Strengthening Community Participation in Early and Pre-school Bilingual Intercultural Education (APEDIBIMI)
This early and pre-school bilingual programme for girls and boys of the Maya Ixchil indigenous community has been developed in the department of El Quiché, Guatemala through community participation
The APEDIBIMI methodology intends to optimise early education through the joint efforts of various actors including APEDIBIMI, the Guatemalan Ministry of Education the communities, and the United Nations Children's Fund (UNICEF). The Ixil indigenous area of the province of Quiché has 20 bilingual Ixil/Spanish nursery schools decorated with bright colours, drawings, and bilingual posters. When children come to school, each chooses one of three ‘corners’ identified in the classroom: language and communication; logical thinking; or artistic expression. After spending some time in these corners, they gather around for a ‘dialogue in chorus’ to openly express themselves. Both languages are spoken in the school by children and adults. Teachers are selected from the community. The parents are directly involved in the educational process, going over at home what the children have learned in the classroom and collaborating on making classroom toys or preparing school snacks.
UNICEF implements workshops to keep teachers updated, train mothers in early education, and deliver support materials. The programme trains mothers of children under three on the importance of early education, stimulation, and health care. Workshops include capacity building for health promoters and teachers and organised circles of interaction on themes related to the curriculum, including comparing it to the national standards.
Meetings of parents in the programme include local community leaders and elaborate what the community and parents can do to support the schools. These meetings also provide parents with guidance on how to support their children's education.
The project focuses on the geographic region called the Ixil triangle, identified by the centralised communities of Nebaj, Chajul, and Cotzal. In 2005, the project included 40 teachers, 25 health promoters, 1,771 children from 0-6 years old, and 700 parents. Community- and school-based projects included a festival of stories and legends for children, a document on the rights of children, an exchange of information and experiences among the promoters and teachers from all the communities, a student exchange of experiences for those entering first grade, and special attention for the needs of 34 youths. Parents met to make toys from local materials for the schools. The education ministry (MINEDUC) certified the teachers and registered the schools. MINEDUC is also involved with ongoing curriculum formation and provision of materials.
APEDIBIMI, UNICEF, Ministry of Education, Bernard van Leer Foundation, Volens/Itinerans, Global Fund for Children, Proyecto Ixil, Red de Información para el Pueblo (the Information Network for the People), Centro de Comunicación Comunitaria Ixil (The Centre of Community Communication Ixil), SERJUS - Servicios Juridicos y Sociales (Legal and Social Services), the Work Group.
Since 1997, the international peacebuilding organisation Interpeace has been working with 8 national partners of Foro de Organizaciones Sociales en Temas de Seguridad (FOSS) to support the peace proce
This initiative uses interpersonal communication in an effort to strengthen the capacity of civil society organisations specialising in security issues to work with the state (from the military to the police, Parliament, and the Office of the President) to elaborate public policy and establish mechanisms for citizen control and monitoring of the security sector. It is implemented in partnership with 8 FOSS national partners and in close collaboration with the Congress and the Advisory Council on Security, which serves as an institutionalised platform between civil society and the Office of the President. This collaborative strategy is designed to create a constructive relationship between political institutions and local citizens in order to formulate more effective public policies.
In its third phase, the initiative is continuing along these strategic lines, working together with the state to support the implementation of the National Security System, which FOSS staff have played a central role in developing. Interpeace is also working to strengthen the capacity of civil society groups to participate in the advancement of democratic security, to the end of hopefully allowing these groups to make informed joint policy proposals and inputs to legislative debates. Finally, organisers are facilitating focused face-to-face dialogues between the state and civil society on various aspects of democratic security and consolidating the institutional mechanisms for such dialogue.
Conflict, Democracy and Governance.
According to Interpeace, years after the signing of the Peace Accords on December 28 1996 that brought a formal end to 36 years of brutal civil war, Guatemala remains a fragile democracy. It has seen a rise in violent crime, the growing threat of youth gangs (pandillas or maras), and drug trafficking and money laundering. The homicide rate is higher than during the civil war. In this context, "[s]ecurity has become a primary concern for both the population and the political elite. In turn, rising insecurity is encouraging repressive measures with a recourse to autocratic habits and army involvement in what should be domestic police responsibility. These trends threaten basic democratic principles and institutions, including human rights and public confidence in the state and its institutions. Confronted by all these challenges, the ability of the Guatemalan state to formulate and implement policies remains weak. Security problems constitute the main threat to democratic governance and reflect the unfinished security sector reform processes spelled out in the Peace Agreements."
Asociación de Investigación y Estudios Sociales (ASIES), Asociación para el Estudio y Promoción de la Seguridad Democrática (SEDEM), Centro de Estudios de Guatemala (CEG), Fundación Myrna Mack (FMM), Incidencia Democrática (IDEM), Instituto de Enseñanza para el Desarrollo Sostenible (IEPADES), Instituto de Estudios Comparados en Ciencias Penales de Guatemala (ICCPG), Universidad Rafael Landívar (URL).
