Grassroots initiatives for change rely on people with limited power, limited resources and limited ability to influence others. From this position, people acting from the bottom up can change their ...own actions, seek to influence others around them and seek to change the social structures that they inhabit. These acts are invariably conceived, initiated and enacted within communities, and there is an emerging interest from practitioner, policy and academic circles in the importance of community as a space for realising pro-environmental change. In this paper, we ask what role grassroots initiatives can have in creating low-carbon communities. Using a theoretical framework from work on community-based practice change initiatives, we discuss the interplay between grassroots action and community capacity. We then present two cases of grassroots low-carbon community initiatives in light of this theoretical work. We conclude by discussing key themes emerging from the cases, including the potential for grassroots initiatives to build community capacity for low-carbon practices, and the importance of locally crafted solutions according to the structures specific to place.
Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in lowand middle-income countries (LMICs). Many ...factors influence CHW performance. A systematic review was conducted to identify intervention design related factors influencing performance of CHWs. We systematically searched six databases for quantitative and qualitative studies that included CHWs working in promotional, preventive or curative primary health services in LMICs. One hundred and forty studies met the inclusion criteria, were quality assessed and double read to extract data relevant to the design of CHW programmes. A preliminary framework containing factors influencing CHW performance and characteristics of CHW performance (such as motivation and competencies) guided the literature search and review.
A mix of financial and non-financial incentives, predictable for the CHWs, was found to be an effective strategy to enhance performance, especially of those CHWs with multiple tasks. Performance-based financial incentives sometimes resulted in neglect of unpaid tasks. Intervention designs which involved frequent supervision and continuous training led to better CHW performance in certain settings. Supervision and training were often mentioned as facilitating factors, but few studies tested which approach worked best or how these were best implemented. Embedment of CHWs in community and health systems was found to diminish workload and increase CHW credibility. Clearly defined CHW roles and introduction of clear processes for communication among different levels of the health system could strengthen CHW performance.
When designing community-based health programmes, factors that increased CHW performance in comparable settings should be taken into account. Additional intervention research to develop a better evidence base for the most effective training and supervision mechanisms and qualitative research to inform policymakers in development of CHW interventions are needed.
Le personnel de santé communautaire (PSC) est de plus en plus reconnu comme élément prépondérant du personnel de santé nécessaire pour atteindre les objectifs de santé publique dans les pays à faible et moyen revenu. Beaucoup de facteurs influencent les performances des PSC. Nous avons mené une revue systématique pour identifier les facteurs lors de la conception d’initiatives qui ont une influence sur les performances des PSC. Nous avons cherché systématiquement dans six bases de données provenant d’études quantitatives et qualitatives incluant les PSC travaillant pour la promotion, la prévention et les soins curatifs dans les services de santé primaires pour les pays à faible et moyen revenu. Nous avons trouvé 140 études correspondant aux critères d’inclusion et dont la qualité a été évaluée ainsi qu’une relecture pour extraire les données pertinentes pour la conception de programmes de PSC. Un cadre préliminaire contenant des facteurs influençant la performance des PSC ainsi que les caractéristiques des performances des PSC (telles que la motivation et les compétences) a permis de diriger la recherche de documents et leur analyse. Un mixe d’incitations financières ou non financières, prévisibles pour le PSC, semble être une stratégie efficace pour améliorer la performance, spécialement pour les PSC qui ont plusieurs rôles. Les incitations financières pour encourager la performance peuvent parfois entrainer une négligence sur les t âches non rémunérées. La conception des initiatives, qui implique une supervision fréquente et une formation continue, a entrainé une meilleure performance des PSC dans certains cas. La supervision et la formation ont souvent été mentionnées comme éléments facilitateurs mais peu d’études ont testé quelle approche marchait le mieux et quel est le meilleur moyen de les mettre en place. L’intégration du PSC dans la communauté et dans le système de santé a permis de diminuer la charge de travail et d’augmenter la crédibilité du PSC. Le fait de clairement définir le rôle du PSC et d’introduire un processus de communication clair entre les différents niveaux du système de santé pourrait renforcer la performance du PSC. Lorsque les programmes de santé communautaire sont conçus, les éléments qui favorisent l’amélioration des performances du PSC dans des contextes comparables doivent être pris en compte. Nous avons besoins d’initiatives supplémentaires afin de développer un meilleur cadre pour une formation efficace, pour des mécanismes de supervisions ainsi que pour des recherches qualitatives afin d’informer les législateurs du développement des initiatives du PSC.
