[MUSIC] We talked in the previous lecture about the political economy. How that implies a need to redress imbalances in power relationships. And one way in which communities organize themselves to address such problems, can be through the formation of community coalitions. In this lecture, we will define coalitions and we will look at some examples. In particular, we will consider a program in Lagos, Nigeria, one of the largest cities in West Africa and see how a program sponsored by the US Agency for International Development brought together groups such as trade associations, religious groups, neighborhood improvement societies, social clubs. Together with private health service providers, to form coalitions called Community Partnerships for Health, CPH. And these CPHs address the issues of access to healthcare for children in particular. The urban setting provided a challenge in terms of the political economy model. Because many of the communities are poor. Even though they are in an urban center, people have lack to access of healthcare because of costs. Government clinics are not available everywhere, private clinics are expensive. People use medicine shops. The environmental conditions in a community foster the spread of diseases, diarrheal diseases. The close proximity of population means that diseases that could be prevented by immunization such as measles spread quickly. And in order to address these problems, coalition is formed, partnerships were established. This will be explained after we've had some comment on the definitions and characteristics of coalitions. Coalition is an organization of individuals representing diversed organizations, factions, constituencies, who agree to work together to achieve a common goal. A variety of organizations could include citizen groups, professional groups. These diverse groups, interest groups, combine their human material resources to affect specific change which members are unable to bring about individually or independently. This issue of focusing on a particular goal is important. Organizations, as we will look at in the next module, have their own individual goals and purposes that have arisen out of their environments. But individual organizations may not have the resources to solve all their problems. There may be organizations with similar, although not exactly the same goals, or who may focus on different aspects of a health issue. And if they worked together, they could be more effective as a group. A coalition may focus on developing the local community, each contributing, each organizational member contributing what it can provide in terms of skills, personnel. Coalitions can also be using community action, to lobby, to pressure agencies and governments to provide more resources. Coalitions allow individual organizations to become involved in broader issues without them having to take the sole responsibility for managing and developing these issues. And coalitions demonstrate and develop widespread public support for issues, actions, and unmet needs. Coalitions maximize the power of individuals and groups through joint action. They increase the critical mass behind a community effort, to bring about specific objectives that may be beyond the scope of any one individual organization. And coalitions also help to minimize duplication of effort. As noted, several organizations may have a similar goal and by working together, they can use their resources more effectively, they can improve communication about particular health issues in a community, and increase trust among the partners that collaborate. Coalitions help mobilize more talent, resources, and new ideas and approaches to influence an issue, more so than any single organization could have achieved on its own. Coalitions provide an avenue for recruiting diverse constituencies. They may be groups that have a political agenda, may involve the business community, professionals in the human services, social and religious groups, as well as prominent individuals can come together when they perceive a common need. Coming together as a group, they're able to exploit new resources and change situations because, again, coalitions are flexible. They are formed for a particular issue. They are able to respond. They're not bogged down in various rules and regulations that the contributing organizations may have had. They are more responsive to problems in the environment. There are different kinds of coalitions, grassroots, coalitions are organized by volunteers, at the community level in times of crisis or to pressure political policymakers to act professional coalitions, bring together, professional organizations, medical, nursing, social work, to combine their power and influence where needed. Community-based coalitions bring together both professional, and grassroots leaders to work together on the long-term welfare of the community Successful coalitions result in an exchange of resources and ideas among the member organizations. It sets up a new level of cooperation within the community and people will see greater benefits for joining in the individual organizations that are members because they have a broader influence on activities in the community. Successful coalitions focus on a clear, clearly articulated mutual need or concern. A coalition that focuses on teenage health. A coalition that focuses on drunk driving. A coalition that focuses on improving education will be more successful than those that are interested in just general community development. Successful coalitions occur in communities where there's a history of previous collaboration and joint efforts. Success occurs when there is compatibility among the potential members, when they're not conflicting for membership or fighting over the agenda. Coalitions are successful when the members have determination to work together. Because coalitions are groups of organizations, each organization in the past has had its own agenda, its own identity. They may have been in competition for memberships or resources before. So, a coalition to succeed needs to foster a good climate of good relationships