Chapter 5
Lessons for Communicators

Experience with social mobilization, social marketing and community participation in developing countries has stirred a good deal of critical thinking and writing on operational and ethical issues during the last two decades. There ar e a myriad of things to consider, such as how to sustain programmes, institutionalize skills and replicate successes. What management methods are most appropriate and what is the best personnel mix when forming a programme team? Which are the best researc h methods to employ in different situations? How should products and services be positioned? And, in what circumstances is it most appropriate to employ social marketing, social mobilization or full-scale community participation where the community is inv olved in choosing and prioritizing problems to solve?

In this final chapter, I have attempted to bring together the lessons communicators can learn from the projects and programmes reviewed in this book, as well as other experiences in development communication gleaned from various sources.

Positioning and Manipulation: The Anthropologist's Dilemma

Social marketers feel that they are fulfilling the expressed needs of target audiences; that their methods do not constitute manipulation. In the first place, they point to the fact that the products or concepts they market really allow the consumer to pa rticipate in his or her own health care and welfare. Through social marketing, people can buy products such as Ors packets or condoms for very low prices at outlets near their homes. Social marketing, they claim, gives people the information needed to mak e informed choices. Their products are in the marketplace, competing with everything else, including commercial goods and messages. People can decide for themselves what products they want.

Social marketers view the process of marketing as one of uncovering unfulfilled demand, not creating demand. For instance, in family planning, 10 to 20 percent of the couples of reproductive age do not want more children but, at the same time, are not usi ng any kind of contraceptive. Social marketers try to find out why this is so in order to give them the information they need to make reasonable choices. In this way, they feel, people are not being manipulated by a system over which they have no control.

But do people from lower socio-economic classes, those who are supposed to benefit most from social marketing programmes, receive and understand enough information to make educated choices? Do they have enough information to use the socially-marketed prod uct properly? In Chapter Two, I outlined an anthropological study¹ which provides evidence that some people may not be using contraceptives correctly because of traditional beliefs about the human fertility cycle. We cannot assume that peop le always have enough information or education to use socially-marketed products properly. The disadvantaged consumer is the most likely to be deceived².

But to what degree can people be manipulated? Social marketers point out that there is a popular misconception about the ability of marketing to manipulate buying behaviour and in the marketing of social products and concepts it is even more difficult to do so. Most of the behaviour related to improved health, nutrition and family planning involves tremendous adjustments and costs in time, money and socio-cultural norms--not the mere purchase of a tube of toothpaste. But this argument does not settle the matter. However true it may be, just because it is not easy to market social products and concepts, it does not follow that there is no manipulation in social marketing.

Another line of defence for social marketing may be that extensive research is used to fully understand the point of view of potential clients. The methods include focus group discussions, in-depth interviews, observation of life styles to see what people actually prefer, finding solutions which are best from their perspective. Social marketers claim that this kind of research should be considered when judging their methodology. Whereas traditional public health approaches entail the assumption that every one wants the service, marketing involves research which might, ultimately, bring about a change in that service or product. It is a two-way process.

However, even if marketing is really predicated on this form of participation, that does not mean it is a totally participation-derived methodology. The social marketing model involves a process which extracts information from consumers and uses that info rmation to modify products and concepts that are fed back to them through messages and packaging or positioning. The quality of the research in this process will determine the extent to which social marketers are really reflecting people's perceptions. Un fortunately, the field of consumer research has not matured in many developing countries. Techniques such as focus group discussions are often misused. For instance, focus groups are supposed to be composed of homogeneous groups of people who do not know one another. In a rural setting in developing countries this is often difficult and expensive to organize. Very often, in practice, one or two wrongly-constructed focus group discussions will be used to plan a whole campaign.

A related problem is the complex working relationships between the various actors in a social marketing programme: health professionals, epidemiologists, marketing and communication experts, behavioural scientists and anthropologists. Who directs the prog ramme? Who determines what kind of messages are to be used? Who determines how products are to be positioned? Traditionally, the role of the anthropologist in international development has been that of a "troubleshooter" someone who comes in to find out why things went wrong, why projects failed³. Anthropologists have expressed dissatisfaction with this "back seat" role. In social marketing they come to the "front seat", contributing to the development of the programme in the formative res earch stage^{3, p.1-2}. The anthropologist has the potential to decipher local values, beliefs and practices which affect the acceptance of such products. If the product appears to go against traditional beliefs it is positioned in a way that will make it more acceptable.

The process of positioning a social product is much more complex than positioning a commercial product because commercial marketers are not necessarily concerned with the social consequences of their actions. On the contrary, the social marketer is attemp ting to solve social problems and it would be counterproductive to create a new social problem or to reinforce beliefs which are detrimental to progress while positioning a social product.

An example of the ethical questions involved in using anthropological knowledge in positioning products comes from the Mass Media and Health Practices project in Honduras (see box page 151). With the tools of anthropology, the social marketing team is abl e to uncover very complex, traditional, belief systems concerning illness and associated treatment. But how does the team apply this knowledge? Would it have been proper to promote Ors as a purgative for empacho in Honduras? Purgatives increase dehydratio n. By asking people to acquire Ors as a purgative, a social marketing programme would be reinforcing the traditional practice of taking a treatment which may lead to the death of children. Similarly, by packaging Ors as a medicine instead of a simple suga r-salt solution and using local concepts to promote it, such as worms in the abdomen, social marketers may be reinforcing beliefs which are incompatible with long-term educational goals.

