4273.0: Tuesday, November 14, 2000 - Board 8

Abstract #13877

Multivocality of Mozambican child survival

Arturo Sanabria, MD, MPH, Project HOPE Moçambique, C.P. 103, Avenida 25 de Setembro, Mocuba, Mozambique, 258-4-213-437, projhope@teledata.mz and Elmar Vinh-Thomas, MBChB, MPH, Project HOPE, Route 255, Millwood, VA 22646, (540) 837-2100, evinhthomas@projhope.org.

This provisional investigation identifies social coordinates which attempt the transformation of community-based health programs. It analyses narratives of community members, NGOs, and their partners in a "Child Survival" program in Mozambique.

We use anthropological concepts derived from a survey of literature on multivocality. The analysis addresses the way competing notions of health within and between groups can be shown to be converted into a verbally expressed narrative of experiences. The analysis focuses on structure, process, and the communicative context of group interaction. We employ an hermeneutic analysis to unpick the emic and etic interpretations used by groups to make sense of created narratives. We explore the meaning-creating processes in group work which are used to elicit meaning from narrated imagery. We conclude that narratives and similar aspects of "the work of culture" carry meaningful messages for the implementation of health projects.

The sets of narratives indicate diverse sets of conflicting priorities: sociopolitical needs, independence of decision-making, community building and funding. The impact of these issues is underlined by the multiplicity of voices: from traditional healers, community leaders, political agents, or government employees.

In these narratives, community needs do not coincide with those of the Health Ministry, funding agencies, or NGOs. Each of these groups articulates needs using specific emphases, thus creating a multivocal discourse. Competing voices must be balanced in implementation. Child survival programs must balance the needs of partners which are articulated in different, conflicting voices. A successful project understands and reflects these in dynamically changing interventions.

Learning Objectives: Indicate the important differences in perceptions and actions of stakeholders in MCH implementation. Understand the multiple community voices and visions that exist in child survival. Develop an improved plan for implementing successful community-based programs

Keywords: Maternal and Child Health, Community Response

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Project HOPE Moçambique
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employment

The 128th Annual Meeting of APHA