Behavior Changes

Lhamu Choden in Scotland, where she attended a health training session sponsored by Mercy Corps. Photo: CHAI Project

Health awareness and hygiene behavior activities are a very important component of Mercy Corps' Community Health and Advancement Initiative (CHAI), funded by Oregon-based Tazo Tea Company and implemented through local partner DEG. In adopting a behavioral change approach to our hygiene promotion program, our main objective is to instill good health behavior through adoption and sustenance of behavioral changes. Factors that influence human behavior are the core of adult education. Demand, expectations, culture and the conditions under which one learns various tasks can facilitate or restrain behavioral changes.

Often people with low incomes are considered illiterate and superstitious, and therefore blamed for not utilizing healthcare facilities. Our studies, however, show they do in fact seek modern medical care when possible. The factors that restrict their use of medical facilities are:

• Inability to pay transportation costs


• Inability to pay for diagnostic tests


• Inability to sacrifice the loss of wages and work, if they are daily-wage laborers


• Ineffectiveness of modern medicine to cure several common diseases, such as hemorrhoids, arthritis, stroke or acute conditions related to hepatitis.

Considering the circumstances, the healthcare decisions of low-income people - such as whether to try home remedies, traditional healers or modern medicine, or whether to go to a government hospital or private nursing home - represent a pragmatic cost-benefit assessment. And the decision to see a traditional healer rather than an accredited doctor is not always related to cost savings.

Take the example of Mr. Syangbo, a 45-year-old traditional healer who lives in Nagri Tea State, less than a kilometer from one of a dozen rural communities that Mercy Corps operates in. Mr. Syangbo is well-known for treating patients with locally available herbs. So far, he claims to have successfully treated more than 1,000 patients ranging in age from a two-day-old baby to an 80-year-old elder. He also claims to acheive success where modern medicine has failed. The village's elected leader, known as the village Pradhan, recently suffered from typhoid which later developed into a jaundice. The Pradhan said his condition did not respond to a science-based medical treatment, but did improve as a result of treatments from Mr. Sangbo.

This example illustrates how human behavior and the ability to understand how relationship influence such behavior is a vital prerequisite for planning any behavioral changes program. Not all learning results in behavioral change. Therefore, all behavioral changes need not be the result of learning.