FINAL REPORT

 

 

Democratic processes of participation and the growth

 of Civil society

 

Four case studies in Banan and Bavel District

 

 

 

A report for The Asia Foundation and Catholic Relief Services

 

 

 

 

By

 

Center for Advanced Study:

Hean Sokhom, Ph.D.

Ngoun Sokunthea, BA

Chan Kanha, BA

Judith Zweers, MA

 

 

 

December 1999

 


Table of Contents

 

Democratic processes of participation and the growth................................................................ 1

of Civil society................................................................................................................................................................. 1

Table of Contents...................................................................................................................................................... 2

Introduction................................................................................................................................................................. 3

Background...................................................................................................................................................................... 3

Methodology..................................................................................................................................................................... 4

1.  The VHC-model.......................................................................................................................................................... 6

1.1 How do villagers perceive the VHC?.................................................................................................................... 6

1.2 Key persons in VHC.................................................................................................................................................. 9

1.3 Ownership of VHC.................................................................................................................................................. 11

1.4 Conclusion............................................................................................................................................................... 12

2.  The CMCF/CR Model.............................................................................................................................................. 15

2.1 Findings in Kdong and Prey Sangha................................................................................................................. 15

2.2 Conclusion............................................................................................................................................................... 16

3.  Key persons and indigenous forms of cooperation.................................................................. 17

3.1 Kdong........................................................................................................................................................................ 17

3.2 Kampong Sromor.................................................................................................................................................... 18

3.3 Prey Toteung I......................................................................................................................................................... 19

3.4 Prey Sangha............................................................................................................................................................. 20

3.5 Conclusion............................................................................................................................................................... 21

4.  Problems and needs.......................................................................................................................................... 22

5.  General Conclusions and Recommendations................................................................................. 23

5.1 VHC model............................................................................................................................................................... 23

5.2 CMCF-model........................................................................................................................................................... 23

5.3 Problems and Needs............................................................................................................................................... 24

5.4 The need for further research................................................................................................................................ 26

 


 

Introduction

 

Background

 

The central focus of this study is the growth of civil society through democratic processes of participation in activities aimed at the development or betterment of society in Banan and Bavel Districts in Battambang province.  The Asia Foundation (TAF) and Catholic Relief Services (CRS) are both concerned with strengthening civil society processes at the grass roots level and want to explore areas of potential collaboration. 

 

The first step was a research project in two districts of Battambang Province, where CRS implements a community health program.  In the first two weeks of November 1999 a research team from the Center for Advanced Study visited five villages in Banan and Bavel Districts in Battambang Province where CRS is implementing highly successful health programs.  Inherent in CRSf programs are approaches to development that might be called gnatural democratic processesh.  The Village Health Committees are selected through a participatory, electoral process that is meant to strengthen and deepen the sense of ownership and responsibility of community members for identifying and finding solutions to problems they face.

 

The research was meant to gain more insight into those processes by asking the following questions:

 

-          Have people in the project areas of Bavel and Banan Districts begun to understand and internalize the participatory processes involved in the Village Health Committees (VHCs) and Co-Management, Co-Financing (CMCF) committees, or are they simply carrying out what is expected of them by donors?

-          What are the factors which explain why VHCs and CMCFs have been successful in meeting their objectives?

-          What are some of the difficulties that have been encountered along the way?

-          Have VHC and CMCF activities remained largely focused on specific health concerns or have they had a broader impact in other areas?

-          Have VHC and CMCF structures had an impact on the building of a esense of communityf (addressing issues and making decisions as a community and not just as a collection of individuals or families)?

-          To what extent have the Management or Governance mechanisms or processes introduced through the VHCs taken hold in the project areas?

-          What is the impact of such mechanisms or processes on the development of civil society in the target communities? How can this further be enhanced?

-          What are the priority issues or concerns of people in the target areas that might benefit from citizen-administered participatory and/or democratic processes?

-          What are the best approaches to deal with such priority issues and concerns?

-          Are there particular sensitivities that one should take into account in addressing these issues and concerns?

 

Two weeks of research were too short to cover all points.  However, we were able to do more than we might have expected because of the facilities provided to our team by CRS-Battambang.

 

CRS and TAF emphasized not having any preconceived views on the outcome of the research, trusting that the people who will be contacted through this research know best what the most important issues, needs, and concerns are for their communities.  This report therefore reflects the perceptions of the people who are directly involved in the above mentioned structures (i.e. as members) themselves, or take an important part in the participatory and democratic processes initiated by CRS.

 

 

Methodology

 

The Terms of Reference asked for a qualitative exploration of the attitudes, perceptions, and aspirations and needs voiced by grass roots civil society actors in the districts where CRS is working.  The views of our informants could only be brought to light by careful, unstructured interviewing.  This methodology rules out precise findings in terms of percentages or numbers; we are not able to answer questions about the prevalence of certain issues, or the frequencies of certain feelings in the communities.

 

Another aspect of qualitative research is that our findings are based on perceptions, which are inherently partial.  In a village, for example, a VHC may carry out many more activities than any particular villager sees or can remember.  The aim of this research was not to evaluate the program or assess the impact of any specific CRS intervention, nor provide a comprehensive account of VHC functioning.  Our aim was to explore the democratic dynamics that CRS had tapped at the village level.