Fox and Kotler said that social marketing is not manipulative "if a cause is marketed openly" and if "a social marketer simply makes the strongest possible case in favour of a cause without distorting the facts" ^{6, p.30}. If a decision was m ade to position a product or concept in a way which is quite contrary to the truth (e.g. Ors as a purgative for empacho), it almost goes without saying that the social marketing programme would be manipulative. So social marketers may have to resign thems elves to positioning their product with "dehydration", a concept which does not appear to have many parallels in local belief systems.

Social marketers may take the last line of defence, a utilitarian approach, claiming that the end justifies the means in their programmes. That is, they are only trying to save lives. However, infant formula marketers in developing countries may have clai med the same before it was found that their products were having the opposite effect. Without honestly addressing these questions in their programmes, or without institutionalizing a capacity to properly deal with such questions in local organizations, so cial marketing methods may certainly lead to manipulating target audiences.

As discussed in the first chapter, the concept of deception or manipulation in marketing has at least four main dimensions:

1. the intent of the communicator;
2. the capacity of the message to deceive;
3. the fact of a person's being deceived; and
4. the standard of judgment to use in determining the extent of deception.⁷

In considering the first dimension, because social marketers are, by definition, attempting to solve social problems, and hopefully not trying to gain a commercial advantage, it seems unlikely that they would be involved in manipulating or deceiving peopl e, except misguidedly. The third dimension is extremely difficult to resolve. Even if deception is intended, it is possible that people may detect the attempted manipulation, consider the options, and go along with the messages anyway. If this happens the y have not been manipulated, although it may appear to be so. The questions surrounding this dimension are complex and the answers can only be speculative. Therefore, I have concentrated on the second and fourth dimensions and have concluded that social m arketing methods, like those of commercial marketing, have the capacity to deceive people, especially when those methods are based on poor-quality research or when anthropological knowledge is used in an unfair or less than open way.

The difficulty in establishing ethical standards when tampering with traditional belief systems requires that social marketers be aware of the choices they make in formulating messages. Many traditional concepts, such as those concerning diarrhoea in Hond uras, are probably incompatible with the realization of long-term health and development goals. There appears to be no substitute for long-term education in changing such beliefs, whether that education be programmed through community workers or evolution ary by continual exposure to messages and information through various media.

This, then, is the dilemma of the anthropologist. He or she is capable of discovering the keys which may help a programme meet its objectives but is, or at least should be, confronted with ethical questions as to how this new-found knowledge can be used.

Community Participation: Pros and Caveats

It must be evident in the examples of social marketing and social mobilization discussed in the preceding chapters that little success has been achieved in developing countries using a strictly mass media model. As concluded in Chapter Two, the most succe ssful strategies in family planning have involved multiple channels, including strong, community-based programming. Also, in Aids education, mass media is seldom sufficient to bring about behaviour change. Networks and peer counselling are needed, involvi ng those most at risk. In Chapter Three we have seen that nutritional improvement and the control of diarrhoeal diseases also depend a great deal on community health workers and volunteers. Finally, in the examples of programmes which follow the social mo bilization model, outlined in Chapter Four, government and Ngo field workers were the primary channel of communication and motivation.

If we consider all of these programmes at a glance, it is evident that much of their claimed success has depended on interpersonal communication and the participation of community-based workers. This is quite contrary to the idea that you can change socia l concepts or sell social products effectively through mass media channels. The overwhelming evidence indicates that in most developing community contexts, there is no substitute for the much more difficult work of community involvement and education. One might ask, then, if there is really any difference between successful social marketing or social mobilization and community-based initiatives which involve a full participatory approach?

As discussed in Chapter One, the main difference between social marketing activities and a completely participatory approach is that in the former the community is not involved in ranking community problems and in deciding what to tackle in what order. No r was the community involved in this way in the social mobilization efforts reviewed, except in the case of the Iringa Nutrition Programme of Tanzania. Some claim that unless and until such involvement takes place, people will not take ownership in develo pment initiatives nor develop a community spirit and real change will not come about.

There are many arguments for community participation. White⁸ gave a summary, as listed on page 156. Not all of the justifications for participation will apply in every situation. However, taken together, they provide a strong argument. The push towards community participation, which began in the 1970s, was an attempt to reapply the principles of the experiments in community development that were fashionable in the 1950s and 1960s. However, most of the cooperatives and community development experiments of the 1950s and 1960s ended in failure because they assumed that communities were internally harmonious and autonomous enough to be able to carry out collective actions in their own interests⁹.

The idea that a small investment in a community in one sector would lead to a chain-reaction of self-sustaining development projects in other sectors simply did not work out¹⁰. Initiatives which were supposed to be egalitarian in nature ac tually increased the relative advantage of the more progressive members of the community at the expense of the weak, resulting in a disruption in traditional community organization⁹.

Many of the past experiments in community participation only involved "cursory consultation" and were in fact "ritualistic rather than substantive"¹¹, p.342. A closer look reveals that many experiments have been "top-down initiatives" depen dent on a charismatic leader and that they have only been able to bring about marginal improvements, seldom benefiting the poorest sectors¹¹, p. 342. For social marketers the completely participatory approach is too idealistic, impractical and nebulous. It is rejected because its impact is so small in scale. With the global restraint on funds available for development, community-based approaches in which people are asked to set their own agenda are not regarded as cost-effective. If all com munities were allowed to decide on their own priorities in an open process, it would be very difficult to arrive at national priorities or to produce national development plans.

