Essay Grade

The Howard Journal of Communications, 20:370–393, 2009
Copyright # Taylor & Francis Group, LLC
ISSN: 1064-6175 print=1096-4649 online
DOI: 10.1080/10646170903303832
Mobilizing and Empowering War-Torn African
Communities to Improve Public Health
CORNELIUS B. PRATT
School of Communications and Theater, Temple University, Philadelphia, Pennsylvania, USA
E. LINCOLN JAMES
Edward R. Murrow College of Communication, Washington State University, Pullman,
Washington, USA
The objectives of this article are to (a) present a theoretical
framework for developing strategies and tactics that could be used
to mobilize and empower African communities and help reduce
the crippling burdens of public-health challenges, even as these
societies suffer from the effects of wars and conflicts; (b) highlight
reasons for mobilizing and empowering communities as strategic
responses to the effects of internal armed conflicts on the delivery
of health services, and, in turn, on a nation’s health; and (c)
recommend communication strategies and tactics for improving
the health of Africa’s populations both in peacetime and in
wartime. The article draws upon two models—the health belief
model and the community mobilization model—that are described
as war- and conflict-victim mobilizing and empowerment models,
which can be used to communicate with and to motivate and
inspire victims of African’s wars. These models are applied in a
case study of two Netherlands-based international development
and co-financing agencies, Cordaid and the Interchurch Organization for Development Cooperation. The article concludes with
suggestions for theory-driven empirical research on the interface
between public trust and health delivery.
This article is a substantial revision of a paper presented at the Unite for Sight Fourth
Annual International Health Conference, Stanford University School of Medicine, Palo Alto,
CA, April 14–15, 2007. We thank the editor and reviewers for their invaluable comments
and suggestions.
Address correspondence to Cornelius B. Pratt, Department of Strategic and Organizational Communication, School of Communications and Theater, Temple University, 221 Weiss
Hall (265-65), 1701 N. 13th Street, Philadelphia, PA 19122. E-mail: cbpratt@temple.edu
370
Mobilizing War-Torn Communities
371
KEYTERMS African wars and conflicts, community mobilization
model, Cordaid, health belief model, health promotion, ICCO,
persuasive communication
In recent decades Africa has experienced more brutal coups,
drawn-out civil wars and bloody instability than any other
part of the world . . . .Violence causes as many deaths in
Africa as does disease.
—Commission for Africa, 2005, p. 34
The purpose of this article is threefold. First, it presents a theoretical framework for developing strategies and tactics that could be used to mobilize and
empower African communities and help reduce the crippling burdens of
public-health challenges, even as these societies suffer from the effects of
wars and conflicts. Mobilizing and empowering such communities pose
major challenges because the welfare of war-torn communities is inextricably
linked to their health status. Second, this article highlights reasons for
mobilizing and empowering communities as strategic responses to the effects
of internal armed conflicts on the delivery of health services, and, in turn, on
a nation’s health. Our intent is to evaluate the strengths of both mobilization
and empowerment in stemming the fallout from conflicts, namely, the
reduction or elimination of health services, the endangerment of life, and
the social marginalization of victims of those conflicts.
The health promotion literature is replete with programs and health
models in pre-colonial and colonial Africa (e.g., Falola & Ityavyar, 1992;
Feierman & Janzen, 1992), and in present-day Africa (e.g., Airhihenbuwa,
Makinwa, & Obregon, 2000; Diop, 2000; Ford, Williams, Renshaw, & Nkum,
2005; Hildebrandt, 1994). With few exceptions (e.g., Cliff & Noormahomed,
1988; Ityavyar & Ogba, 1992; Jinadu & Alali, 2002), that literature focuses
largely on peacetime circumstances. This article attempts to fill a void in
the literature by examining wartime conditions especially because conflicts
have become a critical element of Africa’s political and social landscapes. It
is important, then, to give much-deserved attention to the emergency needs
of the victims of such conflicts. Thus, the third purpose of this article is to
recommend communication strategies and tactics for improving the health
of Africa’s populations both in peacetime and in wartime. To accomplish that
goal, it draws upon programs implemented by Cordaid and the Interchurch
Organization for Development Cooperation (ICCO), two co-financing
international development agencies with major wartime operations in the
Democratic Republic of the Congo (DRC).
