Since Join the Club was published, readers have written in about more successful strategies to solve problems that depend on positive peer pressure. They are all over the map: from Biggest Loser-style team weight loss competitions to a program of Brazil’s Catholic Church that has saved countless children’s lives. We’re checking them out and here’s some of the best ones so far, along with where to go for more information. Keep those suggestions coming! Email firstname.lastname@example.org or post them on Join the Club’s Facebook page.
A Join-the-Club best case: Time Banks
Time banks are local organizations that allow people to use their skills to help others by exchanging hours instead of money. You earn time dollars by, say, taking a neighbor to the doctor, and spend those time dollars on the same number of hours’ worth of other services, such as computer repair or singing lessons. All work – be it financial planning or housecleaning – is valued the same. These organizations not only help people save money, they create community and have had a demonstrable effect on people’s health. Time Banks can allow people to stay in their own homes when they are sick or as they age.
A Join-the-Club best case: The Posse Foundation
Here’s a program with a 20-year record of sending inner-city kids to elite colleges. The Posse Foundation’s incredible success rests on two things: it choose dynamic, intelligent high school students with leadership skills (whether or not they have good SAT scores) and it sends a tight-knit group of ten kids from the same city together to college. There, they form a posse, supporting each other through college.
A Join-the-Club best case: Small Groups for Weight Loss
Weight Watchers’ success doesn’t lie in its eating plans. Finding a good eating plan isn’t a challenge – sticking to it is the challenge. And that’s best done in a small group. Here are reports about two other kinds of small groups that are helping members to be healthier. One is the Daniel Plan of Saddleback Church, which is using the small-group structure (nearly every church has the same thing) to promote healthy eating and exercise. The second story is about Biggest Loser-style competitions. They work because having the goal of winning money allows teammates to violate the usual social norms of polite behavior. It gives them permission to police one another’s food and drag teammates to the gym.
A Join-the-Club best case: Community Health Workers Saving Lives in Rwanda
Concern Worldwide’s Child Survival Program in Rwanda covers a fifth of Rwanda with community health workers. These health workers – ordinary village women working as volunteers – have been pioneering. They not only diagnose pneumonia, they treat it with antibiotics. They administer rapid tests for malaria. They are treating diarrhea, pneumonia, malaria and malnutrition – the most important killers of children in Rwanda. What makes them successful is that they are peers – they understand village problems, they know how to talk to their neighbors, and they are right next door when something happens.
By Caroline Helper
The Child Survival Program in Rwanda began by identifying the top three killers of women and children: Malaria, malnutrition, and pneumonia. They started by building programs that were community-based and sustainable in the long term. Much of that initial groundwork was focused on efforts and tactics that empowered communities to manage their own services by training health volunteers to recognize the first signs of illnesses and diseases.
They recruited volunteers directly from the communities, often by identifying models of positive deviance within a community. For example, if a community has high levels of malnutrition and there is a woman with healthy well-fed children, The Child Survival Program will ask that woman to join them in an effort to educate and influence her community. The health volunteers are taught to screen for illnesses and then to treat them at the first signs – providing initial frontline treatment that has saved lives.
Essentially, this program is looking at prevention and early response rather than treatment when a child or mother is already very ill. A big component of the program is public education – how to prevent some of these illnesses by educating about sanitation and hygiene. Another big part of the program is behavior change and reinforcing education in favor of folk wisdom.
Health workers are trained to treat at the first sign and to know when to refer (to a health facility) if someone is so ill that it’s beyond a worker’s capacity to help. This initial frontline treatment includes giving health workers pneumonia timers so they can time the number of breaths per minute, which indicates pneumonia and whether it is serious enough to warrant a referral. For malaria they are trained to ask whether a child has had a fever for longer than 24 hours, at which point they need to be referred for treatment at a health facility or, if not, to give them malaria tablets for treatment. For malnutrition there are a series of steps to screen – and if the signs do indicate that they can benefit from outpatient treatment they are given therapeutic food.
Over the past five years, The Child Survival program in Rwanda has scaled up from working in one small rural area to partnering with two other large health NGOs and the country’s Ministry of Health. The marker of success is that the program has received several evaluations that indicate the level of knowledge and the capacity of the program’s partners in the Ministry of Health and at the community level are high enough so Concern Worldwide can back out and let those they have trained manage and continue the program on their own.
A Join-the-Club best case: Pastoral da Crianca Revolutionizes Health Care in Brazil
As a young doctor in Curitiba, Dr. Zilda Arns Neumann led a public health campaign to stop a polio epidemic. She coordinated churches, schools and community groups to carry out a successful vaccination campaign. Then she went to work for UNICEF, where she saw first-hand the value of working with mothers to prevent disease. In 1982, Dr. Arns’ brother, Cardinal Dom Paulo Evaristo Arns, met James Grant, then the head of UNICEF. Grant challenged Arns to get the church more involved in children’s health. The next year, the Pastoral da Crianca began work in Florestopolis, in Parana state.
Now the Pastoral reaches every state of Brazil and has exported its model to 19 countries in Latin America, Africa and Asia.
It works — the rate of child mortality in communities where the Pastoral exists is half the national rate.
The Pastoral owes its success to many things: an inspired idea, good organization, well-thought-out curriculum, the guidance and structure of the Church and the power of faith, among other things.
But one of the keys to its success is the network of volunteers, called “leaders” – more than 90 percent of them women — who accompany families in their homes through a pregnancy until their child is 6. Each family is visited once a month. The leaders promote education for the mothers and good health practices for the family, often using Biblical references. They talk about nutrition, breastfeeding, accident avoidance and hygiene. They also meet with other leaders in their area to look at the community’s progress and problems. Many of the leaders are mothers who were themselves accompanied by the Pastoral.
Training ordinary people to support mothers, weigh babies and teach others about how to stay healthy is not just a way to reach more families cheaply. The fact that the person who visits you and teaches you is a neighbor – someone just like you, who understands your life and your problems – makes their messages credible.
We often lament a shortage of doctors and nurses in favelas or rural villages. But doctors and nurses are not the right people to save children’s lives through preventive health care. They are important for many things, but leaving public health to professionals has serious drawbacks. They tend to make us passive. They take away our sense that we can do things to improve our health. They make health care into something mysterious and far away. And of course, they concentrate on curative medicine, not the preventive measures that are by far the most important factors in public health.
Our neighbors are much better than doctors at this work. They are, first of all, always there. They are the one who reveal to us that we ourselves have the power to achieve healthy pregnancies and raise children that thrive. They can show us how they do things, and what a difference it has made in a life just like ours. They can change the social norm in a village, so that good nutrition and hygiene is just what everyone does. In the hands of doctors, a monthly weighing of babies can seem like a requirement imposed on us by someone of authority. In the hands of our neighbors, it becomes a community event: for example, the Pastoral’s Dia de Celebracao da Vida, with games for children, songs and food. Being from the community is what gives it power.