Another counter-argument by social marketers is that any action taken by an outside force towards the development of a community can be manipulative. Community-based activities often depend on the driving force of one charismatic person or a small group o f motivated people. Such people may be well intended but may also have particular political points of view which they are attempting to sell to the community. Even if party politics are not part of the plan, community participation projects can be manipul ative in political directions. That is, community organizers sometimes come to the people with a particular world view, contrasting the "haves" and "have-nots" in emotion-laden exercises which eventually bring the community around to their view. Or they m ay come with technology, such as interactive video, which is used to facilitate what may be an alien process, thereby breaking down traditional power structures within the community.

Social marketers may also claim that community-based activities are more manipulative than social marketing because they involve community pressure. In such approaches there is a greater likelihood of coercion by neighbours to follow collective rules. The example of the family planning programme in China springs to mind. However, in marketing, people make an individual choice to "buy in" or not. It is easier to say "no" to a distributor of a socially-marketed product or concept than it is to turn down org anized neighbours. From this perspective, the marketplace guarantees anonymity and is much less coercive than community-based activities.

There can also be other negative outcomes of participation. Participation often brings about the development of a "participating elite" in a community and therefore contributes to inequality. Participation can involve manipulation by leaders, and it can a lso raise expectations which governments and NGOs have no way of fulfilling. There is always a political dimension to participation since it is tied to changes in the control of resources, regardless of the intentions of those who administer programmes, a nd attempts at restructuring resource allocation can lead to conflict and violence. It is naive to believe that governments or ruling elites will give up control without a struggle.¹²

During the International Drinking Water Supply and Sanitation Decade (1981-1990) there was a great push for community participation in the delivery of water supplies and sanitation. However, according to some of those involved, much of the call for partic ipation was a push from donors and "community participation" became a "buzz phrase" with a wide variety of ill-defined meanings such as "self-help", "self-reliance", "user-choice", "community involvement" and "participatory planning and development". In c onnection with community participation people often talk of "felt needs", "local perceptions", "bottom-up planning", "motivation", "latent development potential", "catalytic development inputs", "integrated development at the village level" all highly complex concepts with different meanings in different contexts.^{13, pp.19-20}

Community participation is usually beyond the resources and ability of governments and so interested donor agencies sometimes turn to NGOs. Such agencies have proven they can be effective, working close to the people, often employing technological interve ntion as a means to community development, not an end in itself. The activities of such groups may be the only alternative in some regions in the face of government inability or inaction. However, few NGOs have been able to acquire the resources or the or ganizational framework to take programmes to scale. Just about anything is possible at the pilot stage but the proliferation of small, grass-roots programmes by a multitude of NGOs or voluntary organizations can also bring about a dizzying array of techno logies spread across the land. Lack of standards may pose great problems to those who are left to hold the pieces together.

Finally, the long and complex process of community participation is often very costly and takes a great deal of time to accomplish. Programmes are not necessarily cheaper just because village people provide labour. For every hour a villager devotes to a particular endeavour, an opportunity cost may be incurred. That is, he or she may give up the opportunity to devote time to other activities which could possibly be more productive. The view that villagers should automatically participate because they have nothing better to do is a pejorative and condescending concept. The value of a villager's time is often overlooked in project evaluations. In community participation, the catalyzing agency may make the assumption that time taken by the villagers will eve ntually improve their well-being. However, villagers may have to wait a very long time to see if the participation pays off.

Although donor agencies have talked a great deal about community participation and reaching the poorest of the poor since the early 1970s, they remained centralized bureaucratic organizations which are biased toward projects, as opposed to integra ted programming, and they have little capacity to respond to diverse community-defined needs. Korten drew the conclusion that:

Projects by nature deal with time-bound start-up costs and emphasize facilities and equipment to the neglect of the development and funding of capacities for their sustained operation and maintenance. Their demands for detailed, up-front planning, coupled with rigorous adherence to fast-paced implementation schedules and pre-planned specifications, assumes task requirements are well understood when, in fact, even the nature of the problem is ill-defined. Furthermore it virtually ensures that the real decisions will remain with professional technicians and government bureaucrats neither of whom are rewarded for being responsive to local conditions nor contributing toward the development of local institutional capacity.^{10, p. 484}

Employees of major donor agencies remain involved in moving ever-increasing amounts of money in shorter time periods with fewer and fewer human resources. They are following what Korten calls "the blueprint approach" in which pilot projects and other studies help planners choose the most cost-effective design and implementing agencies execute the project plan faithfully, just like a contractor follows blueprints for constructing a building.¹⁰

In the late 1980s and 1990s, another constraint was added to the attempt to find a workable community participation model compatible with donor agency agendas. With the decline and fall of communism, capitalist economic theories have become increasingly dominant in development circles. Backed by the monetary clout of the World Bank, the free market economy is extolled as the model to follow and business interests in donor countries have become openly inter-twined with international development processes. The once guilt-laden term, "tied aid", now only evokes a shrug of the shoulders because world economies are perceived as inter-connected. Developing countries are viewed as potential markets for Western products and vice-versa. In this atmosphere, it is b ecoming even more difficult to see how agenda-setting by communities can seriously be taken into account. If donor countries are driven by the need to sell their own products and services, the whole development agenda becomes more and more defined in the boardrooms of corporations, both in industrialized and developing countries, far from developing communities. Within this scenario, attempts at community participation may become just another element of the "blueprint".