Further, the approach taken here is important because the models
appropriate for peacetime conditions are not particularly transferable to
wartime situations, in light of the massive communication, trust, and security
372
C. B. Pratt and E. L. James
issues that emanate from the presence of thousands of refugees and
internally displaced people. According to Toole, Waldman, and Zwi (2006),
these refugees and displaced people have created ‘‘hidden emergencies,’’
yet generally do not attract considerable media and international attention.
Indeed, two significant reports published in 2005 caught the attention of
health-care specialists worldwide. The first, produced by the Commission for
Africa (2005), argued, inter alia, for rebuilding systems and scaling up
services to deliver public-health services in Africa, where more people than
in anywhere else in the world have been forced out of their homes, ending
up in slums in over-crowded cities and towns. The second report, produced
by a joint ministerial Development Committee of the World Bank and of the
International Monetary Fund (2005), proposed a five-point agenda for fostering momentum in implementing the United Nations Millennium Development Goals and the Monterrey Consensus. The agenda included a major
intensification of human development services, such as basic health care,
sanitation infrastructure, control of diseases, and women’s access to education and health care (The World Bank, 2005). The latter also asserted, ‘‘It is
important to ensure that global programs organized around specific health
interventions are aligned with recipient countries’ priorities and support—
rather than undermine—the coherence of their health sector strategies and
systems’’ (p. iii).
To accomplish all three purposes, emphasis will be placed on the centrality and importance of the community- and culture-grounded strategies
and tactics. Such targeted, community-mobilizing approaches could appeal
to both non-governmental and government agencies as they facilitate the
implementation of innovative public-health initiatives.
In essence, then, this article argues for a fundamental shift in persuasive
communication strategies and tactics for improving the health of Africa’s
populations torn by violent and low-intensity conflicts. It presents, mutatis
mutandis, both a complement and a corrective to the dominant approaches
to delivering health services in Africa during peacetime.
USING THEORY TO MOBILIZE AND EMPOWER AFRICA’S
COMMUNITIES
The community mobilization and health belief models are described here as
war- and conflict-victim empowerment models because they both involve
communities in transactions to control the impact of conflicts on their
health—an outcome on which they generally have minimal, if any, influences. According to Guttman (2000), the mobilization model emphasizes
involvement of communities in their health goals, objectives and strategies.1
Of the four models that he identifies, the mobilization model is the only one
that emphasizes high community involvement as both a health-delivery goal
Mobilizing War-Torn Communities
373
and as a strategy. That emphasis casts health programs as a ‘‘social-action
process in which individuals and groups act to gain mastery over their
lives in the context of changing their social and political environment’’
(Wallerstein & Bernstein, 1994, p. 142).
The mobilization model, which has been effective in both health
(Hidelman, 2002) and non-health contexts (Kwimba, n.d.), calls for communities to be mobilized and empowered to help define problems and proffer
solutions that increase grassroots organizations’ capacities or the strategic use
of resources to gain political leverage and to mobilize diverse constituencies
(Guttman, 2000). Indeed, Guttman also noted the unique capacity of the
model to involve consulting, mentoring, and training in skills and to value
conflict, in that stakeholders are more likely to acknowledge differences
among groups about what is important and how things should be done.