 

In this report we utilize some Khmer concepts to emphasize that they are not easily translatable into English.  One of the Khmer concepts frequently used in this report is Angkaa (NGO).  We found that many informants speak of Angkaa as a more or less abstract entity, as something from outside they cannot really grasp.  They often donft perceive NGOs as basically different from one another.  In this report we will frequently use the word Angkaa instead of NGO or CRS to stress its somewhat vague and abstract meaning. 

 

We also frequently use the term Chah tum: respected key people in the village of 40 to 50 years or older.  The villagers themselves frequently used this term. They describe Chah tum as kind people who think of the common interests, who have experience and often have good, 'ripe' ideas.  People trust them, and often turn to them for advice, especially when issues of conflict or money are involved.  These elders are able to call villagers to contribute money or labor for a common goal.  According to the villagers, women can also be Chah tum; during our research however we only met male Chah tum.

 

Given the very limited time for the research (eleven days for field trips) we decided to focus on four villages: Kdong and Kampong Sromor in Banan District and Prey Sangha and Prey Toteung I in Bavel District.  We spent two to two and a half days in each village, which is too short a time to really be able to uncover all the issues, problems and sensitivities.  On average we were able to conduct 22 interviews per village.[1]  We talked to four to seven VHC-members in each village.  In Kdong and Prey Sangha we interviewed one of the two Community Representatives (both women) and in all villages, except Kampong Sromor, we interviewed the village chief.  In each village we conducted on average 15 interviews with villagers, of which about three were ekey personsf. Approximately 65% of our interviewees were women.  We chose our informants on a purposive basis, not randomly. We sought out informative interviewees.  Some interviews took a long time and covered different topics; others were shorter and were more focused on one particular issue, depending on the circumstances.  We did not ask everybody the same set of questions, but chose to cover specific topics in each interview in order to be able to go more in depth.  However, we made sure that in one village all topics were sufficiently covered, i.e. the VHC, the CMCF, key persons and indigenous forms of cooperation, and main problems and needs.  We spent as much time on a topic as was needed to get an understanding.  During our meal breaks, the researchers from our two teams met to discuss the results in order to decide how to proceed.   We always started by interviewing the VHC-members, CR and village chief (if present), after which we interviewed villagers and respected key people (as indicated by VHC-members, village chief, and other villagers).  We made sure that we covered all parts of the village.  We introduced ourselves to the villagers as independent researchers who wanted to learn from the villagers about their village life.  We tried to make clear that we were neither part of, nor linked to an Angkaa providing materials.  When asking our informants about the VHCs (often starting with very indirect questions) we pretended not to know anything about these committees and encouraged them to explain to us everything they knew.  This report presents the main issues that came up during our interviews.

 

Beside the four villages mentioned above, we also visited Knach Romeas in Bavel District for one day, because elections for a newly set up VHC were held only five days before.  We were hoping to gain more insight into the perceptions of the people about the identification process of candidates and the actual election process. 

 

CRS-field staff in all villages we visited had announced our arrival beforehand.  In almost every village the VHC-members and the village chief were waiting to be interviewed.  Although we preferred to speak with people separately (to prevent one person taking over the whole interview and to encourage people to speak about their real feelings), this was seldom possible.  It would have been very impolite to send people away who had arranged their schedule in such a way as to be able to speak with us and sometimes had been waiting for a long time for us.  In Knach Romeas for example, where we initially were not planning to talk with VHC-members at all, our arrival was announced on the wrong day and the whole VHC-committee had been waiting for us on that day.  We felt we had to spend time with them, and so there was only one afternoon left to interview villagers.  However, we also realize that we would not have been able to talk to the VHC-members and CRs in the other villages if our arrival were not announced.  We really appreciate the efforts CRS made to facilitate the interviewing.

 

The village chief often was present during the interviews with VHC-members.  In some cases the village chief also joined interviews with villagers, or VHC-members would follow us to whisper answers to our informant.  These are unavoidable difficulties in conducting research for a very brief time in a village.

 

 


1.  The VHC-model

 

 

The Village Health Committees (VHC) that were the point of departure for our research were set up by CRS-Battambang from 1996 onwards in 29 villages in Banan and Bavel District, Battambang.  An important factor is that the community elects the members of the VHCs through a system of secret ballots.  Village Health Volunteers and TBAs (Traditional Birth Attendants)– if present – automatically become members.  Key people in the community together with CRS staff identify candidates for elections.  For every male candidate there have to be two female candidates; however, the villagers are free to elect whomever they want.  The final results of the elections therefore, do not necessarily reflect the gender composition among the candidates.  Nevertheless approximately 51% of all elected members in the 29 villages is female.

 

CRS staff trains the committee members on issues such as health education and proposal writing.  The members provide health education to the villagers, refer patients to the Health Center, and facilitate village health projects, such as hand dug wells, latrine building, and village health information boards.  The VHC works through monthly VHC-meetings and occasional large village meetings in which at least 50% of the families in the village have to be represented. 

 

1.1 How do villagers perceive the VHC?

 

The main reason for looking at the VHC was to find out to what extent it operates in a participatory way and how it enhances democratic processes of opinion sharing and decision making.  We first tried to find out what people actually know and think about the VHC, its meetings and other activities in which the participation of villagers is needed.

