Health Education That Sticks: Growing from within can be key to changing communities
Sheila, Jen and Sonia all dropped out of high school together when they were juniors – because they were all pregnant. They all gave birth to baby girls. None of them went back to school, although when our organization, Roots of Health, entered their village, all three were eager to learn about health, but especially how to avoid another unintended pregnancy. They joined ROH’s women’s classes four years ago in our first community in Puerto Princesa, Palawan, in the Philippines, and they were lively presences and quick learners. None has had another child, and all three are now working with us as community health advocates.
Roots of Health’s vision is self-reliant women, young people and families living healthy, reproductive lives in Palawan. We seek to improve the reproductive health of women and girls and to help reduce the incidence of maternal mortality. We also recognize the importance of girls delaying pregnancy and staying in school. Therefore we provide health education and clinical services in communities and in the local university and high school populations.
Roots of Health works by fostering self reliance, providing scientifically based, accurate information on health, and improving both health-seeking behavior and access to reproductive health services. Programming is community- or classroom-based and utilizes a human rights framework, which includes the core belief that health is a human right.
In the past four years we’ve found that when education “sticks,” it changes people. It impacts behavior and becomes habit, becomes part of the person. Most teachers know this cannot be done quickly – it is a continuous, ongoing process, as Jessica Thompson Somol describes primary health care in her NextBillion article Primary health education, like primary health care, is a small scale, almost one on one, process.
In academic life in the Philippines I have seen hundreds of lecturers fly into town, speak to assembled teachers, accept the flowers and the lunch, and leave – with very little learning lingering in their wakes. I have seen health missions do the same, swooping down on a poor neighborhood, telling the parents their children are malnourished, leaving pharmaceutical drugs with whomever seems the most enterprising, and moving on.
From the start we did not want Roots of Health to be like that. We wanted to work in marginalized communities, get to know people, educate the women, provide clinical services, become part of people’s lives. We wanted to be sure people were really learning and new health habits and attitudes were sticking. Four years after our beginnings we are still in our very first community – although we have added five more communities, and various new programs, including a financial literacy program. We feel like we are growing from within the communities and community needs, though, not from outside trends or global movements.
When we enter a community, we spend time getting to know people, chatting, gauging interest in issues of maternal health: How many children do they have? Do they practice family planning? Would they have wanted more, or fewer, children than they have? How are their health habits? Do they visit doctors? Who delivers their babies? How is their nutrition?
Then we survey the whole community and set up a women’s health class that runs approximately 18 sessions. These are lively, fun, interactive meetings that really engage the participants. They play games, do skits to illustrate behavior, problematize giving advice: “What would you tell your pregnant friend if she was having dizzy spells, or her feet were swelling, or she kept crying for no reason?” We try to make sure these lessons stick, become real, and translate into healthier behaviors.
After a series of classes we select three to five women to train as community health advocates (CHAs). After training, these women serve as our eyes and ears – and our hands – in their communities. They assist our clinical staff in distributing contraceptive pills, alert us to the need for contraceptive injections, list women who should have prenatal visits, help their pregnant neighbors figure out birth plans and alerting us to emergency needs.
We bring all of our CHAs together two to three times a year so that they have opportunities to get to know us and each other better, know of problems that are shared in several communities, and learn from each other’s experiences. We also train them in various health topics, such as how to take blood pressure and how to prepare oral rehydration therapy for severely dehydrated babies. These women are crucial to the sustainability of our programming in our communities. It is a testament to their characters that they willingly do this work as volunteers. We pay these women a very small stipend and keep their cell phones loaded – that is all.
These are probably the women who are most radically changed and benefit most from our programs, as they learn new skills and knowledge and better health behaviors and at the same time are empowered to help their neighbors, provide solutions, and become positive forces in their communities. They know they are respected and they are vital to us.
We are raising future health advocates, too, with the teenagers we meet in small groups, with the same open attitude and engaging, fun programs. We encourage the teenagers to dream big and to work out how they can reach their dreams – to stay in school, postpone serious relationships and early pregnancies. We aren’t working with Sheila, Jen and Sonia’s daughters yet – but in five years or so, we may be!
Susan Evangelista co-founded Roots of Health and is currently its deputy director.