在低收入和中等收入国家（LMICs）中，为了达到公共医疗 目标，社区医疗工作者（CHWs）越来越多得被认为是医疗 工作者的一个组成部分。很多因素影响社区医疗工作者的绩 效。本文对这些影响因素做了一个系统评价。我们对六个数 据库定量和定性的研究进行了系统搜索，包括了在低收入和 中等收入国家中在促进、预防和基础医疗服务领域工作的社 区医疗工作者。达到我们标准的 140 个研究被进行了质量评 估，并被再次阅读提取出与社区医疗工作者项目设计相关的 数据。我们提前设计好了一个框架来指导文献搜索和综述工 作，框架里包括了影响社区医疗工作者绩效的因素和绩效的 特点（比如动机和能力）。
经济和非经济动机的混合，可以预见到，是提高绩效的有效 措施，特别是对于有多项工作的社区医疗工作者来说。以绩 效为基础的经济刺激有时会导致对一些不支付金钱的工作的 忽视。在一些情景中，包含了经常性监督和持续培训的干预 措施的设计能够带来更好的绩效。监督和培训是经常被提到 的影响因素，但是很少有研究试验哪种方式最有效或者如何 实施最有效。将社区工作者融入社区和医疗系统中能减少工 作量并增加社区工作者的可信度。清晰地界定社区工作者的 角色和引入医疗系统中不同层面的人的对话机制也能加强绩 效。
当设计以社区为基础的医疗项目时，应该考虑在对比情境下 增加社区医疗工作者绩效的因素。还应该进行额外的干预措 施研究建立一个证据库用以找出最有效的培训和监督机制和 为政策制定者设计干预措施提供定性研究。
Los trabajadores de salud comunitaria (TSCs) son reconocidos cada vez más como un componente integral del personal de la salud necesario para lograr los objetivos de la salud pública en los países de ingresos bajos y medianos (PIBMs). Muchos factores influyen en el rendimiento de los TSCs. Se realizó una revisión sistemática para identificar los factores relacionados con el diseño de la intervención que influyen en el rendimiento de los TSCs. De forma sistemática usamos seis bases de datos para buscar estudios cuantitativos y cualitativos que incluyeron los TSCs que trabajan en servicios promocionales, preventivos o curativos de atención primaria de salud en PIBMs. Ciento cuarenta estudios cumplieron los criterios de inclusión y fueron evaluados en materia de calidad. Se hizo doble lectura para extraer datos relevantes al diseño de programas de los TSCs. Un marco preliminar que contiene los factores que influyen en el rendimiento de los TSC y sus características de rendimiento (tales como motivación y competencias) orientaron la búsqueda bibliográfica y la revisión.
Una combinación de incentivos financieros y no financieros, previsibles para los TSCs, resultó ser una estrategia efectiva para mejorar el rendimiento, especialmente para aquellos TSCs con múltiples tareas. Los incentivos financieros basados en el rendimiento resultaron a veces en el abandono de las tareas no pagadas. Los diseños de las intervenciones que implicaron la supervisión frecuente y la formación continua llevaron a un mejor rendimiento de los TSC en ciertos contextos. La supervisión y la capacitación se mencionaron a menudo como factores facilitadores, pero pocos estudios probaron cual enfoque funcionó mejor o cómo éstas se implementaron de mejor manera. Se encontró que el arraigamiento de los TSCs en los sistemas comunitarios disminuyó la carga de trabajo y aumentó su credibilidad. Funciones de los TSCs claramente definidas y la introducción de procesos claros para la comunicación entre los diferentes niveles del sistema de salud podrían fortalecer el rendimiento de los TSCs.