 

We found that the villagers in general do not seem to think in terms of a formal VHC committee structure.  Especially in Kampong Sromor and Kdong the VHC as such was little known, but people were able to mention the names of one or two persons in their village who are ein charge of healthf.  However, most villagers knew well about meetings in which the construction of wells and latrines was discussed; some of them spoke of the ewell and latrine committeef.  The construction of wells and latrines was often not linked to a VHC, especially in Kdong and Kampong Sromor.  The most common finding in those two villages was that informants feel confused by the large number of committees and meetings in their village.  Apparently, there are so many committees and so many Angkaa, that they donft know anymore what is what and who belongs to what.  Currently, there are six NGOs working in Kdong with a total of six committees: a VDC, a VHC, a credit-committee, a fertilizerbank-committee, a ricebank-committee and a loan-without-interest committee.  In Kampong Sromor four NGO are present with in total five committees: the VDC, the VHC, a credit/savings committee, a dry season rice committee and a cow bank committee.

 

In Prey Sangha and Prey Toteung I people were mostly aware of the existence of a VHC, although it was more difficult for them to tell us about the aims of the committee.  Although people in both villages knew the VHC, it still seemed a somewhat vague entity to them.

 

In all villages our informants mentioned activities which had been initiated by other committees than the VHC.  We got the impression that all village committees seem to have blended together for the villagers.  People spoke in terms of meetings rather than in terms of committees.  We found that members of the VHC are often also involved in other committees and this clearly contributed to a blending effect.  Sometimes the village meetings of other committees also distributed information about health.  In Kampong Sromor the most active VHC-members are involved in the VDC and/or in other committees as well.  In order to work more efficiently, they decided to hold just one general committee meeting in which the activities of the different committees and different Angkaa are discussed at the same time. Accordingly the CRS supported VHC becomes merged with similar efforts that use a participatory approach to village development issues.

 

Since participation of villagers in VHC-activities mainly takes place through big village meetings, we decided to focus more on those meetings than on the VHC as a committee.  The first village meeting conducted after the establishment of a VHC is an especially important one. In this meeting the villagers are asked to brainstorm about their most basic health-related problems, the main causes and possible solutions.  In this meeting the VHC also consults the villagers about the first priorities to be set.  Although in many villages this meeting must have taken place more than three years ago, we found several people who could still remember it. Our informants who reported usually attending the meetings, said that their main reason to go was ecuriosityf and avoiding the risk of enot getting anythingf.

 

It is possible that the VHC and CRS-field staff have set their priorities already before this meeting takes place, and more or less eguidef the villagers towards the same conclusions.  Accounts from a CRS-fieldworker and a few VHC-members suggest that this takes place.  The fact that villages all come up with the same priorities (health education, wells and latrines), i.e. what CRS has to offer, reinforces this impression.  However, we found one example of the opposite: villagers setting a totally different priority.  In Kdong people decided to give priority to building a road to the village pond in order to avoid skin diseases.  CRS accepted this and instead of providing culverts for latrines and wells, they provided laterite.  This is a good example of autonomy of villagers, not just following the proposals of a donor, but being able to advance their own agenda, and of the donors responsiveness to expressed needs. We feel that this first meeting made a considerable impression on villagers and is a good example of how democratic processes of participation can take place.

 

The next question was to find out what actually happens at the village meetings: do villagers really participate by raising questions and concerns, by sharing problems and ideas, or are they basically listening to what the VHC-members have to say and accept their proposals?

The accounts from the villagers differ from each other, so it is not easy to get a good overall picture.  Some villagers reported lively discussions, whereas others in the same village reported speeches by the village chief and Angkaa (showing the material they can provide) and a quiet audience that just follows: gwhen Angkaa asks us whether we want something, we just say eyesf.h Many people reported being too afraid to speak out.  Some people seem to be afraid mainly because they are not used to speak in front of a big audience; others think that the presence of the village chief and Angkaa are the main constraining factors.  Nevertheless, all informants told us about the attempts of the village chief and Angkaa to urge people to participate in the meeting by encouraging them to speak. 

 

We think it may need some time for villagers to get used to the idea that their contribution is really appreciated.  After all, Cambodia has a recent history of an authoritarian, very hierarchically structured society.   Two informants told us that the meetings remind people of the meetings in the time of Pol Pot.  gHowever, when they see concrete results, they understand that these meetings are differenth, according to one informant.  According to another informant this experience from the past is still a major obstacle for people to participate in meetings: meetings are eofficialf and are often perceived as ean order from the topf.  The fact that the term Angkaa is the same term used for Pol Potfs government may influence the sentiment voiced here.  More than half of our informants seldom attended meetings. 

 

Besides the meetings, people are supposed to participate in certain project activities as well. 

Those village projects are basically building latrines and digging wells (except the road building in Kdong).  CRS provides material and explains how to proceed; the villagers have to contribute labor and organize it themselves.  One well can serve 10 – 15 families and the cooperation of all families is needed to build it.  The family on whose land the well will be constructed organizes it. The other families have to contribute labor or money. 