In summary, there are just as many problems for community participation as there are possible positive outcomes. These are summarized in the panel on page 161. It is evident that there are many sides to the debate over community participation. Full-scale participation has seldom been possible and attempts to employ it should consider three main caveats:

Caveat 1: Participatory processes are not a panacea for development and not suitable for solving all problems. A mother with a child dying of dehydration does not want to participate in a long-term process. She needs information and action.

Caveat 2: The opposing concepts of participation and manipulation may be viewed from many perspectives. A participatory social communicator entering a village with a particular picture of reality or "world view" to sell may be equally manipulative.

Caveat 3: The price people pay to participate is often overlooked. It is often assumed that villagers have nothing better to do than to "participate". For every hour spent in participating, the villager pays an opportunity cost of foregoing other, potentially more productive activities.

On the other hand, we have an almost intrinsic feeling that participatory processes are one of the keys to sustainable development. The use of participatory communication techniques such as interactive video, community radio systems and rural newspap ers are excellent ways to involve people in decisions which affect them. Full-scale participation, in which the community prioritizes problems and makes decisions on resource allocation, has a place in integrated community development programmes and incom e-generating activities. In the case of the Iringa Nutrition Programme in Tanzania, a full, participatory approach was built around the attempt to find solutions to malnutrition and child mortality.

Later in this chapter I shall further discuss some of the implications of the Iringa experience. However, in general, I conclude that it has seldom been possible to take a full, participatory pilot project to scale.

Now we return to the concept of communities, at various levels in the national arena, participating in courses of action which are decided upon at the national level rather than the grass roots.

A Synthesis of Advocacy,Social Mobilization and Programme Communication

In many ways the social marketing model fits very well with the "new world order" of the 1990s. It can be understood easily in development circles which are more and more business and free- market oriented. As discussed earlier, if it is carefully applied , it also involves a process of continual learning, in close contact with the perceptions of the target audiences, and therefore offers a partial answer to some of the questions concerning participation. In theory, social scientists are involved from the beginning in selecting and modifying the products and concepts to be marketed, according to the preferences of the consumers; in defining and segmenting the market; in working with marketers on the positioning of products and concepts; and in working with communication specialists in developing the right messages for maximum effect. In the final step of this model the review of activities is fed back into programme design.

In this approach there is, in other words, a continual reassessment since people are never static. Preferences change and therefore products, services and concept offerings as well as positioning must change. This is as close as social marketing can come to community participation. People are certainly consulted but there is no provision for building societal consent for an innovation within the process. Nor is there a vision of how a universally-available innovation may be demanded and adopted widely in a given time.

The experience with social mobilization for the Expanded Programme on Immunization and other programmes, described in Chapter Four, sheds some light on the constraints of social marketing. Around the world, a large number of motivational activitie s have been carried out, leading to unprecedented coverage levels for a social programme. In the case of Bangladesh, I have classified these activities as Advocacy, Social Mobilization and Programme Communication. I have defined social mobilization in Cha pters One and Four. However, advocacy and programme communication need clarification. Programme communication is simply a term for the communication processes involved in social marketing minus the marketing language. It includes all of the valuable resea rch components which social marketing has brought to the field of development communication. It is a more widely-accepted term which avoids the misunderstanding which is often unavoidable when marketing language is used in development contexts, as discuss ed in Chapter One. Programme communication is also readily understood in the context of the community-based, interpersonal communication activities which were found to be so necessary in the programmes described in Chapters Two, Three and Four. For clarity, I have defined the three main concepts below and graphically shown how they are related on the next page:

Advocacy consists of the organization of information into argument to be communicated through various interpersonal and media channels with a view to gaining political and social leadership acceptance and preparing a society for a particular deve lopment programme.

Social mobilization is the process of bringing together all feasible and practical inter-sectoral social allies to raise people's awareness of and demand for a particular development programme, to assist in the delivery of resources and services and to strengthen community participation for sustainability and self-reliance.

Programme communication is the process of identifying, segmenting and targeting specific groups/audiences with particular strategies, messages or training programmes through various mass media and interpersonal channels, traditional and non-tradi tional.

The model on page 164 is important for it allows us to classify and relate a large number of activities, the purposes of which are not well understood outside the information and communication field. In the context of this model, advocacy consists of a large number of what are traditionally known as information and public affairs activities, such as lobbying with decision makers through personal contacts and direct mail; holding seminars, rallies and newsmaking events; ensuring regular newspaper, magazi ne, television and radio coverage and obtaining endorsements from popular people. The goal of advocacy is to make the innovation a political or national priority that cannot be swept aside with a change in government. Advocacy, in the first instance, may be carried out by key people in international agencies, as well as special ambassadors, but is gradually taken over by people in national and local leadership positions and the print and electronic media.

Advocacy leads directly to social mobilization, a process which involves the addition of more national partners for advocacy and programme communication activities, resource mobilization and service delivery. It is my opinion that the concept of social mo bilization within the model given above, helps a great deal in understanding how social mobilization is related to the rest of the communication/information world. It is the glue that binds advocacy activities to more planned and researched programme comm unication activities.

As the process of social mobilization gathers momentum, advocacy is taken up by a whole new range of partners so that early advocacy is magnified many-fold. A host of allies at the national, regional and community level will join in, influencing a wide sp ectrum of society. Some of the same allies may join directly in service delivery, mobilizing resources from international, national or community sources; providing new channels for communication; providing training and logistical support for field workers who will implement the programme; and, in some cases, managing field workers directly. Social mobilization, therefore, magnifies advocacy activities and strengthens programme communication, for many more societal partners participate in the programme, su ch as NGOs, grass-roots organizations which often have the motivation and skills for involving local communities in programmes.

