CDI Module 4: Mapping Community Structure, Networks and Organization ©Jhpiego Corporation The Johns Hopkins University A Training Program on Community- Directed Intervention (CDI) to Improve Access to Essential Health Services

Module 4 Objectives By the end of this module, learners will: State the definition of community used in “to roll out community-directed interventions (CDIs)” Describe the purpose of community mapping in building support and solving problems Explain the value of involving community members in mapping their own community List the steps and activities needed to map the organizations and resources in a community

Community in CDI In CDI, we create a strong community-clinic linkage We start our definition of community by identifying all the settlements, villages, etc. that are served by a primary health care facility (catchment area) To make CDI effective, we work with each of the smallest functional units of a community (such as a kindred, clan, neighborhood, hamlet)

Mapping Mapping is: A very important component of almost all practical situation assessments A joint activity with the community that can help everyone involved learn more All programs need to have a sense of where: People live The problem areas are The community resources are located Others are doing their activities

Resource and Social Mapping Locating Physical Structures Health facilities and providers Schools, religious institutions Boundaries Understanding Social Relationships Existing organizations, associations, societies and levels of activity Wards (sub-districts), kinship groups Utilization patterns and barriers Communities are built from their social networks

Why Social Mapping? In mapping, we are interested in our target population—for example pregnant women—and the people or groups with whom they relate: Pregnant women People pregnant women turn to for advice and assistance Key members of social networks to which pregnant women belong Mapping helps link people in need with the services and resources they need

Social Mapping Helps Make Sense Mapping provides useful tools for making sense of social networks and behaviors related to using services during pregnancy In this case, we are interested in: The size of the population group we are targeting Their utilization behaviors The places and persons to whom they go for help What attracts them to these people and places

Mapping Is Not Just about Locations When community members are involved in mapping, they learn more about the problems and resources in their community They can visualize service quality issues like access and equity What can you tell about the community from this map?

Components of Mapping During the community meeting: Ask the group to list key persons and organizations in the community that can help promote the program Identify any potential road blocks or people who might oppose the program Learn about the community’s past development efforts and why these did or did not succeed Past efforts provide lessons on how to undertake future efforts more successfully

Map Health and Development Resources Ask people: To name and describe the location of key health and development resources that the community values, such as: Healers Opinion leaders Medicine shops Local associations, etc. About major sub-divisions (e.g., wards, communities, kindreds/clans and settlements)

Map Resources for Women Specifically ask about resources—people and organizations—to whom pregnant women go for advice and help, for example: Where do they get advice? Are there women who regularly deliver babies? Where do they get medicines? From whom do they get financial, emotional and other support? Take notes during the meeting

Identify Women’s Associations and Support Groups

Use the Social Mapping Information At the community meeting, encourage people to use the information generated to help plan program development, for example: Develop criteria for the best types of people to serve as community-directed distributors (CDDs)—for example, for malaria in pregnancy (MIP) programming Determine sub-communities (e.g., kindreds/clans, settlements, neighborhoods) that could form the basis of selecting CDDs)

If There Is Time, Actual Maps Can Be Drawn and Kept with the Community

Mapping Varies by Type of Community Many factors influence a community’s structure, organization and networks, such as: The status and concentration of the services in the area Whether it is urban or rural The way people utilize the services that are available

Rural and Urban Communities Some Rural Issues Greater community cohesion and identity Smaller and more dispersed units Seasonal habitations (e.g., farm hamlets) Generally poorer Can you think of other examples? Some Urban Issues Weaker identity and cohesion More compact, but people travel far for work and social needs Financial gain often supersedes other social needs Greater divide between poverty and wealth

Chart the Mapping Results for Malaria in Pregnancy Community Resource Specific Examples Names of women leaders Names of community sub-sections (e.g., kindreds/clans, settlements) Names and locations of health resources—public, private, indigenous Names of key women’s social groups Other special resources for pregnant women

Discussion—A Look at Other Issues Let’s think of another health issue, for example: Community management of child illness Food security Home-based care for people with HIV What are the community resources we would need to find and map for these issues?

Chart the Results for Another Health Issue Community Resource Specific Examples Names of leaders Names of community sub-sections (e.g., kindreds/clans, settlements) Names and locations of health resources—public, private, indigenous Names of key social groups Other special resources

Summary and Conclusions Community members’ involvement in social mapping can help them learn more about problems and resources in their community Service issues like access and equity are more easily visualized by community members Community participation in mapping makes community landmarks and identity more visible Mapping helps link people in need with the services and resources they need