Strategy 1



Save the Children’s Community Action Cycle (CAC)

The Community Action Cycle (CAC)[1] is a proven community mobilization approach which fosters individual and collective action to address key health program goals and related outcomes. Applied to improved health outcomes the CAC works to increase access to and demand for health services, especially where gender and other socio-cultural barriers exist. SC’s CAC approach, used successfully around the world, fosters individual and collective action for sustained community participation in achieving health outcomes.

The CAC approach fosters a community-lead process through which those most affected by and interested organize, explore, set priorities, plan and act collectively for improved health. Phases in the CAC include preparing to mobilize; organizing for action; exploring the issues affecting access and demand for health and setting priorities; planning together, acting together, evaluating together, and “scaling up” successful efforts. Each Phase of the CAC has a series of related steps which guide communities and facilitating partners. As applied to health each phase and its related steps will lead to greater community ownership and sustained collective action after the end of project through the capacity-building of community groups.

With USAID support in 2002, SC compiled its experience in mobilizing local communities into a field manual is entitled,“ How to Mobilize Communities for Health and Social Change”. Along with the accompanying Community Mobilization Trainers Guide and CD-ROM, the manual guides its users through the phases and steps of the CAC. The material and accompanying tools are written for program managers of community-based programs and their teams. Accompanying community-level tools have

also been developed.

The Community Action Cycle (CAC)

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By working through the CAC cycle communities and individuals will identify the socio-cultural barriers/enhancer, resources, risk factors, especially for those most marginalized, to access health services and begin to work towards positive change. They will also identify bottlenecks to accessing services—and will link with internal and external partners to address these barriers. The CAC approach recognizes that people do not change their behaviour based on information alone; it is a combination of having the information as well as the confidence and enabling environment to make positive choices, collectively and individually, while addressing underlying social norms that ultimately leads to changed behaviours.

Through the application of the CAC by multiple partners at community, district and provincial levels, community mobilization as an empowering approach to social change will:

• Increase community level decision-making required by decentralization and democratization

• Address the different needs, problem, assets, beliefs and practices of diverse communities through greater ownership and understanding

• Build mechanisms and systems through which communities can sustain an enabling environment for social change, and link effectively with education and economic systems to support themselves

• Bring additional resources that may not be available through from government or donors

• Apply political pressure to improve quality of health services

• Change social structures and norms in order for those most affected, especially for women and those most marginalized groups.

COMMUNITY ACTION CYCLE PHASES & STEPS

The Community Action Cycle Phase and detailed steps:

Prepare to Mobilize

Step 1. Put together a community mobilization (CM) team

Step 2. Develop your CM team

Step 3. Gathered information about community resources and constraints

Step 4. Develop a community mobilization plan to guide you forward.

Organize the Community for Action

Step 1: Orient the community

Step 2: Build relationships, trust, credibility and a sense of ownership with the

community

Step 3: Invite community participation

Step 4: Develop a ‘core group’ from the community

Explore Health Issue and Set Priorities

Step 1: Explore the health issue with the core group

Step 2: With the core group, explore health issues with the broader

community

Step 3: Analyze the information

Step 4: Set priorities for action

Plan Together

Step 1: Determine who will be involved in planning and their roles and responsibilities

Step 2: Design the planning process

Step 3: Conduct/facilitate the planning process to create a community action plan

Act Together

Step 1: Define your team’s role in accompanying community action

Step 2: Strengthen the community’s capacity to carry out its action plan

Step 3: Monitor community progress

Step 4: Problem-solve, trouble shoot, advise and mediate conflicts

Evaluate Together

Step 1: Form a representative evaluation team with community members and

other interested parties

Step 2: Determine what participants want to learn from the evaluation

Step 3: Develop and evaluation plan and evaluation instruments

Step 4: Conduct the participatory evaluation

Step 5: Analyze the results with the evaluation team members

Step 6: Document Lessons Learned and provide feedback to the community

Prepare to Scale-up

Step 1: Identify communities of promising practice

Step 2: Provide opportunities for community-to-community exchange and learning

Step 3: Utilize lessons learned to consolidate and refine approach to prepare for scale-up

Step 4: Develop a scale up plan including roles and responsibilities of implementing partners

Documentation on effectiveness of CAC

1. Community Action and the Test of Time – Case Studies of Mobilization and Capacity Building to Benefit Children in Malawi and Zambia, July 2006, USAID /Displaced Children’s and Orphans Fund (DCOF)

2. Positive Change: Children, Communities and Care (PC3) Ethiopia, Endline Study -5-year PEPFAR-funded $20 million Cooperative Agreement

3. Strengthening Girls Voices – Sustainability Evaluation, 2011, NIKE Foundation

4. Community Action Cycle Adapation of the Post-Abortion Care Model in Eygpt and Peru, USAID and Extending Service Delivery, 2006

5. Effect of Participatory Intervention with Women’s Groups on Birth Outcomes, LANCET, 2010, 375; 1182-92, Anthony Costello.

6. Building and Measuring Community Capacity in Neighborhood Health Committees, Health Communication Partnership (paper under development based on research undertaken), 2009.

7. Community participation: lessons for maternal and child health, LANCET 2008, 372, Mikey Rosato1, Glen Laverack2, Lisa Howard Grabman3, Prasanta Tripathy4, Nirmala Nair4, Charles Mwansambo5, Kishwar Azad6, Joanna Morrison1, Zulfi Bhutta7, Henry Perry8, Susan Rifkin3, Anthony Costello1

8. Community Empowerment at Scale, 2006, Health Communication Partnership.

9. Health Communication Partnership/Zambia, 2004-2009 End of Project Report.

10. De-mystifying Community Mobilization – An Effective Strategy for Addressing Maternal, Newborn and Child Health, ACCESS 2009.

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[1] SC is the principle author of the field manual How to Mobilize Communities for Health and Social Change, published by Johns Hopkins University, Population Communication Services (2003).

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Organize Community for Action

Explore Health Issues & Set Priorities

Plan Together

Act

Together

Evaluate Together

Prepare to Mobilize

Prepare to Scale-up

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