Al diseñar los programas de salud basados en la comunidad, los factores que aumentan el rendimiento de los TSCs en contextos comparables deben ser tenidos en cuenta. Son necesarias investigaciones adicionales sobre la intervención para desarrollar una mejor base de pruebas sobre los mecanismos de formación y supervisión más eficaces, e investigaciones cualitativas para informar a los responsables de las políticas en el desarrollo de las intervenciones de los TSCs.
The escalating illegal wildlife trade (IWT) is one of the most high-profile conservation challenges today. The crisis has attracted over US$350 million in donor and government funding in recent ...years, primarily directed at increased enforcement. There is growing recognition among practitioners and policy makers of the need to engage rural communities that neighbor or live with wildlife as key partners in tackling IWT. However, a framework to guide such community engagement is lacking. We developed a theory of change (ToC) to guide policy makers, donors, and practitioners in partnering with communities to combat IWT. We identified 4 pathways for community-level actions: strengthen disincentives for illegal behavior, increase incentives for wildlife stewardship, decrease costs of living with wildlife, and support livelihoods that are not related to wildlife. To succeed the pathways, all require strengthening of enabling conditions, including capacity building, and of governance. Our ToC serves to guide actions to tackle IWT and to inform the evaluation of policies. Moreover, it can be used to foster dialogue among IWT stakeholders, from local communities to governments and international donors, to develop a more effective, holistic, and sustainable community-based response to the IWT crisis. El creciente mercado ilegal de vida silvestre (MIVS) es uno de los obstáculos de más alto perfil para la conservación hoy en día. La crisis ha atraído más de US$350 millones en financiamiento por donadores y por el gobierno en los años recientes, principalmente dirigido a un aumento en la aplicación de la ley. Existe un reconocimiento creciente por parte de los practicantes y quienes hacen las políticas de la necesidad de hacer partícipes a las comunidades rurales que colindan o viven con la vida silvestre como compañeros clave para aplacar el MIVS. Sin embargo, se carece de un marco de trabajo para guiar dicha participación comunitaria. Desarrollamos una teoría de cambio (TdC) para guiar a quienes hacen las políticas, los donadores y los practicantes en el asociamiento con las comunidades para combatir el MIVS. Identificamos cuatro vías para las acciones a nivel comunitario: fortalecer los impedimentos para el comportamiento ilegal, incrementar los incentivos para la adopción de la vida silvestre, disminuir los costos de vivir con la vida silvestre y apoyar los sustentos que no están relacionados con la vida silvestre. Para tener éxito, todas las vías requieren fortalecer la activación de las condiciones, incluyendo la capacidad de construcción y de gobemanza. Nuestra TdC sirve para guiar las acciones que impidan el MIVS y para informar a la evaluación de las políticas. Además, puede utilizarse para fomentar el diálogo entre los accionistas del MIVS, desde las comunidades locales hasta los gobiernos y los donadores internacionales, para desarrollar una respuesta basada en la comunidad más efectiva, holística y sustentable a la crisis del MIVS.
This study investigates the degree to which community can be found in Dutch neighbourhoods and attempts to explain why there is more community in some neighbour than in others. We apply a perspective ...on community which assumes that people create communities with the expectation to realize some important well-being goals. Conditions that account for the creation of a local community are specified, i.e. the opportunity, ease, and motivation to do so. These conditions are realized when (i) neighbourhoods have more meeting places; (ii) neighbours are, given their resources and interests, motivated to invest in local relationships; (iii) neighbours have few relations outside of the neighbourhood, and (iv) neighbours are mutually interdependent. Data from the Survey of Social Networks of the Dutch on 1,007 respondents in 168 neighbourhoods are used. Results show that there is a sizeable amount of community in Dutch neighbourhoods and that all the four conditions contribute to the explanation, while interdependencies among neighbours have the strongest impact on the creation of community.
