INTRODUCTION
Injuries, and in particular those related to road crashes, are among the major causes of potential life years lost in Nigeria and other developed countries, and cost many billions of naira each year.
Prevention of traffic injury is thus a major priority for public health in the country and requires a comprehensive approach involving a combination of environmental, legislative and educational strategies along with law enforcement.
Until recently, a substantial proportion of road safety measures have been developed by government and non-government agencies with relatively little active involvement of the community.
There has been, however, increasing recognition that community participation is desirable as part of a comprehensive approach. The term ‘community’ refers to people living in a defined geographic area such as members of a city or town. Community members also include professionals who, through their employment, may be involved with a specific issue such as road safety. Community participation can occur at many levels, ranging from minimal or passive involvement, such as watching televised road safety advertisements, to active involvement, such as planning and implementing road safety programs. However, it is often a major challenge to encourage significant numbers of the community to become actively involved. It is acknowledged that road safety can progress with minimal community participation, and that community involvement is only one aspect of the road safety initiative. Nevertheless, it can make a significant contribution as part of an orchestrated and comprehensive approach to improving community safety.
Road safety initiatives are more likely to be supported when the community feels they have a role in setting the agenda and is working towards solutions. However, resources and responsibility for the major thrust of road safety ultimately belongs with the relevant government agencies. Community involvement cannot replace them and their responsibilities. It can only be an adjunct or an enhancement to the agency driven programs. It is therefore desirable to include community involvement as a part of the overall road safety initiative. The desirability of increased community participation in road safety has been recognised internationally and nationally.
In Ogun State there has been a rapid expansion of community action in road safety initiatives. To date however, there have been relatively few published reports on such programs. Projects involving community participation conducted in other countries during the last two decades have recorded positive outcomes. Some of the better-documented examples are from New Zealand and the United States. A project in New Zealand for example, indicated that the use of community mobilization along with mass media, were effective in influencing support for alcohol policy changes.
A six-community project in Massachusetts, USA, included
substantial community participation. A 42% reduction in fatal crashes involving
alcohol was attributed to that program.
A good example of a recent large-scale efficacy trial conducted in the
United States is “The Preventing Alcohol Trauma: A Community Trial.” This
five-year project used an environmental policy approach incorporating community
participation to reduce alcohol-involved injuries in three American communities
of 100,000 population each. Community mobilisation was one of its five major
components. The project is purported to have significant effects on reducing
alcohol-related traffic crashes; lowered sales to minors; improved alcohol-serving
practices and increased community awareness and support of alcohol related
problems. Community participation was achieved by working with existing
community groups, with low cost media advocacy a major strategy for public
communication. The project is a good illustration of how local policies can be
implemented at relatively low cost with significant benefits to the community.
Local leaders were supportive of this approach, which is likely to be more
sustainable than other approaches that exclude significant community
involvement. Strengthening of community action and empowerment are among the
five key principles of the Ottawa Charter for Health Promotion, which was
devised almost 20 years ago. These principles were re-affirmed at the Jakarta
Conference on Health Promotion. The Jakarta Declaration states:
The
WHO strongly encourages community involvement in injury prevention including
road safety. The adoption of this philosophy and its incorporation as a key
component in the ‘Safe communities’ projects which had their beginning over a
decade ago in Sweden, gave community involvement in injury prevention a major
boost. Despite enthusiasm to strengthen community participation in road safety
in Australia, there are many barriers that may limit the likelihood or
potential of community participation.
A
FRAMEWORK FOR COMMUNITY DEVELOPMENT AND PARTICIPATION
The
community development process is most commonly referred to where community
participation is a significant component of projects. Hence, it is useful to
present a framework for community development that illustrates the ‘ideal’
circumstances for community participation. The first five elements of this
framework are more related to the process, and the latter two elements are more
related to the outcomes. These ‘ideal’ elements can be contrasted with the
challenges or barriers to participation experienced in the ‘real’ world. The
five process elements of community development are:
•
Control of decision making by community members who participate to control the
identification of issues and the project interventions.
•
Involvement in action by the community to change the issue.
•
Development of a community culture by the project that contributes to community
members taking responsibility for improving their area and services.
•
Organisational development that occurs where the project builds a new
organisation or improves an existing one. • Learning which occurs when the
participants acquire new skills and information.
The
two elements that relate more to the outcomes of a project are:
•
A concrete benefit results through the achievement of a new or improved service
or facility
•
New power relationships result in the community, that are more equitable.
BARRIERS AND POTENTIAL SOLUTIONS TO COMMUNITY PARTICIPATION
There
are many factors that reduce the likelihood of community members becoming
actively involved in prevention activities like road safety. Ten barriers in
particular appear consistently as impediments to community participation. These
barriers are grouped into two broad categories of personnel and planning issues:
• Personnel Issues
—A
reduction in social capital
—Lack
of time of community members
—Lack
of leadership
—Lack
of relevant skills and knowledge of community members
• Planning Issues
—Adherence
to one approach or process
—Top
down or bottom up planning
—Inappropriate
program focus
—Inappropriate
program evaluation
—Lack
of funds and resources
—Lack
of sustainability
Personnel Issues
A Reduction in Social Capital - There has
been a worldwide trend in developed countries towards increasingly
individualistic societies. The resulting reduction in community involvement, or
social capital, may be attributable to several reasons. These include the
dominance of economic rationalism; a perception of increased competition and
therefore increased emphasis to look after one’s self and family as a priority
to the exclusion of others; the increased proportion of family members in the
workforce; longer work hours; the growth of population in cities and the
related loss of social cohesion along with increasing distrust and isolation.
