This presentation reports on a health and livelihood promotion project employing a community engagement approach, driven by an anthropological perspective dating back to the late 1980s (Stone 1989). The approach has roots in medical anthropology, which employs a critical lens to highlight, from a social perspective, the “lived experiences and contested social worlds” in which community members live,” (Panter-Brick & Eggerman 2018). The perspective is holistic in contrast to programs that focus on a single health problem. In some ways findings echo those of the common factor approach recently used in Nepal to understand the persistence of the role of shaman (Pham, Koirala & Kohrt 2020).

This presentation reports the complex findings from ethnographic research on two closely associated communities on a two-stage project. First, the team conducted research on the community perspective on their own health challenges. Secondly, in cooperation with the community, we identified and prioritized issues this marginalized community identified as their main goals. This stage also entailed creating a structure to raise funds and to identify and implement plans to carry out small-scale programs to achieve the community-identified goals.

Primary information derives from open ended interviews taken from each of the 45 households in the two communities of Maigum and Rawal Gaun on the outskirts of Besishahar Municipality. These communities are characterized more by internal variation than uniformity, with substantial variation by geography, caste, gender, religion and economic status. The findings reveal a wide variety of health concerns as well as a plethora of factors affecting their cause and treatment. A primary factor described by locals is the “belief system.” However numerous other factors are also at play. They include local variables that directly affect illness onset, diagnosis and treatment, social structural variables of age, caste and gender. Regional concerns such as the evaluation of the project by the Municipality and global effects of involvement in labor migration are also influential.

Information is taken from the ensuing program to establish a cooperative structure to address the main concerns of the community, giving equal voice to the community and to a group of social-science and health advisors with knowledge of the research and its cultural context. Although the project is ongoing, several important preliminary observations and conclusions have emerged that illustrate the advantages and challenges involved in our novel approach to addressing community health. Chief among the advantages is the empowerment of the community to co-create its own health infrastructure to improve their health from a broad, community-based perspective. The biggest challenges relate to the coordination of information and resources from a small-scale support organization with membership in the US and Nepal.