This article investigates the association between sense of community belonging and health among settlements of different size and across the urban to rural continuum in Canada. Using data from the ...recent 2007/08 Canadian Community Health Survey (CCHS), the objective is to identify the major health, social and geographic determinants of sense of community belonging and to consider policy options aimed at improving sense of belonging among certain segments of the population. The research found a significant and consistent association between sense of belonging and health, particularly mental health, even when controlling for geography and socio-economic status. At the same time, sense of community belonging improved progressively across the urban to rural continuum with remarkably high levels of belonging evident in the outer most regions of Canada. Despite the health deficit that exists in rural and small-town Canada, the paper postulates that these communities are able to overcome health challenges to create conditions conducive to a positive sense of belonging. Overall, sense of belonging was also found to be highest among seniors, people residing in single-detached homes and among couples with children and was lowest among youth, residents of highrise apartments and among single-parents. Finally, in the context of addressing deficiencies in sense of belonging, the paper examines several recent policy developments aimed at improving mental health services in Canada.
Exploring how technology, instead of bringing us together, has driven us into more isolation, this book provides examples that show that community building can be a more powerful way to address ...social problems than more traditional policies and programs. --
Community-based monitoring (CBM) in the Arctic is gaining increasing support from a wide range of interested parties, including community members, scientists, government agencies, and funders. ...Through CBM initiatives, Arctic residents conduct or are involved in ongoing observing and monitoring activities. Arctic Indigenous peoples have been observing the environment for millennia, and CBM often incorporates traditional knowledge, which may be used independently from or in partnership with conventional scientific monitoring methods. Drawing on insights from the first Arctic Observing Summit, we provide an overview of the state of CBM in the Arctic. The CBM approach to monitoring is centered on community needs and interests. It offers fine-grained, local-scale data that are readily accessible to community and municipal decision makers. In spite of these advantages, CBM initiatives remain little documented and are often unconnected to wider networks, with the result that many practitioners lack a clear sense of the field and how best to support its growth and development. CBM initiatives are implemented within legal and governance frameworks that vary significantly both within and among different national contexts. Further documentation of differences and similarities among Arctic communities in relation to observing needs, interests, and legal and institutional capacities will help assess how CBM can contribute to Arctic observing networks. While CBM holds significant potential to meet observing needs of communities, more investment and experimentation are needed to determine how observations and data generated through CBM approaches might effectively inform decision making beyond the community level. Dans l'Arctique, la surveillance communautaire (SC) reçoit un appui de plus en plus grand de la part de nombreuses parties intéressées, dont les membres de la communauté, les scientifiques, les organismes gouvernementaux et les bailleurs de fonds. Dans le cadre des initiatives de SC, des habitants de l'Arctique effectuent des tâches permanentes d'observation et de surveillance ou participent à de telles tâches. Les peuples indigènes de l'Arctique observent l'environnement depuis des millénaires. Souvent, la SC fait appel aux connaissances traditionnelles, connaissances qui peuvent être employées seules ou conjointement avec les méthodes classiques de surveillance scientifique. Nous nous sommes appuyés sur les connaissances dérivées du premier sommet d'observation de l'Arctique pour donner un aperçu de l'état de la SC dans l'Arctique. La méthode de SC est centrée sur les besoins et les intérêts de la communauté. Elle permet d'obtenir des données à grain fin à l'échelle locale, données qui sont facilement accessibles par la communauté et les preneurs de décisions municipaux. Malgré ces avantages, il existe peu de documentation au sujet des initiatives de SC et souvent, ces initiatives ne sont pas rattachées aux grands réseaux, ce qui fait que bien des intervenants ne comprennent pas clairement ce qui se passe sur le terrain et ne savent pas vraiment comment appuyer la croissance et le développement de la surveillance communautaire. Les initiatives de SC respectent les cadres de référence nécessaires en matière de droit et de gouvernance, et ceux-ci varient considérablement au sein des contextes nationaux. L'enrichissement de la documentation en ce qui a trait aux différences et aux similitudes qui existent entre les communautés de l'Arctique en matière de besoins d'observation, d'intérêts et de capacités juridiques et institutionnelles aidera à déterminer en quoi la SC pourra jouer un rôle au sein des réseaux d'observation de l'Arctique. Bien que la SC ait la possibilité déjouer un rôle important dans les besoins d'observation des communautés, il y a lieu de faire plus d'investissements et d'expériences pour déterminer comment-les observations et les données découlant des méthodes de SC pourront favoriser la prise de décisions au-delà des communautés.