 

We found several cases in which the cooperation seemed to work very well.  After its construction the families really considered the well as etheirf well.  However, we also found other perceptions of well ownership. To the villagers it does not always seem to be clear whether it belongs to the families who built it, to the eauthoritiesf, or to the community as a whole.  In one case several families refused to cooperate in construction, but wanted to use the well when it was finished.  This caused a conflict between the families that did cooperate and the families that did not, and the non-cooperative families were refused access to the well.  In another case the families using the well didnft consider it to be their well, but the well of the family on whose land it was built.  We are however not sure that this was a well constructed through VHC mediation.  In another case villagers did not use the well because it was located too far away from their homes.  Another problem mentioned was the maintenance of the well. Some families accused others of not cleaning the well, after which it became unusable.

 

Considering the accounts of several villagers and VHC-members we have the impression that sensitive decisions such as the location of the wells may not always be taken in the large meetings. According to the perception of our informants it is the village chief who takes those decisions together with Angkaa. 

 

For the building of latrines we found no cooperation between families.  Each family is supposed to build its own latrine, and if it lacks the force to do so, no one will help.

 

We have the feeling from the comments of our informants that activities of the VHCs in general tend to decline over time. In the beginning the committee is quite active, involving villagers through many village meetings, but after a few years it reduces its activity.  In two villages people complained that the activities had stopped (Kdong and Prey Toteung I) and in Kampong Sromor people felt that the activities in general (all committees) were reduced.  Kdong and Prey Toteung I seem to be divided in two parts: people of one part accused the VHC-members of only building latrines and wells for their own (and village chieffs) relatives in the other part of the village, after which the activities seemed to have stopped.  In both villages people reported not having seen any activity/meeting in the last year. 

 

A certain decrease in activities over time was confirmed by VHC-members in different villages: they reported not having enough time to spend for VHC-activities.  A VHC-member in Kdong told us that the last village meeting took place one year ago.  There were no such complaints in Prey Sangha.

 

 

1.2 Key persons in VHC

 

In Cambodian society each village traditionally has certain generally recognized, highly esteemed and respected key persons who play an important role in generating ideas for cooperation, and mobilizing villagers to take up certain tasks for the betterment of the village.  CRS recognizes the importance of such key people in the community by involving them in the selection process of candidates for the VHC.  By doing so, it seems to us that CRS is one of the few international donor organizations applying such a strategy. 

 

Before elections for VHC-members takes place, a list of candidates is prepared.  CRS first asks the village chief to identify candidates (of whom 2/3 should be women, then other key persons in the village, as well as villagers, are asked to recommend people.  If the potential candidates accept, a final list is prepared from which the villagers (at least 50% of the households have to be present) can elect candidates through a system of secret ballots.

 

Although certain respected key people in the community are asked their advice and recommendations, the village chief seems to play an important role in drawing up the list of candidates for elections, at least in the perception of the people.  Almost all our informants, whether VHC-member or not, emphasized the designation of certain people by the village chief.  Most VHC-members told us that this was their main reason for becoming a candidate.  Listening to the words of one VHC-chief, it seemed to us that it had been difficult for him to refuse because it was the village chief who had pointed him out. 

 

One informant felt that all members are people whom are somehow related to the village chief/local authorities.  We have no further evidence for this.  However, it is noteworthy that several other informants mention that the village chief is not automatically a respected person in every village.  In some villages people criticized the village chief for being selfish, gaining money at the cost of the community, and nepotism.  This is not to say that the village chief is always a selfish person: in some villages he may indeed be generally considered as a helpful and trustworthy person.  It is likely that the village chief selects candidates who he thinks are capable of carrying out the VHC tasks.

 

We asked the members of the VHCs about the most important reason for becoming VHC-member.  Almost all mentioned reasons such as: Plew Loak (working for the betterment of the village), good reputation, a good name for the village as a whole vis-a-vis other villages, setting a good example for the next generation, and Plew Thoa (gaining merit for next life).  Underlying all those reasons, there are of course also other ambitions.  Several informants expressed the hope of finding a job in the future with an NGO or at the district hospital.  Or, as one informant said: gI hope that one day Angkaa will see meh.

 

The VHC-members were all very positive about the VHC and its health activities. They perceive the VHC as an important improvement to the health situation in their village. All members told us they want to continue their VHC activities for a long time.

 

However, a big issue in almost all villages was the fact that the VHC-members do not receive any other salary or incentive than an allowance for following training courses.  Except for Prey Sangha, all VHC-members complained about not getting any salary or gift for their work.  Not all villagers believe that the committee members work for free.  They often talk about ethe people who work for Angkaaf.  The villagers who are aware that no pay is involved, assured us that it affects their work: it demoralizes them, and makes them less and less active over time.  Many villagers added that the committee members only work when Angkaa comes to the village. 

 

Many elected members were already active in the past: some were echief of womenf in the communist time; others were just helpful in common works in the village, such as building a road, a dike, etc.  They are often also involved in other committees, such as the VDC, credit committee, etc, as we noted above.  Most villagers consider the VHC-members as good, kind and helpful persons.  Some informants added that the VHC-members are talkative and gare able to speak with Angkaah. 

