1 ABC D Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana Anita Dohn, MD, MSc (Public Health) Michael Dohn, MD Matthew St. John (Episcopal Relief &Development) Everyone, Everywhere 2011
2 Structure of Poverty Poverty Poor Health Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana Confounding and “reverse causality”
3 Competitive Public Space (also called “Contested Public Space”) NGO’s Edu’s Gov’s FBO’s CBO’s “ I don’t worry myself about the poor … they have the church to take care of them. “I don’t worry myself about the rich … they have the government to take care of them.” ~ Facundo Cabral Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana
4 Community SpatialNon-spatial Social interactions Shared needs & concerns Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana
5 Community Health What communities can do for themselves Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana
6 Community Health: Two Premises Mosley WH. Principles of Community Health. In Ewert (ed). A New Agenda for Medical Missions. 1990. Page 39. First Premise “The ultimate performance of any health care program is only measurable in terms of improved health among the people.” Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana
7 Community Health: Two Premises Mosley WH. Principles of Community Health. In Ewert (ed). A New Agenda for Medical Missions. 1990. Page 40. Second Premise “Programs must be as concerned about the process of improving health among people as they are about the outcome.” Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana
8 Assets, Deficits & Needs Assets Deficits Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana N EEDS
9 Community Asset Mapping: Building Blocks In community, community control In community, outside control Outside community, outside control Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana PrimarySecondaryPotential
10 McKnight J (1995) The careless society: community and its counterfeits. New York: Basic Books. Kretzmann J, McKnight J (1993) Building communities from the inside out: a path towards building and mobilising communities’ assets. Evanston, IL: Institute for Policy Research. Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana
11 http://www.docstoc.com/ docs/28622740/ 2-Community-Asset-Map-sample Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana
12 http://www.thedirt.org/node/4954 Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana
13 http://found-money.info/missing-money/state- assets-used-to-secure-hospital-funds/ Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana
14 http://www.flickr.com/ photos/campuskitchens/ 5630808541/ Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana
15 Needs Assessment Normative Normative Comparative Comparative Felt Felt Expressed Expressed Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana
16 How strict an ABCD rule? Whether, when, and how to apply outside resources Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana
17 The ‘Quick & Dirty’ Method Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana
18 The “Outsider” What’s the non-community asset-based developer to do? Community Outside ‘experts’ Government Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana Three-way partnership Taylor-Ide & Taylor, Just and lasting change, 2002
19 Political & Macro- economic Socio- economic Beliefs & Behaviors Biology Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana Health Determinants
20 International National Society Community Household Individual Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana Health Determinants
21 Whose job is it, anyway? “… responsibilty to address the [upstream] determinants of health rests with the whole government …” Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana WHO. Bangkok Charter. 2005. Geneva: World Health Organization.
22 Social Determinants of Health Communities with high “social capital” are healthier Speller 2006. In: Health Promotion Theory. Pp 108-24. “…look for where the bodies are piled highest.” Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana Rudolf Virchow
23 Community Approach Strengths Effective uptake ‘Value added’ effect Sustainability Promotes health equity Challenges Labor intensive Difficult to scale-up Highlights conflicts Marginalized groups Difficult to evaluate Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana
24 Equity “Equity is the central challenge for the future of medicine and public health.” “Equity is the central challenge for the future of medicine and public health.” Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana Paul. Farmer. Pathologies of Power. University of California Press. 2005. Page 20.
25 Evaluation “Community programs are notoriously difficult to evaluate since they are highly flexible and have complex, often changing goals.” Hargreaves & Twine. Health promotion practice. 2006. Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana
26 “Blueprint” versus “Process” Projects Initial Plan Process Goal GOAL Intervention Salaries Etc. Personnel Budget Materials Etc. Program Budget Transportation Etc. Support Budget Objective 1 Intervention Objective 2 Intervention Objective 3 Intervention Clínica Esperanza y Caridad Goal
27 Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana
28 ABC D Clínica Esperanza y Caridad Un ministerio de la Iglesia Episcopal Dominicana Anita Dohn, MD, MSc (Public Health) Michael Dohn, MD Matthew St. John (Episcopal Relief &Development) Everyone, Everywhere 2011