How To Lose Trust and Anger People
As mentioned last week we are hard at work to develop the structure of the Community Health Worker (CHW) program—all which hinges on one very important factor: community members allowing our health workers into their homes. The purpose of the visits is to collect information to inform future services, share health knowledge, assess current health problems, and eventually sell and distribute commodities that will prevent and mitigate the most common diseases in the area. So far this has proven to be a challenge. We have received extensive feedback from the CHWs and their respective supervising Field Officers about community members not allowing them into their compounds. When the service we are trying to package is for the direct benefit of the community members it begs the question, why would these households refuse what is currently free and potentially lifesaving? A few of possible reasons that were brought to our attention are:- Households believe that the CHWs are using them to make mone
- Survey fatigue due to the extensive questioning the Ministry of Health requires CHWs to conduc
- Households are unaware that CHWs will be providing services and therefore, don’t believe the CHWs have anything (knowledge or otherwise) to provide them with.
- Not fully greeting the head of household - Not introducing oneself and the purpose of the visit - Asking too many questions - Wasting people’s time - Pulling farmers off their shambas (farms) - Using technical language - Not being knowledgeable about topics discussed - Being a bad health role model - Being rude and passing judgment on their homes and lifestyles - Visiting too often - Making disrespectful comments or facial expressions - Make the family feel health problems are their fault or that they are stupid - Gossiping about what is discussed in the visit - Making promises and not delivering
After reviewing the chaotic whiteboard I realized the value of exploring the inverse. No matter how creative or useful the services provided are, if we don’t understand exactly what upsets the community and change our approach we will never be successful. So what now? As per the recommendation of our Field Managers the first of our supplemental CHW training will be on home visits style. While it will outline the process of what to do (introducing oneself, making a connection with the person with whom they are speaking, how to ask questions and give advice in a respectful manner, and how to following up as needed), a large part will be based on what doesn’t work using specific examples. We will have our own anti-brainstorm in this training which I suspect will incite a few ah-hah moments about their own behaviors, and we include the popular activity of role plays to demonstrate productive and counterproductive visits. After this training we hope the CHWs can paint a clearer picture of their role and goals for the community while developing a good foundation of trust and respect as they continue to go door-to-door enhancing access to health care. I will let you know what happens!
While it is good not to dwell on the negative, in this case your article is extremely insightful. Unless this type of assessment is made, you would have continued to ‘piss people off’ without knowing the impact you were having on the communities you serve. When we can remember our primary function in community development in these rural and remote areas it is easier to stay on track with the original mission. Bravo for being the “hanged man” and looking at this situation from another perspective.
Good reminder on the power of the anti-brainstorm! I appreciate your conclusion- train on how to do a home visit. I’m grateful for Nuru’s culture of admitting mistakes and creative problem-solving through research, brainstorming and collaboration.