Why "Community Participation: Science and Technology"? Experiences of acTBistas in La Libertad, Peru.
2014 World Conference in Barcelona, THE UNION AGAINST TB.
Pedro Enrique Quiñones Figueroa, MD, MPH
President
Institute for Health and Human Rights (INSADEH)
Community participation is the reference framework for the development of public fiscalization, control and defense of rights to health in the region of La Libertad, and is based on the systematization through research work done in the district of Villa El Salvador, Lima, PERU in the 90s.
Villa El Salvador was founded in 1971 as slums, and as a government response to the need for housing and overcrowding in the city of Lima, and based on a participatory approach to urban management.
It is organized as a self-managed Urban Community and later achieved recognition as a district, and among his achievements is that of organizing a district health plan.
Here we have to consider the Adult Education in interests and needs, education to be done at work and with the elements of the context, and rquires analysis of social sciences .
On the other hand, Community participation is exercise of Citizenship, and therefore requires a level of awareness, knowledge of rights and duties, and a level of affiliation, requires a human rights framework in the field of legal science .
A study about empowerment and citizenship are as follows:
The community health work in Villa El Salvador (Lima / Peru); perception of health promoters. CARLOS MARQUEZ CABEZAS Thesis, Federal University of Rio de Janeiro for obtaining the degree of Master of Public Health.
The methodological approach was The Life History method that seeks to identify the perception of the health worker about their work and their relationships with the community and health institutions, in a peri-urban community called Villa El Salvador, and requestS research subjects to speak what they consider important in their lives about through an open interview. It is a suitable method for the homeless discourse to be heard.
"Social participation of the promoter is expressed through the exercise of power, manifested first by being- up because of the new status, and the conquest of personal and public relations (relations with important people: professionals health, Mayor, local and central leaders etc.) in their community, they start to be trained and to perform their functions, acquiring knowledge and information about health services (technical power).
Therefore, the facts to be "up", for use of resources, possessing knowledge and important information for their and having established more visible personal and public relations in their community unwrap the ability to influence and make decisions about health programs (political power). This also determines the health promoters to be recognized and considered important persons, as they conquered areas in their community. "
While both the Education and Law are not strictly science, but rather Technologies, ie the application of a set of sciences, they it also require the social sciences to understand the constructions of community partnerships, to understand the position of women, and to initiate social processes.
Social processes is liberating Education, Citizenship construction, and to necessarily clarify the relationship between society and state.Requires social empowerment, the right to health, the right to life, the right to freedom and the right to search for happiness.
The Call for education : Condition for technical-methodological processes
Conditions that requires a process of Permanent Education in Health, is the Call that requires the preparation of the overall project with the community, and in particular the establishment of educational objectives, all of which is actually a process of local participatory planning .
In this process, the responsibilities must be clearly established in the community, as this is going to participate in the monitoring and evaluation of medium term and final evaluation, and the process of transfer of the project to the community, and the required capabilities.
Also as part of the Call, a Bureau of Coordination should be established from the preliminary moments of the operation of the project since the planning processes are educational processes, and what is needed is to support what exists and to develop it , so it is important to set the foundation for a district development plan as function of the overall project to organize, since the function of the project is the educational process of training, developing skills and social empowering.
From the beginning this bureau is responsible for incorporating organizations and institutions, promoting democratic election processes of community health workers, to disseminate the required profiles as a function of the Local Plan, to inform those who will be the trainers promoters and supervisors plan, evaluation mechanisms, schedule meetings, and social communication campaign and the launch of the project.
Adults must see clearly reflected their interests, should actively participate in the selection process and should be clearly stated as expected addressing workplace or employment situation.
For example for young health promoters, the profile is presented to the health centers or in agreement with colleges and universities as part of the curriculum, and for older women promoting the conformation of service cooperatives and agreement with the municipality district, or the conformation of small businesses such as popular restaurants .