The activities of advocacy, social mobilization and programme communication do not necessarily happen in a consecutive order. However, in general, advocacy begins the process and leads to social mobilization and programme communication. But the "planning continuum" arrow on the circles is two-directional because advocacy is needed at various times in a programme's life, not only at the beginning. For instance, in Epi in Bangladesh advocacy was first geared to gaining political and social commitment to the programme and this facilitated rapid expansion. However, with changes in Government five years into the programme, it was found that specifically- directed, high-level advocacy was needed once more to bring the new leadership "on-board", even though wide-scale, societal ownership in the programme remained strong. Also, as the programme matured, advocacy was used to underline the need to make programme adjustments, such as the need for a new strategy to deal with drop-outs and left-outs.

In terms of analysis and research, the planning continuum is also two-way. Advocacy must remain somewhat opportunistic and therefore less planned and researched. Social mobilization benefits from a thorough analysis of who the best partners are for a part icular programme, and what they potentially may contribute, but also should involve some experimentation and lateral thinking since social mobilization is most successful when the chain of command is decentralized, allowing for alliances which may not hav e been conceived of at the central level. On the other hand, programme communication should be backed by planning research, formative evaluation, programme monitoring, as well as summative and impact evaluation, all research steps involved in the process of social marketing, as outlined in Chapter One, page 11. There should also be an attempt to standardize messages among partners.

The outer circle of this model is necessary but not sufficient, in most circumstances, whether it is called social marketing or programme communication. The lesson which should be learned from the analysis of all the efforts described in this book is tha t many communication programmes have begun and ended in the outer circle. Careful consumer research may be carried out but there is an absence of strategy for creating a societal ownership and demand. In the original social marketing model, there is no im petus for communities to buy into the idea. It is based on an appeal to the individual, if he or she can be reached. In many developing countries, reaching people with new ideas is the most difficult thing to do. Adding the social mobilization element to this communication model ensures that the product, concept or innovation will be widely diffused through various interpersonal channels.

Even without agenda-setting by the grass-roots community, the social mobilization element within this model, if taken to its fullest, can provide wide-scale participation and ownership. Through social mobilization the programme becomes so widely known and accepted that it is not viewed as an imposition. A vertical programme becomes horizontal. It becomes part and parcel of society. Community leaders throw in their lot and communities become mobilized for the cause. The demand creation brought about by soc ial mobilization ensures an accelerated process of diffusion.

Secondly, the formative research involved in programme communication is not lost in this model. As previously discussed, such research involves the community in defining concepts and how they should be communicated. The programme communicator learns about the beliefs and perceptions of the community and adjusts concepts accordingly. In a later stage of the programme, research may reveal that there is a need to take on new allies or that communities are sufficiently aware of programme goals and services to decrease support for certain activities. In other words, the process of analysis can take place throughout each of the concentric circles at any time. In this way, the activities encompassed within advocacy, social mobilization and programme communicatio n are not linear and do not become stagnant. As realities and communities change, adjustments are made.

Where can the model be applied?

The above model must be tested further with other programmes, concepts and innovations over time. Immunization is one thing that almost everyone wants, once its survival benefits are widely understood. In some societies, the control of diarrhoeal diseases, breastfeeding and other nutrition programmes, family planning and changing Aids-related behaviour may become rallying points for a mobilization process. However, changing hygiene, dietary and sexual behaviour is much more difficult. That does not mean t hat the model is inappropriate for social programmes which seek change in such areas but it may take longer for change to come about. However, it is unlikely that all programmes are candidates to be starting points or "leading-edge" programmes. For instance, acute respiratory infections (Ari) require a more straightforward programme communication approach. It is likely that Ari would benefit from a system already energized by another main programme but it is unlikely that one would be able to mobilize nu merous allies for Ari. At any rate, it may not be necessary or desirable to apply the same level of mobilization for all services which are added to a "leading-edge" programme such as Epi. That is, if a health delivery system has been given a boost by a p rogramme such as Epi, other interventions such as the supply of Ors, vitamin A, iron folate and counselling on breastfeeding and child spacing may be added gradually.

Other likely candidates for social mobilization in most societies are programmes such as universal sanitation and the education goals set by the World Conference on Education for All in 1990. Both programmes appear to be obvious anchors for a grand allian ce of partners, such as political, social, and religious leaders; women's groups; service clubs; and Ngo, religious and private schools. These partners can be involved in strengthening service delivery. The process begins with advocacy and moves into soci al mobilization but also adds the dimension of carefully planned and researched programme communication which will target major problems such as drop-outs and the low enrolment of girls.

In the diagrams on page 137, 169 and 170 I have outlined how these programmes have been conceived in the context of Bangladesh. Not all the partners and channels of communication will apply in all countries but the examples may be instructive in expandin g the use of the model in other programmes.

Within all of these programmes it is essential that we establish political will through advocacy and that we mobilize a wider spectrum of allies in order to make a difference. It is equally important that we apply high-quality research methods to such pro grammes so that the most important channels of communication are identified and improved from the beginning and standard messages are given by all partners concerned.

