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explain in detailed answer 10marker for this Define community and explain community based approach. Describe community entry strategies.

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WHO community engagement health programmes community entry strategies

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

Community, community-based approach, and community entry strategies

1. Definition of community

A community is a social group of people who live within a defined geographical area and/or share common values, interests, identity, or needs. Members of a community interact with one another, follow certain norms, use common institutions, and work together to meet their needs.
The WHO Expert Committee definition states:
“A community is a social group determined by geographical boundaries and/or common values and interests. Its members know and interact with each other, function within a particular social structure, and create norms, values and social institutions.”
Thus, a community may be:
  • Geographical: people living in a village, ward, slum, town, or district.
  • Functional or interest-based: school community, workplace community, migrant group, women’s self-help group, or persons with disability.
  • Cultural or identity-based: people connected by language, religion, tribe, caste, ethnicity, or shared traditions.
Main characteristics of a community
  1. A defined geographical area or a common identity.
  2. People living or functioning together.
  3. Social interaction and mutual relationships among members.
  4. Common needs, problems, interests, and goals.
  5. Common institutions, such as families, schools, markets, religious bodies, panchayats, health centres, and voluntary groups.
  6. Shared customs, values, norms, leadership, and social structure.
  7. Cooperation in fulfilling basic needs and solving common problems.

2. Community-based approach

A community-based approach is a method of planning and providing health, development, or social services in which the community actively participates in identifying its problems, deciding priorities, planning interventions, implementing activities, and evaluating results.
It is not a situation where health workers simply deliver services to people. Instead, health workers work with people, treating them as partners. WHO describes community engagement as building relationships that allow stakeholders to work together to address health issues and improve well-being, as outlined in this WHO community-engagement guide.

Principles of the community-based approach

  1. People’s participation
    Community members participate in decisions rather than being passive recipients of services.
  2. Need-based planning
    Programmes are based on locally identified needs, such as unsafe water, malnutrition, poor immunization coverage, malaria, tuberculosis, or adolescent health issues.
  3. Community ownership
    The community feels that the programme belongs to them. This encourages continuation after external workers leave.
  4. Use of local resources
    Local people, leaders, traditional knowledge, voluntary groups, schools, health workers, and material resources are used wherever possible.
  5. Intersectoral coordination
    Health improvement requires cooperation between health, education, sanitation, water supply, agriculture, women and child development, local government, and other sectors.
  6. Equity and inclusion
    Women, children, older persons, persons with disabilities, poor families, migrants, and marginalized groups must be included in planning and decision-making.
  7. Empowerment
    The community develops knowledge, skills, confidence, and capacity to solve its own health problems.
  8. Cultural acceptability
    Services should respect local language, culture, beliefs, customs, and social practices, provided these do not harm health.
  9. Continuous feedback and evaluation
    Community members review progress and help modify the programme when needed.

Steps in the community-based approach

  1. Community assessment or community diagnosis
    Collect information about population, health problems, resources, beliefs, health practices, and vulnerable groups.
  2. Identification of priority problems
    The community and health team jointly decide which problems need immediate attention.
  3. Planning
    Decide objectives, activities, responsibilities, resources, time frame, and indicators for evaluation.
  4. Implementation
    Carry out planned activities with community participation. For example, sanitation drives, nutrition education, immunization sessions, village health meetings, or mosquito-control activities.
  5. Monitoring and evaluation
    Assess whether the programme is reaching people and improving outcomes.
  6. Feedback and sustainability
    Share results with the community, correct weaknesses, and strengthen local leadership so that activities continue.

Advantages

  • Services are more acceptable because they match local needs and culture.
  • Community participation improves trust in health workers.
  • Local resources are used effectively.
  • Health awareness and self-reliance increase.
  • Programmes are more likely to continue for a long period.
  • Marginalized groups can be identified and included.
  • The approach improves accountability of health services.
For example, in a village with frequent diarrhoeal disease, the community may identify unsafe drinking water and poor waste disposal as the main concerns. Together with health workers, it may plan household water treatment, safe storage, hand-washing education, repair of water sources, drainage improvement, and monitoring by village health committees.

3. Community entry

Community entry is the planned process through which a health worker, nurse, researcher, or development worker first gains access to a community, obtains acceptance, builds trust, and establishes working relationships before starting a programme.
It is the first and essential stage of community work. Proper entry prevents suspicion, resistance, poor participation, and programme failure.

Objectives of community entry

  • To introduce oneself, the organization, and the purpose of the visit.
  • To obtain permission and acceptance from the community.
  • To understand the local social structure, culture, power relations, and health needs.
  • To identify formal and informal leaders.
  • To establish trust and rapport.
  • To encourage participation and community ownership.
  • To identify local resources, institutions, and vulnerable groups.

4. Community entry strategies

1. Preliminary study of the community

Before entering, the health worker should collect basic information regarding:
  • Population size and distribution
  • Language, religion, customs, and cultural practices
  • Important health problems
  • Existing health facilities and health workers
  • Local leaders and organizations
  • Social hierarchy, caste or ethnic groups, and vulnerable populations
  • Previous experiences with government or outside agencies
This preparation helps the worker avoid cultural mistakes and plan an acceptable method of entry.