 

We found only a few examples of Chah tum in the VHC.  Interestingly enough, the village chief of Prey Sangha only wanted young people in the VHC: older people were excluded from membership.  According to one Chah tum, the main reason behind this is the faster understanding of young people: they can work faster and have a higher education than the elders.  At the same time he feels that the young often lack a feeling of responsibility.  Although the Chah tum in this village can not be member of the VHC, they are always invited to attend the meetings and are considered as important advisors to the VHC.  Still, it seems an arbitrary exclusion of one particular group in society by the village chief.

 

Villagers do not seem to look at the VHC-members with different eyes now they are working in the VHC.  In general, they are considered as helpful, but not as people they would turn to for help if they have a (health-related) problem.  We did not have enough time to get a firm impression on whether the VHC-members gain in prestige or esteem in society. Several women VHC members reported feeling better able to express themselves.  One woman told us that she is proud of her membership and the knowledge she gained through the training: she gained confidence in speaking out. 

 

In Prey Toteung I new elections were held because some members had dropped out.  The main reasons mentioned, were: too many illiterate people in the committee, not willing to work without a salary, or husbands who donft want their wife to work for free.  Once an informant told us another reason: husbands who donft want their wife to work for roat (government/authority).  In Kdong one informant stated that working for a committee does change the character in some cases.  Before becoming a committee member, they are good people: honest, hard working and helpful.  But after some young members become committee members, they take advantage from working in the committee.  He stressed that was is not the case for the VHC, because there is no money involved.

 

Besides Kdong, Kampong Sromor, Prey Sangha and Prey Toteung I, the research team also visited Knach Romeas in Bavel district for just one day.  The main reason for visiting this village was the fact that elections were held just five days before. 

 

Due to circumstances (see Introduction) we only could spend half a day (3 hours) talking to some villagers, not all of whom participated in the elections.  We feel this is too limited really to be able to comment on the identification process and the elections, as the villagers perceived them.  Only two informants were able to comment on the identification process and the elections.  According to them, the elections were conducted in a fair and secret way.  They were positive about the elections and had the feeling that the right people were chosen.  They told us that this way of selecting people for a certain task was entirely new to them, and that they could imagine using it also for other occasions, such as for the commune council. 

 

 

1.3 Ownership of VHC

 

One of the main ideas underlying the VHC is that it belongs to the people, to the villagers.  We asked the villagers how they look at the VHC: to whom does it belong and for whom is it working? In case our informants didnft know the VHC, we asked them about the ownership of committees in general, or focused more particularly on the meetings, asking villagers by whom they are organized.

 

In Kdong and Kampong Sromor all informants told us that Angkaa and the village chief organize the health and wells/latrine meetings.  One woman in Kdong, who could still remember the VHC-elections, spoke in terms of electing grepresentatives for CRSh.  Another woman in the same village thought that the chief of the gwell and latrine committeeh is working for Angkaa.  In Prey Sangha and Prey Toteung I most people believed that the VHC belongs to Angkaa.  Only two informants (in Prey Sangha and Knach Romeas) stated that the VHC belongs to the villagers.  One should realize however that the notion of ownership in question here is a Western (development) concept, which may have a different meaning to our informants. It would require further research to find out how this concept is really understood.

 

It is not surprising that many people connect the meetings/VHC to the village chief.  The village chief is heavily involved in any VHC-activity.  Although he is not an official member of the VHC, he is officially an advisor to the committee.  The moment CRS comes for the first time to the village, the Village chief is contacted.  He is the first (and according to many villagers also the most important person) to select candidates. He calls the villagers to a meeting (often through the help of meekroms). He is present at the village meetings and seems to play an important role by delivering speeches.  In Kampong Sromor the village meetings are often held in the house of the village chief or a village policeman. 

 

Angkaa representatives are often present in the meetings and play an important role.  According to the people, Angkaa shows its projects (latrines/wells) and shows the material it can provide.  Many villagers feel there are only activities when Angkaa comes to the village.[2] Some people say about the VHC members that gwhen Angkaa comes, they workh.

When we asked the villagers in Kdong and Kampong Sromor to tell us about the whole process - from organizing the meeting until the meeting itself - they only talked about the village chief and Angkaa.  When we asked them whether there were also villagers or a committee involved in the organization of a meeting, they said that villagers from a committee were present and participated but they did not know whether they were involved in organizing it.  In some villages the CRS field staff seemed to play a very important role in urging villagers personally to participate in activities. 

 

Only in Prey Sangha we found a few people who considered the VHC as their committee.  However, when we asked them why, they explained that Angkaa told them so.  Some villagers would consider the members as working for the villagers (although one said they are working for the authorities), but couldnft answer the question whether the VHC belongs to the villagers, Angkaa or the authorities.

 

Our VHC-informants in all villages were positive about the future of the VHC, but at the same time made it very clear that they need the continuing support of CRS, and preferably a salary or other incentive.  The villagers in Kdong, Kampong Sromor and Prey Toteung I were also very clear about the future. Viewing the overall reduction in activities over time, they saw little or no future for the committee, unless Angkaa stays heavily involved.  In case Angkaa would withdraw, they saw no future at all.  Because, as one informant told us: gOur people are not strong in contacting (other) Angkaa for supporth.  The biggest fear seems to be that there will be no NGOs to provide material, and without material there will be no concrete activities anymore. 

