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Community-Based Interventions

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Challenges in Health and Development

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Abstract

National programs create materials for and interest in health and development, but the benefits of such programs are not equally distributed across geographic territories or across sub-populations. The poor, minorities, women and those living in rural areas tend to receive fewer benefits and experience large differentials in terms of overall development and health outcomes. Non-governmental organizations , civil society, and parastatal organizations can address the gaps in services and resources. They do this through small-scale enterprises and locally-based investment in individuals and households. One such community-based program is the Grameen Bank , an NGO that provides microcredit to poor, rural, women. It has been successful in raising household income and improving human capital in Bangladesh , but it has had mixed results in terms of scaling up for broader-scale poverty alleviation and social impact. Gonoshasthaya Kendra is an NGO that provides community-based health care in Bangladesh using allopathic and traditional means. It has been successful in reducing maternal mortality in the regions it serves by understanding and using resources at the local level. Although this NGO provides evidence that community-based health programs can be successful in delivering appropriate and acceptable health care to select communities, difficulty remains in scaling to national levels. A final example of community development is found in the Millennium Villages Project which addresses multi-faceted poverty through coordinated efforts by local, national and international actors to address development across economic, health and social sectors. The Project proved successful in improving livelihoods and health at the community level but has yet to prove either scalable or sustainable.

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Notes

  1. 1.

    These data reflect conditions from 2005, a period when the district was under LTTE control (albeit during a ceasefire). This speaks to the difficulty of gauging development during war, and to the difficulties in realizing equity in development during conflict.

  2. 2.

    See http://depts.washington.edu/ccph/index.html, http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hserta&part=A148846, and http://www.press.jhu.edu/journals/progress_in_community_health_partnerships/ for details on this type of research.

  3. 3.

    The official death toll according to the government of Bangladesh is 3 million; Harff and Gurr (1988) estimate 1250 to 3,000,000. Matthew White (2005) provides a well documented list of deaths associated with various wars at his website http://users.erols.com/mwhite28/warstat2.htm.

  4. 4.

    This is based on data as to where deliveries occurred, who was in attendance and where and with whom maternal deaths occurred.

  5. 5.

    Calculated from income levels in Islam (2007). Taka converted to US dollars based on Jan. 2010 international exchange rates.

  6. 6.

    See NPR (2010) for several stories on the enterprises financed by microcredit, including Bangladesh’s “phone ladies.”

  7. 7.

    For resources on measuring poverty, see: http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTPOVERTY/EXTPA/0,,contentMDK:20202198~menuPK:435055~pagePK:148956~piPK:216618~theSitePK:430367,00.html.

  8. 8.

    A Framework for Understanding Poverty by Ruby K. Payne (2005) and An African Centered Response to Ruby Payne’s Poverty Theory (2006) by Jawanza Kunjufu provide interesting cross-cultural discussion of causes, and (mis)perceptions of poverty.

  9. 9.

    Grameen Bank stopped accepting donations in 1995 and adopted a stance in which it will not take out loans.

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  1. Josef Korbel School of International Studies, University of Denver, Denver, CO, USA

    Sandy A. Johnson

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Johnson, S.A. (2017). Community-Based Interventions. In: Challenges in Health and Development. Springer, Cham. https://doi.org/10.1007/978-3-319-53204-2_4

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