Working in Public Health is full of opportunities to touch many lives. While it is most important to have sound technical knowledge on the subject that you are working in, it is equally essential to reflect back upon your past experiences and learnings. There is no worth in doing things which are just “part of the job”. Public health is a field where you learn by doing and redoing. Everyone has a different journey and a learning curve.
The experiences I have had and the problems I witnessed
During my formative years in the field of public health research, I had the opportunity to visit some of the poorest and most remote villages of India. During one such interview in a Naxalite (armed rebel groups with communist ideology) affected village, I could see what it meant to be poor. While sitting in a mud-walled house, with utensils and few clothes in the name of assets and asking questions about food and nutrition security was not an easy task. While we were told to be sensitive to the condition of the respondent, I myself was not in the most comfortable state of mind to ask these questions. This journey had so many impressions in my mind. There was some fear of safety and security on the way back to base station but a plethora of questions kept my mind busy. But, things kept going, and those faces, their lives, and their problems found themselves in the papers, on the computers and then they became research study.
A transition happened and I had the opportunity to work on an implementation project – something which I really wanted, and I entered the project with a lot of enthusiasm. Then came the service delivery part which which required a lot of work where I was supposed to monitor services for the poorest of the poorest in the tribal areas.
There were frequent interactions which left me wondering if the people really wanted these services. While I was not questioning the effectiveness of the measures that were being taken to improve their lives, my only concern was whether anyone has even asked those people that what they exactly needed. I was somehow unsure of the results that could be achieved with that kind of top-down approach. The place had a long history of poverty, malnourishment, and underdevelopment. Despite a lot of development works in the past, there was no evident change that I could see.
A solution to the problems
My experience with change happened with my most recent job while working in a community health program with another development organization. But this time the approach was different. The program focused on a collective. It saw vulnerable populations as resources and not as the beneficiaries. The program did not offer solutions to people to change their lives instantly but rather, there was a lot of focus on investing on people to form repositories of knowledge so that they could make better decisions about their health and find local solutions. It helped to identify what they needed to make their lives better, and then helped them access whatever they needed, most important of which is the livelihood, income, and health. This seemed to me as a more realistic approach.
Maybe we need more local solutions. Maybe we don’t necessarily need to scale up everything that we know. For the first time in years, I was working with problems where I found solutions. I have tried to summarize them here to share with you:
- Begin from what is needed and not from what is tried and tested. The latter is not a formula for success.
- Believe in local. Invest in local capacities, resources, and people. People? Yes, people are resources too so invest in capacity building. Create local heroes rather than trying to be one by yourself.
- Imbibe cultural values to gain credibility. Do not appear foreign. It is important to earn trust before becoming a Messiah of change to anybody.
- Invest time in not only caring for outcomes but also on experiences. Do not underestimate the power of open dialogues. Provide exposures to people which motivate them to change. If they have not visualized what you want them to become, will they be willing to listen to you at all?
- Break the silos. Most of the time we only do what has been asked of us because we don’t believe in what we are doing and what we can do. Working in reproductive health doesn’t mean it has no connection with mental health or nutrition, livelihood gender etc. Make those connections and help others to make them as well.
- Small is sustainable. Investing a lot of resources in one place and sustaining it is better than doing big things and seeing no impact for years.
All said, it is also important to have a pool of like-minded people with good knowledge and intent. It is not as easy as it sounds because working in the health and development sector is full of challenges and insecurities. Many times we confront the situations where we find ourselves helpless and weak. But these are the challenges which make us strong and more determined to change things.
For some, successful outcomes may be seeing a mother delivering a healthy baby in the hospital and for some, it might be seeing a mother going to work after a healthy delivery and seeing her fighting against domestic violence.
So, approaches in Public Health are different. But it is important to question the status quo, learn and grow. Most important of all is doing what you believe can bring a change!