Promising High-Impact Practice
Engaging and mobilizing communities in group dialogue and action to promote healthy sexual relationships.
What Is It?
Community group engagement (CGE) interventions maximize broad engagement and move beyond conversations with decision makers and leaders to better understand sexual and reproductive health from the perspective of the community. CGE interventions work with and through community groups to influence individual behaviors and/or social norms rather than shifting behavior by targeting individuals alone. Specifically, community support can shift individual behaviors, including contraceptive behaviors, either by changing norms or individual knowledge and attitudes (Storey et al., 2011).
What Are the Benefits?
- Community support can overcome individuals’ fear of social and/or health consequences of using family planning.
- It can increase individuals’ desire for smaller families and healthy birth spacing while increasing community acceptance of family planning use.
- It can improve the quality of family planning services by empowering the community to hold the health system accountable as well as jointly coming up with solutions to address challenges faced in the delivery of health services.
- It can also improve communication between providers and clients.
How to Implement?
Intervention designs vary substantially between the hubs based on local gender barriers to accessing family planning information and services as well as leveraging existing platforms available, wherever possible. However, all interventions includes the following core components.
Give voice to previously unheard community members, be empowering, horizontal and biased toward local content and ownership
Group dialogue, reflection, and tailored participatory activities can highlight the contribution of gender and other social norms to poor reproductive health outcomes. These approaches are also particularly useful for individuals with little power, such as adolescents and ethnic minorities.
Community group engagement approaches may give marginalized groups a stronger collective voice and agency to affect health and social change for themselves, within their families, and across the larger community (Storey et al., 2011). Once local stakeholders and community members articulate and explore these dynamics, they are better equipped to develop and carry out contextually relevant strategies that enable social support for changing norms and improving SRH practices.
Support and build the capacity of individual community members to lead group processes
CGE interventions should support individual community members and the community as a whole, for example, by building capacity to lead group processes to promote informed decision-making and collective action (Cheetham, 2002; IAWG, 2007). Strengthening the capacity of local youth-led or youth-serving organizations is also recommended (Youth Health and Rights Coalition, 2011; IAWG, 2007). With increased capacity to identify and address problems that affect them and their community, these groups can tackle other issues as they arise.
Facilitate a process through which communities identify root causes to problems and craft solutions
Community group engagement interventions should avoid predetermining solutions. Community group engagement facilitates a process through which communities identify root causes to problems and craft approaches to addressing these causes. Once the goal is clear, communities often benefit from flexibility to identify and implement their own localized responses. Such flexibility on the part of programs is likely to increase local ownership, capacity, and commitment to achieve and sustain the community’s desired results.
What Is the Evidence?
- Community group engagement is associated with higher levels of contraceptive use. Studies in Benin, Ghana, Nigeria, and Senegal, using multivariate analysis, found that in all four countries CGE contributed significantly to an increase in modern contraceptive use or a decline in fertility rates after two to three years of program implementation (Speizer and Lance, 2016; Debpuur et al., 2002; IRH, 2016).
- In Kenya, 150 trained community-based facilitators held ongoing community dialogues with men and women about gender, sexuality, and family planning over three and a half years. Women who participated in these dialogues were nearly 80% more likely to be using modern contraceptives at endline compared with women who did not participate in dialogues (Wegs et al., 2016).
- Community group engagement may be a critical component of comprehensive adolescent SRH programming. Community group engagement can facilitate dialogue with influential individuals to identify and clarify values around adolescent marriage and childbearing and to address norms, myths, and misconceptions about adolescent sexuality (Dick and Chandra-Mouli, 2006; Daniel et al., 2008; Daniel and Nanda, 2012; Denno et al., 2015).
- Large-scale implementation of CGE in family planning programs is not yet common place. Evidence for application of CGE in maternal and child health programs, however, demonstrates that this approach can lead to “cost-effective sustained transformation to improve critical health behaviors” (Farnsworth et al., 2014; Prost et al., 2013).
