Example 5: Zawtar El-Charkiyeh-American University of Beirut Partnership

Based on a project titled “ZeC-FHS Community Partnership” implemented by the American University of Beirut. For more detailed information please visit the AUB-FHS Community Engagement and Services website.

BACKGROUND 

The town of Zawtar El-Charkiyeh (ZeC) is spread on a hill overlooking the Litani River from the north, in the province of Nabatiyeh, South Lebanon. The total population of the town is 3,750, (60% below 21 years of age; 3% above 65 years of age), only 69% reside in the village on a permanent basis. Most of its population depends on tobacco farming as the main or supplementary source of income (50% of village land is cultivated; tobacco represents 70% of all cultivations) with very low revenues for the farmers. There is one intermediate public school, one public library, one nursery, and one partially functioning health center affiliated with the Ministry of Social Affairs (MOSA) in the town. There is an active civil society in the town, which is involved in different community initiatives. The main civic society organizations include 3 Scouts Organizations (Risala, Mahdi, Ittihad El-Chabab El-Democrati), the Agricultural Cooperative, the Socio-Cultural Club and an Environmental Action Committee. Finally, there are 13 municipal committees in addition to the mother and child sub-committee.

Among all villages of South Lebanon affected by the war, Zawtar was selected by the Faculty of Health Sciences because of its potential for becoming an effective partner in the health and environmental field and for the opportunity it provided to collaborate with a committed and active mayor and municipal council. More specifically, selection of ZeC was based on the following reasons:

• The town is relatively poor and in need of support in more than one aspect
• The town is in the South but located in a less military zone
• The mayor had expressed willingness to examine potential collaboration with the Faculty of Health Sciences
• Young, university-educated men and women have established an association and are actively volunteering their time, including the formation of a support group for the health center
• This community has local resources and potentials that are instrumental for the success of the partnership

The International Management Training Institute (IMTI) set a solid foundation that could be built upon. The main active groups in the town were identified, a community profile was prepared, and the main problems facing the village in the rehabilitation/ recovery process were identified. In addition, a 2-day workshop on the principles of project development and management was organized.  The priority needs that participants identified included health in general (specifically the chronic disease drugs), solid waste management, wastewater management, quality of drinking water, need for irrigation water, and need for youth activities.

COALITION/PARTNERSHIP MEMBERS 

The idea of this partnership project was conceptualized after the war in July-August 2006, which shattered the southern villages of the country. During the war, FHS received 50,000 US$ from the Health and Medical Relief Committee (HMRC) to provide direct medical care to refugees from the southern villages temporarily residing in Beirut. After the war, FHS identified Zawtar El-Charkiyeh in the province of Nabatieh as a town with which a long-term relationship could be established. Consequently, the partnership between the FHS and the town of ZeC was initiated in February 2007 with the remainder of the funds provided by the HMRC. Preliminary contacts with the town were established by Dr. Iman Nuwayhid from the Faculty of Health Sciences (FHS) at the American University of Beirut, through Mr. Jean Dib El Hajj and Mr. Khodor Najdi, from the International Management Training Institute (IMTI), a non-profit civil company affiliated to the YMCA of Lebanon.

Two Research Assistants (RAs) from FHS were appointed to initiate this partnership starting February 15, 2007. Through regular visits to the town, the RAs paved the way to the establishment of a Community Volunteer Committee (CVC). In coordination with the RAs, the CVC conducted a comprehensive profile of the town, and assessed its health needs and evaluated the health services available. This assessment involved visiting people at home, holding informal meetings and focus groups, interviewing key people, surveying selected households, and observing activities at the health center and the school. Upon the completion of these activities, the RAs worked on identifying some of the major needs and generating focused project ideas.

The RAs/coordinators of the project mediate between the FHS faculty, the students, and the town. A Zawtar committee comprised of Faculty members and students was established at FHS, but it is currently inactive. However, several faculty members are directly involved in the different activities, guiding and supervising students through assignments implemented in the community as part of course projects. On October 1, 2010, the project was placed under the umbrella of the Outreach and Practice Unit (OPU) at FHS, managed and coordinated by the Community Engagement and Services (CES) group.

DEFINING THE GOALS AND OBJETIVES 

The town’s health and environmental needs assessment conducted by the RAs with the CVC led to the following findings:

• Poor solid waste management (SWM) practices
• Poor wastewater management (No sewage system)
• Insufficient supply of water for irrigation
• Contamination of drinking water
• Poor nursery conditions
• Unavailability of a safe playing area for the nursery children
• Low income from the agricultural sector especially from cultivation of tobacco
• Need for health awareness sessions

Based on the needs identified, a conceptual framework and a partnership-human resources framework were established, as well as a preliminary plan for responding to urgent needs. Some health and environmental needs that required quick response were specified as priorities, including supporting the community health center and establishing a water-testing program.

With the exception of some student assignments, all the activities that were implemented were identified according to the results of focus groups/needs assessment meetings, or were responses to requests of the community. A collaborative partnership and participatory approach were adopted to involve community members in all phases of the intervention processes. The community members/stakeholders were involved not only in making decisions about priority activities, but also in the planning, design and implementation of the activities carried out.

The aim of the ZeC-FHS community partnership is improving the quality of life of local residents by building their capacities to identify and respond to their needs in health and the environment and providing FHS students and Faculty with an opportunity for field work and practice.

Based on the initial needs assessment and the partnership framework developed, the agreed upon objectives were to:

• Work jointly to identify and respond to health and environmental needs directly or by raising funds;
• Utilize academic and scientific expertise in building capacity within the local community;
• Connect students to local communities and enrich their educational experience;
• Establish a long-term partnership with the community as “equal” partners based on mutual beneficence and trust.

