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We talked in the previous lecture about the political economy.

How that implies a need to redress imbalances in power relationships.

And one way in which communities organize themselves to address such problems, can

be through the formation of community coalitions.

In this lecture, we will define coalitions and we will look at some

examples. In particular, we will consider a program

in Lagos, Nigeria, one of the largest cities in West Africa and see how a

program sponsored by the US Agency for International Development brought

together groups such as trade associations, religious groups,

neighborhood improvement societies, social clubs.

Together with private health service providers, to form coalitions called

Community Partnerships for Health, CPH. And these CPHs address the issues of

access to healthcare for children in particular.

The urban setting provided a challenge in terms of the political economy model.

Because many of the communities are poor. Even though they are in an urban center,

people have lack to access of healthcare because of costs.

Government clinics are not available everywhere, private clinics are

expensive. People use medicine shops.

The environmental conditions in a community foster the spread of diseases,

diarrheal diseases. The close proximity of population means

that diseases that could be prevented by immunization such as measles spread

quickly. And in order to address these problems,

coalition is formed, partnerships were established.

This will be explained after we've had some comment on the definitions and

characteristics of coalitions. Coalition is an organization of

individuals representing diversed organizations, factions, constituencies,

who agree to work together to achieve a common goal.

A variety of organizations could include citizen groups, professional groups.

These diverse groups, interest groups, combine their human material resources to

affect specific change which members are unable to bring about individually or

independently. This issue of focusing on a particular

goal is important. Organizations, as we will look at in the

next module, have their own individual goals and purposes that have arisen out

of their environments. But individual organizations may not have

the resources to solve all their problems.

There may be organizations with similar, although not exactly the same goals, or

who may focus on different aspects of a health issue. And if they worked

together, they could be more effective as a group.

A coalition may focus on developing the local community, each contributing, each

organizational member contributing what it can provide in terms of skills,

personnel. Coalitions can also be using community

action, to lobby, to pressure agencies and governments to provide more

resources. Coalitions allow individual organizations

to become involved in broader issues without them having to take the sole

responsibility for managing and developing these issues.

And coalitions demonstrate and develop widespread public support for issues,

actions, and unmet needs. Coalitions maximize the power of

individuals and groups through joint action.

They increase the critical mass behind a community effort, to bring about specific

objectives that may be beyond the scope of any one individual organization.

And coalitions also help to minimize duplication of effort.

As noted, several organizations may have a similar goal and by working together,

they can use their resources more effectively, they can improve

communication about particular health issues in a community, and increase trust

among the partners that collaborate. Coalitions help mobilize more talent,

resources, and new ideas and approaches to influence an issue, more so than any

single organization could have achieved on its own.

Coalitions provide an avenue for recruiting diverse constituencies.

They may be groups that have a political agenda, may involve the business

community, professionals in the human services, social and religious groups, as

well as prominent individuals can come together when they perceive a common

need. Coming together as a group, they're able

to exploit new resources and change situations because, again, coalitions are

flexible. They are formed for a particular issue.

They are able to respond. They're not bogged down in various rules

and regulations that the contributing organizations may have had.

They are more responsive to problems in the environment.

There are different kinds of coalitions, grassroots, coalitions are organized by

volunteers, at the community level in times of crisis or to pressure political

policymakers to act professional coalitions, bring together, professional

organizations, medical, nursing, social work, to combine their power and

influence where needed. Community-based coalitions bring together

both professional, and grassroots leaders to work together on the long-term welfare

of the community Successful coalitions result in an exchange of resources and

ideas among the member organizations. It sets up a new level of cooperation

within the community and people will see greater benefits for joining in the

individual organizations that are members because they have a broader influence on

activities in the community. Successful coalitions focus on a clear,

clearly articulated mutual need or concern.

A coalition that focuses on teenage health.

A coalition that focuses on drunk driving.

A coalition that focuses on improving education will be more successful than

those that are interested in just general community development.

Successful coalitions occur in communities where there's a history of

previous collaboration and joint efforts. Success occurs when there is

compatibility among the potential members, when they're not conflicting for

membership or fighting over the agenda. Coalitions are successful when the

members have determination to work together.

Because coalitions are groups of organizations,

each organization in the past has had its own agenda, its own identity.

They may have been in competition for memberships or resources before.

