to discuss the ma response needs

ike in your comm

B

136

and to be rther

unity


137

Have each group member write on one pieces of paper “what it was like before the project” and on the other paper “what was it like now”. Then pin these responses up on the board in two columns; Before and After


Group Discussion: The facilitator can ask the group to discuss each response and share their ideas. Then the facilitator will draw several arrows connecting the Before and After and ask for further description of what each response means in order to get to the root term or word which will be labeled on each arrow.

Materials: • Large and small pieces• Making pens • Pins or tape • Board

5) Choose the top three changes/terms to

Purpose:

• An example would look like this:

Before After

A

C

B

FE

D

Before

A

C

B D
Term 1
of

de

After
Term 2
FE
Term 3
138

paper

fine further


139

Limit the focus of the evaluation down to two or three important terms represe n ctors. Objective:

Choose three factors/changes that the group feels are the most important to evaluate.

Activit o Group discussion and vote to choose the top two or three term

• cision making can be either consensus or majority. The vote can be done in a variety of ways. For example, voting by raising hands. Or

Mate • Small pieces of paper • ns

) Develop tions for den

Purpose: Continue to build the evaluation tool by getting the group to further define what each of the three identified term ean and how they can be evaluated in the community. Objective: • Discuss how the identified community change is experienced in the

com u • Discuss the different levels or the range of the identified community change. Activities:

o Group discussion: Ask the questions

What are the different ways people in our community experience ________?” • Facilitator writes these comments on the board

nti g social changes or empowering fa

•

ies:

s/changes

De

writing on a piece of paper the top two or three terms and counting the votes. Or asking the group to choose the best, and see the natural breakdown of the top three through this voting process.

rials:

Pe 6 ques each i tified term

s m

m nity.

“


140

“What are the different levels or the range of ________?” i.e. good to bad, 0 to 00…

tator writes these comments on the board

?, 1 ?... an example of 0 is ?, an example of 100 is ? … • Facilitator writes these comments on the board

aterials:

Large pieces of paper • Pen

7) Develop a tool f

urpose:

ummarize ideas and build a form that will be used to measure the identified (empowerment).

Objective:

• Develop an evaluation tool for measuring community changes or rment.

scussion: The facilitator needs to ask questions that will help the team take the identified terms and develop a tool to use in the community.

riences and a range that best describes each term on the board.

questions we need to ask to learn where our community is today based on identified. This can be done by asking the question:

our community are experiencing Term

”

See p ool

1• Facili

“What does each level mean and what are some examples of each?” i.e. 0 means 00 means

M •

s

or assessing the identified terms in our community

P Ssocial community changes

empowe • Make it easy and clear. Activities: o Group Di

This process can begin by summarizing the identified terms and defining specific expe

o Group Discussion: The facilitator leads the group in a discussion of what

each term

“How can we find out how members of1?

A pendix 1 for an example Range vs Experience T


141

o Group Summary: The facilitator summarizes what the group has come up

with for each term. The facilitator will help the group choose which questions the evaluation tool. The

ollowing questions:

e want to have peo eriences, or do we want to

o both?” “For example, tell me a story of how you feel about term __1__ based experiences (if the experience they mention is not listed on our

valuation tool, can we add it later or do we have a section called other?) We Then, show the range we developed today and have

their experience accordingly.” Materials:

• Large pieces of paper

8) Dev

be c evaluation.

oing to do it?

• How many do we need to ask the questions to?

• hen will the results be given to the community?

ho will the results be given to?

they like the best and help the group finalize facilitator can ask the f

“Do we want to collect simple answers to each question or do wple tell us stories about each term based on their exp

don personaledocument what they say. them rate

• Pens

elop and Evaluation Plan

Purpose: To collectively decide on an evaluation plan. Clearly identify the tasks needed to

ompleted for the Objective: • Who is g • When is it going to be done?

Who are we going to ask the questions to?

• • Who will analyze the data collected?

W • W Activities:


142

Group Discussion: The facilitator asks the group to discuss how to do this ev luation in the community. The following questions can be asked:

• Who do we ask these questions to? How many people do we need to ask?

a

aterials:

Pens

) Closing Remarks- set a date for a reflection meeting

he facilitator needs to question any weaknesses in the evaluation tool, and how it will be conducted prior to final approval. ) Phase 4 – Community Meeting: Reflecting on the Evaluation Process

Purpos cussion about how the evaluation process went and determine if we want to do it again. By virtue of the participatory methods used to develop the evaluation, facilitators need to know that good feedback is achieved when one feels they can openly criticize the process without fear of any bad feelings or repercussions, and that the su Object : • Ide fy• Discuss recommendations for the next evaluation. Activity: Group discussion:

• as ss been effective? • its long-term impact be?

•• Who will ask the questions? • When will we ask these questions? • Who will analyze the data? • When will we analyze the data? • How will we document and display the findings? • When will we share our findings with the community?

