FHS has been working for some years to put people first when it comes to health systems, whether it be through understanding how people actually use new technologies, such as in our project on health information seeking behaviour in Bangladesh, or working with communities in Afghanistan to rate and improve their health services through community scorecards.
But putting people at the centre of health systems also means finding different research approaches to studying health systems strengthening. We're profiling a few methods during the symposium. And today's focus is on photovoice.
A bit about photovoice
Photovoice is a visual research methodology through which people can represent, and enhance their community by photographing their daily lives and the lives of those around them. It is a qualitative and participatory research method that aims to capture what occurs when researchers are not necessarily present.
Following a range of trainings – on how to use digital cameras, how to approach a picture subject, and getting people's consent – study participants use the cameras provided to them to capture photographs and moments that are relevant to the research study. These photos are then discussed, often in a group, to highlight particular photos and to explain their particular relevance to the topic at hand. In many cases, these photographs then also serve as a key part of the communication strategy of the research project.
How FHS has employed photovoice
Although this is a relatively new approach for us, The Future Health Systems consortium has already used the photovoice technique in two of our focus countries: Uganda and India.
In Uganda, as part of the FHS young researcher grant, David Musoke worked with select youth in a community in rural Uganda to document issues related to maternal and childhood health in the community. Study participants used the cameras provided to them to capture aspects and situations in their community where youth can contribute to improving maternal health for a period of five months. Monthly meetings were held between the youth and research team to discuss the photos and to identify collectively emerging themes and areas for action. See the Uganda photovoice slideshow below, or download the booklet, to see some of the results.
Health facilities in rural areas do exist FHS Uganda Photovoice: EriaMdidde |
Despite stories of limited numbers of qualified health workers and the poor attitudes these workers can take towards pregnant women, they manage to serve many women and children.
Pictured here is a pregnant woman who is smiling after having received adequate care at a local health facility.
But that doesn't mean they're easy to get to! FHS Uganda Photovoice: Denis Mpiima Mukooza |
A common way to get to the health facilities is on a hired motorcycle, known as a bodaboda. These motorcycles are convenient, and they're one of the few means of transportation that can navigate the rugged terrain, but they're not a particularly safe way to transport pregnant women. But there is little choice.
In this picture a mother takes her young child to a health centre for an immunisation.
Getting there is half the challenge, getting seen might be just as difficult FHS Uganda Photovoice: John Ssewadda |
Here, two pregnant women lay on the grass outside the health centre waiting for the health workers to arrive.
'Free' doesn't really mean 'free' FHS Uganda Photovoice: Annet Nakayima |
Because of limited funding from the government and from international sources, many facilities are forced to charge for basic materials like latex gloves. In cases where women were expecting that they wouldn't need to pay, or who are simply too poor to pay, this can result in death.
In this picture, a woman counts money collected in a local savings group which can assist members when in need particularly pregnant women during time of delivery.
Many don't know about the risks of early pregnancy FHS Uganda Photovoice: Anthony Mpanga |
Pictured here is a pregnant teenager who is also carrying her first child in her arms.
And there is still limited use of contraception FHS Uganda Photovoice: Roger Mubiru |
In this picture are two siblings who can be mistaken to be twins, which is an indication of lack of use of family planning methods. As the older is only learning how to crawl, the young one is starting to sit.
There remains low male involvement FHS Uganda Photovoice: Annet Nakayima |
Here, a pregnant woman not accompanied by their spouse for antenatal care waits to be seen by a health worker at a government health centre.
Being pregnant doesn't mean there's relief from household chores FHS Uganda Photovoice: Roger Mubiru |
In this picture is a pregnant woman a few weeks from delivery as she was from collecting water from a distant water source for household use.
In India, researchers worked with women's groups in the Indian Sundarbans of West Bengal to document the interplay between climate, health and resilience there. The focus remained mainly on maternal and newborn health. The participants mainly sought to capture images that explain how a changing climate affects their daily livelihoods, barriers that exist to accessing health services, and ways that locals are adapting to these challenges. The results are available for download in our FHS India photovoice booklet and for viewing in the slideshow below.
Meen dhara: A costly way to make a living? Photographer: Bandana Haldar, (Binodhpur, Kultali) |
Crab catching Photographer: Parul Bhakta (Satyadaspur, G-Plot) |
'Sometimes you get wounded, causing heavy bleeding... then you have sit quietly, waiting for your body to absorb the shock... then you can start working again.'
A broken ferry ghat Photographer: Sita Das (Jayasree Colony, G-plot) |
The cost of medicine adds up quickly for those with chronic conditions Photographer: Lakkhana Debnath (Jayasree Colony, G-Plot) |
Teenage mother coddles a baby born at a low birth weight Photographer: Sipra Haldar (Binodhpur, Kultali) |
Older children as caretakers Photographer: Bornali Giri (Nogenabad, Kultali) |
Discussing findings with decision makers |
Giving photovoice a try at HSR2014
On Thursday, 2 October 2014, FHS invited participants at the Symposium to take pictures with Instagram and Twitter and to tag them with #HSG2014PV, #HSR2014PV or #HSR2014. These were collected via Evenstagram to form our own snapshot of the Symposium for the day.
You can review the photos below or online. Let us know which ones are your favourite and why!
By Jeff Knezovich, FHS Policy Influence and Research Uptake Manager.