So, a coalition to succeed needs to foster a good climate of good

relationships among the members seeing that there is more to be gained by

cooperating than by competing. Coalition needs access to external

support and resources. Here again, is the value of joining

together. Some members may have contact with the

media. Some member organizations may have

political influence. Some member organizations may have

financial resources. Different organizations may, because of

the nature of being a membership group, may have contact with a national level

organization, they may be chapters. And so, these kinds of external support

and resources help the coalition gain information, gain additional resources to

solve it, the problems. Coalitions, like any organization in a

community, need to actually have achievements in order to stay together.

An organization or a coalition that works for several months or years without

seeing any results are likely to disband. Short-term successes are important to

increase motivation and pride and enhance credibility of the organization.

It's important therefore that coalition members set achievable or reasonable

goals and observable indicators of progress along the way to keep members

interested. The idea of coalition building was

carried out by the basics program, a USAID project that in other countries,

was involved in strengthening the health services.

Ironically, when they reached Lagos, it was the time of political change,

military dictatorships and US government agencies were not allowed to work with

Nigerian government agencies. And so, the project have to look for

another way to strengthen and improve the child survival programming at the

community level. They came upon the idea of establishing

community partners for health in six of the poorer communities or neighborhoods

in Lagos. The concept was based around a

collaboration between private health providers who are ubiquitous in the, in

the community and existing community groups.

Initially, an inventory of community groups and private providers was

conducted. And these two sets of organizations were

invited to a forum to discuss their mutual interests.

Groups such as hairdressers association, tailors association, men's and women's

clubs and groups from churches and mosques, social clubs, came together with

the proprietors and staff of private clinics in the community, and discussed

how they could work together to improve the health of children in their area.

Although several hundred organizations were identified,

community-based organizations, civic organizations, and professionals in

terms of the private providers. In the end, approximately 200 member

organizations formed into six different coalitions or community partnership

groups in the six different communities. As noted, a coalition needs rules so that

each member organization knows its responsibility.

And relationship to each other. And one of the first activities for each

of the six community partner groups was to develop their own memorandum of

understanding. One of the key issues that was of concern

in terms of child health in the urban setting, was access to affordable care in

a timely manner. People knew that private clinics were

available. People knew, of course, the government

clinics were available but they very rarely had drugs or supplies.

So, they knew that private clinics were available.

They were much more costly. There was an agreement made that the

private clinics who were members of the partnership would provide reduced price

healthcare, and would provide this on credit if the member community-based

organization, CBOs, also agreed, or guaranteed that they would cover the cost

of any member who defaulted from payment. This was one of the core understandings

that the, the groups came together with. They also agreed mutually ro promote

childhood immunization, to pro, promote clean environment in their area.

They agreed on such things as membership dues, they agreed on developing a, a

Board of Directors. But this issue of coming up with their

own rules made it possible for them to work together and to know where each

member stood. They were able, therefore, to set out

clear goals. So, we mentioned some of the groups were

more successful than others. The two groups that had the higher

collective efficacy score were able to set up environmental sanitation

exercises, AIDS awareness campaigns. They set up a saving cooperative for

their members. So, they were able to achieve some

organizational successes and engage in fundraising.

They were also able to use their status as a recognized group to get registered

with the government as a non-governmental organization.

And then, the issue of external support, they took this registration paper to some

of the donor agencies, such as UNICEF, and were able to use that to get supplies

of oral rehydration salts when a cholera epidemic broke out, able to get

recognition from, from other agencies for programs.

And so, this partnership was even able to convince the local government.

So, the AID couldn't go directly to the local government but the partnership

could and convince the local government to provide them with vaccines,

so that they participated actively in the immunization program and were able to

increase immunization coverage in their communities.

The CPHs, the Community Partnerships for Health, were able to sustain themselves.

They've been going now for four years, because they built on existing social

units. They identified CBOs that were concerned

about healthcare and welfare of children, and this was the basis for successful

coalitions, building on these existing groups.

They were also successful because they reached out to obtain external resources,

as we said, from UNICEF and from the local government.

They were able to identify the needs of members and set up the savings

cooperatives so the people could see some benefit of membership.

They were able to identify and solve problems.

And, as we mentioned, those that were, the most successful in terms of carrying

out these activities clearly had a heightened sense of community efficacy

and have gone on to elect new leaders, continue to function, and look like they

will be sustainable into the future.

Lecture 7: Community Coalitions

Community Change in Public Health

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