2. Entry through formal leaders and authorities

The worker should first contact recognized formal leaders, such as:
  • Panchayat members
  • Village head or ward councillor
  • Local government officials
  • School headmaster
  • Medical officer or ASHA/ANM
  • Anganwadi worker
  • Religious leaders
  • Leaders of registered community organizations
The purpose and expected activities should be explained clearly. Their cooperation can help introduce the worker to the wider community.
Limitation: formal leaders may not always represent poor, women, youth, migrants, or marginalized groups. Therefore, the worker must also contact other sections of the community.

3. Entry through informal leaders and key persons

Informal leaders are people who are respected and influential, even if they do not hold official positions. They may include:
  • Senior citizens
  • Traditional healers
  • Respected women
  • Teachers
  • Shopkeepers
  • Youth leaders
  • Leaders of self-help groups
  • Community volunteers
They can provide information about local beliefs, social relationships, hidden problems, and the best way to communicate with people.

4. Entry through existing community organizations

Existing groups provide an easy and acceptable entry point. Examples are:
  • Village Health, Sanitation and Nutrition Committees
  • Women’s self-help groups
  • Youth clubs
  • Farmers’ groups
  • School management committees
  • Religious groups
  • Parent-teacher associations
  • Voluntary organizations and NGOs
The worker can attend meetings, introduce the programme, listen to concerns, and invite members to participate in planning.

5. Courtesy visit and self-introduction

The worker should make an initial courtesy visit rather than immediately beginning surveys or services. During this visit, the worker should:
  • Introduce name, organization, and role.
  • Explain the purpose in simple local language.
  • State clearly what can and cannot be offered.
  • Ask permission before collecting information.
  • Avoid making unrealistic promises.
  • Show respect for local customs and leadership.
This first contact should be polite, transparent, and non-threatening.

6. Building rapport and trust

Rapport is developed through repeated respectful interaction. The health worker should:
  • Listen more than speak initially.
  • Use the local language where possible.
  • Be punctual and keep promises.
  • Respect privacy and confidentiality.
  • Avoid criticizing local customs or beliefs.
  • Participate appropriately in community activities.
  • Treat all groups fairly and respectfully.
Trust is particularly important where communities have experienced neglect, discrimination, failed projects, or exploitation. Current public-health guidance emphasizes enduring, equitable, culturally sensitive relationships and shared decision-making, rather than one-way outreach, as described by the CDC discussion of community engagement.

7. Community meeting strategy

After initial contact with leaders and key persons, a community meeting may be organized at a convenient time and place. It should include women, youth, elderly people, minority groups, and vulnerable families.
At the meeting, the health worker should:
  • Explain the purpose of the programme.
  • Encourage people to express their health concerns.
  • Discuss possible solutions.
  • Identify interested volunteers.
  • Decide the next steps jointly.
The meeting must not be dominated only by influential persons.

8. Participatory community assessment

Instead of collecting information only through outside observation, the worker should involve people in assessing their own needs. Methods include:
  • Home visits
  • Focus group discussions
  • Community mapping
  • Transect walk through the village or locality
  • Resource mapping
  • Seasonal calendars
  • Problem-ranking exercises
  • Interviews with different groups
  • Observation of water sources, sanitation, housing, and health facilities
This is often called participatory rural appraisal or participatory learning. It enables people to identify their own priorities and resources.

9. Entry through an immediate felt need

A useful strategy is to begin with a problem that the community already recognizes as important. Examples include:
  • Lack of safe drinking water
  • Mosquito breeding
  • Diarrhoea outbreak
  • Poor waste disposal
  • Malnutrition among children
  • Lack of antenatal care
  • Substance misuse among adolescents
Addressing a felt need builds confidence and demonstrates that the worker is responsive. However, the solution should be jointly planned and should not create dependency.

10. House-to-house or family approach

Home visits allow the worker to understand individual and family circumstances. This strategy is useful for:
  • Identifying pregnant women, newborns, elderly persons, and persons with disability.
  • Understanding family health practices.
  • Reaching people who do not attend public meetings.
  • Including women and marginalized groups who may not speak freely in community gatherings.
The worker should seek consent, respect privacy, and avoid appearing intrusive.

11. Use of local communication methods

Information should be communicated through acceptable local methods, such as:
  • Local language and simple words
  • Folk songs, drama, puppet shows, or street plays
  • Posters and wall paintings
  • School activities
  • Religious gatherings
  • Village announcements
  • Community radio or social media where appropriate
The message should be two-way. Community members should have the opportunity to ask questions and disagree.

12. Formation of a community action group

After gaining acceptance, the worker may help form or strengthen a representative group, such as a village health committee. The group can:
  • Identify problems
  • Plan activities
  • Mobilize local resources
  • Coordinate with health services
  • Monitor progress
  • Ensure inclusion of disadvantaged groups
The group should include women, youth, marginalized populations, local leaders, health workers, and community volunteers.

Conclusion

A community is a group of people connected by place, social relationships, common values, interests, and institutions. The community-based approach places people at the centre of health action by involving them in identifying, planning, implementing, and evaluating solutions to their own health problems. Community entry is the foundation of this process. It requires preparation, respect for local culture, contact with leaders and groups, rapport-building, participatory assessment, transparent communication, and shared decision-making. Proper community entry creates trust, participation, ownership, and sustainability of health programmes.
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