When Communities Own Their Futures, by Daniel Taylor-Ide and Carl E Taylor, Baltimore: the Johns Hopkins University Press, 2002
Once in a great while a real synthesis occurs of the issues and ideas surrounding a topic, one that puts together a summary of years of writings, worlds of experiences and principles. The book JUST AND LASTING CHANGE accomplishes this task in regard to Community Based Health Care. Although broad in scope, covering many aspects of community development in the developing world, its major emphasis is on health issues. Dr. Carl Taylor, the senior author, was born in India, the son of missionary physicians. He trained in medicine and public health and subsequently served as a missionary to India and several other locations. Later he returned to the US to found the School of International Health at Johns Hopkins, where he trained and inspired several generations of future luminaries, including Raj and Mabelle Arole, Jim Grant, and Dan Fountain. He was the chief Medical Consultant for the World health Organization at the 1978 Alma ATA Conference, which is considered the beginning of world attention and acceptance of Community Based Primary Health Care. The other author, Daniel Taylor-Ide, is Carl’s son, and a renowned community developer and organizer in his own right. Together they have fashioned a unique book that summarizes the noble experiments in community-based health care that span the 20th century. Then they insightfully analyze the reasons for the successes and the failures of these programs, and synthesize these insights into a plan for future projects that combines the best principles and premises of community development with what has worked in the field. This plan is described by the acronym SEED-SCALE. SEED stands for Self Evaluation for Effective Decision-making. The process begins by requiring the community to change its behavior by self-examination and evaluation, using needs assessment and community meetings, then to combine that data with the experiences of other communities to initiate a development project. Three principles are keys to initiating this community change in behavior that ensures the success of a community project.
1. Three-way equal partnerships with full collaboration are necessary between the people of the community, outside experts, and government officials. One partner cannot be dominant over the others.
2. Subsequent decisions and actions need to be based on locally specific data, collected at the community level by members of the community (assessment and evaluation of needs). Measurable results are necessary.
3. Development and health are impossible without basic changes in the attitudes and behaviors of the community.
The SCALE part of the acronym defines the specific three steps that communities need to take on the path to community development. First, the community selects, learns from and promotes a project that has been successful elsewhere, and defines the changes that need to take place in their community in order to make it happen. During the second step they transform those initial demonstration projects into learning centers that pass the experience on to others. The third phase promotes the systematic expansion of the project throughout societies by policy development and financing. Those of us familiar with the history of the Jamkhed Project will realize how closely the Aroles followed this SEED-SCALE plan in developing their program.
The book closes with this statement:
“Success will only come if we remain humble, expecting more mistakes than successes. If we are humble, we can take real next steps and sequence them into a continuing journey. In taking these steps we must remember that development is not a product but a process; it is not a solution but a way by which each community can create an evolving and unique pattern to achieve a more just and lasting future.”
It is impossible to summarize in brief form the many complex ideas and insights and the depth of experience covered in this challenging and thought provoking book. I feel that it is a must read for all of us who are concerned about health care in developing countries, particularly Community Based Primary Health Care.
Submitted by Roger Boe MD