Preventing Disease in Primary Health: Harnessing Group Consensus through Ubuntu in Zimbabwe and Communitarianism in Vietnam
Main Article Content
Abstract
For the past fifty years, the dominant paradigm in public health has been the Health Belief Model of knowledge transfer, using an individualistic appeal to ‘beneficiaries’ with the expectation that community members are able to undertake change through solo decision‑making. However, most subsistence societies are organised along communitarian lines with an emphasis on group consensus rather than individual decision making. Technology transfer has often failed to achieve long term sustainability, using top-down transfer of information to achieve change. Since 1995, the Community Health Club Model of community mobilisation has been successfully introducing the idea that instead of approaching individuals in a community, a dedicated group is formatted which is mandated to make communal decisions so alleviating the need for individual choice. This paper argues that a communitarian ethic — known as ‘Ubuntu in Africa — may explain the success of health clubs, and account for the long-term sustainable development in rural communities. Using health promotion as an entry point this is a group approach which can rekindle a culture of mutual reciprocity in a collective mobilisation strategy. Practical group activities related to hygiene, water, sanitation, agriculture and women’s empowerment through skills transfer have achieved remarkable success in a variety of contexts across 13 countries in Africa and two countries in Asia.
Policy recognition of this community mobilisation approach in both Rwanda and Zimbabwe demonstrates the potential for the institutionalisation of the Community Health Club model into other African countries particularly in fragile states. In addition, there is also compelling evidence that health clubs in Vietnam can improve hygiene and sanitation with reduction of diarrhoeal disease, showing the model may also be successfully replicated to other countries of Asia. This approach may provide a bridge for the prevention of many diseases in primary health because it reinforces cultural values of group consensus.
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