However, even if the three-part model can be applied to a large number of problems, it may not have universal applicability. For instance, in religiously conservative and male-dominated societies it may be very difficult to find a large number of allies t o advocate or mobilize for breastfeeding. Likewise, family planning and Aids education may be taboo. And still more difficult are non-democratic countries where there are strict controls on the media and where governments may consider social programmes to be their business alone. In such countries "mobilization" will likely remain coercive and communication channels strictly controlled. Communication activities will probably remain restricted to the transmission of approved messages via mass media and the field workers of the sector concerned. A pure programme communication method may be feasible through these channels but it would be difficult to broaden the process into a social mobilization through advocacy. In addition, if the people are repressed and moving toward rebellion, positioning the programme with the central government may do damage to its acceptability. It is fortunate for us, and for the application of the ideas contained within the model, that there are fewer and fewer examples of countri es where it may not apply as we proceed into the 1990s.

But what about community participation in the sense of agenda setting by beneficiaries? Does this model allow for it? The answer is, where full-scale community participation is possible, there is no conflict within this three-circle model. In the case of the Iringa Nutrition Programme in Tanzania, the programmers advocated at the national, regional and local level for their programme in order to develop a supportive environment for the participatory processes. No one from the Prime Minister to the village council leader was allowed to remain neutral to unacceptable levels of malnutrition and child mortality. The mass media became involved in popularizing the programme's goals. Participation was not seen as a goal in itself. In this sense, the programme w as both "top-down" and "bottom-up".¹⁴

Advocacy supported social mobilization, a process which began with problem assessment and analysis at the community level and moved on to action on chosen courses, involving many strategic allies at all levels in a wide range of support activities. Early mobilization created demand. Through continuous assessment, analysis and programme monitoring, the programme of action became more and more refined.¹⁴

The programme involved all available media channels including films, interpersonal communication and traditional media¹⁴. Thus programme communication, including excellent interactive training strategies for interpersonal communication, wa s employed to spread knowledge and action to an ever-increasing number of participants and, eventually, to facilitate its expansion to new regions of the country. There were many programme aspects of the Iringa experience which I have not described here. The point of the above analysis is that from a communication perspective, the Iringa Nutrition Improvement Programme involved all of the elements of advocacy, soci al mobilization and programme communication. The repetition of the three-circle model on the next page, with adjustment for full-scale community participation, should make the above points clear.

However, as earlier discussed, this version of the model is the most difficult to apply. Although there were a good number of programmatic factors which made Iringa a success, there were also a host of environmental factors. As previously mentioned, when the programme began, Tanzania had undergone 25 years of grass-roots, social transformation and had implemented national policies, such as universal primary education, which increased the literacy rate to almost 90 percent¹⁴. In addition, th e traditional settlement pattern had been totally reorganized from a difficult-to-mobilize, scattered population, to collective villages. Tribalism had nearly disappeared. Local government structures, which had been abolished, were re-established in 1986, allowing for decentralized decision making^14. These factors were also important in the noted success of replicating the Iringa programme in other parts of Tanzania.

However, in attempting to transplant the Iringa approach to other countries and continents, programmers may meet with formidable obstacles. In South Asia, for instance, there are many factors inhibiting full-scale participation, such as the caste system in Hindu communities and a top-down concept of governance inherited from colonial times. In Bangladesh, there is strong, pragmatic individualism and poor village-level structures and organizations to support such a programme. There are also strong patron- client relationships derived from the landlord system which was strengthened during colonial times. This strong system of benefactor and beneficiary is reinforced by traditional concepts of charity and the central government establishment. It has been sai d that, in Bangladesh, even the relationships between NGOs and the people are patron-client oriented rather than social movements.

In such a society, the adoption of full-scale participatory methods in setting priorities for action would be difficult to achieve. It would require a major social revolution which could quickly become politicized, given the multiple political groupings a nd factions which are struggling for control of resources in the new wave of democracy which has overtaken the world today.

In spite of such constraints in many countries, the social mobilization programmes described in this book have demonstrated that the end result of the process is the participation in programme goals of a wide spectrum of social allies and communities, inc luding the grass-roots. There are lessons to be learned in the management of mobilization, research and training which can help to strengthen the process and increase community participation. I shall now turn to those lessons.

A Summary of Lessons Learned

This book has entailed a survey of a large number of programmes in public health, nutrition and family planning fields which have used, to varying degrees, the methodology of social marketing and social mobilization. There are many lessons in these pages for the management of programmes and institutionalization of skills which ultimately relate to the sustainability and replicability of such programmes. I have summarized a few of the main lessons, below, but have also drawn on other experiences in order t o give the reader more substantial information on social mobilization and programme communication.

Managing mobilization
In the context of one household, once one child has received a health service such as immunization, there is a greater likelihood that subsequent children born to the family will be immunized. In other words, the goal is to create a "culture" for an innov ation such as immunization¹⁵. Many of the communication programmes undertaken to address health, nutrition, education, population and environmental problems around the world have started and ended in the "outer circle" of social marketing o r programme communication without addressing the problem of gaining strong political commitment and without identifying and empowering allies who can create a "culture" for programme goals. When the elements of concerted advocacy, social mobilization and programme communication are successfully combined, the result is a critical force for bringing about fundamental progress in relation to the goals of social programmes.

In creating a "culture" programmers should not create dependency. Although it is excellent that health providers reach out into the community to create demand for services, balance is needed. The strategy of taking health care to the people may encourage a culture of dependency on government outreach¹⁵. Door-to-door service provision is not a good policy under most circumstances. If people provide an outreach post at some cost to them, the programme has a greater chance of being sustained.

