Self-reliance in health among village women
Objective: A project in a remote region in Sarawak, Malaysia, in which village women were mobilized to plan and implement a kindergarten and child feeding program, illustrates the potential of carefully conceptualized community participation. Permission was obtained from village elders to train 18 mothers (all of whom has at least 4 years of education) to conduct a community needs survey. III health among children emerged as the problem of greatest concern to villagers and a health committee was formed to plan an intervention.
Methods: Although a team of outside professionals was available for technical support, the emphasis from the onset was on developing self-reliance and community involvement in all decisions. To build confidence and develop leadership, a month-long participatory training course in promotive health care was organized by village health volunteers. Preparation for the project included conversion of an unused hut into a kindergarten and construction of furniture by village men, registration of preschool children, preparation of educational materials, and organization of a kitchen and duty roster for the feeding program. Project funding came from local bake sales and kindergarten subscriptions. Monitoring during the initial phase identified several problems, such as food shortages brought about by drought, some parents' inability to pay for kindergarten services, and a lack of trust in the teacher's abilities. These problems were corrected by the field team, but subsequent supervisory visits focused on teaching problem-solving skills to the local women. An evaluation conducted 1 year after program implementation revealed dramatic increases in the proportion of households producing fruits and vegetables, a higher percentage of breastfeeding mothers, and improvements in weight-for-age among kindergartners.