Christine's work focuses primarily on the use of participatory methodologies in formative research and evaluations, in order to enhance behaviour change interventions for public health. Christine is also currently studying for a PhD on the effectiveness of WaSH behaviour change interventions for pastoralist communities in Afar region, Ethiopia.
Participatory action for nutrition & WASH with pastoralist women in Afar, Ethiopia
It is fair to say that including significant community engagement in development has become the standard, at least in theory, as we recognize that the acceptability and sustainability of any project rely a great deal on community buy-in. Working closely with communities, projects are better able to incorporate local knowledge into the planning, implementation and monitoring of interventions. However, in practice the ability to apply truly participatory methods is often constrained by context, culture, budgets and timelines, not to mention attitudes and understanding of what participatory practice entails and its goals.
Over the past year, Fostvedt-Mills Consulting (FMC), supported by GIZ Ethiopia, implemented the Nutrition-WaSH (Water, Sanitation and Hygiene) pathways project in Northern Ethiopia, which aimed to investigate options for improving Nutrition and WaSH outcomes. We worked with pastoralist communities in the Afar region of Ethiopia to understand key barriers to improved nutrition and WaSH. One of our primary objectives was to ensure the project remained participatory and centred the voices of women in the community, specifically mothers and female community leaders.
One of the key ways that we did this was through the use of photovoice, an innovative qualitative data collection methodology that relies on photography done by community members to uncover their lived experiences and highlight what is significant to them. Early in the project, we were encouraged by the community’s reception to the methodology. Participants shared that they felt they were actually part of the study, that they were able to participate, had some responsibility to participate, were not under the supervision of anyone and felt empowered. One participant expressed it this way: “when you have an itch on your back, if I ask you to scratch it, it won’t be satisfying. But if I can scratch it myself, it will feel better, and I will feel more satisfied.” (Read the first blog in this series on the use of PhotoVoice methodology in this project)
Ayisa Abas captures her daughter preparing mulfie, a flatbread made from maize or wheat: “Mufie is the main food of the Afar people. We use maize flour, salt and water to prepare the dough. Then we flatten the dough using our palm, put the dough on a hot stone and cover it. After some time, the Mufie is ready and we can give it to the family with milk or sauce.” (Photo taken by Ayisa Abas of Awura village)
Building on that sense of ownership over the findings of the research, we concluded the project by holding a series of Community Action Planning (CAP) workshops in six communities in the project area. Striving for diverse representation, we deliberately included participants from each village including religious and natural leaders, youth, women, health workers, teachers and the photovoice participants. Each group averaged 50% female participation, remarkable in a region where women’s voices are largely absent.
Typically, development interventions in the region arrive in communities with a project plan already designed and ready to implement. Project teams then consult with the community with the intent to gain community approval for the already formed plan. This approach is inherently limited in that communities tend to lack a sense of ownership over the plan as they see it existing outside of and separate from their actual lives. Additionally, in typical consultation settings, it is less likely that women (who are often less educated and with lower levels of literacy) are going to participate meaningfully in providing feedback or sharing their experiences and insights.
Conversely, our approach was to include the community more meaningfully in conducting the research in the first place and then bring the findings of the baseline research to the group as the basis for them to build an action plan. We included some more traditional methods such as key informant interviews and focus group discussions but a large part was the photovoice research that had been conducted by local women in each of the villages. Each of the workshop groups were then provided with albums made up of all the photos from each of the villages and grouped by theme. As some time had passed between the photovoice research and the workshop, these albums proved extremely effective in stimulating discussion, with those who had taken the photos eager to explain why they had included certain images and why they felt they were important.
Following discussion, we presented the communities with a list of the most significant issues the research had uncovered around nutrition and WaSH. Facilitators then supported the participants to rank the issues from most to least severe and then agree upon key actions to be taken and who would be responsible to carry them forward. The project had begun with the assumption of further intervention, however as a result of the shifting context the project was cut short. Knowing there would be no further funding or support from GIZ or FMC in implementing those actions, participants were able to develop solutions that would be entirely community-driven.
Despite some significant contextual constraints, including COVID-19 restrictions, growing political unrest and an election, our research team was impressed by the enthusiasm and engagement of the participants. Indeed, some of the communities had already begun implementing specific actions after having participated in the research and they were proud to share what they were doing. For example, one religious leader explained: “women carry a great workload throughout their life. Before, women were supposed to carry babies when they go to collect firewood and water, but now some husbands will stay with the babies at home until mothers come back from water and firewood collection.” Through the photovoice project, we had developed a significant level of trust with the community researchers who took their responsibility as researchers seriously and thus took very honest photos as they wanted to present a truthful view of practices, even those they knew to be unhealthy or unhygienic.
Ayisa Ali’s photo shows women coming back from the river, where they have collected water. “Only women collect water. If there is no one at home to look after our babies, they come with us. Since we collect water from the river, I don’t think it is safe, and I don’t do anything to it to make it safe.” (Photo taken by Ayisa Ali of Yallo village)
As they developed their action plans, participants identified the practices negatively affecting their communities, discussed why these should change, how they could change, who might support or oppose the change (risks and possible solutions) and who would be responsible for implementation. For example, one village identified the need to reduce women’s workload. They agreed that religious, clan and community leaders were responsible to lead this change and they would do this by holding up those husbands who are already helping their wives as an example for others to follow. They also agreed that religious and clan leaders would start collecting water and firewood to act as role models for the community to break taboos about men doing this type of work.
Experience tells us that sustainable change depends a great deal on addressing knowledge gaps, ensuring appropriate incentives and maintaining adequate motivation to sustain the change. In this case, our team was encouraged by the small changes in attitude observed at the action planning stage and hopeful that enough momentum had been created to carry the implementation forward. However, the reality is that several of the communities have since been displaced by conflict and because of the nomadic nature of pastoralist communities, external factors may often play a significant role, such as access to markets and water sources. Ideally, this type of action planning would be followed up in a few month’s time to check in with participants on progress, provide additional learning opportunities and generally encourage communities to continue the work.
Community Action Planning is not new, but its application with pastoralist communities on issues of WASH and nutrition such as those in Afar, Ethiopia is limited. Large gender gaps in education, women’s heavy workloads, poverty and cultural factors typically exclude women from decision-making spaces, even when tackling development issues that disproportionately affect them. This project demonstrated that given the right conditions, such an approach can generate culturally appropriate, gender balanced and community-driven actions toward improved nutrition and WaSH practises. Building trust with participants by involving them throughout the project, using methodologies like photovoice to center their voices and asking them directly to design solutions to their own problems has demonstrated promising results.
Participatory and community-led change is not simple or quick. It takes significant time and resources to build relationships in communities, gain trust and understand the context within which you are working. However, by truly shifting practices informed by cultural norms we can start to imagine broader implications through the ripple effect. Communities do not exist in isolation, they have contact and relationships with other communities and can influence attitudes and behaviours through that contact. Ultimately, behaviour change must take into account the social and cultural context and this community action planning approach can provide a framework to effectively do so.
Fatuma Hussen captures her neighbour constructing her family’s house: “In our culture, house-building is always the responsibility of women. So we collect nice wood from the forest and build the house. When were supposed to migrate to another area to search water and grazing, we demolish the house carefully and collect the wood, take it with us and build another house there. (Photo taken by Fatuma Hussen of Chifra village.)