Social capital—especially through its "network" dimension (high levels of participation in local community groups)—is thought to be an important determinant of health in many contexts. We investigate ...its effect on HIV prevention, using prospective data from a general population cohort in eastern Zimbabwe spanning a period of extensive behavior change (1998—2003). Almost half of the initially uninfected women interviewed were members of at least one community group. In an analysis of 88 communities, individuals with higher levels of community group participation had lower incidence of new HIV infections and more of them had adopted safer behaviors, although these effects were largely accounted for by differences in socio-demographic composition. Individual women in community groups had lower HIV incidence and more extensive behavior change, even after controlling for confounding factors. Community group membership was not associated with lower HIV incidence in men, possibly reflecting a propensity among men to participate in groups that allow them to develop and demonstrate their masculine identities—often at the expense of their health. Support for women's community groups could be an effective HIV prevention strategy in countries with large-scale HIV epidemics.
Deborah Daro and Kenneth Dodge observe that efforts to prevent child abuse have historically focused on directly improving the skills of parents who are at risk for or engaged in maltreatment. But, ...as experts increasingly recognize that negative forces within a community can overwhelm even well-intentioned parents, attention is shifting toward creating environments that facilitate a parent's ability to do the right thing. The most sophisticated and widely used community prevention programs, say Daro and Dodge, emphasize the reciprocal interplay between individual-family behavior and broader neighborhood, community, and cultural contexts. The authors examine five different community prevention efforts, summarizing for each both the theory of change and the empirical evidence concerning its efficacy. Each program aims to enhance community capacity by expanding formal and informal resources and establishing a normative cultural context capable of fostering collective responsibility for positive child development. Over the past ten years, researchers have explored how neighborhoods influence child development and support parenting. Scholars are still searching for agreement on the most salient contextual factors and on how to manipulate these factors to increase the likelihood parents will seek out, find, and effectively use necessary and appropriate support. The current evidence base for community child abuse prevention, observe Daro and Dodge, offers both encouragement and reason for caution. Although theory and empirical research suggest that intervention at the neighborhood level is likely to prevent child maltreatment, designing and implementing a high-quality, multifaceted community prevention initiative is expensive. Policy makers must consider the trade-offs in investing in strategies to alter community context and those that expand services for known high-risk individuals. The authors conclude that if the concept of community prevention is to move beyond the isolated examples examined in their article, additional conceptual and empirical work is needed to garner support from public institutions, community-based stakeholders, and local residents.
One of the most interesting and vexing problems in ecology is how distinctly different communities of plants and animals can occur in the same ecosystem. The theory of these systems, known as ...multiple stable states, is well understood, but whether multiple stable states actually exist in nature has remained a hotly debated subject. This book provides a broad and synthetic critique of recent advances in theory and new experimental evidence. Modern models of systems with multiple stable states are placed in historical context. Current theories are covered in a rigorous fashion with the specific goal of identifying testable predictions about multiple stable states. The book provides a more synthetic, more critical, and broader analysis of multiple stable states in natural ecosystems than any previous review. By making the theory more transparent and the analysis of the evidence more comparative, the book broadens the discussion about multiple stable states, leading to a more general consideration of the interplay between theory and experiment in community ecology and environmental management.
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