Capacity building to improve women's health in rural China

The Women's Reproductive Health and Development Program (WRDHP) is an ambitious attempt to operationalize two important tenets of health development thinking within a rural reproductive health context. First, it is important for communities to participate in decisions about the services and programs that affect them. Secondly, the complex nature of healthcare is best addressed by intervention processes which call for a multi-functional approach to planning and coordination. In both planning and intervention approach, the WRHDP recognizes the social, cultural and economic realities that affect women's efforts to secure the health and well-being of themselves and their families. The focus of the WRHDP is on capacity-building within a rural reproductive health environment, in this case Yunnan Province in rural China. Rather than using international donor funding to provide a specific intervention, the WRDHP used Ford Foundation funding as a lever to encourage community investment in environmental resources that affect health, to improve the technical skills of individuals within the existing health bureaucracies, and to promote structural changes within existing health and development bureaucracies to support interagency collaboration and community empowerment within the region's health and development agencies. This article describes how the WRHDP created new methods for provincial and local agencies to overcome obstacles and work with one another to improve women's health. It also describes the processes used in the rural areas of Chengjiang and Luliang counties to assess local conditions and needs, and the supported and expanded local efforts in improving woman's reproductive and family health that resulted from the processes.

Photovoice: concept, methodology, and use for participatory needs assessment

Photovoice is a process by which people can identify, represent, and enhance their community through a specific photographic technique. As a practice based in the production of knowledge, photovoice has three main goals: (1) to enable people to record and reflect their community's strengths and concerns, (2) to promote critical dialogue and knowledge about important issues through large and small group discussion of photographs, and (3) to reach policymakers. Applying photovoice to public health promotion, the authors describe the methodology and analyze its value for participatory needs assessment. They discuss the development of the photovoice concept, advantages and disadvantages, key elements, participatory analysis, materials and resources, and implications for practice.

Chinese village women as visual anthropologists: a participatory approach to reaching policymakers

In developing countries, rural women are often neither seen nor heard, despite their extraordinary contribution to the labor force. Photo novella is an innovative methodology that puts cameras in the hands of rural women and other constituents who seldom have access to those who make decisions over their lives. As an educational tool, the practice of photo novella has three main goals: (1) to empower rural women to record and reflect their lives, especially health needs, from their own point of view; (2) to increase their collective knowledge about women's health status; and (3) to inform policymakers and the broader society about health and community issues that are of greatest concern to rural women. In this paper we analyze the third goal: the contributions and limitations of photo novella as a tool for informing policymakers. We conceptualize first the theoretical and practical underpinnings of photo novella. After tracing the relationships among empowerment education, feminist theory, documentary photography and policy, we describe photo novella within the broader context of the Ford Foundation-supported Yunnan Women's Health and Development Program and explain its application for influencing policy based on our experience carrying out photo novella in China.

Seeking women's voices: setting the context for women's health interventions in two rural counties in Yunnan, China

If interventions to improve health are truly to benefit women, they must be developed from the start with a critical understanding of women's own perceptions of their health problems and needs, and how these concerns are linked to other facets of women's lives. To obtain such understanding, it is crucial for health planners to seek out women in the communities where they live, to encourage them to speak in their own voices about their health and lives, and to be genuinely committed to listening to what the women have to say. This paper presents results of focus group discussions with village women in two rural counties in Yunnan, China. The data are derived from 28 focus group discussions conducted by the Women's Reproductive Health and Development Program in Yunnan as part of a comprehensive assessment of reproductive health needs in poorer, more remote areas of the two counties. The discussions were held to ascertain what village women themselves feel to be their most pressing health problems, and how these relate to work, family, social status and their use of health services. Results show how women's health and their use of health services are rightly intertwined with their labor roles, harsh environmental conditions and oppressive poverty. Widespread breakdowns in the village-level primary health care network lead village women to express a profound lack of confidence in local health services. The findings have several implications for planning and implementation. Demands on women's scarce time need to be explicitly considered when designing health education activities and health service delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Empowerment through photo novella: portraits of participation

Photo novella does not entrust cameras to health specialists, policymakers, or professional photographers, but puts them in the hands of children, rural women, grassroots workers, and other constituents with little access to those who make decisions over their lives. Promoting what Brazilian educator Paulo Freire has termed "education for critical consciousness," photo novella allows people to document and discuss their life conditions as they see them. This process of empowerment education also enables community members with little money, power, or status to communicate to policymakers where change must occur. This paper describes photo novella's underpinnings: empowerment education, feminist theory, and documentary photography. It draws on our experience implementing the process among 62 rural Chinese women, and shows that two major implications of photo novella are its contributions to changes in consciousness and informing policy.