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Chapter 11. Establishing committees for implementing Healthy Villages programmes

This chapter describes how to establish committees for Healthy Villages programmes and discusses the key roles of committees in implementing the programmes. It also provides an overview of the local and national government support that community leaders may expect when developing a Healthy Villages initiative. It is not meant as a definitive guide for government staff, as this is covered elsewhere (see Annex 2).

Healthy Villages initiatives usually extend beyond a single community or group of communities and are incorporated into provincial, district and national plans. Healthy Villages programmes are also often linked to similar programmes, such as Healthy Cities and Basic Development Needs. Each of the different programmes greatly benefits from close association with other programmes. For example, a Healthy Villages programme may be easier to run if the local urban area is engaged in a Healthy Cities programme. Thus, both national and local governments play key roles in supporting and developing Healthy Villages programmes.

Healthy Villages programmes in action

In the eastern Mediterranean region, Healthy Villages programmes have been integrated into national plans for improving health. In Egypt, for example, the Healthy Villages programme has been part of an integrated approach to rural development. By 1999, the programme had covered 4 405 villages and satellite settlements in 1 087 local administrative units. An estimated 36 million people (about 57% of the population) have benefited from the programme. A total of 25 450 projects were implemented within five years in the economic, social and health sectors. A key lesson is that it is possible to integrate environmental and health concerns in a local development agenda and that this leads to greater stakeholder involvement.

11.1 The role of local community committees in Healthy Villages programmes

Each village and community participating in a Healthy Villages programme should establish a committee at the local level. Local committees are essential for broad approaches to health improvement that involve a wide range of activities and individuals, such as the Healthy Villages programme. A committee can coordinate and support the different activities and provide leadership for the community, and can serve as the community contact point with local and national government staff involved in the Healthy Villages programme. Local committees can also facilitate broad community participation in the programme, something that may be difficult to achieve by outsiders. Local committees are therefore crucial for promoting the Healthy Villages approach in a community.

11.1.1 Composition of a Healthy Villages committee

The composition of a local committee is critical for a successful outcome. Committee members should be influential people within the community who are respected and who are able to represent the interests of all the different community sections. If the committee reflects the narrow interests of only a small group of people, confidence may be lost in the entire programme, leading to failure. Ideally, the composition of the committee should reflect the gender balance of the community. While it may not be possible to have completely equal gender representation, because of cultural and social norms, women should be adequately represented to ensure that their concerns are taken into account and dealt with sensitively. It is also helpful if staff from the national or local government are members of the committee.

The importance of local committees in Healthy Villages programmes

Local village councils in the Islamic Republic of Iran have played key roles in the successful implementation of integrated rural development programmes. The strong role played by the local committees, supported with a legal mandate, has helped rural development programmes meet the demands of the local populations and deliver sustained improvements in public health.

The influential members of a community are not necessarily the people with administrative responsibilities within the community. They can also be people who are respected and act as opinion leaders, such as village chiefs, teachers, religious leaders and ordinary community members. It is best that committee members are elected by the community and have limited terms of office, to ensure that serving on the committee does not become a burden to key community members, or become a way for individuals to use the committee for personal gain. As the committee is expected to be the principal implementing body for the Healthy Villages programme, members must also have time to allocate to the committee and other Healthy Villages activities. They will also need to be accessible both to the community and to staff from local government and other bodies that provide support to the Healthy Villages programme.

11.1.2 Transparency and accountability

The committee should be accountable and transparent both to the community and to external organizations, such as local government, NGOs or external support agencies that may provide support. The committee should take minutes of all meetings, record the decisions made and make sure that other community members have access to this information. A regular feedback mechanism to the broader community should also be established, along with a forum for broader debate by the community about major activities and issues. If the committee manages funds, accounts should be kept and made available to other community members and external support agencies. To do this, the committee should elect executive officers, such as a chairperson, treasurer and secretary, and meet regularly.

11.2 The role of local government committees in Healthy Villages programmes

Local governments usually have their own Healthy Villages committees and coordinators who provide technical and administrative support to community committees overseeing Healthy Villages programmes. A key role of local government committees is to provide new ideas and to make communities aware of initiatives and successes in other communities participating in Healthy Villages programmes, and provide the impetus for communities to improve their own health and environment. For example, local governments may support improvements to communities under their jurisdiction by providing services and infrastructure. This may be paid for by local government revenue, by grants and loans from central government, or by raising funds from national and international support agencies. The delivery of many health services, such as immunization programmes or programmes that provide health centres and clinics, will be carried out by local government.