among the members seeing that there is more to be gained by cooperating than by competing. Coalition needs access to external support and resources. Here again, is the value of joining together. Some members may have contact with the media. Some member organizations may have political influence. Some member organizations may have financial resources. Different organizations may, because of the nature of being a membership group, may have contact with a national level organization, they may be chapters. And so, these kinds of external support and resources help the coalition gain information, gain additional resources to solve it, the problems. Coalitions, like any organization in a community, need to actually have achievements in order to stay together. An organization or a coalition that works for several months or years without seeing any results are likely to disband. Short-term successes are important to increase motivation and pride and enhance credibility of the organization. It's important therefore that coalition members set achievable or reasonable goals and observable indicators of progress along the way to keep members interested. The idea of coalition building was carried out by the basics program, a USAID project that in other countries, was involved in strengthening the health services. Ironically, when they reached Lagos, it was the time of political change, military dictatorships and US government agencies were not allowed to work with Nigerian government agencies. And so, the project have to look for another way to strengthen and improve the child survival programming at the community level. They came upon the idea of establishing community partners for health in six of the poorer communities or neighborhoods in Lagos. The concept was based around a collaboration between private health providers who are ubiquitous in the, in the community and existing community groups. Initially, an inventory of community groups and private providers was conducted. And these two sets of organizations were invited to a forum to discuss their mutual interests. Groups such as hairdressers association, tailors association, men's and women's clubs and groups from churches and mosques, social clubs, came together with the proprietors and staff of private clinics in the community, and discussed how they could work together to improve the health of children in their area. Although several hundred organizations were identified, community-based organizations, civic organizations, and professionals in terms of the private providers. In the end, approximately 200 member organizations formed into six different coalitions or community partnership groups in the six different communities. As noted, a coalition needs rules so that each member organization knows its responsibility. And relationship to each other. And one of the first activities for each of the six community partner groups was to develop their own memorandum of understanding. One of the key issues that was of concern in terms of child health in the urban setting, was access to affordable care in a timely manner. People knew that private clinics were available. People knew, of course, the government clinics were available but they very rarely had drugs or supplies. So, they knew that private clinics were available. They were much more costly. There was an agreement made that the private clinics who were members of the partnership would provide reduced price healthcare, and would provide this on credit if the member community-based organization, CBOs, also agreed, or guaranteed that they would cover the cost of any member who defaulted from payment. This was one of the core understandings that the, the groups came together with. They also agreed mutually ro promote childhood immunization, to pro, promote clean environment in their area. They agreed on such things as membership dues, they agreed on developing a, a Board of Directors. But this issue of coming up with their own rules made it possible for them to work together and to know where each member stood. They were able, therefore, to set out clear goals. So, we mentioned some of the groups were more successful than others. The two groups that had the higher collective efficacy score were able to set up environmental sanitation exercises, AIDS awareness campaigns. They set up a saving cooperative for their members. So, they were able to achieve some organizational successes and engage in fundraising. They were also able to use their status as a recognized group to get registered with the government as a non-governmental organization. And then, the issue of external support, they took this registration paper to some of the donor agencies, such as UNICEF, and were able to use that to get supplies of oral rehydration salts when a cholera epidemic broke out, able to get recognition from, from other agencies for programs. And so, this partnership was even able to convince the local government. So, the AID couldn't go directly to the local government but the partnership could and convince the local government to provide them with vaccines, so that they participated actively in the immunization program and were able to increase immunization coverage in their communities. The CPHs, the Community Partnerships for Health, were able to sustain themselves. They've been going now for four years, because they built on existing social units. They identified CBOs that were concerned about healthcare and welfare of children, and this was the basis for successful coalitions, building on these existing groups. They were also successful because they reached out to obtain external resources, as we said, from UNICEF and from the local government. They were able to identify the needs of members and set up the savings cooperatives so the people could see some benefit of membership. They were able to identify and solve problems. And, as we mentioned, those that were, the most successful in terms of carrying out these activities clearly had a heightened sense of community efficacy and have gone on to elect new leaders, continue to function, and look like they will be sustainable into the future.
