Hesperian Health Guides

Who Gets Things Started?

In this chapter:

Within a community or neighborhood there will often be persons eager to become involved in starting rehabilitation activities or even a program. All it may take is something to ‘spark the idea’. This spark can be in the form of a person, a pamphlet, or even a radio program that triggers people’s imaginations with ideas or basic information.

For example, we know of one village medic with paralysis due to polio who received a WHO magazine with an article on “Rehabilitation for All.” As a result, she began to organize the villagers to build a simple rehabilitation playground. In a similar fashion, CHILD-to-child activity sheets have sometimes inspired teachers to conduct activities that help school children to prevent certain disabilities or to behave toward children with disabilities in a more friendly, welcoming way.

Often, to get things started, it takes a person with some background in rehabilitation and in community work, to stay for a while in a village or neighborhood. Her role is to bring together people with similar needs, helping them to form a plan of action and to obtain the information and resources they need. Such a person is sometimes called an “agent of change.” She need not be a highly-trained professional in rehabilitation or social work. In fact, persons who have professional degrees often have the hardest time accepting that parents and people with disabilities can and should be the primary workers and decision makers in a community rehabilitation program.

What is necessary is that the agent of change respects the contributions that all community members can make and is committed to helping them join together to meet their needs and defend their rights.

The agent of change should be a counselor, not a boss; a provider of information and choices, not orders or decisions. Especially when such a person comes from outside the community, her role is to stay in the background, to help the people make their own decisions and run their own program. At all costs she avoids taking charge.

Staying in the background, however, is easier said than done, especially for an agent of change who is deeply committed. To make sure that a program is run by the people, not by outsiders, it is often a good idea that agents of change and any visiting professionals not be present all the time. Instead, they should encourage the program to continue without them. Perhaps the final test of an agent of change’s success is to leave the community forever, without her absence being much noticed. These ideas are said beautifully in this old Chinese verse:

chinese man


A good example of this process can be found in Community-based Rehabilitation in the Bolivian Amazon.

To help start a program for people with disabilities, it often works out better if the agent of change is also disabled. This helps make the outsider an insider.


This page was updated:04 Apr 2024