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How Can Community Health Programmes Build Enabling Environments for Transformative Communication? Experiences from India and South Africa

Abstract

Much research has examined how to empower the poor to articulate demands for health-enabling living conditions. Less is known about creating receptive social environments where the powerful heed the voices of the poor. We explore the potential for ‘transformative communication’ between the poor and the powerful, through comparing two well-documented case studies of HIV/AIDS management. The Entabeni Project in South Africa sought to empower impoverished women to deliver home-based nursing to people with AIDS. It successfully provided short-term welfare, but did not achieve local leadership or sustainability. The Sonagachi Project in India, an HIV-prevention programme targeting female sex workers, became locally led and sustainable. We highlight the strategies through which Sonagachi, but not Entabeni, altered the material, symbolic and relational contexts of participants’ lives, enabling transformative communication and opportunities for sexual health-enabling social change.

Resumen

Mucho se ha investigado acerca de cómo empoderar a personas en situación de pobreza para demandar condiciones de vida favorables a la salud. Sin embargo, existe un conocimiento limitado acerca de cómo crear entornos sociales receptivos donde los poderosos presten atención a las voces de los pobres. Exploramos aquí el potencial de la ‘comunicación transformadora’ entre personas en condición de pobreza y aquellas que se encuentran en posiciones de poder, a través de la comparación de dos estudios de caso acerca del manejo del VIH/SIDA. El Proyecto Entabeni en Sudáfrica buscó empoderar a mujeres empobrecidas para administrar cuidados domiciliarios a personas con SIDA. Éste suministró exitosamente bienestar a corto plazo, pero no consiguió desarrollar liderazgos locales ni sostenibilidad. El Proyecto Sonagachi en India, un programa de prevención del VIH dirigido a trabajadoras sexuales, logró ser liderado localmente y sostenible. Destacamos las estrategias a través de las cuales Sonagachi, contrario a Entabeni, modificó los contextos material, simbólico y relacional en las vidas de los participantes, permitiendo una comunicación transformadora y oportunidades para un cambio social favorable a la salud sexual.

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Acknowledgements

Thanks to Entabeni Project co-researchers Yugi Nair, Sbongile Maimane and Andrew Gibbs, to Sonagachi Project co-researcher Riddhi Banerji, and to Morten Skovdal, Jacquie Priego-Hernandez and Kerry Scott for editorial work on the manuscript. This paper was written while the authors were funded by a joint scheme of the Economic and Social Research Council and Department for International Development (UK) to investigate ‘The social conditions for successful community mobilisation’ (Award Number RES-167-25-0193).

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Campbell, C., Cornish, F. How Can Community Health Programmes Build Enabling Environments for Transformative Communication? Experiences from India and South Africa. AIDS Behav 16, 847–857 (2012). https://doi.org/10.1007/s10461-011-9966-2

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Keywords

  • HIV/AIDS
  • Communication
  • Community health
  • Volunteers
  • Sex workers
  • Empowerment