Focus-group methods: effects on village-agency collaboration for child survival

In the West African nation of Togo an essential element of healtheducation in support of child survival is the training of mid-levelhealth workers to conduct focus-group interviews with caretakersof children under 5 years of age. The intent is to develop thecapability of the National Health Education Unit to establishqualitative data bases that complement survey data on maternalpractices related to child health. These data are used to designand evaluate the health education component for programmes ofchildhood immunization, the control of diarrhoeal diseases,and malaria. Following a five-day training programme in late 1986, healthworkers collected and prepared for analysis data from 81 focus-groupinterviews involving a total of 324 mothers living in nine ruralTogolese villages. In addition, two unanticipated effects wereobserved during and after training. First, the focus-group methoddemocratized data gathering by forcing health workers out oftheir perceived roles as experts and teachers, and mothers outof being helpless villagers and learners. Second, by stimulatingthis shift in roles, the focus-group process enhanced the developmentof community competence, thereby promoting collaborative programmeplanning by health workers and target villages. Dramatic increases in childhood immunization rates offer evidencethat focus-group interviews can play an important role in stimulatingthe needed interaction between clients and providers to planand carry out a community education ‘mini-campaign’in each village. It is from such group processes that collectiveawareness of needs, and actions to resolve them, can arise.Child survival projects should consider training mid-level healthworkers to gather focus-group data as an action-research approachto planning, implementing and evaluating their community healtheducation programmes.