M •• Large pieces of paper

9 T

d e:

To have a dis

ir ggestions will be acted on.

ive

nti lessons learned

H the participatory evaluation proceWhat would


143

• ow did we identify the major stakeholders? • • tion-makers

and e• Wh• Wh ade? • Discuss and analyze the strengths and weaknesses of the data-gathering process. • Dis ss lay of the evaluation findings. • Dis ss• Dis ss ation. What can you say

abo to

tion of participants p dynamics

erall organization • evaluation process in the future? • h might be needed to repeat the participatory evaluation

in the future? s to do if they are interested in

Large pieces of paper and Pens

HWhat steps were taken to include or exclude various stakeholders? What conclusions can we make about the stakeholders' roles as ques

qu stion-answerers? at would we have done differently?

ns have mat difference(s) might our decisio

cu the documentation and dispcu how we used our findings. cu the overall management of the participatory evaluut he various elements, including:

evaluation tool building workshop timing o seleco grouo ov

Do we want to repeat this W at resources or support

• What would we recommend other communitiedoing a participatory evaluation of empowerment?

Materials: •


Attachment 1: Example of Rating Evaluation Tool

Range

Variable

1 = and 2 = and 3 = and 4 = and its

5 = and its its its its

Meaning Meaning Meaning Meaning Meaning Stories

144


Att

achment 2: Example of Data Display – Star Plot

1

5

5

5

5 5

5

Experience

Experience

Experience

Experience

Expe

Expe

rience

rience

145


Appendix E: CBO Quantitative Evaluation Results SaLuang Herbal Medicine Group

ariables of Community Change

easures of central tendency and variability for ratings

Concepts Mean Median Mode Range (min-max)

V M

Unity 4.11 4 4 3-5 Participation 4.44 5 5 3-5 Wisdom of Local People 4 4 3,5 3-5 Resources (Funding) 2.88 4 4 1-4 Leadership in Group 3.71 4 4 3-4

Star Plot

Leadership Cooperation

Unity

5

Conservation of Local Wisdom

5 5

5

3.71

4.11

4.44

4

1

2.88

Funding/Resources

5

146


Mohr Muang Group Variable of Community Change Measures of central tendency and variability for ratings

ian Mode Ran Concepts Mean Med ge (min-max) Physical Health 4.55 5 5 4-5 Unity 4.55 5 5 4-5 Strong Community 4.21 4 4 3-5 Mental Health 4.45 4.5 5 3-5 Family Warmth 4.45 4 4 4-5 Active Compassion 4.33 4 4 4-5

tar Plot

S

Family Warmth Strong Community

Unity

Physical Health

Active Compassion 5

5

5

5 5

1

Mental Health

5

4.45

4.33

4.55

4.55

4.21

4.45

147


SiBaoRuang Elderly Group

ariable of Community Change

V Measures of central tendency and variability for ratings Concepts Mean Median Mode Range (min-max) Unity 6.63 7 7 2-7 Cooperation/Participation 5.35 5 5,7 2-7 Local Growth/Development ,7 5.06 5 4,5 3-7 Resources 4.89 4.5 4 3-7 Mental Health 4.44 4.5 3 1-7 Economic Situation 4.50 5.5 6 1-7

Star Plot

Economic Situation

Community Growth

Cooperation/Participation

Unity

Men

7

7

148

tal Health

7

7 7

Resources

7

1

4.44

4.5

6.63

5.35

5.06

4.89


SanPaBao, Elderly Group Variable of Community Change Measures of central tendency and variability for ratings Concepts Mean Median Mode Range (min-max) Community exercising groups 6.75 7 7 4-7 Family warmth 5.94 6.5 7 2-7 Happy, Joy, Gay 5.41 5 5,7 3-7 Decreased Illness 5.52 5 7 3-7 Decreased Stress 5.74 6 7 3-7 Revitalization 6.47 7 7 5-7 Self-care with old wisdom 6.63 7 7 5-7

Star Plot

Community coming together to exercise

Family warmth

Happiness, joy

149

ful, and gay

Reduced illnesses Reduced stress

Revitalized

Self-care with old w m isdo

7

7

7 7

77

1

7

6.75

6.47

5.74 5.52

5.41

5.94 6.63


MaebaKee Health Promotion and Leadership Development Projects Variable of Community Change Measures of central tendency and variability for ratings Concepts Mean Median Mode Range (min-max) Community Development 5.27 5 5 2-7 Knowledge about Health 5.11 6 6 3-7 Unity 5.41 5 5 4-7 Health Status 5.11 5 5,6 3-7 Education 5.29 6 6 2-7 Hill Tribe Culture 4.88 6 6 1-7

tar Plot

out Health

Community Development

S

7

7

Hill Tribe Culture

7

150

Education Unity 7 7

Health Status

7

1

5.29

4.88

5.27

Knowledge ab

5.11

5.41

5.11


Three age groups working towards Health Promotion Projects Variable of Community Change Measures of central tendency and variability for ratings Concepts Mean Median Mode Range (min-max) Unity 6.23 7 7 1-7 Compassion 4.67 5 6 2-7 Community Power 4.86 5 5 3-7 Happiness 5.82 6 7 3-7 Networking 5.95 6.5 7 3-7 Togetherness 5.86 6 6,7 3-7 Decreased Stress 6.23 7 7 3-7