Regarding the call and institutionalization from the state, we have the study: ITURRI, M. Jose. The cholera epidemic in Peru as a social event. Representations of community leaders from Villa El Salvador. Lima: 1991. Rio de Janeiro. Osvaldo Cruz Foundation / National School of Public Health. Dissertation in Public Health, 1994.
"On METHODOLOGICAL CONSIDERATIONS Our object of study is defined as the social representations of a group of community leaders from a limenho district, about the cholera epidemic; epidemic regarded as a "social event" and a "climate crisis". In this context the study subjects developed a set of practices oriented to modify the course of the epidemic. Our purpose is to try to clarify the meanings that had this process for the leaders of Villa El Salvador.
The interests and positions of individuals and groups involved in Peruvian society, their relations with the state and with other individuals and groups, are covered-from the theoretical perspective of dynamics chosen "illusion-allusion ' proper of ideological processess.
For these reasons our methodology had two "phases" worked on simultaneously:
1. A historical reconstruction of the period studied, based on the compilation of secondary data sources (historical data, epidemiological and economical, official documents of organizations and institutions and written journalistic material); will be analyzed and recolected seeking an approximation of the "social totality" that fits the phenomenon studied.
2. A compilation and analysis of primary sources, considering leadership as "privileged informants" about the situation studied. For this was held a semi-structured interview, following an interview guide. Our goal in this "phase" was to get a closer understanding of the meanings that have interviewed about this situation.
FINAL THOUGHTS The problems that this research poses revolved around the question: how the social representations that the community leaders have produced over the cholera epidemic, expressed at the level of discourse and social practices the relationship between dominant and dominated ideologies, and how from this specific level if related to processes of hegemony and legitimacy.
In January 1991 began in Peru the first cholera epidemic of the century in Latin America. In that year the disease, according to official statistics, reached 322 562 people, killing 2,909 people in the country. Provoked a climate of intense fear and affected in important ways the daily life of millions of Peruvians. It was estimated that the treatment of sick people cost approximately $ 40 million and that this period of time have accumulated approximately $ 1 billion in economic losses.
At the end of 1991 was considered in virtually all sectors of Peruvian society that the Government's response to the epidemic had been a success, despite the damage mentioned and the following facts: not to have changed the conditions that determined the appearance disease; the epidemic to have become endemic and the government that continued applying the strictly economic program of neoliberal, that severely worsened the living conditions of the majority of the population "
Permanent Education raises Context, as Local Participatory Planning condition.
Permanent Education states that the educational needs arise from the context of the problems that arise in the workplace and in life. From here emerge as conclusions for health personnel, the health needs of the population are the problems that must be faced, and the educational goals of any training process arise of these needs .
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From the needs of permanent education surges training and a participatory process is established, with responsibilities assuming tasks for problem solving. So local participatory planning grows out of educational planning, all stakeholders become subject, and we speak of facilitators or promoters, and we develops leadership.
The reformulation of the problems and educational needs, the definition of responsibilities, and the constitution of the Committee are built with progressive definition of objectives and activities of the people on priority problems defining the Plan document. .
So the plan becomes the group of people working toward a goal, the Plan becomes life, and educational Planning in its central element, return policy for empowerment at the local level, as stated in the following study.:
COMMUNITY INVOLVEMENT AS CRITICAL KNOT IN THE PROCESS OF SOCIAL HEALTH DESCENTRALIZATION. MASTER'S THESIS. PUBLIC HEALTH FACULTY Universidad Peruana Cayetano Heredia. PEDRO ENRIQUE FIGUEROA QUIÑONES
Centralism, the subsequent industrialization model, and the constant state of rural population growth and agricultural crisis, prompted this development and social policies that had to be done from an oligarchic or aristocratic status and in response to social pressure and the birth of modern movements and parties.
It is the policy of Human Rights, the government projects to develop local management and improve utilization of resources, with greater involvement of impact groups and the whole work of donors and recipients.
"The central notion of sustainability among its requirements the active involvement of local leaders must be considered in the project." (Report: Investing in Health World Bank 1993...).
