Healthy settings approach – is it the key to holistic community health and development?

Introduction
Despite effective prevention measures existing for priority communicable and non-communicable diseases, rates of infection and incidence continue to be high. However, to achieve prevention, we must address barriers to effective prevention, such as the influence of cultural, economic, environmental and social factors, and the need for communities to take ownership of their development.
The Scotland Chikwawa Health Initiative seeks to achieve this through a healthy settings approach. This pilot seeks to develop model villages using a process of community-led prioritisation and action planning. The process and outcomes of the priority setting are outlined here.
Methodology
The SCHI programme targets the Mfera Area of Chikwawa District (1800 households) and includes villages (n=18), schools (n=3), markets (n=2) and a healthy facility. The approach was community-led and used transect walks (n=18), and FGDs (n=108), to identify key priorities (self generated) and levels of satisfaction (basic and social needs) of community members (leadership, men, women, marginalized and youth). These were conducted over a six-month period and were consolidated into village profiles, which were then used to support the development of village action plans. Priority setting also considered issues of social capital, communication and effective leadership, and their impact on sustainable health improvements.
Results
Priority setting outcomes showed variation in the priorities and levels of satisfaction both between villages and communities therein. Consistent areas of satisfaction included religion and recreation, and the priorities of food security, water access and health access were universal. Levels of social capital varied widely between population groups, with youth showing the lowest sense of belonging, and a low level of trust between communities, villages and extension workers overall.
Conclusions
The development of the village profiles, community dialogue and feedback provided SCHI with a strong base from which to develop bespoke healthy settings approach.