Overcoming Coloniality in Adolescent Health Programmes: Harnessing Cultural Values and the Indigenous Roles of Grandmothers to Promote Girls' Holistic Development in Senegal

"Any action you want to take must be contextualized [grounded in local culture]....When we realized that excision [female genital mutiliation/cutting, or FGM/FGC] was a problem, we had to tackle it. Today, who is the custodian of this cultural practice? It's the grandmothers - who had been marginalized. Grandmothers shouldn't be involved [in a programme on FGM/FGC] to be goaded into doing what other people want - they should be involved because it is their right." - Mamadou Ba, cultural expert/sage

Scholars have argued that theory and praxis in global health and gender and development employ models of gender and social change that are Euro-North-American-centric and fit poorly with cultural realities and community dynamics in the global South. This paper unpacks how coloniality informs some of the dominant approaches used by major organisations to improve the health and well-being of adolescent girls and explores why they can result in ineffective and sometimes harmful interventions. The limitations of these approaches include: top-down imposed objectives and pathways to change; individualist, sexist, ageist, and modernist biases; and ignorance or denigration of local cultural values, resources, and family and community dynamics. Instead, the authors present the Girls' Holistic Development (GHD) programme, implemented by the non-governmental organisation (NGO) The Grandmother Project - Change Through Culture (GMP) in Vélingara, Senegal, since 2009, as a decolonial alternative.

Decoloniality is a political project that aims to identify, understand, and dismantle coloniality and other inequalities to create a more just world. Whereas coloniality is grounded in the binary of modernity-tradition that emerged during the Enlightenment and risks reproducing hierarchies by neglecting the marginalised in their design and implementation, proponents of participatory and community development, in line with decolonial principles, advocate that community members must be involved throughout the development process to ensure that change results from consensus, not coercion. In addition to the ethical imperative of such an approach, change is more likely to be sustained when individuals and communities own and define the change process and when goals are adapted to local realities.

Indeed, GMP conducted 18 months of community consultation to inform the design of the GHD in Senegal, which involved understanding community members' perceptions of, and explanations for, factors that undermined girls' health and well-being. Results were that community members, young and old, perceived that cultural values, knowledge, and practices were being lost due to the breakdown in inter-generational trust and communication, as a result of the influence of Westernisation of school content, mass media, and international development programmes. Addressing these concerns became a principal programme objective. (See Related Summaries, below, for more on the GHD and its grounding in theories and methodologies from participatory and community development, anthropology, family and community systems theory, transformative learning/adult education, and community, cultural, and Indigenous psychology.)

Moreover, theorists of community development argue that behaviour change - whether catalysed from within or outside a community - requires building community capacity for collective action. GMP draws on these insights from community development and uses a participatory action research methodology. In this approach, the NGO catalyses - rather than defines or imposes - the change process. GMP supports communities to identify formal and informal leaders and key actors from all groups who influence, or are affected by, adolescents' rights, health, and well-being. It then facilitates dialogue and builds capacity to discuss shared problems and define a vision of the future.

Decolonial practitioners have also argued that the linear communication model shaped by the colonial paradigm is faulty, as it assumes that people will internalise the prescribed messages and change their behaviour accordingly. Instead, GMP's approach uses what it intends to be transformative and empowering education/learning techniques informed by the insights of Paulo Freire and feminist pedagogy. Their tools depict problems that communities are likely to encounter through role plays, theatre, or pictures designed to be accessible to individuals with and without literacy skills. Facilitators then open discussion of people's experiences of these scenarios and support the development of their capacity to analyse new information actively and critically, propose solutions, and design their own strategies to deal with these problems.

Furthermore, in contrast to a deficit or culturally ignorant approach, GMP is inspired by a decolonial "assets-based approach" to culture and community resources. This appraoch involves recognising that communities and their cultures - which include norms, collectivist values, and the roles and influence of key individuals in family and community decision-making - contribute significant assets to the development process. However, GMP recognises that not all cultural values and norms have positive outcomes. Hence, GMP frames culture as a dynamic set of values and norms that, through participatory involvement of local peoples in the process, can be reformulated and renewed.

Finally, in contrast to linear and individualistic models of behaviour change, GMP's approach reflects the work of systems theorists who assert that programmes are more effective when they focus on promoting changes in social norms - understood in collective terms - which can only come about if a community comes to a consensus in favour of that change. Empirical evidence shows that, because of the intersection of age hierarchies and gender in "non-Western" contexts, grandmothers play important roles in the spheres of sexual and reproductive health (SRH) and children's health. Thus, GMP has developed a "grandmother-inclusive" approach, where grandmothers are involved as change agents alongside other influential authorities in families and communities.

Building on the insights from these diverse paradigms, as part of GHD, GMP designed a series of interactive community activities to strengthen community cohesion and catalyse dialogue for consensus building for change to support adolescent girls' health and well-being. These activities include:

• Inter-generational forums with community leaders;
• 'Days in Praise of Grandmothers' and 'Days of Dialogue and Solidarity';
• Other participatory learning activities;
• Leadership training with grandmothers and adolescent girls; and
• Grandmother-teacher workshops.

The article unpacks how these activities have evolved over time based on input from community participants and other challenges identified by GMP. Overall, results show that GMP has contributed to shifting social norms underpinning child and forced marriage, female genital cutting, adolescent pregnancy, and premature school-leaving because it is culturally affirming, inter-generational, grandmother-inclusive, assets-based, and rooted in building community capacity and consensus for change towards locally defined objectives. For instance, the video below features testimonies from grandmothers, adolescent girls, and a female teacher on the positive changes that have resulted from involvement of grandmothers and inter-generational relationships.

However, GMP faces a number of constraints to implementation, which point to broader structural barriers to the implementation of decolonial programmes in the field of adolescent health. To address these barriers, the researchers suggest that organisations and donors should:

1. Consider a broader range of evidence that would involve evaluating the ethics as well as efficacy of programme approaches. This evidence could come from: anthropological ethnographies on cultural dynamics in local communities; postcolonial and decolonial critiques of the harms caused by Euro-North-American-centric models used in adolescent health; and alternative paradigms, like systems thinking, community development, and Indigenous approaches, that promote collective community empowerment instead of linear, directive, and individualistic approaches to social and behaviour change.
2. Recognise that cultural affirmation, as well as strong relationships within communities and between community and development actors, are central to decolonial community development processes. Project funding models need to evolve to support such activities.
3. Invest in more resources universities and institutes in the global South to train practitioners to design and implement programmes informed by decolonial principles. This investment must be separate from project-related funding. The long-term end goal needs to be strengthening communities' own capacity for collective mobilisation to realise independence from the constraints and power inequalities inherent in external development intervention.