MSF interview: Using social structures to improve access to healthcare

An interview with sociologist Glyn Alcock.
Nadja Groux Photo: Nadja Groux The team run work-shops and talks in the communities to raise awareness about health and the sustainability of the community's sick-bay.
What is a sociologist doing in an MSF programme? My goal is to offer tools and techniques to the different communities to facilitate the sustainability of a revolving fund that allows them access to basic healthcare services. Making it work is not just a matter of the health promoter and the health committee doing a proper financial follow-up, but it also requires the active participation of the whole community. When we realised that fact, we created the sustainability module in July 1999. What kind of activities does that involve? It is about mobilising the communities, making them own the project. To get to that point, I work with health committees, the authorities and the community at large. We've done interactive work-shops with at least half of the community, to discuss issues such as community health, the objective of the sick-bay and the community's roll in maintaining and managing it. We've also organised training modules for promoters, the local authorities and health committee members. Afterwards, during regular visits to the communities, we follow-up to reinforce knowledge. The final objective is to raise awareness so that the population takes on their responsibilities, because MSF will leave one day. Why is the role of the community so important? They are small settlements, between 60 to 300 people, geographically quite isolated and very poor. Medical brigades of the Ministry of Health have little economic and human resources to offer a quality service on a regular basis. Therefore, it is necessary that the communities maintain a basic healthcare system. This means supporting the healthcare promoter, who works on a voluntary basis but also has family needs to respond to. It means getting involved in the management of the sick-bay, obtaining funds to buy the drugs, etc. Without the communities' participation the system is unsustainable. What difficulties have you encountered? These communities don't know their rights very well, have a very low educational level and, if they ever make a complaint, they are not listened to. On the other hand, they are used to getting everything for free because of their condition as a vulnerable population. So, it was quite difficult to make them understand that they have to fight, that by getting organised they can make things happen. Briefly, make them understand that MSF is ready to help them to improve their situation, but they are the ones to decide their own future. What conclusions are you drawing now that the project has ended? Training of health promoters and community leaders has been very positive for the communities. Not only they have a basic healthcare service that works now but through the training we offered, the organisation of the communities has improved, which helps them in a range of other fields. However, I think we should have included the sociological part right at the beginning of the project, so that we knew more about the communities, their social structure, and make the functioning of the medical programme more efficient. At personal level, it's been very enriching to share with people and to know how they live, what they feel and think. Glyn Alcock is a 32-year-old English sociologist responsible for the sustainability module of the project that MSF run in Pucallpa region, Ucayali Department, to improve the shipibo and mixed race populations' access to healthcare services. The project was handed over to Peruvian Ministry of Health in late June. Glyn arrived as first mission volunteer in 1999.