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Define community and explain community based approach. Describe community entry strategies explain in detail for 10,marker in detailed

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"Community Health Services"[MeSH Terms] AND "Community Participation"[MeSH Terms]

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WHO community engagement community entry principles health programme

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https://www.who.int/publications/i/item/9789240010529

Community: Definition

A community is a social group of people who live within a defined geographical area and/or share common values, interests, needs, identity, or culture. Members interact with one another, follow common norms, and function within an organized social structure.
The WHO Expert Committee definition states that a community is a social group determined by geographical boundaries and/or common values and interests. Its members know and interact with one another, function within a social structure, and create norms, values, and social institutions.
Park's Textbook of Preventive and Social Medicine, section “Community”

Examples

  • People living in a village, urban ward, or slum
  • A tribal population
  • A school community
  • A workplace community
  • A group of people with a shared condition, such as people living with diabetes or HIV

Main characteristics of a community

  1. Locality or geographical boundary: village, town, ward, settlement, etc.
  2. Population: a group of people or families.
  3. Social interaction: members communicate and interact regularly.
  4. Common interests and needs: such as water, sanitation, maternal health, education, safety.
  5. Shared culture and values: customs, beliefs, language, traditions, and practices.
  6. Social organization: families, leaders, schools, religious institutions, self-help groups, local government, and health workers.
  7. Sense of belonging: members identify themselves as part of the group.

Community-Based Approach

Definition

A community-based approach is an approach in which health programmes are planned, implemented, monitored, and evaluated with the active involvement of the community. It recognizes people not merely as recipients of services but as partners and decision-makers in improving their own health.
WHO describes community engagement as developing relationships that allow stakeholders to work together on health-related problems and well-being. The WHO community engagement guide emphasizes that engagement can influence health behaviour, environments, policies, programmes, and practices.

Meaning

In this approach, the health worker does not enter a community only to deliver instructions or conduct a survey. Instead, the worker:
  • understands the community and its needs;
  • involves people in identifying problems;
  • jointly decides priorities;
  • uses local knowledge and resources;
  • develops community capacity;
  • supports the community to take ownership of the programme.
This is closely related to the principle of community participation in primary health care. Community participation means that individuals and families assume responsibility for their own health and welfare and participate in planning, organizing, and managing health services.
Park's Textbook of Preventive and Social Medicine, section “Social control of medicine”

Principles of the community-based approach

  1. Community participation
    People participate actively at every stage, rather than being passive beneficiaries.
  2. Community ownership
    The programme should be viewed as “our programme,” not as an outside agency's programme.
  3. Needs-based planning
    Activities should be based on real and felt needs of the people, not only on the health worker's assumptions.
  4. Equity
    Special attention must be given to vulnerable groups such as women, children, elderly persons, persons with disabilities, migrants, poor households, and marginalized castes or tribes.
  5. Respect for culture
    Local beliefs, language, customs, and practices must be understood and respected. Harmful practices should be changed through discussion and education, not insult or force.
  6. Intersectoral coordination
    Health problems often require cooperation with sectors such as education, nutrition, water supply, sanitation, agriculture, housing, and local governance.
  7. Use of local resources
    Community leaders, volunteers, self-help groups, schools, youth clubs, traditional institutions, and local funds should be involved.
  8. Empowerment and capacity-building
    Community members should gain knowledge, skills, confidence, and leadership ability to solve problems independently.
  9. Transparency and accountability
    The health team should clearly explain the purpose, benefits, limitations, costs, and use of data. Community feedback must be respected.
  10. Sustainability
    The programme should continue even after the outside worker or agency reduces involvement.

Steps in a community-based approach

1. Community assessment

The health team collects information about:
  • population and family structure;
  • health status and common diseases;
  • maternal and child health indicators;
  • water, sanitation, nutrition, housing, and environmental conditions;
  • available health facilities;
  • local leaders and community groups;
  • cultural beliefs and practices.

2. Identification of health problems

Problems are identified jointly with the community. For example:
  • high diarrhoeal disease incidence;
  • poor immunization coverage;
  • anemia among adolescent girls;
  • malnutrition;
  • unsafe drinking water;
  • poor antenatal care attendance.

3. Priority setting

Not every problem can be solved at once. Priorities are selected according to:
  • magnitude of the problem;
  • seriousness;
  • community concern;
  • availability of resources;
  • feasibility of action;
  • expected benefit.

4. Joint planning

The community and health team decide:
  • objectives;
  • activities;
  • responsibilities;
  • local resources;
  • time schedule;
  • indicators for measuring progress.

5. Implementation

Activities may include health education, screening, immunization sessions, nutrition demonstrations, sanitation drives, referral services, village health meetings, and home visits.

