2. PRA findings: community priorities and institutions.

Priority Development Concerns

Men and women are asked in each of the research sites to identify the main institutions in their community, the importance of these institutions to them, and whether they perceive these institutions as belonging to the community. They are then asked to identify the institutions they would like to see in the community. This exercise is done to gain a better understanding of how people view their community, identify their priority problems, and ascertain the overall priority attached to health concerns.

In each LGA access to and storage of potable water is identified as the primary concern followed by the need to raise agricultural production and improve access to markets. This relates closely to the belief that poverty has increased, making it is necessary to improve agricultural yields and increase access to credit and markets. While the lack of adequate health care services and drugs is a concern in the LGAs, they are secondary to broader poverty-related concerns.

Policy makers and public sector health service providers are also interviewed on the priority concerns of individuals in their LGA. The sizable overlap between the matrix ranking of policy makers and that of community groups shows that political authorities are aware of the issues that concern their constituents. Officials caution nonetheless that without financial resources they are unable to address many of their communities' needs.

Box 1
How to Read Institutional Maps

The circles and boxes in the map represent the
relative importance and accessibility of institutions
to the group. The large circle represents the
community, and the smaller circles signify key
institutions. The importance of an institution is
depicted by its size--the larger the box or circle,
the more important the institution. Institutions
that are placed outside of the larger circle represents
the perception that they do not "belong" to
the community; and, in the case of the idealized
maps, these are institutions that should be located
outside of the community.

A focus group of women in Zamko community,
Langtang drew the two maps below, and explain
them as follows:

Water. This is a basic necessity but the sources are
too distant.

Hospital. The hospital is built but not equipped; it
should be on the outskirts of the community so
that people could not catch infectious diseases.
Existing private facilities do not belong to the
community, as they could close at any time.

Market. It must be easily accessible, grinding
machines in the market must be close to its center
for ease of access.

School. More government schools would be
cheaper than private education.

Bank. It would provide loans for market women,
protect money against theft, and allow them to
save.

Church. It is located outside the community and
controlled by missionaries.

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]

Priority Health Concerns

To ascertain communities' perceived health needs, respondents are also asked to list and rank their main health concerns. STDs and AIDS do not feature significantly in any of the rankings, with the exception of one group of women in Langtang Town (see Table 4). They rank AIDS as their fourth health priority; and they also rank gonorrhea as a problem. In general, women perceive childhood diseases as priorities, and they rank them higher than men do. Among women, the main health concerns are measles, dysentery/diarrhea, and hypertension; men's main health concerns are meningitis, typhoid, and hernia. Malaria is mentioned more by men than by women.

Doctors and nurses identify similar health priorities with some notable exceptions. In each LGA, for example, doctors at private and public hospitals indicate complications arising from abortion as a priority health problem, particularly among girls under age 20. Relatedly, one of the health concerns secondary school girls express is the fear of pregnancy and having abortions.

With respect to two high risk populations, CSWs rank their reproductive health top among their health concerns, and LDTDs give priority to piles, headaches, and backache.

Community Organizations

Two types of community-based organizations have evolved in the LGAs: groups established at governmental request, such as the Health and Village Development Committees, and organizations formed around local women's, civic or religious concerns. In most of the communities studied government-sponsored organizations have either not met in a long time or were never established. In the cases of groups that once functioned, such as the Village Development Committees, the lack of sustained support is cited as a reason for their failure. According to a group of women in Laranto, Jos North: The problem with the committees is that after meetings are held with us once or twice the organizers of such meetings don't come again and most of the time they don't supply the women with enough materials to develop their skills, for example in soap making, mat making. As a result, we feel it is a waste of time and everyone has to disperse.

The exception to this pattern is the government-sponsored groups which conduct fortnightly sanitation activities. In some areas participation in sanitation days is the only health activity that involves the entire community. However, government officials generally perceive community participation to be limited to contributions of local labor. According to one LGA official, "Community participation means acceptance of our education to them and taking part which makes our work very easy."

Meanwhile, village-based organizations have developed in all of the communities to address common concerns. Indeed, local leaders and groups are willing to become fully involved--financially, technically and managerially--in developing and implementing strategies to address priorities and problems that they identify. For example, Langtang church leaders organize communal labor groups, or Gaya, for building repair and agricultural work. Community groups also construct market stalls, schools and clinics; dig wells; work on agricultural pests control; and maintain drainage systems. In Jos North, one community buys drugs and provides them at subsidized rates in PHC clinics. Nevertheless, in the absence of sustained support such as credit or technical assistance from outside and within the community, even many of these local initiatives have not been sustained.

Table 4: Ranking of Health Problems

Jos North LGA

          Laranto                                Apata

    Men             Women                 Men                Women

Fever          Meningitis         Malaria                Hypertension
Meningitis     Gastro-enteritis   Tuberculosis           Malnutrition
Typhoid        Typhoid            Typhoid                Diabetes
Tuberculosis   Measles            Cough                  Anemia
Hypertension   Malaria            Gastro-enteritis       Measles
Asthma         Tuberculosis       Piles                  Pneumonia
Pneumonia      Hypertension       Hypertension           Whooping Cough
Epilepsy       --                 Meningitis             Asthma

Mangu LGA

          Kombun                             Mangu Town

    Men             Women                 Men                Women

Typhoid        Headache           Hypertension/Typhoid   Hypertension
Ulcer          Typhoid            Meningitis             Appendix
Worms          Hypertension       Diarrhea               Diabetes
Meningitis     Worms              Measles                Ulcer
Bilharzia      Measles            Worms                  Diarrhea
--             Dysentery          Malaria                Rheumatism
--             Diarrhea           --                     Fever
--             --                 --                     Measles

Langtang LGA

          Zamko                                Langtang

    Men             Women                 Men                Women

Snakebite      Eye Problem        Hypertension           Meningitis
Drug Abuse     Diarrhea           Typhoid                Measles
Diarrhea       Cold/Chills        Appendicitis           Diarrhea
Hernia         Convulsion         Hernia                 AIDS
Meningitis     Chest Pain         Malaria                Appendicitis
Measles        Liver Cirrhosis    Dysentery              Diabetes
Malaria        Whooping Cough     --                     Pneumonia
Bilharzia      Measles            --                     Gonorrhea