One small community rises to become a national model.
Sapasoa, Peru. Throughout Peru, the child malnutrition rate averaged 25% in 2007. In many rural and remote regions, that rate soars to over 50%. Yet in the small community of Almendras, made up of 40 families in a remote region of Northern Peru, none of the children under five are malnourished. In the past two years, every infant has been exclusively breast fed for six months, and all children under five are receiving five meals a day. What has brought about this change? One factor has been the community’s early adoption in the Healthy Communities and Municipalities Project, implemented by LMS.
The Healthy Communities and Municipalities Project
Since late 2005, Almendras has been part of the Healthy Communities and Municipalities (HCM) project. HCM’s objective is to improve maternal, child, and peri-natal health in communities that have signed coca-eradication agreements in six regions of Peru. These areas have been traditionally neglected both by the government and private investment. At its core, health promotion consists of providing people with the means to better control their own health. To achieve this, the project works on improving "health determinants" (latrines, housing conditions, parks, safe water, nutrition, access to family planning) within the participating communities. USAID approached LMS in early 2006 to administer the implementation of the HCM Project, after two years of development and testing with PRISMA, a Peruvian NGO.
A typical community
The region of San Martin in Peru contains hundreds of communities much like Almendras: 50 to 200 people who migrated to the area less than 10 years ago and live primarily by farming the rich soil. Almendras is one of 557 communities to voluntarily discontinue coca production in exchange for assistance in alternative crops and other development, including the HCM Project.
The first phase of the project is to organize the community. The federal government passed a law which encourages communities to organize in Juntas Vecinales Comunales (JVC, community committees). The JVCs legally represent their communities and are designed to give communities additional legitimacy and more engagement in municipal planning and budgeting. For many years, few communities organized themselves into JVCs, yet with the HCM project all 557 communities selected their JVC members as the first step in participation.
In the first week, eight families from Almendras signed on to the project, including the families from the five members of the JVC. Through their example, another eight quickly joined in and soon every family in the community was taking part. "We prepared our own diagnostic plan, we organized and worked together to create improvement, and now we are monitoring the results," explained Ernesto Jesus-Perez, a member of the JVC. "The community no longer waits for an authority to help them. We have taken control of our development."
Overall results in Almendras
The improvements in Almendras are far reaching. "We have achieved many improvements," Mr. Perez explained. "Before, diarrhea, stomach problems, and sickness were common. Now it’s really rare for someone to be sick. Even the few poisonous snake bites we’d get each year have vanished since clearing our yards and the paths." Additionally, all three women who have become pregnant in the last year received full prenatal care and gave birth in a health facility. The community health promoter, a member of the JVC, has also given training in modern family planning methods to every woman of reproductive age. While some trainings in the methods are provided at the small health post in the community, the health promoters primarily rely on individual home visits, discussing the methods with both the wife and husband. "The change has been significant," the health promoter explained. "We had the family planning supplies in stock at the health posts, but no one used them. But in the past year, now there is steady use."
A model community
Almendras has become a "Model Community" for the HCM project. The mayor of Sapasoa noticed the improvements in Almendras and the other participating communities immediately. "The change in behavior is amazing. I believe that development starts with the individual, and in these communities we have seen evidence of this. They’ve learned now to solve their problems, and how to best come to the municipality for activities requiring additional support."
Sapasoa is made up of 56 rural communities and 14 urban JVCs, fewer than one third of which are a part of the HCM Project. Not content to simply wait for expansion of the project from the outside, Sapasoa has developed a plan for expanding the interventions to all its communities, using many of its own funds. "We’ve had 180 years of development from the top," explains the mayor. "Many of the people who live here have seen decades of this. It’s time we try something new, something different. Each of us must take on the responsibility for the whole community."
The HCM project exemplifies the importance of intervening at every level. The project focuses on lifestyle and behavior changes in the family, school, and health centers, educating the whole community about putting health as a priority in everyone’s lives.