 

One informant in Kdong was more confident about the sustainability of the VHC.  He compared it with other committees in his village (a rice bank and a credit scheme) that seem to work well and are able to continue without support from outside.  In Prey Sangha people in general seemed to be more self confident and proud of their own capabilities than in the other three villages.  Almost all our informants expressed their confidence in the VHC and were quite sure it would continue its activities even if Angkaa would withdraw.  According to one informant: gFirst we should do things ourselves and then we can ask Angkaa to help provide the material.h However, he also added that the VHC-members need more training.  Prey Sangha is different from the other villages because of its Kampuchea Krom roots and its relatively well developed civil society (see page 20-21).

 

We found two examples in which the VHC might have had a broader impact in the community.  In Kdong one VHC-member said he used his training on proposal writing from CRS to write a proposal to ea generous womanf in the United States to build a school.  We heard many different stories about who actually got the idea and wrote the proposal, not supporting the first (VHC-) account.  Nevertheless, it clearly shows that someone got the idea and took the initiative to contact other donors.  In Prey Toteung I the chief of the VHC stated that she initiated the idea to create different associations in her village and that the VHC had served as an example.  Considering the fact that the husband of the VHC-chief was involved in the initiative of setting up the associations, we have good reason to believe that the VHC may have served as a catalyst for the reestablishment of traditional self-help village associations. 

 

1.4 Conclusion

 

When looking at the VHCs, we can basically distinguish three levels of participation: the participation of the members of the VHC; the participation of villagers in the meetings; and the participation of villagers in the concrete project activities.

 

Considering the good results of the health programs of CRS and the accounts of the VHC-members themselves, we conclude that the members of the committee are important contributors to the improvement of the health situation in their village.  They seem to be participating well in the program, although their activities tend to reduce in time and seem to be linked more or less to the arrival of CRS in the village.  The motivation of the members is a point of concern.  We will return to this issue later.

 

One of the roles of the VHC-members (amongst many others) is to be an intermediary between the villagers and the CRS, and to make sure that the projects decided upon in the meetings by the villagers are really carried out.  The villagers elect the members of the committee through fair and secret elections, and in general it seems that the right people were chosen to take up the job.  The VHC-members consult the people through village meetings where they can voice their concerns, their needs and their ideas.

 

The participation of the villagers in general mainly takes place through those meetings.  There are basically two different kind of meetings: the first meeting in which priorities are discussed, and the meetings following thereafter.

 

In the first general village meeting people are asked to brainstorm about the most basic health problems in the villages, about the causes and possible solutions.  The villagers take the opportunity to speak out about problems and solutions in a fairly democratic way.  The example of the road building in Kdong is the best evidence that - at least in this village – the meeting was taking place in a participatory and democratic way and that CRS was really willing to respond to the wishes of the meeting by providing laterite instead of culverts.  In several villages people were still able to recall this meeting, although it must have taken place several years ago.  This is quite remarkable when considering the number of village meetings (of all committees) that take place in a village in general.

 

The third level of participation is the participation of villagers in carrying out specific projects: mainly digging wells and in the case of Kdong also the construction of a road.  There were cases in which good cooperation was reported and places where this was not the case.  However, we have got enough evidence that a small group of families can take up a common task and perceive the outcome as common property.  Nevertheless, conflicts around scarce goods are always likely to arise.  Therefore, we think the process could benefit from the development of a conflict resolution or mediation agency or mechanism that could deal with such disputes.

 

The cases where the well digging did not have good results seemed to be connected to the decision of the place where to build it and who would take care of it.  A logical place/space for deciding upon those issues, would be the village meetings following the first one mentioned above.

 

This brings us to our next point: to what extent can we speak of the village meetings following the first meeting in which the priorities are set, as places where people can and will speak out and are really heard? The introduction of formal democratic processes such as fair and secret elections and majority vote are the first stage.  Consolidating democracy in daily practice is a second one.

 

The research findings showed that one of the main reasons for villagers to attend the meetings, was the hope of getting something out of it for themselves (or being afraid of losing a chance when not going).  The meetings are important places where potentially limited and strategic goods are distributed and where decisions may be taken about their allocation.  We have some indications to believe that the decision about whom is going to receive a well first and where this well will be located (potentially very strategically and politically sensitive questions) may not always be taken in the meetings by the villagers themselves.  According to some informants this decision was made by the VHC and the 'higher levelf.  We do not know to what extent such important decisions are taken in the meetings, since the perception of people may be different from reality.  However, we think this should be a major point of concern.  Our sense is that villagers are well able to distinguish between the form of democracy (elections, majority vote) and its substance (participation in decision making on all levels about the allocation of strategic resources).  The enthusiasm of people for village meetings would be a reflection of their perception that a sufficient degree of decision making power were really available in these meetings.

 

However, we are aware of the fact that shared decision making is not only a matter of giving the possibilities, but also one of taking the opportunities offered.  Here an important constraining factor is the presence of the village chief in the meeting (and in general the influence of the village chief in the whole of VHC activities).  We should not forget that the village chief is an appointed official, representing an authoritarian communist system.  One of the aims of enhancing democratic and participatory processes is to try to break into the all encompassing power of the local authorities and give the people a chance to have a say in the developments that affect the future of their village and that affect their personal lives.  We are very much aware of the sensitivity of this subject and will come back to this later on.

