Tilburg University Appreciative principles and appreciative inquiry in the Community Action for Health Programme in Kyrgyzstan Schüth, T. Publication date: 2011 Link to publication in Tilburg University Research Portal Citation for published version (APA): Schüth, T. (2011). Appreciative principles and appreciative inquiry in the Community Action for Health Programme in Kyrgyzstan. [s.n.]. 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Download date: 29. sep. 2021 Appreciative Principles and Appreciative Inquiry in the Community Action for Health Programme in Kyrgyzstan Proefschrift ter verkrijging van de graad van doctor aan Tilburg University op gezag van de rector magnificus, prof. dr. Ph. Eijlander, in het openbaar te verdedigen ten overstaan van een door het college voor promoties aangewezen commissie in zaal AZ 17 van de Universiteit op maandag 7 november 2011 om 10.15 uur door Tobias Raphael Schüth geboren op 6 augustus 1958 te Herne, Duitsland 1 Promotor: Prof. dr. J.B. Rijsman Promotiecommissie: Prof. dr. H. Martens Prof. dr. A. de Ruijter Dr. A.W.M. Keune Dr. V. Vermeulen 2 Appreciative Principles and Appreciative Inquiry in the Community Action for Health Programme in Kyrgyzstan PhD Thesis By Tobias Schüth Taos/Tilburg PhD Programme 3 Table of contents Acknowledgements ............................................................................................................................. 6 Summary ............................................................................................................................................... 7 Part I ....................................................................................................................................................... 8 Chapter 1: Purpose and outline of this study ............................................................................... 8 Chapter 2: The importance of respectful behaviour in the work with communities ....... 10 2.1. A personal note .......................................................................................................................................... 10 2.2. Why is respectful, non-dominant behaviour so important in working with communities?....................................................................................................................................................... 14 2.3. Beyond behaviour: meaningful relationship ................................................................................ 17 2.4. Little practiced ........................................................................................................................................... 17 Chapter 3: Description of the Community Action for Health program in Kyrgyzstan ..... 18 3.1. Overview of Community Action for Health in Kyrgyzstan .............................................. 20 3.2. Short information about Kyrgyzstan ................................................................................... 22 3.3. The Development of CAH in Kyrgyzstan ............................................................................. 23 3.4. Structure of CAH in Kyrgyzstan ............................................................................................. 27 3.5. Building blocks and results of CAH in Kyrgyzstan ............................................................ 31 3.5.1. People’s analysis of health ................................................................................................................ 31 3.5.2. Formation of VHCs ................................................................................................................................ 34 3.5.3. Health actions ......................................................................................................................................... 35 3.5.4. Organisational capacity building of VHCs ................................................................................. 43 3.5.5. Capacity Building of the Health System...................................................................................... 47 3.6. Enabling factors, lessons learnt, challenges ....................................................................... 51 3.6.1. Enabling circumstances ..................................................................................................................... 51 3.6.2. Enabling design factors ...................................................................................................................... 53 3.6.3. Challenges ................................................................................................................................................. 55 Chapter 4: Theoretical foundations of the CAH program in Kyrgyzstan ............................. 57 4.1. Overview of concepts that influence CAH in Kyrgyzstan ........................................................ 57 4.2. The socio-environmental public health model ............................................................................ 61 4.3. Healthy lifestyle/health education model ..................................................................................... 62 4.4. Health Literacy .......................................................................................................................................... 63 4.5. Engagement with communities to promote health .................................................................. 66 4 4.6. Synthesizing the different streams of health promotion ........................................................ 86 4.7. Summary of Theoretical Foundations of CAH ............................................................................. 86 Part II ................................................................................................................................................... 88 Chapter 5: Social Constructionism ............................................................................................... 88 5.1. A simple proposition ................................................................................................................................ 88 5.2. Consequences .............................................................................................................................................. 90 Chapter 6: Methodology of the two investigations of this study ........................................... 93 6.1. Introductory note ...................................................................................................................................... 93 6.2. Data producing processes – The presence of appreciative principles in CAH .............. 95 6.3. Data producing processes - Introducing AI into CAH .............................................................. 96 Chapter 7: The presence of appreciative principles in the CAH program before the introduction of AI ............................................................................................................................. 98 7.1. Reflection on PRA trainings with HPU staff ................................................................................. 98 7.2. Discovery with HPU staff ..................................................................................................................... 100 7.3. Discovery with trainers ........................................................................................................................ 101 7.4. Interviews with trainers and HPUs on appreciative principles in CAH in Kyrgyzstan .................................................................................................................................................................................. 102 7.5. Guest contributions ................................................................................................................................ 108 Chapter 8: Appreciative Inquiry in CAH in Kyrgyzstan ......................................................... 117 8.1. Appreciative Inquiry .............................................................................................................................. 117 8.2. Introduction of AI in CAH .................................................................................................................... 119 8.3. Open Interviews with trainers/oblast HPU staff ...................................................................... 130 8.4. Monitoring the number of own initiatives of VHCs ................................................................. 133 8.5. Generation of new ideas from below ............................................................................................. 134 8.6. Guest contributions ...............................................................................................................................