A second model, the health belief model (HBM), focuses on the
information-processing strategies of individuals who can then help engender
community activism for health promotion and improvement, but only to the
degree that enabling administrative and societal factors allow. Like the community mobilization model, it is a framework for motivating people to act on
a common health concern, to avoid a negative health consequence, and to
improve overall public health. The model has six components, all based
on the individual’s perceived (a) susceptibility to a health problem; (b) severity of the health problem; (c) benefits from the effectiveness of engaging in a
proposed preventive behavior; (d) barriers to engaging in a preventive behavior; (e) cues to action, that is, physical or environmental events that trigger
action; and (f) confidence in one’s ability to perform a preventive health
behavior (Dutta-Bergman, 2006; Rosenstock, 1974). Indeed, White (n.d.)
recommended that to mobilize a community for action, a plan must be developed such that it (a) determines attitudes toward a problem, (b) assesses
public expectation, (c) provides adequate information about the far-reaching
effects of the problem, and (d) develops effective information that acts as a
catalyst for community support and involvement.
The strengths of both these models lie in their similarities and in their
being readily amenable to being used pari passu. For example, empowerment occurs at two levels: at the individual level (characteristic of HBM),
by which people are both motivated and persuaded to develop their
health-related competencies such as knowledge or resources; and at the
community level (characteristic of CMM), by which additional network,
resources, and opportunities are developed (Becker, Guenther-Grey, & Raj,
1998). The Rwandan government, for example, empowers local populations
by initiating decentralized (health) service delivery as an instrument for
fighting poverty by having them participate in planning and managing
local health initiatives (at the individual level), and mobilizing them for
reconciliation, social integration, territorial reform, and well-being (at the
community level; Malinga, 2008). Both models also involve reciprocal
374
C. B. Pratt and E. L. James
determinism, by which a bidirectional change results from interaction among
people, communities, and environments (U.S. Department of Health, 2005).
CONFLICTS, MOBILIZATION AND EMPOWERMENT IN PUBLIC
HEALTH IN AFRICA
Africa, particularly the region south of the Sahara, has for decades suffered
from protracted civil wars and factional and internecine conflicts that have
left thousands homeless or displaced. As reported by the United Nations
High Commissioner for Refugees (2006), 5 of the top 10 countries of origin
of refugees are in Africa. These are Sudan, Burundi, the DRC, Somalia, and
Liberia. Also, 3 of the top 12 countries of origin of internally displaced people
are African: Sudan, Somalia, and Liberia. Interestingly, the continent also has
8 of the top 10 countries of origin to which refugees returned in 2005, the
other 2 being Afghanistan and Iraq. To the degree that such displacement
of citizens results from instability and conflicts, it takes its toll on health
programs that have been stretched to their capacity. The DRC is the archetype of a country destabilized by lingering conflicts and civil wars; its two
major wars (the first from 1996 to 1998; the second referred to as African
World War, from August 1998 to 2003) led to 3.8 million deaths (Coghlan
et al., 2004) and caused the displacement of some 3.4 million people. The
crisis in the Congo, which is escalating as of this writing, has thus been
described as ‘‘the deadliest anywhere since the end of World War II, dwarfing
Bosnia, Kosovo, Darfur and even the South Asian Tsunami’’ (Brennan &
Husarska, 2006, p. B3).