 

Another constraining factor is the role of Angkaa as perceived by the villagers.  If meetings are perceived as a major Angkaa-device to get things done, the meetings may not develop into places where real and free sharing of opinions can take place, and where the villagers will feel free to make decision of their own.  Activities seem to take place especially when CRS comes to the village; this can partly be explained by the fact that CRS brings material which makes it possible to start concrete activities such as digging wells or building latrines.  However, a lack of motivation from the part of the VHC-members may, to a certain extent, play a role as well. The meetings often seem to be a place where the village chief and the CRS-field staff play the most important, or perhaps the most visible, roles.  Few villagers could remember the roles of VHC-members in those meetings.

 

Many of the above mentioned findings were the same for all villages.  The main difference we found is that the villagers in Prey Toteung I and Prey Sangha mostly know about the existence of a VHC.  Prey Sangha was different from the other three villages in that the villagers seemed to be more confident about the future of the VHC. 

 

It is still a bit too early to be able to speak of a recognizably positive impact of women taking active part in committees.  However, it is likely that it will be positive in the long run.  One important factor to take into account is that we have the impression that meetings in general (not only health related) are for at least 50% attended by women, one of the most important reasons being that men are often working outside the village during the time meetings are held.

 

 


2.  The CMCF/CR Model

 

 

gThe linkage of communities to health services is one of the key principles of Community-Based Primary Health Careh, according to the Implementation Guide CRS/CBPHC, and this linkage must be gsustainable and responsive to the health needs of the communityh (Implementation Guide CRS/CBPHC, p.  145).  In order to achieve such a linkage between the village level and the commune level, CRS set up Co management / Co-financing committees (CMCF).  The purposes of the committees are, amongst others: to facilitate the flow of information from the community to the Health Center and vice versa, and to create a system for community gownersh of the Health Center to participate in management and financing of the Health Center (Implementation Guide CRS/CBPHC, p.  146).  The committees consist of two Community Representatives (CR) from each village served by the Health Center (one man, one woman) and two Health Center staff.  The villagers elect the CRs.  Although the CMCFs were established only from 1998 onwards, the Health Centers show a dramatic increase in numbers of patients.

 

We talked to the Community Representatives (CR) in Kdong and Prey Sangha (Kampong Sromor and Prey Toteung I do not have CRfs yet; we were for a too short time in Knach Romeas to have a look at the functioning of the CR in that village).

 

2.1 Findings in Kdong and Prey Sangha

 

In Kdong we talked to the female CR. She explained us that the male CR stopped his activities as a CR because of lack of time and money.  The CR in Kdong does not have any medical background.  According to her, the villagers mainly elected her in 1998 gbecause I always showed up in the meetings.h She told us that her main duties are to visit sick people and tell them to go to the Health Center.  But she added that when she is busy, she has no time and stops this activity.  In the CMCF-meetings, the health center staff mainly wants to get information from her, such as the diseases in the village, how many people go to private practitioners, whether the fees are suitable, etc.

 

She did not attend the meetings the last two months, because she was ill.  However, during the interview she repeatedly stressed the fact that she has to pay for her own transportation to the Health Center and that she does not always have enough money to go.  This suggests that the reason of her absence may not have been illness, and may occur more often in the future.

The CR had only vaguely heard of the VHC: there was no relation between her and the VHC.

The vice-chief of the VHC knew the CRs, but another member of the VHC had never heard of them.  There is obviously a lack of coordination between the two, which could easily be remedied.

 

When asking the villagers, we found out that almost no one knows about CRs.  Even after an explanation from our side, most villagers assured us that Kdong does not have such representatives.  Even the niece of the CR we interviewed – living almost next to the CR – assured us that she was not involved any such activity.  All our informants, except one, told us they go to the private practitioner when ill.  One informant told us that a man and a woman in the village can help people go to the Health Center by asking the Health Center to waive any fees.  There probably is some vague understanding of the idea of a CR, without specific knowledge of who serves in this capacity.

 

The situation in Prey Sangha was different.  In this village we also interviewed only the female CR.  She has a medical background as Village Health Activist in the past and was trained by CRS as TBA.  Besides, she works as a private practitioner.  She is also a member of the VHC.  She described her role as follows: informing the Health center about diseases in the village and informing the villagers about vaccination programs, medicine, and fees and services at the Health Center.  She told us her activities included going house-by-house, gathering people in small groups, or usingVHC-meetings to inform people.

 

Most villagers know the woman who is CR, but apparently more as a private practitioner and someone gwho works at the Health Center and can give injections and vaccinationsh, than as a key informant who informs people about policies and fees at the Health Center.  Only one of our informants could remember ever having received information about fees, but mentioned someone else as the informant than the two CRs. 

 

2.2 Conclusion

 

We must admit having a problem in drawing any conclusions about the CMCF.  Our findings suggest that the activity of the CRs is not well known, at least in Kdong.  But the dramatic rise in patients at the Health Centers indicates that somehow information is reaching villagers.  Obviously, the CMCF somehow managed to overcome the natural mistrust of the villagers regarding Health Centers.  It was beyond the reach of this study to approach this part of the research in another way (i.e. a tracer-study of people who visited the Health Centers in the past few months).  However, we think it is worthwhile to try to get a deeper insight into the dynamics in play here.