11.2.1 Funding and accountability

Often local governments have access to both conditional and unconditional grants for improving services to their populations. These grants can be used to support immunization programmes, for example, or provide funds for the operation and maintenance of water supplies and latrine construction. To retain access to these grants it is critical that local governments properly account for the funds. In most cases, central governments, external support agencies and NGOs are willing to provide continuing support to local governments if the funds are spent in accordance with agreements between the local governments and the finance providers and if all previously released funds can be properly accounted for. One of the greatest barriers to local governments accessing funds is an inability to properly account for money previously provided. This can result in local governments being blacklisted by agencies or central government departments, and lead to frustration within the local government and funding agencies over the inability to release funds.

In many cases, the lack of accountability does not reflect misappropriation of funds, but rather a lack of understanding of accounting procedures. It is essential, therefore, that local governments request proper training and support in accounting procedures, and ensure that their staff understand the accounting requirements and can prepare and submit accountability forms in the correct format.

11.2.2 Technical advice and support

In addition to providing infrastructure and services directly, local governments play an important role in other ways by providing support to communities in terms of technical advice, health education, water quality monitoring and management, lobbying for funds to support community-based initiatives, and facilitating access to spare parts and tools. Often, they can also support the development of health care provision within, or close to, communities. These different types of support can provide opportunities for educating community members on how to practise good hygiene, and how to improve the operation and maintenance of water supplies. Local governments can also provide services that the community is unable to deliver, such as periodic testing of wastewater quality, food inspection and food quality analysis.

Partnerships between communities and local governments

In Morocco, the rural water supply programme (PAGER) has developed close relationships between local rural governments (communes) and communities. The communes also provide a vital link to the national government. Rural water supplies have been developed through a partnership between the communes and local communities, with the communes providing technical support and advice. However, initiation of the process always comes from the local population.

Local government officials play a crucial role in providing technical advice to communities. Many communities or households may wish to facilitate better health by improving the environment, but do not know how to achieve this. Local government staff can provide technical advice on a wide range of activities, such as the design of sanitation, water supply, waste disposal and drainage projects, and work with communities to define and implement improvements that the community can afford and sustain. Local government staff willing and able to answer questions from community members can therefore assist in resolving many health problems.

Local government staff can also be the main implementers of health education by providing health education directly through community meetings, by providing posters, or by training and supporting local health educators. The use of community health educators, drawn from the community in which they live, can be a very successful approach if they are given adequate technical and financial support from local government. Local government staff also play a crucial role in helping communities to analyse their environment and the risks to their health, and in helping them prioritize interventions. They can also help communities use the checklists included in this document.

Finally, the local government can play a critical role in identifying the most needy communities and households, and in directing external agencies (whether large donors or NGOs) to those areas. This can ensure that all communities, rather than just a few lucky ones, receive equitable support and funds from Healthy Villages initiatives.

11.3 The role of national committees and coordinators in Healthy Villages programmes

A Healthy Villages programme usually has a national committee and a coordinator who are responsible for promoting and developing the programme at a national level. National committees help to articulate policies that support the development of Healthy Villages initiatives, and help to attract external support when required. They may also provide training for local government staff in techniques that are required to support Healthy Villages initiatives at local levels, to evaluate progress and to ensure that experiences are shared. To remain relevant, it is important that national committees remain in touch with developments in communities with Healthy Villages programmes and are aware of the reality of life in rural areas. They should also understand how community members want to develop their village. National staff should therefore make regular visits to villages participating in Healthy Villages programmes and listen to the views and concerns of local people.

The importance of national committees in promoting Healthy Villages programmes

To ensure that Healthy Villages programmes receive support, it is essential that there are national level professionals who are committed to the development of the Healthy Villages initiatives. In Egypt, the Islamic Republic of Iran, Jordan and the Syrian Arab Republic, the role of national committees in developing materials and attracting resources has been crucial. In all these countries, support from the highest levels of governments has been secured because of the profile and performance of these committees. A common factor across all these countries is that the national committees have maintained close contact with grassroots activities, thus ensuring that they remain responsive to the needs of the rural population and are well-respected.

National committees and coordinators are often responsible for the development of supporting materials that can be used by local Healthy Villages committees when undertaking a range of interventions. These materials can include overview guides for entire Healthy Villages programmes and concepts, or pamphlets and manuals on specific subjects, such as protecting and maintaining a water supply or improving sanitation and hygiene. Any materials developed should be properly tested before they are used and communities should be given opportunities to provide feedback on the usefulness of the documents and on changes that may be required.

National committees and coordinators should also make sure that lessons from different areas or countries with Healthy Villages programmes are shared with key stakeholders, including community leaders. Building on successes from other communities can be an important way for communities to improve their own programmes and avoid the mistakes of others. Consequently, community leaders should make sure that they know who the national committees and coordinators are, where they are located and what their roles are in developing a Healthy Villages programme. They should also request information about activities in other areas of the country, as well as those at the national level and in other countries.