Between 1963 and 2002, at least 30 civil wars and low-intensity conflicts
occurred in Africa. They affected about 450 million people, approximately
60% of the continent’s population, directly and indirectly affecting health
programs (The World Bank, 2005). Indirectly, wars and conflicts serve to
divert resources from the health sector and are associated with increases in
deaths from diseases and malnutrition (Kloos, 1992; Palmer & Zwi, 1998;
Perrin, 1996; Simmonds, Vaughan, & Gunn, 1983). Directly, conflicts deter
health-service practitioners from delivering care to even the neediest, particularly those in disputed territories, and they destroy the existing fragile
health infrastructure (Dodge, 1990; Levy & Sidel, 1997; Manoncourt et al.,
1992; Palmer, Lush, & Zwi, 1999; Reed & Keeley, 2001; Roberts & Zantop,
2003; The World Bank, 2005). Health care is also hampered even when a
truce is negotiated, or a compromise found—as was done in June 2007
between representatives of the Ugandan government and those of the rebel
group, the Lord’s Resistance Army of northern Uganda. Similar situations
prevailed in 2006 among tribal rivals in the western region of Sudan, in
2002 among warring factions in 2002 in the Congo, and in December 2000
between Eritrea and Ethiopia. And the effects of wars that have resulted
Mobilizing War-Torn Communities
375
in more than 4 million deaths in the Congo since 1997 and an estimated
300,000 deaths and 2.5 million displaced from Darfur since 2003 are still
apparent on the well-being of all those nations. It is this interface of health
and security (e.g., Burris, 2006); violence and mortality (e.g., Toole & Waldman, 1990); and conflict and extensive negative effect on health and health
services (e.g., Aluwihare, 2005; Médecins Sans Frontières, 1997, 2001;
Toole & Waldman, 1993; Toole et al., 2006; Ugalde, Richards, & Zwi, 1999;
The World Bank, 2005; Zwi, Ugalde, & Richards, 1999) that provides
the rationale for this article, which argues for a shift in strategic approaches
in communities where conflicts are rife and where health services are
particularly lacking.
The effects of internal wars and conflicts in Africa suggest the need to
empower communities to play leading intervention roles in their health conditions. To empower such communities requires effecting broad-based
changes in health-related behaviors. These can occur by providing support
that helps them define their own health problems, identify the determinants
of those problems, and engage in effective individual and collective action to
respond to the impacts of those determinants (Beeker, Guenther-Grey, & Raj,
1998). African communities, under peaceful conditions, boast a wide array of
institutional structures that provides governance at the local level, where
chiefs and tribal elders still wield enormous political clout in the
decision-making process among their subjects. In the DRC, for example,
more so under wartime conditions, ‘‘‘tribal’ clientelism provides a mode of
access to state institutions; ethnic polarization a mode of exclusion of ‘the
other’’’ (Englebert, 2002, p. 593). Such strategies pose a paradox. On
the one hand, they are still very much the channels for tracking community
agendas. On the other, they ‘‘never translate into a broader agenda of
self-determination, as they enhance rather than challenge the failed and
predatory institutions they pursue’’ (Englebert, 2002, p. 593).
Arguments have been made for a shift from the biomedical model of
health care whose structural and cultural hegemony marginalizes patients’
social concerns about their health status to one that recognizes the patients’
(e.g., war victims’) role and influence in health-related interactions (Sharf &
Street, 1997; Vanderford, Jenks, & Sharf, 1997; Verwey & Crystal, 2002), and
to one that views disease as a social and cultural construct (Jablensky, 2005).
Such a shift affirms public health as not merely the absence of disease but as
the delivery of services that promote fulfilling, satisfying lives.
It is important to note that empowerment is predicated on three
assumptions: (a) that the health problems are multifactorial, (b) that communities must participate in defining and responding to the problem, and (c)
that the effectiveness of the strategies depends on community’s self-efficacy.
The empowerment must, therefore, take place at two levels: at the individual
level, by which people develop their health-related competencies; and at
the community level, by which additional resources and opportunities are
376
C. B. Pratt and E. L. James
developed (Beeker et al., 1998). This empowerment approach is consistent
with the theoretical foundation of this article.
HEALTH-PROMOTION STRATEGIES IN PEACETIME
Donor-driven strategies tend to be used in promoting public health during
periods of relative stability. Indeed, international donor agencies, to the
degree that they fund much ground activities, require a level of accountability and transparency that can only be achieved through a centralized model
that calls for such activities to be coordinated either at a headquarters or at
regional levels. So, even if international donors form partnerships with local
agencies such as the Nairobi, Kenya-based African Population and Health
Research Center (APHRC), these agencies are still largely responsible to their
benefactors. Yet, oftentimes, benefactors’ ground activities are not fully
synchronized with those of recipients, regardless of the continent-wide
leadership role of APHRC in research in population and health issues and
policy. A rationale for more direct communal discourses and involvement
in health projects is borne out by the results of a study undertaken in southern Africa by Save the Children UK that showed that many blockages and
bottlenecks prevent the priority allocation of HIV=AIDS resources from
reaching communities (Foster, 2005). That study also found that neither
donors, government departments, non-governmental organizations nor community groups could provide effective mechanisms for channeling those
resources to communities and households that respond to children and that
intermediaries are unwilling to empower community groups.
