©Jhpiego Corporation
The Johns Hopkins University
A Training Program on Community-
Directed Intervention (CDI) to Improve
Access to Essential Health Services

By the end of this module, learners will:
 State the definition of community used in “to roll out communitydirected interventions (CDIs)”

Describe the purpose of community mapping in building support and solving problems

Explain the value of involving community members in mapping their own community

List the steps and activities needed to map the organizations and resources in a community
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 In CDI, we create a strong community-clinic linkage
 We start our definition of community by identifying all the settlements, villages, etc. that are served by a primary health care facility
(catchment area)
 To make CDI effective, we work with each of the smallest functional units of a community (such as a kindred, clan, neighborhood, hamlet)
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Mapping is:
 A very important component of almost all practical situation assessments
 A joint activity with the community that can help everyone involved learn more
All programs need to have a sense of where:
 People live
 The problem areas are
 The community resources are located
 Others are doing their activities
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 Locating Physical Structures
 Health facilities and providers


Schools, religious institutions
 Boundaries
 Understanding Social Relationships
Existing organizations, associations, societies and levels of activity
 Wards (sub-districts), kinship groups
 Utilization patterns and barriers
Communities are built from their social networks
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 In mapping, we are interested in our target population —for example pregnant women—and the people or groups with whom they relate:
 Pregnant women
 People pregnant women turn to for advice and assistance
 Key members of social networks to which pregnant women belong
 Mapping helps link people in need with the services and resources they need
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 Mapping provides useful tools for making sense of social networks and behaviors related to using services during pregnancy
 In this case, we are interested in:
 The size of the population group we are targeting
 Their utilization behaviors
 The places and persons to whom they go for help
 What attracts them to these people and places
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 When community members are involved in mapping , they learn more about the problems and resources in their community
 They can visualize service quality issues like access and equity
 What can you tell about the community from this map?
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During the community meeting:
 Ask the group to list key persons and organizations in the community that can help promote the program

Identify any potential road blocks or people who might oppose the program
 Learn about the community’s past development efforts and why these did or did not succeed
 Past efforts provide lessons on how to undertake future efforts more successfully
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Ask people:
 To name and describe the location of key health and development resources that the community values, such as:
 Healers
 Opinion leaders
 Medicine shops
 Local associations, etc.
 About major sub-divisions (e.g., wards, communities, kindreds/clans and settlements)
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 Specifically ask about resources —people and organizations —to whom pregnant women go for advice and help, for example:
 Where do they get advice?
 Are there women who regularly deliver babies?
 Where do they get medicines?
 From whom do they get financial, emotional and other support?
 Take notes during the meeting
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At the community meeting, encourage people to use the information generated to help plan program development, for example:
 Develop criteria for the best types of people to serve as community-directed distributors (CDDs) —for example, for malaria in pregnancy (MIP) programming
 Determine sub-communities (e.g., kindreds/clans, settlements, neighborhoods) that could form the basis of selecting CDDs)
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If There Is Time, Actual Maps Can Be Drawn and Kept with the Community
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Many factors influence a community’s structure, organization and networks, such as:
 The status and concentration of the services in the area
 Whether it is urban or rural
 The way people utilize the services that are available
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Some Rural Issues
 Greater community cohesion and identity
 Smaller and more dispersed units
 Seasonal habitations
(e.g., farm hamlets)
 Generally poorer
 Can you think of other examples?
Some Urban Issues
 Weaker identity and cohesion
 More compact, but people travel far for work and social needs

Financial gain often supersedes other social needs
 Greater divide between poverty and wealth
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Community Resource Specific Examples
Names of women leaders
Names of community subsections (e.g., kindreds/clans, settlements)
Names and locations of health resources —public, private, indigenous
Names of key women’s social groups
Other special resources for pregnant women
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 Let’s think of another health issue, for example:
 Community management of child illness
 Food security
 Home-based care for people with HIV
 What are the community resources we would need to find and map for these issues?
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Community Resource Specific Examples
Names of leaders
Names of community subsections (e.g., kindreds/clans, settlements)
Names and locations of health resources —public, private, indigenous
Names of key social groups
Other special resources
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 Community members’ involvement in social mapping can help them learn more about problems and resources in their community
 Service issues like access and equity are more easily visualized by community members
 Community participation in mapping makes community landmarks and identity more visible
 Mapping helps link people in need with the services and resources they need
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