So,
while there is a call to encourage increased community participation in health
there has been a trend for the community to become less involved. The concept
of social capital has become a focus of research in an attempt to identify
reasons why community involvement is declining and to help identify ways to
reverse this decline. It is particularly relevant in respect to the emphasis of
the Ottawa Charter for Health Promotion on community action and empowerment.
However, work is still required to develop valid and reliable ways to measure
social capital.
There
is no simple solution to reversing the reduction in social capital and its
effect on community participation in road safety initiatives. It has been
argued that social capital is accumulated through a time-consuming, primarily
local process. Therefore, programs to enhance social capital and restore a
sense of community must have a long-term outlook. Social capital can be
strengthened by activities that build cooperation and trust, and which involve
community members working together on common goals for the improvement of their
community.
In
the case of CPIPP (Child Pedestrian
Injury Prevention Project), the project generated substantial cooperation
between the researchers, the participating schools and community agencies as
well as local community members. Anecdotal evidence indicates that the project
was regarded positively by these groups who were brought together to work on a
common goal for the good of their community.
Lack of Time of Community Members - Many
community projects fail or are not sustained due to time constraints of group
members. Community members who become involved in community projects usually
already have other significant commitments. It is not unusual to find the same
small core group of people responsible for several initiatives in a community.
Programs
need to show regular tangible progress so that people feel their time is not
being wasted. Funds need to be available, if possible, to pay for the
employment of a project officer who can ensure that progress on a project will
continue with minimal dependence on the time of voluntary group members.
In
the CPIPP (Child Pedestrian Injury
Prevention Project), community members were represented on several groups;
the Project Advisory Committee, the City of Gosnells Road Safety Committee and
15 school road safety committees. Progress on the project was regularly
communicated back to these participants and their contributions were regularly
acknowledged. Although the project did require significant voluntary time of
community members, much of the work was supported by paid staff funded from
project grants.
Lack of Leadership - Lack of
interested, skilled and committed people in the area of road safety can be one
of the main barriers to prevention interventions being developed and
implemented in a community. Whilst it is possible for a project to be initiated
by an outside facilitator, the development and ultimate sustainability usually
is dependent on local leadership.
Committed
leadership has been identified as an essential component of effective community
participation, in both instigating and sustaining programs. It is essential to
have people of influence on a project ‘management’ committee to ensure that it
does not lose impetus prematurely. They need to be peopling with interpersonal
and decision making skills. Active involvement of the mayor/shire president,
senior council officers and local stakeholder representatives is also usually
advantageous. Programs are more likely to flourish in communities that already
have ‘entrepreneurs of change,’ i.e. people who are already actively involved
in similar community initiatives. An example of this representation in the
CPIPP was the active involvement of the City of Gosnells Traffic Engineer and
the Deputy Mayor of the City along with other key stakeholders as members of
the Gosnells Road Safety Committee and the Project Advisory Committee.
Lack of Relevant Skills and Knowledge of Community Members - Many community projects falter because group members lack relevant knowledge and skills. Professional facilitators can help community members develop skills by working closely with them, and by conducting training. The latter needs to be geared to the education level of the community members and consideration must be given to appropriate venues, time and resources. This approach was used extensively as part of CPIPP.19 Teachers in participating schools, for example, were provided with a specially developed road safety syllabus along with in service training.
In addition, a project officer assisted the Gosnells Road
Safety Committee members in their development and implementation of road safety
interventions in their community. Another approach used in the CPIPP to
facilitate the skill development of community members who were involved in the
road safety project, was the allocation of specific tasks to them. This seemed
to also help strengthen their commitment to the project.
Planning Issues
Adherence to One Approach or Process - Dogmatic
support of a particular ‘process’ for establishing community participation in
road safety projects or programs can be counter productive. Proponents of a
single approach who criticise alternative approaches can be very destructive
and jeopardise cooperation. A good example of this problem is the debate
surrounding the ‘healthy cities’ approach during the 1980’s.
No
one ‘model’ or approach is recommended as the only ‘process’ for establishing
programs and enlisting community participation. Many variations exist for the
implementation of such projects. Respect for a variety of approaches, and the
adaptation of the most appropriate components is likely to yield the best
results. A combination of approaches from recognised and proven planning
processes was adopted for CPIPP.
Top Down or Bottom Up Planning - Some
proponents of initiatives that have a significant community participation
component maintain that bottom up planning (i.e., ‘community development’) is
essential. They advocate for a community development approach at the program
initiation stage. That is, they believe that the community members should
identify their own health needs and priorities, and develop the interventions.
This process may include very minimal involvement of health and other
professionals, and is intended to empower the community members. Major problems
associated with this approach include being very time consuming especially if
the community members lack skills in the planning process and lack knowledge
about road safety. This is especially a problem when there is limited time
available for the program (e.g., funding may only be available for a one or two
year period).
At
the other extreme there are proponents of a top down approach (i.e., ‘community
organisation’). They advocate that professionals should develop and deliver the
programs for the community. Involvement of untrained community members, they
maintain, is inefficient and time wasting.
Most
programs lie between these extremes, with a community organisation process used
initially, and with increased orientation towards a community development
approach as the program proceeds. This ensures that sound planning has been undertaken
initially by professionals who have the relevant training. It also allows
involvement of community members early in the program, with increasing
opportunity for participation as the program progresses. This approach, which
was used for the CPIPP, enables community members to work along-side trained
practitioners. The community members subsequently develop skills and
competencies relevant to such programs and hence become empowered to continue
the program themselves. This is an example of ‘capacity building’ which is
increasingly espoused as an important role of health promotion.
To be continued...
No comments:
Post a Comment