Another characteristic of these agencies is that they tend to adopt
Euro-American centralized health-promotion models. An example is the
three-level, hierarchical network model whose basic design the U.S. government adapted from a successfully implemented HIV=AIDS prevention model
in Uganda (Institute of Medicine, 2007). At the apex of the hierarchy is the
central health authority (in the case of the Global AIDS Initiative, it is the
Office of the Global AIDS Coordinator [OGAC]), which, depending on the
specifics of the organization, is generally far removed from the ground—
inarguably an effective administrative approach to health promotion in
developed donor nations, but not quite as effective in the developing world,
where such structures inherently contradict dominant cultural practices and
mores. Granted, the OGAC has a robust staff and field support, but presence
by proxy is not equivalent to having continuing firsthand experiences on
the ground. The next level is the public and private (e.g., faith-based) health
facilities that organize satellite clinics and mobile units and use communitybased health workers to reach the patient public.
Another feature of the donor-driven health-promotion model is that it is
predicated on monitoring and compliance with, in the case of, say, the
Mobilizing War-Torn Communities
377
Global AIDS Initiative, ‘‘PEPFAR’s stated policies and strategies’’ (Institute of
Medicine, 2007, p. 58).Yet another characteristic of such models is their
emphasis on the clinical aspects of health promotion, even though there
are other ancillary factors that impinge on public health. Finally, heath-care
strategies are the province of a massive bureaucratic setup. The Global AIDS
Initiative, for example, relies on the OGAC and its Deputy Principals Group,
other implementing agencies such as the Department of State, the Department of Health and Human Services, the Department of Defense, and the
U.S. Agency for International Development. There is also heavy reliance
on several other interagency coordinating committees, including task forces,
working groups, and country teams, supported by a similar one at headquarters, led by the U.S. ambassador to (and her or his steering committee in) a
recipient country and includes representatives from implementing departments and agencies. Such a structure is commensurate with the funding
mechanism for PEPFAR: central funding from the State Department’s Global
HIV=AIDS Initiative, and oversight funding for the U.S. agencies that implement the initiative.
This strategy has administrative, clinical, and societal implications
especially for the Congolese, and calls for a fundamental shift in health
delivery during conflicts and wartime. In this section, then, we illustrate
those implications by presenting an overview of the DRC, where some
1,200 people, mostly children, continue to die each day because of a health
crisis fueled by the challenges of multi-country conflicts, HIV=AIDS, and
sexual violence. Rape in the DRC is particularly daunting because of its
implications for the spread of sexually transmitted diseases, including
HIV=AIDS, and of ‘‘opportunistic’’ infections, most notably tuberculosis.
The average Congolese infected with HIV=AIDS is unlikely to be able to
afford the cost of anti-retrovirals, whose generic equivalents cost nearly
$30 per month. This raises policy issues of subsidies from both the government and the international pharmaceutical industry.
To use the DRC’s health care, provided by government, private, and
nongovernmental organizations, the average Congolese must summon
the courage to risk her or his life to visit a clinic, where counseling tends
to be spotty and confidentiality is hardly guaranteed. Even the DRC’s
Ministry of Health, which set up a national committee to prevent sexual
violence, did not benefit from community input in developing its vision
and in articulating its goals and strategies, let alone the committee’s
minuscule funding for accomplishing any of its goals in the most rudimentary way. The mission of the committee was ultimately misunderstood
by the public, resulting in rumors about the victims it was set up to
protect. Victims seeking health care found themselves faced with additional hardships in the form of stigmatization, rejection, and social
exclusion. Thus, today, many survivors and communities are left to their
own designs.
