Community development in the third world-walking a fine line

A commitment to PHC-which outlines that health services should be appropriate, effective, affordable, and acceptable to the communities-is a vital component of community development. This involves working in partnership with individuals from within the community, encouraging self-help measures, assisting people in identifying their needs, and helping them establish the most acceptable and suitable ways to meet these needs. NGOs, which many writers identify as the most suitable kind of organisation to undertake such initiatives, frequently undertake CD initiatives in Third World countries. However, putting a CD approach into practice can be fraught with difficulties, in particular the CD workers’ unfamiliarity with the concept and the slow progress of work. To be effective, CD programmes must be fully integrated into their surroundings, based on a knowledge of and familiarity with the political, economic, and social systems affecting the community. The choice of clinic staff meant that we had initially (and unwittingly) worked with the local èlites rather than with the grassroots since our NGO was as yet unfamiliar with the workings of the local communities. With some experience and knowledge of working in the community, the PHC team was able to work better with the local communities and to find more appropriate staff. Allowing the nurses to select their own teaching topics and to identify their own teacher endorsed our commitment to CD by supporting their decisions, and contributed to the overall success of both the examinations and the entire programme. The gap between theory and practice is a concern for CD workers. The need to let people take control of their own destinies, to stand by and grit one's teeth as they take a less appropriate method to secure their aims, requires a firm commitment to the principles of CD. The desire to rush in and dictate solutions is difficult to curb. Furthermore, donors who may not fully appreciate the difficulties involved in implementing CD control the purse-strings and set the criteria for aid organisations. This places pressure on NGOs to attain goals and secure their objectives within specific timeframes.