It is not possible to continue mobilization efforts at the same level for an extended period of time. Once a population is fully aware of a programme and is demanding its services or product, awareness-building events may be held periodically, while servi ce delivery and reinforcing communication between field worker and client remain constant.

Mobilization of partners must be built on a basis of mutual benefit. They have often been regarded as convenient accomplices whose loyalties can be temporarily purchased. One of the unfortunate consequences is that it may create expectations among partner s for material and financial support in exchange for further involvement¹⁶. This should be avoided.

The sustainability of social mobilization is directly and positively related to the degree of control a government or project leader is willing to give up. The social mobilization process encourages the participation of many partners who have their own pe rceptions and attitudes concerning an innovation, whether they be local government authorities, NGOs or service clubs. However, they should continue to receive strong central guidance and support. Decentralization should not be seen as an alternative to c entralization but as an extension of it¹⁶. Day-to-day decision making at the local level takes time to develop and needs to be reinforced and supported over the long-term.

There are a number of other process indicators which can be used to monitor social mobilization to determine if the programme is reaching sustainability (see page 176).

Messages and research
Often there is a rush to produce messages on materials such as posters, flip charts and flashcards before distribution channels and utilization methods are established and before field workers have the skills to use such material properly. These materials may give visibility to a programme but often entail a waste of resources without such synchronization.

Social marketing and social mobilization must work within the mind-set and indigenous knowledge of beneficiaries. There are excellent qualitative research methods available for determining the most important elements of belief systems. Sometimes programme s entail formative research but production of communication materials goes ahead before the research is complete. Communicators often do not know the basic minimum required in the planning and research process.

When consumer research is applied it is often shoddy, especially focus group discussions. Focus groups are "in vogue" but very few people know how to run them properly. For instance, one rule of focus groups which marketing experts insist upon is that the members of the group should not know one another so that they can speak freely, unhindered by existing relationships. This is often overlooked in development work because it is difficult and expensive to transport people from various villages to a central location. It is also difficult to find a secure place, where comments will not be overheard by curious onlookers and eavesdroppers.

One of the main uses of research in social marketing is for the positioning of products and concepts vis-a-vis complex, traditional belief systems. This is difficult to do well and can become a manipulative endeavour if not carried out by profess ionals and used ethically. However, when there is a shortage of time or money in programmes, the formative evaluation, feedback and revision phases often suffer or are even dropped entirely. Often, administrators of programmes do not understand the purpos e and value of such research and it is seen as an unnecessary step, blocking progress. They prefer that communicators get on with the job of producing posters and videos or anything that is visible and may impress their bosses in turn. Very often, communi cators give in to this kind of demand.

Significant progress has been made in bringing about awareness amongst people. But few communication strategies promote understanding of these issues by the people. Messages must go beyond simple slogans to address the "whys". We must carefully examine wh at people need to know. Too much technical information does not always lead to improved knowledge or practices and can confuse people. Messages should be "actionable".¹⁸ There are methods for mobilizing people that do not require their prior knowledge, in the first instance, of the detailed benefits of an innovation. For example, in Epi activities the most salient factors are the physical presence at vaccination sites of a person of high credibility and integrity and the participation of women from the community who previously had their children immunized, to act as change agents and role models in their community¹⁵.

Often messages are too complex and aligned with beliefs which cannot easily be changed or with sources that are not credible. The entertainment-education movement has brought new energy and imagination to many population and health programmes around the w orld and should be expanded. Likewise, traditional folk media should be utilized to convey programme messages where such forms of communication still have wide appeal.

Finally, more effort is needed in the formulation and implementation of research which actually measures behavioural change. Little is known about the extent to which such change actually takes place or how it should be measured. Few programmers build int o their plans the necessary longitudinal studies which will document changes over time. Such studies must also be able to measure the influence of various interventions and environmental factors in order to prove the case for communication methods.

Relating research to action
When research is commissioned, it is often carried out in isolation by a professional research group. Unless policy makers are involved in the research from the beginning, they may reject the findings because they do not understand the purpose or need for the research, especially that of a qualitative nature, or may question the methodology and therefore the findings. Programme managers, who often come from a technical field such as medicine, may not be conversant with qualitative methods and may want har d data on which to base decisions. They must be thoroughly briefed beforehand so that the lack of tables and numbers is not a surprise to them.

One method of managing research found to be successful in social mobilization programmes is the convening of a technical committee from various relevant sections of government, NGOs and donor agencies who review the objectives and methodology of the resea rch, follow its progress through periodic briefings and give feedback on the final report. This gives wide-scale ownership to the results and allows people to think about the implications of the research as the results become available. Researchers, in th is method, must give up some control and be less protective of preliminary data. Although this may cause problems in some cases, the preliminary nature of the results can be emphasized continually at technical committee meetings to prevent the misuse of d ata.

However, when the final report is ready it is essential that it not be "shelved". If ownership in the report is wide, there is less likelihood that this will take place. One excellent method of avoiding the disuse or misuse of research is to time the rele ase of results with the beginning of a new planning cycle for the programme. By coding the major findings and recommendations for use by different sections of the programme, such as management, logistics, surveillance, communications and training, it is p ossible to feed research results directly into problem analysis and strategy formulation. In Bangladesh, the Epi programme has carried out such an exercise successfully, using a methodology called Visualization in Participatory Planning (see panel on page 180-181).

