PATH: Program for Appropriate Technology in Health

LESSONS LEARNED: PROVIDING COMMUNICATION
AND TECHNICAL ASSISTANCE IN FGM PROGRAMS

Carol Corso
Previous Director of Communication, PATH

1. FGM must be identified by the community, and by the women, in particular, as an issue on which they are interested in working. The issue and need can not be identified by "outsiders". Technical assistance should be requested by the local implementing agency rather than by the donors or by the technical assistance (TA) agency looking for implementing partners, as occurs in many other health and family planning programs.

2. Due to the sensitive nature of FGM, the process by which technical assistance is rendered is different from TA rendered to family planning or other health projects. Agencies providing TA in FGM must have much more of a "behind the scenes" role than is true in other health projects. High visibility/profile external TA could possibly be detrimental to the project. TA agencies must b mindful that FGM traditionalists could easily misconstrue or distort the TA as a "Western plot to breakdown traditional cultural values and practices."

3. TA may be provided more appropriately from the local perspective by staff living and working in the respective country. Staff members providing TA who speak the same language, are from the same ethnic group, countnry, or region are often trusted more than a "foreign" provider of TA.

4. Working "behind the scenes" can be translated to working with local counterparts at the national level and with representatives of the community to transfer communication skills to them. The local counterparts are much more successful leading discussions and interacting with the community once they've acquired and/or strengthened their skill base.

For instance, the local dialect will often have slang words for the FGM and sexually related actions and body parts that the local community is comfortable with, but that an outsider wouldn't know. An example from Meru, Kenya follows. Instead of using the technical word for circumcision when talking, the local project person used a word that translated as "when the girl becomes mature." The group understood and felt comfortable with the term, the person facilitating the discussion and the discussion itself.

5. Research on the issue by local implementing organization must guide the intervention design. The communities must be involved in the design and the interventions. TA efforts can guide the local organization through the research process. Assumptions should not be made by the local organization regarding underlying issues or reasons behind the practice.

6. TA works best when it is district or state specific. Research bears out the differences in practices among or even within districts, states, or villages. The needs and approaches must therefore differ from place to place as it is critical to respond to the community's felt needs.

7. Providing TA and training through a workshop setting is very important, as it allows for the exchange of ideas and personal enrichment. PATH has learned that the local implementing group and the community have excellent ideas regarding project activities but often need assistance translating ideas into action interventions requiring skills training.

8. Project staff at the local level need assistance not only in skills training but very often need support on an individual level for their efforts. Often the staff from the local implementing organization feel they are part of the local culture and, yet, at the same time, they are on the outside. Some have a sense that they are betraying their community, and yet, they are committed and want to support the eradication of FGM. Often, local implementing staff feel anxious. Thus they need TA that will build their confidence and empower them with the skills to continue to make in-roads within their communities. Equally important is helping local staff feel confident about themselves and their efforts.

9. Behavior change is a process. Each individual moves through this process at a different pace of each person is affected by a number of different factors that impinge on the behavior change process. We have learned that behavior change often must occur within and among the local staff identified as change agents by the local implementing organization. There is often peer pressure for behavior change and conflict surrounding it among staff identified to work on the project. Through skills training, staff can be encouraged to work through their individual issues surrounding behavior change on FGM. These skills are invaluable for them to learn as they will be using them with their communities.

10. As behavior change is process, it takes time, continuous efforts, positive support and reinforcement to make change. Continuity in the process is important--the community needs time to work through its issues and needs the constancy of individuals to guide them through their efforts. FGM is a tradition deeply immersed in the culture and behavior change is a process which occurs over time. Behavior change around FGM will take time, perhaps at least a generation in some cases. It will not occur overnight or through one time intervention processes. Donors and local implementing organizations must bear in mind the time change will take.