6. Monitoring and feedback

Progress is regularly reviewed with community members. Problems, complaints, low attendance, misinformation, and exclusion of vulnerable groups should be identified early.

7. Evaluation and continuation

The outcome is assessed, such as increased immunization coverage, reduced open defecation, improved antenatal registration, or improved nutrition. Successful activities should be integrated into routine community action.

Advantages

  • Services are more acceptable to people.
  • Health programmes are culturally appropriate.
  • Community trust in health workers improves.
  • Local resources are better used.
  • People develop self-reliance.
  • Behaviour change is more likely to last.
  • Programmes become sustainable and cost-effective.
  • Health inequities can be identified and reduced.

Limitations

  • It requires time to build trust.
  • Communities are not homogeneous: leaders may not represent women, poor households, or marginalized groups.
  • Conflicts, local politics, caste, gender inequality, and power differences can affect participation.
  • Expectations of money or material benefits may arise.
  • Health workers need communication and facilitation skills.
  • Participation may become tokenistic if decisions are actually made only by outsiders.

Community Entry

Definition

Community entry is the planned and respectful process by which a health worker, nurse, researcher, or development worker gains access to a community, introduces the purpose of the visit or programme, develops trust, understands the local social system, and obtains cooperation for community activities.
It is the first and essential step before starting a community health programme, survey, research study, health education activity, or intervention.

Objectives of community entry

  1. To introduce oneself and the organization.
  2. To explain the purpose of the proposed activity clearly.
  3. To obtain permission and acceptance from the community.
  4. To identify formal and informal leaders.
  5. To understand local culture, beliefs, power relations, and communication patterns.
  6. To establish rapport and trust.
  7. To prevent misunderstanding, suspicion, resistance, or conflict.
  8. To ensure participation and ownership of the programme.

Community Entry Strategies

Community entry should be systematic, respectful, ethical, and participatory. The following strategies can be written in detail for a 10-mark answer.

1. Preliminary preparation

Before visiting the community, collect basic information about the area.

Activities

  • Know the location, population, language, religion, customs, and health problems.
  • Learn about previous health programmes and community experiences with outside agencies.
  • Identify existing health services, schools, anganwadi centres, panchayat, self-help groups, NGOs, and youth clubs.
  • Know the likely local leaders and influential persons.
  • Obtain official permission, if required, from health authorities or local administration.
  • Prepare simple information about the programme in the local language.

Importance

Preparation prevents mistakes, avoids culturally insensitive behaviour, and helps the worker enter with confidence and respect.

2. Identify community gatekeepers and leaders

A gatekeeper is a person who can facilitate access to the community. Gatekeepers may be formal or informal.

Formal leaders

  • Panchayat members
  • Village head or sarpanch
  • Ward councillor
  • Religious leaders
  • School headmaster
  • Anganwadi worker
  • Accredited Social Health Activist (ASHA)
  • Auxiliary Nurse Midwife (ANM)
  • Local health committee members

Informal leaders

  • Respected elderly persons
  • Women leaders
  • Traditional healers
  • Youth leaders
  • Leaders of self-help groups
  • Influential shopkeepers or farmers

Strategy

Meet them early, introduce the programme, seek guidance, and request help in reaching the wider community.

Precaution

Do not depend only on powerful leaders. The health worker should also hear the views of women, adolescents, poor families, minority groups, and people who may not speak openly in front of leaders.

3. Make a respectful first contact

The first meeting strongly affects future cooperation.

How to do it

  • Visit at a convenient time.
  • Wear appropriate and culturally acceptable dress.
  • Use polite greetings and the local language where possible.
  • Introduce yourself, your role, institution, and purpose.
  • Avoid technical terms and complicated explanations.
  • Be humble, friendly, and patient.
  • Listen more than you speak initially.
  • Do not make promises that cannot be fulfilled.

Example

Instead of saying, “We have come to conduct a maternal-health programme,” say:
“We are part of the health team. We would like to understand the health needs of mothers and children here and work with you to improve services.”

4. Obtain permission and community consent

Permission should be obtained from appropriate local authorities and, importantly, from the community itself.

Key points

  • Explain the proposed activity honestly.
  • Explain who will benefit and how.
  • State what participation will involve.
  • Clarify that participation is voluntary.
  • Explain how information collected will be used and protected.
  • Obtain consent before household surveys, interviews, photographs, screening, or research.

Importance

This protects autonomy, builds trust, and prevents the community from feeling exploited.

5. Build rapport and trust

Rapport is a friendly, trusting, and cooperative relationship between the health worker and community members.

Methods

  • Make repeated visits rather than one-time contact.
  • Participate in community meetings and suitable local events.
  • Visit households and speak respectfully with families.
  • Be punctual and keep commitments.
  • Maintain confidentiality.
  • Respect cultural practices.
  • Respond to concerns and questions honestly.
  • Give feedback after surveys or meetings.

