A Critical Analysis of Urban Environmental Health Discourses in Promoting Community Participation: Focus on Addis Ababa, Ethiopia
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Date
2013-06
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Addis Ababa University
Abstract
This study analyzed environmental health, particularly sanitation discourses with a
critical discourse analysis approach to see how community participation is promoted.
Since the adoption of the Alma-Ata Declaration in 1978, community participation has
been promoted as a global discourse of health promotion. This is based on the belief that
health is a matter of life and death and it has to be owned by the people. Drawing on
Norman Fairclough’s (2003) approach to discourse analysis, global views on
environmental health and approaches to the promotion of community participation,
power relations in environmental sanitation discourses have been focused for
investigation in this study.
The study employed mixed methods design although the emphasis is on the qualitative
data. The required qualitative data were taken from 5 key policy and strategy documents,
13 environmental health communication resources, 4 scripts of environmental sanitation
education lesson observations, 13 scripts of individual in-depth interviews and 4 scripts
of focus group discussions. Survey data from 250 respondents were also used to
complement the qualitative data. All in all, the study involved 281 participants including
seven key informants, six individual in-depth interviewees, 18 FGDs discussants and 250
survey respondents. Participants were selected using multi forms of strategies. The data
analysis utilized mainly latent level content and critical discourse analyses.
The findings revealed that though community participation has consistently been
promoted as a nodal policy discourse of environmental health in general, and
environmental sanitation in particular, communities were not participating in the
planning, implementation, monitoring and evaluation of policies, programs and
interventions as intended. The analysis also showed that in the environmental health
education materials, as well as during the actual communication practices, the promotion
of community participation has been left aside. The environmental sanitation packages
and the awareness raising lessons were found dominated by bio-medical information;
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whereas, community participation is a social practice which requires behavioral change.
Moreover, though the policy discourses acknowledged the role of communities’
indigenous knowledge to maintain sustainable environmental sanitation, the waste
management and disposal oriented environmental sanitation discourses demonstrated the
usual top-down flow of information. It also emerged from the analysis that the unspoken
exclusion of communities from the process of designing, implementing, monitoring and
evaluating their respective environmental health activities as promised in the policy and
program documents resulted in silence and resistance. This is to say that communities
were not empowered to develop attitudes of responsibility and participation essential to
own the environmental sanitation interventions. They rather considered participation as
political affiliation and developed sense of mistrust. The communities took the health
extension workers as political agents of the government and resisted to take part even at
grass-root level activities. In Ethiopia, low community participation is a contributing
factor to poor environmental sanitation observed in the capital.
Finally, it is recommended that the Ethiopian government needs to use participatory
communication where communities participate in agenda setting, operational strategies
and accountability of results. The present health communication strategy is top down and
does not impact change of behavioral practices towards environmental sanitation. It is
also suggested that more research needs to be done on community health communication
discourses to get better insight into community assumptions and beliefs of health in
general and environmental sanitation in particular. There should be more studies on
communication strategies and ways of operationalization of health communication
activities and community actual responses to such communications. The author strongly
believes that unless we bring transformation on community perceptions and beliefs on
development, where health is an important component, we cannot ensure sustainable
growth and better life style.
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Keywords
Urban Environmental Health