Community health and development: an integrated approach

Community health workersChristian Distinctiveness

by Stan Rowland.  

Many Christian organisations are concerned with meeting either people’s spiritual needs or their physical needs. Too often, Christians separate the needs of people. 

Some church groups feel that they solve the problem by developing two parallel ministries using different people: an evangelist will minister spiritually, while a nurse or agriculturalist helps physically. However, to follow God’s command (see Bible study), Christians should not separate the spiritual ministry from the practical and physical help that they give. 

A few Christian organisations understand this and develop an integrated ministry. This is where one person has both a spiritual and practical ministry to those around. 

We are told in 2 Timothy 2:2 to find faithful people whom we can teach who, in turn, will teach others. For lasting change, we need to meet the physical and spiritual needs of people in such a way that the process will be shared, multiplied and will be ongoing. 

These principles are used in the work of LIFE Ministries in many countries throughout Africa, in the training of health workers.

God is in the business of changing lives. True and lasting development cannot take place unless individual lives are transformed. Our Christian community health work is therefore concerned with individuals whose lives are changed and who are involved in changing others’ lives.  We measure success, not with projects, but with people putting what they have learnt into practice and then teaching others. We believe that the basis for all health care should be a blend of curative and preventative care balanced with biblical instruction.

Community health evangelism

How can we begin to establish an integrated physical and spiritual ministry? LIFE Ministry in Africa has developed the training of community health evangelists (CHEs). This is a Christian community health programme that is concerned with individuals whose lives are changed and who are involved in changing others’ lives.

On the page opposite are some of the key stages we use in establishing community health evangelism in an area.

Our results

By January 1992 Medical Ambassadors and LIFE Ministry had 39 projects, having trained over 1,500 CHEs in 13 African countries. Since 1984 we have worked with over 160 other African Christian groups, sharing the principles of community health evangelism so that they could integrate these principles into their work. They in turn have trained over 10,000 CHEs in many African countries.

As an example, let us look at the work in Buhugu, Uganda. The twelve people chosen by the community here to undergo training have been very effective in passing on their training and beliefs.

Local trainees and workers from the ten villages involved in the Buhugu project have protected 40 springs and built a 13 km gravity-feed water system that provides clean water for more than 10,000 people. The incidence of measles in the area has been reduced by 40% and deaths due to diarrhoea have been reduced by 30%.

Several individual projects have also been successfully carried out by groups within the community. These include bee-keeping, seedling tree nurseries, ponds for fish raising and improvements in many home garden plots.

Conclusion

We have found that it is easy to say, ‘Let us have a programme that combines both physical and spiritual truths.’ However, careful planning is needed to put this into practice. 

It is important to spend as much time in discipleship as in physical subjects. This shows that both are equally important. If we are not careful, CHEs may spend all their time meeting physical needs, which are so visible. This is the main reason why we do not encourage CHEs to be involved in curative medicine, as it takes up so much of their time and resources. 

Community health evangelism needs to be thought about, talked about, planned, practised, expected and evaluated if it is really to take place.

Phase 1 INITIATION

 
Up to a year should to be allowed for this phase. This will depend on whether the training team is made up of local people or of outsiders. 

Step 1  Get to know the area and the health needs and resources. 

Step 2  Meet with government and church leaders in the most likely areas, to discuss their needs and resources. The aim is to begin in areas that are likely to succeed, not necessarily in areas of greatest need. 

Step 3  Choose the area in which to begin. Work with the local chief to organise a large community meeting. Help the community to identify their problems and needs and encourage discussion about ways of solving these problems. 

At follow-up meetings, discuss ways of solving one or two of their most important problems. Discuss ways in which an outside team could help as well as the role of the community and the team. The community then chooses a community health committee with 25% - 30% of its members from the supporting church.  

Phase 2 TRAINING

 
The length of this phase will vary greatly. We believe that the key to success is for the programme to be community based, and for the community leaders - the committee - to first receive training.

The training of the community health committee is as important as the training of the health workers.

Step 1  Train the committee members. Help the committee to finalise its members, make plans and organise the community. They need to work out the expected roles of the community health evangelists and then choose a team of CHE volunteers - which the team will train.

They also need to identify the main health concerns of their own area - which will form the basis of the training.

Step 2  The training of the CHEs begins with a community survey to discover the main needs. Training is given in spiritual truths and then in the identified problem areas. Initial training takes between 30 to 50 days and can be arranged as convenient. Each training day includes one physical and one spiritual subject. Home visits are begun early on during the training. Local churches are encouraged with discipleship training to be prepared to welcome new members. After completion of training, the CHEs are officially commissioned by the community.  

Phase 3 EVALUATION 

Many projects consider their programmes complete at the end of Phase 2, but we believe that the evaluation of the programme is very important. 

Step 1  Continue training the CHEs for two or three days each month for a further year and then four times a year afterwards. Evaluate their progress with them. The committee and community should choose a second team of CHE volunteers to receive training. 

Step 2  Select CHEs to be trained as trainers and to begin training programmes on their own. Continue training until a ratio of one CHE for every 50 to 75 families is reached. The original training team will move to a new area, while the local teams continue their expansion into neighbouring areas.  

Some of the material in this article is adapted from Stan Rowland’s book on community health evangelism which is reviewed on 'Resources' page.  

Stan Rowland has a business background in marketing and the development of new medical products. He spent 13 years with Campus Crusade for Christ (LIFE Ministry) in Africa, working in management and giving training in community health. Here he developed the concept of ‘community health evangelism’. He is now Director of Community Health Evangelism for Medical Ambassadors International in the USA.