 

 


3.  Key persons and indigenous forms of cooperation

 

 

When talking about participation it is most important to try to get an understanding of and insight into Cambodian culture and society.  What are the occasions in which Cambodians get together to cooperate, how do they mobilize resources and how do indigenous forms of cooperation appeal to the villagers? Are they willing to work for the common benefit of the community, and are there things we can learn from it when entering a village with the aim of setting up a program based on participation and cooperation?

 

We tried to find the indigenous forms of cooperation in the four villages, as well as the main key persons behind those activities.  We found quite some diversity among the four villages with regard to both the number and activity of key persons in the communities and the level of cooperation among villagers, whether in a more or less organized form or not. 

 

We will discuss both issues (key persons and indigenous forms of cooperation) together for each village because they are closely linked to one another.

 

3.1 Kdong

 

The research team found the lowest level of cooperation in Kdong village.  Many villagers talked about the past with a slightly nostalgic feeling: we often heard the names of two important key persons in the past, especially the former commune chief who used to live in the village and was a great initiator of many projects.  He was considered as a real leader who called villagers to a meeting to discuss his plans and ask for contributions in kind, labor or money.  He was able to make the projects (such as building a road) attractive to such an extent that men, women and children, and even people from nearby villages would join to help.  All villagers talked about the past as the time of the real leaders, whereas nowadays the village seems to lack such key persons.  One informant stated that this kind of cooperation doesnft happen anymore without the involvement of Angkaa: gAngkaa has to create the idea.h

 

When we asked villagers whom they consider as key people in their community, most of them replied that there are no key people, other than the village chief.  Further asking sometimes elicited one or two names, but those names would seldom be the same for different informants.  Sometimes Chah tum were mentioned, but they only seemed to be called upon in case of conflicts.  Mistrust among people was mentioned several times as the main problem preventing cooperation. When we asked the people whom they would turn to for help if they had a problem, the answer would be that gwe solve our own problemsh, mainly within the own family and sometimes with the help of a neighbor.  Only in case of conflicts people would turn to the village chief and Chah tum.

 

We found no other forms of cooperation without an NGO involved, than individual contributions to a family organizing a death ceremony.  Not even occasionally for constructing a house, or helping with someonefs harvest. 

 

Kdong does not have a pagoda: villagers go to the nearby pagoda in Phnom Sampeu.  That pagoda has a Wat-committee, but this committee seems to be involved only in the building of the pagoda.  The village chief is the key person for collecting money from villagers for development projects organized by NGOs.

 

3.2 Kampong Sromor

 

The situation in Kampong Sromor was not very different from that in Kdong, although there was a little more conformity in key persons pointed out by villagers than in Kdong.  The most respected persons are the acaa and some Chah tum.  They are known for leading villagers to join religious ceremonies at the Pagoda in Choe Tiel (Kampong Sromor does not have a pagoda either).  They are sometimes also involved in raising money from the villagers for building a road or other village projects.  But as in Kdong, the people in Kampong Sromor told us they would basically solve their problems within the own family: gwe can help ourselvesh, was the much-heard adage.  Only in case of conflicts, the village chief would be called upon, as well as Chah tum playing part in conflict resolution basically as witnesses.

Some informants complained that the Chah tum in the past used to be more active in the village, but nowadays mainly worked for the development of the Wat.  Our informants recognized that the Chah tum, as in the past, are still the ones with ideas and initiatives, but they are gslowh.  They do not have the energy and the materials that the Angkaa has. 

 

The acaa in Kampong Sromor blames foreign organizations for changing the tradition of mutual help, such as exchange of labor or draft animals.  He claims that since efood for workf programs were started in this village, it has become more difficult to ask peoplefs contributions without paying them (either in food or money).  He admits that poverty also plays an important role: people are too busy trying to earn a living.  Nevertheless, he tries to urge people to contribute money for community activities, especially for road building.  Although the main reason given is bon craen, gaining merit for next life, it mainly leads to the betterment of the community.  He is afraid that people will forget about the importance of bon craen.  Another informant, chief of VDC, complains that people are more and more often only thinking about themselves.  He especially blames the rich who are often less willing to contribute than the poor.  Two villagers see the main reason behind the decline of exchange of labor rather in the fact that each family has less farming land than in the past.  People can do everything by themselves now and donft need the help of others anymore.

Probably there are more factors playing a part in the slow disappearance of mutual help.

 

Other villagers praise Angkaa. In the recent past nobody had the idea of joining forces to get things done for the betterment of the community, mainly because people were too poor to spend time for anything else than earning a living.  But since Angkaa came, people feel they themselves can do things for the village. 

 

The village chief sometimes raises money or other contributions from villagers.  However, most villagers admitted that they prefer to give money to monks or the acaa, especially when it is used for religious purposes. The main reason they give is trust in monks and acaa and gaining merit.  Monks and acaa are occasionally involved in raising money for village construction works as well, especially roads.  Once the VDC and village chief were not able to complete the construction of a road.  The acaa turned to the abbot and the Wat-committee in Choe Tiel. With the help of two monks and a loudspeaker they were able to collect money needed. 

 

As in Kdong, we found no indigenous forms of cooperation or association, other than ceremonies organized by the acaa for religious purposes.

 

 

 

3.3 Prey Toteung I