Star Plot

Unity

Community Power

Happiness Networking

Togetherness

Decreased Stre

151

Compassion ss 7

7

7 7

77

1

7

6.23

5.86

5.95 5.82

4.86

4.67

6.23


Muay Thai Group Variable of Community Change Measures of central tendency and variability for ratings Concepts Mean Median Mode Range (min-max) Drug Prevention 6.33 7 7 3-7 Place to Play 5.71 6 6 4-7 Sports Interest 5.78 6 6 3-7 Strong Health 6.29 7 7 4-7 Kindness 5.71 7 7 3-7 Human Relationships 5.33 5 5 3-7 Know Friends 5.62 6 7 3-7 Interest in Learning 5.75 6 7 2-7

Star Plot

Drug Prevention

152

Place to Play

Sports Interest

Strong Health Human Relationships

Know Friends

Interest in Learning

5.75

5.62

5.33

5.71

6.29

5.78

5.71

6.33

7

7

7 7

7

7

7

7

Kindness


Lahu Group for the Promotion of Dala Spiritual Leader for Drug Prevention Variable of Community Change Measures of central tendency and variability for ratings Concepts Mean Median Mode Range (min-max) Unity 6.55 7 7 5-7 Thinking and Deciding Together 6.18 6 6 5-7 Culture 6.64 7 7 5-7 Strength 6.18 6 6 5-7 Learning 6.08 6 7 5-7 Networking 6.73 7 7 5-7

tar Plot

ing

Unity

Networking

S

153

Learning Culture

Thinking and DecidTogether 7

7

7

7 7

Community Strength

7

1

6.09

6.73

6.55

6.18

6.64

6.18


BanMaeJong School Variable of Community Change Measures of central tendency and variability for ratings Concepts Mean Median Mode Range (min-max) Family Life 5 5 5 4-6 Using Free Time 5.58 6 6 4-7 Gangs 4.46 5 5 1-7 Knowledge 5.78 6 5 4-7 Exercise 6 6 6 5-7 Participation 5.25 5 5 4-7

Star Plot

Free Time Participation

Physical Exercise Gangs

7

7

154

Using 7

7 7

7

1

6

5.25

5

5.58

4.46

5.78

Knowledge of Drugs

Family Life


Mae Hak Group Variable of Community Change

or ratings

easures of central tendency and variability fM

Concepts Mean Median Mode Range (min-max)Unity 5.45 6 6 4-7 Responsibility of Community and Family

5.4 5 5 3-7

Love and Active Compassion 5.73 6 7 4-7 Community Relations ,7 5.64 6 5,6 4-7 Use of Addictive Drugs 5.7 5.5 5 4-7 Knowledge about Drugs 6.09 6 6 4-7 Self-care for Health 5.73 6 7 3-7 Family Life 5.4 5.5 7 3-7

tar Plot S

Responsibility of Community and Family

Love and Active Compassion

Community Relations

Stop using Addictive Drugs

Knowledge about Drugs

Self-care for Health

Family Life

5.40

5.73

6.09

5.70

5.64

5.73

5.40

5.45

7 7

7

7

7

7

7

Unity

7

155


Appendix F: Timeline

December 1 – 27: Collect background information of ICE and the CBO projects via document analysis and nd ceremonies.

icipatory he first

o with ICE aff, create fi draft of a Facilitator Guide which

icipatory eval ion of soci o t co bui nships h member e CBO and to get

feel about t ion. o workshop. o uation metho for Pilo .

January 17: Workshop for 5 CBO members from the pilot community who will facilitate their community n doing the evaluation.

January 18 - February 7: Incorporate changes i the evaluation methodology based on the outcome of the workshop and further discussions with the facilitators.

f the Herbal Project participates in the Pilot evaluation process. Representatives from 18 other CBO’s observed the process and 11 asked to go through the process in their communities.

o February 11: Workshop for the 11 CBO’s, decide on when to do it. o February 17: Second group o February 18: Third and Fourth Groups o February 22: Fifth group o y Sixth and Seventh Groups o February 25: Eight Group o February 27: Ninth and Tenth Groups o February 29: Eleventh Group o March 1 – 6: Summary of Evaluation Data o March 7: Meeting with CBO representatives, Thai Health Foundat , Ministry of Public Health

Representative, other interested individuals to present the Summary of Evaluation Data and get feedback regarding the process; strengths, weakness, and recommendations.

onon participant observation of community meetings, activities a

o December 28: Meeting with all CBO representatives to discuss developing and implementing part

evaluation of social changes. Establish time for workshops and pilot community to conduct tevaluation.

December 29 – January 14: In collaboincludes a methodology for conducting a workshop on part

ration st rst uat al changes.

January 9 – 10: Site visit with pilo mmunity to ld relatio wit s of thunderstanding of how they he evaluat

January 15: First evaluation

January 16: Compile eval dology t CBO

ogroups i

o nto

o February 8: Community meeting with 30 members o

Februar 23:

ion

156


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a globalization vaccine by uthaiwan kanchanakamol

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