Communities in Africa are complex and variation in culture and language requires sensitive approach to cause social change. Cancer Free Women uses Community Based Participatory Research (CBPR)  approach to increase capacity building and sustainable adoption of evidence-based practices to fight breast cancer. In this partnership, community members (Women primarily), organizational representatives (Women group leaders & church leaders), and researchers are equitably involved in all aspects of the research process, education and implementation (Action). Partnering entails sharing resources with community entities to enable their participation at all levels and permanently impact even generations to come.
Repetition causes behavioral changes. Reward reinforces positive behavioral changes. Performance based incentives would create self interest to create sustainable social and health change in women being killed by breast cancer.
Traditionally, donors and Non-Governmental Organizations have been pouring billions of dollars on framework(s) controlled by corrupt governments with little or no evidence that the desired outcome will ever be achieved. Evidence has shown that performance based compensation will not only improve quality but also volumes.
Looking Inside the box: The idea is to engage the communities in their natural settings with performance based incentives to create a sustainable social change. Based on CBPR, the following are our core principles guiding our breast cancer approach:
  1. Recognizing a community as a unit of identity.
  2. Building on the strengths and resources within communities
  3. Facilitating collaborative partnership with communities at all phases (Education, research, solution and action).
  4. Promoting a co-learning and empowering process that attends to social and cultural inequalities
  5. Addressing breast cancer from both positive and ecological perspectives
For example, in Kenyan women communities, over 85% of women over age 40 belongs to a church group or a women group of some sort. These groups form basic units of identity.
It is not realistic to expect a community health worker to reach out deep into the villages without performance based incentives. Salaried community health workers simply does the bare minimum since change in input has no effect on output. Waiters & Bartenders work hard to please their clients because their input is rewarded with tips.
Most of these women groups have leaders with formal knowledge like teachers and nurses. Instead of using external educators, using one of their own and giving them performance based incentives could be more proper than using an outsider with a fixed salary. This is the principle of building on strengths and resources already existing in a community and collaborative partnership.
The project goal includes developing, implementing, and evaluating a culturally sensitive, community-based model for coordinated outreach campaigns to enhance women’s participation in early detection programs and follow-up services for breast cancer.