WORKING TOGETHER 

The project depended on the limited funds remaining from the HMRC. Although the project’s activities do not necessitate a large budget, some funding is still required to cover expenses such as cost of transportation, communication, and partial contribution to some activities. Fundraising attempts of the project management were mainly unsuccessful due to the policies of most funding agencies that require funds to be provided exclusively to NGOs and GOs (not academic institutions such as AUB). However, the project was partly successful in raising some funds internally within the AUB community for certain activities.

A Community-Based Participatory Approach encouraged the partnership members to be involved, active, and honest about what is being implemented and advice for future activities. The main ZeC stakeholders would agree together on activities based on the community members' requests and the FHS would rely on its many contacts to find appropriate implementers within and outside the faculty. The different activities included an underlying element of empowerment, team building, and negotiation skills.

Finally, it is beyond any doubt that there is a strong bond of trust that has been built between the community and the FHS over the past few years. The renewal of the partnership following municipal elections (change in community officials) is solid evidence of the above statement. This trust is undoubtedly a strength for the project, especially within the context of Lebanon’s fragile socio-political standing.

From 2007 until 2010, many activities were implemented in different areas in the community. These activities included:

• Water: Preliminary bacteriological assessment of drinking water from sources and a number of households conducted by students from the Environmental Health department (ENHL) at FHS. Preliminary bacteriological assessment of the Litani River springs and recreational waters led by students and faculty from ENHL. A comprehensive evaluation of the water network, access to and quality of drinking water in ZeC was undertaken as part of a student's thesis in English and an abridged report in Arabic was prepared. The findings of the water study were presented to the members of the municipal council and other stakeholders from the community. Suggestions and recommendations were made and an Arabic version of the final report was submitted to the municipality council.
• General awareness on environment and health: A one-day clean-up campaign of the Litani River in ZeC was led by the town's Environment Action Group and volunteers from FHS. Financial support was provided by FHS for purchasing barrels, gloves, bags, etc. Several workshops (a total of 5) were conducted on various topics in health and the environment for the students at the public school in ZeC. This was led by undergraduate students from FHS in collaboration with the municipality’s Mother and Child subcommittee and the school's teachers. Public lectures on breast cancer, women’s health, and prostate and impotence were conducted. A health fair on water safety was conducted by 26 undergraduate students from the ENHL department.
• Nursery: An assessment of the safety conditions in the town’s nursery was conducted by the director of the AUB Safety Center. Over 34 volunteers from FHS and the town joined efforts to repaint the nursery and clean up its backyard. This rehabilitation activity was in response to the nursery’s acute safety needs. FHS-Student Representative Committee submitted a proposal and received a $5000 award to help build a playground for the nursery. Undergraduate students from the Landscape Design Program at AUB, supported by the CCECS, assessed the playground and prepared a design as part of their summer camp training.
• Women: A group meeting was held by FHS members to assess women’s emotional and mental health. A needs assessment meeting with women from ZeC was organized. Members of the community included the Mother and Child Committee, Mahdi and Risala party representatives. 9 women discussed potential activities to be organized by women for women. Three First Aid sessions were implemented with 23 women in ZeC in collaboration with the municipality, and the Red Cross Youth Club at AUB. Training women for professional “mouneh” preparation took place in collaboration with Jihad al-Binaa and the municipality of Zawtar targeting 22 women from the community.
• Solid Waste: One third of the households in ZeC were surveyed about their knowledge and practices of proper solid waste management (SWM) by FHS-Environmental Health undergraduate students and volunteers from the local community. A town meeting was held during which the findings of the SWM study were presented to the community followed by an open discussion on potential future activities to integrate SWM in the town. A training workshop, “Training of Trainers on SWM at the household level,” was conducted for 27 members of the community. The aim was to prepare a group of trainers who would take responsibility for disseminating the concept and the practice of proper SWM in the community in the future.
• Health and Health Services: An assessment of the primary health care center in town was conducted. A household assessment of health conditions was performed by undergraduate students in collaboration with the village health center, municipality and community volunteers. An assessment of available health services in the area, a qualitative study on the determinants of health among tobacco farmers, and a study on Community-driven Health Interventions in ZeC was conducted by a group of Med IV students as part of their clerkship in preventive medicine/public health. The public middle school in the town has been connected to the Healthy Schools Initiative.

Lessons Learned

• Limited funding: When planning for long-term community partnerships, it is not enough to merely secure start-up funding for the initiative. It falls upon the project stakeholders to work together and develop a fund-raising plan to continue to financially support activities. As the main target is long-term, new efforts should be geared towards attempting to secure more reliable funds for needed activities.
• Monitoring and Evaluation Plan: The objectives of this project which were set in 2007 were meant to represent general strategic guidelines of the desired outcomes. This in itself makes the process of measuring the extent of achievement of these objectives difficult and unique. The only intervention that was evaluated in a formal way was the “TOT on composting at Household Level” through a questionnaire with the trainees. Lack of a detailed Monitoring and Evaluation plan is a major drawback. Effort should be made to inform and convince the community of the need for evaluating interventions.
• Economic Development: The ZeC-FHS partnership provided limited opportunities for economic development to the community. This is expected since the objective of this partnership was to provide technical assistance to the community to define and respond to its health and environmental needs. However, having an economic development component even at a small scale could have strengthened the partnership by augmenting the enthusiasm and participation of the community, further improving the community quality of life and increasing the chances of a sustainable long-term partnership.
• Sustainability: Despite mutual trust, sustaining activities continue to be a challenge due to the fact that motivation and enthusiasm of all parties involved dwindles with time.