Importance

Without trust, people may refuse services, provide inaccurate information, or fail to participate.
WHO identifies trust, accessibility, contextualization, equity, transparency, and autonomy as important principles for community engagement, as outlined in the WHO guidance on engagement.

6. Conduct community reconnaissance or social mapping

The worker should understand the community before proposing solutions.

Methods

  • Transect walk through the village or area.
  • Observe roads, water sources, drainage, waste disposal, schools, markets, health facilities, and housing.
  • Prepare a social map with community members.
  • Identify hamlets, slums, remote households, and high-risk groups.
  • Discuss seasonal diseases, childbirth practices, food habits, and health-seeking behaviour.

Benefits

  • Reveals actual living conditions.
  • Identifies underserved groups.
  • Helps locate local resources and risks.
  • Shows respect for community knowledge.

7. Use participatory communication

Communication must be two-way, not merely giving instructions.

Techniques

  • Small-group discussion
  • Village meeting
  • Focus-group discussion
  • Home visits
  • Storytelling
  • Role play
  • Flip charts, posters, local songs, and demonstrations
  • Problem tree analysis
  • Participatory rural appraisal methods

Principle

Ask people what they think the problem is, why it occurs, and what solutions are possible. Community members often understand local barriers better than outside workers.

8. Involve all sections of the community

Participation is meaningful only when it includes people who are commonly excluded.

Ensure participation of

  • Women
  • Adolescents
  • Elderly persons
  • Persons with disabilities
  • Poor households
  • Migrant families
  • Scheduled caste and scheduled tribe groups
  • Minority groups
  • People living in remote areas

Strategies

  • Conduct separate women's meetings if needed.
  • Choose accessible venues and timings.
  • Use local language and visual materials for low-literacy groups.
  • Visit households of those unable to attend meetings.
  • Avoid meetings at times when women or labourers are busy.

9. Form or strengthen community groups

Existing groups should be used wherever possible instead of creating unnecessary parallel structures.

Possible groups

  • Village Health, Sanitation and Nutrition Committee
  • Self-help groups
  • Mothers' groups
  • Adolescent groups
  • Youth clubs
  • School health clubs
  • Water and sanitation committees
  • Patient support groups

Role of groups

  • Identify health problems.
  • Mobilize community members.
  • Support health education.
  • Monitor local services.
  • Help refer patients.
  • Maintain sanitation activities.
  • Provide feedback to health workers.

10. Negotiate priorities and make a joint action plan

After identifying needs, the health worker should not impose priorities.

Steps

  1. Present the findings in simple language.
  2. Ask the community to validate or correct the information.
  3. Discuss possible solutions.
  4. Decide which issue should be addressed first.
  5. Divide responsibilities between community members and health workers.
  6. Set realistic timelines.
  7. Identify required resources and referral support.

Example

If diarrhoea is common, the action plan may include:
  • repairing a hand pump;
  • promoting household water treatment;
  • handwashing demonstrations;
  • ORS availability;
  • early referral of children with danger signs;
  • monitoring cases through ASHA and village volunteers.

11. Use local resources and develop local capacity

A community entry strategy should identify strengths, not just problems.

Local resources may include

  • Community halls
  • Schools
  • Religious institutions
  • Local volunteers
  • ASHA and anganwadi services
  • Traditional communication methods
  • Local funds
  • Skilled persons such as teachers, artisans, or farmers

Capacity-building activities

  • Train volunteers in basic health messages.
  • Teach mothers preparation and use of ORS.
  • Train adolescent peer educators.
  • Teach community members to identify danger signs in pregnancy and childhood illness.
  • Develop leadership and record-keeping skills.

12. Maintain feedback, accountability, and follow-up

Community entry does not end after the first meeting. It is a continuing relationship.

Methods

  • Share findings of surveys and assessments.
  • Inform people about programme progress.
  • Listen to complaints and suggestions.
  • Hold review meetings.
  • Modify activities based on feedback.
  • Acknowledge community contributions.
  • Maintain regular visits.

Importance

Feedback promotes transparency and strengthens ownership.

Conclusion

Community entry is the foundation of successful community health work. It requires preparation, respect for local culture, involvement of leaders and marginalized groups, honest communication, trust-building, participatory assessment, joint planning, and continuous feedback. A community-based approach makes health programmes more acceptable, equitable, sustainable, and effective because the community becomes an active partner in improving its own health.
Recent evidence note: a 2025 systematic review on strategies for building community health movements supports structured approaches to participation and capacity-building, but local adaptation remains necessary because no single participation model suits every community (PMID: 39856625).
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