Community-driven change: Part 1

by Ayesha Khan

“The world as we have created it is a process of our thinking. It cannot be changed without changing our thinking.” ― Albert Einstein

Ever had someone try to tell you to change?  Doesn’t work too well, does it?  Unless you decide that you need to change yourself.

Trying to bring about change in the world is similar to changing yourself. The only way change will be lasting is if individuals or communities identify the change as a necessity within themselves. This concept is what we refer to as community driven or a bottom-up approach.

NGOs are sometimes criticized for imposing their own worldview on a country. Such top-down projects have been likened to “The White Man’s Burden” or the Rudyard Kipling poem that alludes to Western countries’ policy of imperialism as a noble quest that is done to introduce the native people to a “better” way of life.

If one country knows a “better” way of life than another, why is it that the whole world has not adapted these best practices? Could it be because local details matter?


The picture above of a basketball court was built by well-intentioned American NGO for youth in Haiti. It’s a wonderful idea, but perhaps asking a country of aspiring Renaldos what they would like would have led to a different project!

Let’s take the example of malaria and bed nets. Half a billion people are infected with malaria every year. Of these, a million die, mostly children and infants.

A simple bed net can prevent millions of deaths. When bed nets are distributed by NGOs for free, 70% of recipients used their free nets. Yet when a program developed by Malawians sold bed nets for 50¢/net in new mother clinics, almost 100% of nets were used (Postrel, 2006).

We tried to adapt this bottom-up approach as we set out to improve health care in Haiti. To do this, we surveyed the community by visiting and speaking with Fort Liberte families about their barriers to care, illnesses and needs.

Primarily, community members identified the need for jobs and money. In terms of health care, the majority noted that they could go to the hospital in times of emergency only. One community member stated: “If we get sick, try to neglect the problem until it goes away. But sometimes it doesn’t. Then, even though we do not have money to pay, we have to go to the hospital or we will die.”

Money was identified as the greatest barrier to care. Respondents identified a need for reliable, affordable care based in the community. In the community, there was a willingness to see trained healthcare providers if they were not doctors or nurses and to pay for this service.

The results of this survey are the foundation of our emergency community health care worker program. It was created to address the need of emergencies in the community by training members in the community to respond to them.


Virginia Postrel, The Poverty Puzzle, The New York Times, March 19, 2006