Planning, Training and Partnership Building
Many social mobilization strategies have not put enough emphasis on improving the service provider's willingness and capacity to respond to the needs of the people. The credibility of the service delivery system will be damaged if the people's expectation s are raised but fail to be met by service providers¹⁵. There is no substitute for the long and sometimes difficult task of training field workers to be effective mobilizers, communicators and counsellors or for assisting the establishment of peer networks amongst people who are the most vulnerable. Even where there is wide-scale social ownership in a programme, this element may be weak.

One of the most overlooked facets of many social marketing and social mobilization programmes, which has a great bearing on institutionalization and sustainability, is the extent and quality of training. Too often, programmes suffer from outmoded training methods in which field workers, mid-level managers and administrators are lectured to for hours.

Trainers need to be trained to employ participatory methods such as visualization, role play, observation, small group discussion, interactive video, practical demonstrations and field observation. Supervisors and managers should be exposed to the same. U nless there is a change in training culture we cannot expect a change in the culture of communication between field worker and client.

Once a core group of communication trainers has been established, training success will benefit from decentralization. Trainers who are given the tools and the opportunity to construct their own syllabus and determine the best methods to apply in a given area will take ownership in their programme and put more effort into motivating field staff to become good communicators.

Visualization in Participatory Planning (Vipp)
The Vipp method is a useful methodology in training and orientation of field workers, as well as planning with partners. Vipp counters the "seminar culture" which is predominant in most workshops, training and orientation sessions as well as so-called pla nning meetings in many developing countries. These are usually formal affairs where participants are required to listen to a large number of speeches from a dias, set rigidly before rows of chairs or a boardroom-style table. Hierarchical relationships are strictly adhered to. Speakers come with fixed positions on various subjects and attempt to pass on information in lectures, relying on their wit and charm to keep audiences receptive. Very often discussion sessions consist of another series of formal spe eches with little or no feedback. Much of the content of speeches is lost to audiences.

Although there are many methods for participatory group interaction, the Vipp method is different. It relies on the preparation of a large number standard-size cards of different colours on which participants express their main ideas in large enough lette rs or diagrams to be seen by the whole group. Private note taking is not allowed. Participants are asked to stick to the rule of one idea per card. They are asked to synthesize their thoughts, or the thoughts of others, on these cards and to display the c ards on moveable boards.

By this method, everyone takes part in the process of arriving at a consensus. Less talkative participants find a means of expression and those who might normally dominate a group lose control and are forced to let others have their say. By visualizing th e group's main proceedings, repetition and circularity in argument are reduced. If there is a record of the group's progress, visible to everyone, it is easier to point out such repetition.

The rule of one idea per card is important. Flip charts with long lists of ideas allow only part of the group process to be visible at one time. Some of the ideas are flipped out of sight. It is possible to pin or tape flip chart paper to a wall or board. However, it is difficult to separate individual ideas, move ideas to other groupings or categories or to collapse the ideas of two sub-groups, ruling out redundancy. If there is one idea per card, all of this is possible. Individuals and sub-groups can i dentify their own work and see how it fits in with the thoughts of the group as a whole.

The Vipp method also may involve a good number of warm-up exercises and presentation through role play, a method of gaining group attention and involvement in the issues. With techniques such as role play, the proceedings of the workshop become alive to a ll. The additional level of visibility through the card system makes recording the proceedings easy for the cards can be photographed and a report written from them, or the information can be transferred directly to computer at the workshop site.

In Bangladesh, this methodology has proven extremely useful in galvanizing a whole number of partners for various social programmes such as Epi, breastfeeding, sanitation, control of diarrhoeal diseases, basic education, urban planning and child rights.

Conclusion

In this book I have shown that major social marketing initiatives around the world have relied very much on community-based activities. In this chapter, I have attempted to demonstrate how the researched communication activities of social marketing can be incorporated into a new model for broader and potentially more successful development communication. This new model was arrived at by analyzing a large number of social marketing/social mobilization endeavours around the world.

I have concluded that there is a great amount of rhetoric and confusion, as well as a large number of questions involved in the concepts of social marketing, social mobilization and community participation. In the latter field, some successes have been ac hieved, but it has not yet been demonstrated how true agenda-setting by individual communities on a massive scale, if it were possible, could mesh with the plans of governments, bilateral and multilateral agencies.

With programme communication, incorporating the research tools of social marketing, the alliance-building process of social mobilization and the extra element of advocacy, I have constructed a model which is useful in conceptualizing concerted national ac tion around a particular social problem or sector such as sanitation and the control of diarrheal disease, nutritional problems, basic education, environmental problems and in some societies, family planning and control of sexually transmitted diseases su ch as Aids.

The model should help implementing and donor agencies understand how all the various elements of communication and information fit together in the development process. The terms used by development communicators are incorporated and redefined, according t o their place in the circles. With the use of such a model, the functions of various occupations in the communication and information world are brought together for focused action in a particular social programme. Some people are involved in advocacy, som e with social mobilization and others are more involved in programme communication. As previously discussed, the borders between advocacy, social mobilization and programme communication are not exact. The activities might better be described on a continu um. They need not take place in a linear order either. There is a need for new kinds of advocacy, social mobilization and programme communication as a programme matures. Strategies must be adjusted according to the programme needs of the day.

I hope that this synthesis of advocacy, social mobilization and programme communication offers new possibilities to the success and expansion of social programmes which face enormous challenges in this decade and beyond.