In prioritizing local health actions fall within the actions of individuals, families and communities in the process of local development emphasizing social participation, intersectoral action and the use of appropriate health technologies. "
At local level the Peruvian population has developed multiple health practices and creative integrated development, has been generating many health workers with the mother of his primary family representative, which arise from other stakeholders such as health promoters .
This healthcare network has been growing and interacting with institutional actors such as the church; non-governmental institutions and local governments, achieving a level of accumulation of experiences.
In Peru we have a rich tradition of social participation is also expressed in the field of health, and in 1925 Dr. Manuel Nunez Butron responsible for the Altiplano Region of Health convened Rijchary defined as voluntary staff. This experience culminated in 1937 after having spread to 17 districts of Puno.
The Ministry of Health, although it had been decentralizing initiatives and appropriate legal instruments for state reorganization, it still remains basically unchanged.
"The orientation of the health guidelines could have created a space for the development of organized decentralization and social participation." ("Economic and training profiles of a group of health promoters in Villa El Salvador (VES) descriptive study of the major social, demographic, political, Thesis of Bachelor of Medicine, Universidad Peruana Cayetano Heredia, 1988. Pedro Enrique Figueroa Quiñones ).
These three moments: Community Participation, Institutionalization in the State and district level decentralization, explained in the studies mentioned above, were developed in the experiences of the Institute for Health and Human Rights (INSADEH), and acTBistas of La Libertad, Peru.
The Multisectoral Regional Health Coordinator (COREMUSA La Libertad) the INSADEH participated and organized the Regional Strategic Plan HIV AIDS Multisectoral STI (STI HIV AIDS PERT) and project portfolio.
With the participation of the Regional Association of Health Promoters DOTS Plus, the Regional Association of HIV Positive People (ARPPOLL) and the Lutheran Church, we agreed to organize the Committee acTBistas of La Libertad, and develop the work to the district level.
With the visit of the French NGOs Medical Assistance for Latin America (AMAL) in 2012, we held meetings with mayors and health facilities, which were later recognized as Multisectoral District Coordinators of Health (CODIMUSA) for the Regional Health Management (GERESA La Libertad) to develope.
With the visit of Partners in Health - PERU, projects with NGOs and district Mayors were presented in training workshops for developing TB DOTS seeking improved uptake and monitoring symptomatic patients and also had MDR TB patients .
The INSADEH start meeting with Ombudsman's Office, Public Prosecutor, High Court of Justice and Penitentiary Institute, and Dr. Doris Saldana Pinedo, a lawyer specializing in human rights take them out through three workshops, in coordination with the Regional Health Management (GERESA )which ended with the signing of a letter of commitment
Dr. Doris Pinedo Saldana also made an analysis of the Law 29414, Law of Users of Health Services, amending the General Health Law, which concludes with the need for protocols, product of which was the development of a Protocol TBC for Persons Deprived of their Liberty by INSADEH.
The Regional Association of Health Promoting DOTS Plus participated in the International Workshop on New Financing Mechanism of the Global Fund, with their draft projects product of workshops.
The INSADEH actively participated in the Multisectoral Meeting - Country Dialogue and Presentation of the Concept Note TB - Global Fund, and later presented the TBC Protocol Persons Deprived of their Liberty to Partners in Health, PAHO and the Technical unit CONAMUSA- MOH.
ARPPOLL and Lutheran Church began meetings to spread a message of values among patients with HIV, and create with them a draft project of Improving the Quality of Life for Children Living with HIV, which includes the prevention and monitoring of TB, and was presented to CONAMUSA technical Unit, and the Division of health Education GIZ - Deutsche Backup initiativse - .Alemania.
So we got as tasks for 2015, assessing activities, assessment of community participation at the district level, and given the sustainability achieved by the participation of the community, managing by INSADEH the feasibility through projects for international cooperation , and through participatory budgeting to district municipalities.
Lima October 27, 2014
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