378
C. B. Pratt and E. L. James
HEALTH-PROMOTION STRATEGIES IN WARTIME
This section is organized into three subsections: administrative, clinical, and
societal. Here, we present a trionym of considerations that provide contexts
for the notion that health-care delivery strategies used in, say, peacetime DRC
are generally inappropriate in wartime DRC for four reasons. The first is that
trust issues are magnified by conflicts and wars. Trust, defined by Rotter
(1967) as ‘‘a generalized expectancy that the oral or written statements of
other people can be relied upon’’ (p. 653), is more fragile in wartime than
in peacetime. Social theorists argue that interpersonal trust enables a people
to manage the complexities and anxieties that are part of modern society
(Giddens, 1990; Luhmann, 1988). But when that society is in flux, it fails to
cope with everyday activities.
To the degree that the assertions of parties in a relationship cannot
be relied on, then, it is logical to expect that communication programs
for health care cannot be preceded by open discourse and by robust dialogue and analyses for larger social causes and for better public health
than are apparent in peaceful environments. Gilson (2006) argued, for
example, that ‘‘a health system founded in trusting relationships can contribute to generating wider social value. This argument is based on the
understanding that health systems do not just produce health care and
have the goal of improving health’’ (pp. 361–362). Second, peacetime is
more amenable to both reliability and integrity, key variables in persuasive communication for health. That notion is supported by Morgan and
Hunt’s (1994) commitment-trust theory, which holds that commitment
(an exchange partner’s belief that an ongoing relationship is so important
to warrant maximum efforts to sustain it) and trust (confidence in an
exchange partner’s reliability and integrity) lead directly to cooperative
behaviors. Such behaviors are few and far between in wartime. Third,
because administrative and health-delivery infrastructures are among the
first casualties of wars and conflicts, the challenges of health-care delivery
are commensurately magnified. In the DRC, for example, collapsing infrastructures—let alone militia incursions into the daily routines of a population—present a monumental challenge to health workers. Finally, a
society in flux, that is, in a state of utter chaos is more readily challenged
to deliver even the most basic of human services, which, in peacetime,
have the possibility for both use and expansion at the very least.
These contingencies do not necessarily translate into jettisoning peacetime strategies; they, however, require that health-delivery specialists be particularly mindful of the greater odds associated with accomplishing their
program objectives in environments largely grounded in shifting political
and social landscape and that their health programs be broadly cognizant
of those unique challenges.
Mobilizing War-Torn Communities
379
Since the demise of the Mobutu Sese Seko government (administrative),
which ruled the former Zaire for 32 years, low-intensity conflicts (societal)
have commonly undermined national and community health (clinical). But
such conflicts (societal) do not imply low impact on population (clinical);
rather, most are characterized by extreme violence on civilians (Addison,
Le Billon, & Murshed, 2002). We suggest that strategic health promotion be
based on that trionym of non-discrete levels: administrative, clinical, and
societal.
Administrative
This is defined from a sociological perspective as administrative action
that serves power relationships—and that which tends to be ‘‘ordered’’ by
outside interests. It is not just about the issue of meager resources or
ineffective health infrastructure; it’s about the will of a constituted authority
to make key policy decisions that identify and place priorities where they
should be and goals that the agency should accomplish. But the administrative infrastructure is particularly important during wartimes for two reasons.
