A village seizes the reins of health care
METHODS: The setting-based approach to health promotion and education has been adopted in an Albanian village. The project requires a high degree of self- determination and self-help. External support comes from the International Islamic Relief Organization. Encouraging progress is being made as villagers acquire a wide range of skills, connected not only with the provision of care but also with such matters as fund-raising, health education and relations with public and private bodies. A model health promotion project organized by the International Islamic Relief Organization in an Albanian village demonstrates the significance of the principles of self-help and community participation. The first step in the process was a mass meeting where villagers identified their problems and needs and volunteered for committees and working teams. To obtain in-depth data on social, personal, and health characteristics, 115 of the village's 284 households were randomly selected for interviews with the female head. Priorities were selected on the basis of the following criteria: probability of excellent results, effect on the maximum number of villagers, prevention of future health problems, cost-effectiveness, fulfillment of perceived community needs, and potential for community planning and implementation. Endemic goiter, childhood diarrhea, and unsanitary refuse disposal were selected. Community leaders and working teams then created an intervention program and defined aims, indicators, instruments, and roles. Participants were provided with computer training, and electronic media were used to present ways of dealing with common health problems.
RESULTS: To date, villagers have made improvements in the local school, established a room for oral rehydration therapy, obtained iodine tablets and iodized salt from the Ministry of Health and some nongovernmental organizations, and constructed special sites for the burning of refuse. As a result of this project, villagers have developed skills in organizing, supervision, education, and fund raising and have learned how to approach nongovernmental organizations and government agencies for support. The self-reliance that has emerged as a result is expected to provide a sound basis for sustaining the projects even after external agents depart.