In bringing about behavior change in public health, we often focus on
the individual mother, student, or farmer. We should not forget the community
structure and norms constrain for encouraging individual health behaviors.
This course examines the community context of the changes needed to promote
the public’s health. We begin by examining the various definitions of ‘community’
and the processes by which we ‘diagnose’ or seek to understand the structure
and characteristics of different types of communities. An appreciation
of community similarities and differences is necessary lest we fall into
the trap of designing one-size-fits-all interventions. We need to recognize
that no matter that outsiders may view a community as poor or neglected,
we can find strengths and capacities for improvement in each community.
Identifying community capacities and resources is the first step in facilitating
community change. Different practical and philosophical approaches to change
and therefore, examined. Specific to the change process is our recognition
of the need for communities to participate in the design, implementation
and evaluation of any intervention. We examine the concept of participation
in an effort to see how different levels of involvement may affect sustainability
of community change efforts. Finally a case study of a community participatory
approach to onchocerciasis control in Africa is presented. Community Directed
Intervention has subsequently been successfully applied to providing other
essential primary health care services by and in the community, such as
insecticide treated bednets, malaria treatment, vitamin A distribution,
deworming medicines, and pneumonia and diarrhea case management.