Summary of M wanza WAGE Situation Analysis of Households Managing Long-
term Care and Support
The Mwanza WAGE team used a process of challenge or in-depth probing as a way of
conducting a situation analysis of the communities it was working with. It involved
engaging the community members in the process of defining the situation of concern,
confirming their interest in change, and then developing actions for change.
The project’s main area of interest was reproductive and sexual health, but while
exploring some of the issues of concern among communities, it was discovered that long-
term care and support for people with chronic conditions such as cancer or
HIV/AIDSwould be a useful subject for a process of challenge and probing deeper.
The following steps initiated the process:
Discussions about long-term care, including stories about individual households,
as a way of confirming interest and relevance of the subject in communities
Mapping of local services and groups related to care and support around the
villages, and then mapping of service providers and organizations working in the
Household survey to determine how many households in three villages had long-
term care situations, who provided care, how well households perceived
themselves to be coping, and access to support.
After the team met to analyze the situation, they were able to clarify strategies the project
would use to support communities to strengthen networks of service and social support in
order to ensure more effective inclusion of households struggling to cope.
What this report documents is the actual flow of the discussions, the proceedings of the
meeting. The facilitators asked key questions, to which the team responded, and then the
facilitators challenged presenters on what they had just said, asking them to dig deeper
and make their responses more informative, or asking whether there were ways that they
could have elicited even more information.
Through challenging and probing questions about the basic information that had been
gathered, the team came up with some conclusions and a hypothesis:
There was no correlation between the type of illness and whether a household
HIV-related care was only a small part of the picture.
There may be different levels of coping and different levels of access to services.
Hypothesis: Respect and maintaining dignity were key priorities for households
The group then was able to explore potential linkages between long-term care and
support, and village savings & loan programs.
In the information gathering period, villagers were asked about other problems that they
had in addition to chronic illnesses, and then they were asked how they coped with these
various situations. When those data were presented, facilitators aga in challenged project
staff as to whether they had probed their informants sufficiently enough, helping people
think through their situations and establish collective action to change their situations.
The use of particular words was discussed, and whether what people said were problems
were actually problems. In other words, when does “normal” become “problematic”?
Issues of support as they related to inclusion and trust were discussed, and how people
manage relationships with those they do not like.
The spectrum of risk-taking behavior in every social group was illustrated, and how
design interventions to effect change among those who avoid risk and those who actively
seek risk, as well as everyone in between. Certain interventions, such as providing
information about family planning, are better for those who are not prepared to take risk
or don’t need to. But there are also those who need to take risks even though they don’t
want to, and the focus of interventions needs to be on that group plus those who actively
A second meeting with leaders and VSL groups yielded information on problems arising
from exclusion, and why some people get help from neighbors while others do not, and
what can be done about some people being excluded. Small groups analyzed the data and
cam up with the main conclusions reached from the data and what the principle options
for change might be.
While there was consensus that village leaders were a key bridge between CARE and the
community, the team realized there was still a lot to learn about the situation. The major
1) needs that are beyond the support that is available in the village,
2) how to work with the excluded and self-excluded, and
3) how to manage external support.