Sierra Leone currently has one of the highest child mortality rates in the world. Among those children who have the greatest chance of survival are those who have access to life’s basic needs. Because the government of Sierra Leone does not provide child welfare programming, non-governmental organizations (NGOs) are often lifelines for millions of children. Few studies have explored the barriers facing these NGOs or have used participatory action research methods to do so. This case study serves agencies working to address barriers to individual and community health in war-torn and developing countries. This research also makes a case for using technology as a tool for community engagement and empowerment. This chapter will highlight the findings of a participatory action research study and describe how Photovoice can be used to build community capacity and mobilize communities, organizations, and governments to bring about social change.
TopProject History And Context
Sierra Leone, a West African country, is one of the world’s least developed countries and has one of the highest child mortality rates in the world (United Nations Development Programme, 2007). Sierra Leone is recovering from a decade long civil war which resulted in thousands of fatalities and orphaned and abandoned children (United Nations International Children’s Emergency Fund [UNICEF], n.d.). Despite the poor health indicators reported by Sierra Leone, there is a paucity of research that explores the barriers and impacts to child health and development for the millions of orphaned and abandoned children living there. It is necessary to examine the barriers to child health from an ecological standpoint, which includes the sociological, economic, environmental, political, and cultural aspects of society.
The Sierra Leonean government does not provide support for child welfare programming; therefore, care provided by non-governmental organizations (NGOs) is vital to child survival. Recommendations in the literature support the need for action-based research to evaluate services provided by organizations that provide care to children, but prior to this project no known research of this kind was completed (De Jong & Kleber, 2007; Denov & Maclure, 2006). Because of the role these agencies play in child survival, NGOs should be willing to engage in participatory action research to improve upon these services. The purpose of this research was multi-fold: first, to examine factors that impede and promote the health and well-being of orphaned and abandoned children in Sierra Leone; second, to facilitate Photovoice, a participatory action research method, among NGO workers to identify barriers to care giving for orphaned and abandoned children; and third, to use digital technology to build organizational and community capacity to bring about social change. The researchers became acquainted with an international NGO in Freetown, Sierra Leone, during the summer of 2007. After discussions with the executive director about the barriers and challenges of caring for abandoned and orphaned children in a war-torn country and the global community’s lack of awareness of these issues, the idea of participatory research emerged as a mechanism to explore these problems further and develop a plan to address the barriers. Participatory research emerged as a way to assess the needs of the community and build academic alliances within and outside of the country. The researchers and executive director agreed upon the plan to complete a Photovoice project in 2008.
Photovoice is a method developed by Dr. Caroline Wang and Mary Ann Burris, and was first used with the Yunnan Women’s Reproductive Health and Development Program (Wang & Burris, 1997). Historically, this technique has been used to organize communities to address specific health issues among diverse and often vulnerable populations. Photovoice is emerging as a significant research tool in global health and it supports the objectives of Participatory Action Research (PAR) because individuals come together to identify factors contributing to social problems and organize to initiate change (Wang, Morrel-Samuels, Hutchinson, Bell, & Pestronk, 2004).
Wang and Burris present a nine-step methodology to help carry out the goals of Photovoice. These steps include: recruiting participants, selecting a target audience of community members, obtaining informed consent, conducting a training session, brainstorming with participants, distributing cameras, allowing time to take photographs, meeting to discuss photographs, and creating a plan for change (Wang & Burris, 1997). To complete this research project, we followed the methodology steps highlighted by Drs. Wang and Burris.
According to Wang (2006), Photovoice projects should include a sample of six to ten participants. To follow this recommendation, the researchers recruited ten caregivers employed by the NGO in Freetown. The participants were all natives of Sierra Leone, English-speaking, and included the two administrative directors, teachers, nurses, a security guard, childcare workers and childcare support staff at the Center.