First, it has potential to funnel much-needed outside support to areas at the
brink of collapse. Second, absent institutional decision-making mechanisms,
it becomes imperative that external agents collaborate with field agents
whose leverage on the health agenda may be much higher than local actors
may comfortably bear. Even so, the relevance and the effectiveness of the
administrative structure are possible only to the degree that (a) wartime
conditions allow, and (b) collaborative efforts between the administrative
structure and the community are informed by the involvement of grassroots
organizations that will be in the forefront of delivering programs that both
parties deem necessary. Cordaid and ICCO, two of the widely known
co-financing international agencies in the DRC, have always insisted on such
meeting of the minds with a variety of partners (e.g., Centre Olame, BOAD,
and CME Nyankunde) through which they implement health-care programs
on the ground.
Clinical
The clinical approach focuses on prevention as the key to a nation’s health.
Failing that, quick, sustained medical attention can provide some victims of
sexual violence a much-needed opportunity for survival. Interruptions in
treatment can be as dangerous as their total absence.
Societal
This raises trust and cynicism issues, both fundamental criteria for effective
health promotion. The DRC’s high power distance (that is, high human
380
C. B. Pratt and E. L. James
inequality and an entrenched belief that authorities cannot be questioned) in
itself is a source of social conflict and tension, both of which have spawned a
much higher level of mistrust among the Hutu and the Tutsi, particularly in
the wake of the 100-day Rwanda genocide of 1994, when as many as
800,000 Rwandans were murdered, three million sought refuge in other
countries, and similar tensions fueled civil wars in both the DRC and Burundi
(Lopez & Wodon, 2005). The importance of reconciliation was critical to
restoring inter-ethnic trust and it is important to note that the government
used gacaca—a culture-based, tradition-bound conflict resolution system
through communal efforts—for national healing. Gacaca has overtones of
South Africa’s Truth and Reconciliation Commission, with the key difference
being that the former is open to full community participation; the empowered community intervenes for or against a defendant during hearings and
uses the forum for pilot-testing ideas on advocacy and prescription for community well-being and health and for consensus-building. Because the
restorative model of justice assumes that justice will take place in, and be
managed by, local communities, sentences can be served through community service (Corey & Joireman, 2004; Daly, 2002; Harrell, 2003). Such service
has included building and renovating health centers such as the Rwinkwavu
District Hospital and rural clinics in Bisate, Kareba, Kinigi, Mareba, and
Mayange; establishing conduits for health-care delivery; and contributing in
immeasurable ways to rebuilding a health infrastructure decimated by
neglect and mayhem. The high patient volumes in those clinics are a testament to their health impact on the regions that they serve and on the country
in general, and the cross-over effects of, say, Hutus helping to build a social
service in a Tutsi stronghold, and vice versa, enables both physical and social
development to occur pari passu.
The Gacaca court system also has therapeutic implications: Truth telling
contributes to healing among individuals and groups that have suffered at the
hands of their neighbors (Borland, 2003). To the degree that Gacaca
acknowledges human rights and, hence, engenders peace and stability, hallmarks for health-care delivery in war-torn societies, Rwanda, for example,
benefitted immensely from the cessation of hostilities occasioned by the
extensive use of that legal institution and its capacity to promote trust.
COMMUNITY-GROUNDED AND CULTURE-COMPETENT
STRATEGIES
Innovative persuasion strategies need to be identified and implemented in
response to the unique circumstances of displaced people. Such strategies
should be sensitive to the limitations of churches, local governments, and
social institutions—the societal infrastructures—as partners in and targets
of health promotion. This approach could also facilitate the interplay of
Mobilizing War-Torn Communities
381
several important factors, which Owen and Miller (1989) identified as essential to mobilizing a community: (a) concerned citizens, with a community
vision, willing to accomplish a project; (b) involved people who allow that
a variety of methods can be used to accomplish goals, yet support the common goal; (c) inspired leadership that develops strategies to guide a project,
but does not become the focus of the project; and (d) specific goals to reduce
the impact of at-risk situations. As such, the community becomes empowered
to produce specific health outcomes (Mayer, 1996) and certain competencies
(Eng & Parker, 1994). In the DRC, these empowerment criteria become
me