Centro de Estudios para la Equidad y Gobernanza en Sistemas de Salud (Flores and Gomez); International Development Research Center (Zakus)
Published in the summer 2010 issue of Health Exchange, this article explains how, through an action research project, citizens in Guatemala have become empowered to monitor public health policy
Health Exchange website, September 10 2010.
Launched in 2005, Save the Children United States (USA)'s 4-year Maya Salud project worked to bring high-quality sexual and reproductive health (SRH) services to 51,985 women and men of reproductive a
To achieve its aims, Maya Salud engaged a range of constituents as equals in a process that built local capacities to improve and monitor the quality of SRH services: community members, Ministry of Health (MOH) representatives, Cooperativa Todos Nebajenses or Cooperative of the People of Nebaj (COTONEB), and community health workers (CHW) - MOH volunteers who receive a stipend to provide certain health services in rural communities.
Maya Salud used a methodology that Save the Children calls Partnership Defined Quality (PDQ), which was developed in 2000 and has since been implemented in more than 18 countries. (click here for a related toolkit in PDF format.) PDQ engages community members in improving and monitoring the quality of their health services, and is shaped by the awareness that solutions to health service problems might lie outside the formal health system.
Representatives of 88 communities and of the health system jointly examined and improved SRH services according to this 4-phase PDQ process:
- Building Support: Save the Children staff held a series of meetings with residents who could represent their communities' concerns to the health system and with local, district, and national service providers, including the MOH and COTONEB. In all, Maya Salud achieved acceptance of the PDQ process in 88 communities (or 92% of target) over the life of the project.
- Exploring Quality: 5 Maya Salud field staff guided community groups and service provider groups - separately - to explore their perceptions of what constitutes a quality health service, particularly in matters of SRH. Each group developed its own definition of quality by considering its members' needs, resources, rights and responsibilities, and cultural heritage. Each group also explored the benefits of a partnership between community and health workers.
- Bridging the Gap: In each community, the residents' group and the health workers' group brought their definitions and characteristics of quality health care to a joint forum. They presented their own and heard each other's ideas and perspectives. In each case, Maya Salud staff guided the 2 groups to form a team and develop a shared vision of quality. Together, each team then identified and prioritised problems and constraints that made it difficult to achieve quality health services within the community. Each of the 88 participating communities established its own Quality Improvement Team (QIT) composed of a subset of community members and health workers.
- Working in Partnership: Through dialogue and analysis, the QITs explored the root causes of inadequate quality of services and identified appropriate, feasible solutions for reaching the desired level of quality. The resulting Quality Improvement Plans delineated actions to fill gaps in knowledge, skills, or attitudes at 2 levels: community/client (service demand) and community/provider (service supply). The QITs also established goals and identified indicators to monitor progress and determine when a goal had been achieved.
Here are a few examples of activities that the QITs undertook in their Quality Implementation Plans.
- Peer networks called Amigas/Amigos (friends) were established in participating communities. Amigas and Amigos learned the basics of FP, including modern methods, peer counselling, and referral (and sometimes accompaniment) to health facilities.
- Maya Salud developed and distributed a Contraception Sample Kit to help the Amigas/Amigos, MOH service providers, and CHWs show which methods are available, what they look like, and how they work. The kit was designed to demystify contraception for new users who could touch, see, and ask questions about methods in an informal environment.
- Maya Salud trained 1,000 QIT members to mobilise their peers and community members to promote social change. Likewise, 1,000 QIT members learned the basics of family planning (FP) and modern contraceptive methods so that they, too, could promote them and counsel others in their use.
- The MOH and COTONEB trained more than 200 health workers in FP and SRH counseling.
- 80 CHWs learned the basics of SRH and modern contraception, counselling, and information dissemination. In the most remote communities, the CHWs dispensed condoms, pills, and quarterly injections to new users who did not have the time, resources, or confidence to travel dozens of miles to seek contraception from the nearest health facility.
- One community built a new post, and 3 more rehabilitated their posts to provide comfortable, confidential FP services. In one case this involved building a wall to create more privacy; in others, interiors were painted and basic furniture built. Some clinics changed their operating hours to better suit the needs of clients who worked long days in the fields.
- QITs and Maya Salud partnered with APROFAM (the Guatemalan branch of International Planned Parenthood Federation) to bring 5 mobile clinics to the most remote of villages. The clinics offered voluntary tubal ligations and vasectomies, Jadelle® implants, and gynaecological exams including pap smears. "Such services had never before been offered in these far-flung hamlets."
- Maya Salud staff gauged client satisfaction with SRH services via exit interviews, monitored contraceptive stocks, and observed service delivery to clients as appropriate. Staff shared the results with the QITs as a way to ensure consistent application.
Sexual and Reproductive Health.
The Ixil Triangle, deep in the highlands of western Guatemala, is an isolated area home to the Ixil Maya, who make a living from their farms and looms. Ixil's remoteness and near-invisibility on the national stage made it a target during Guatemala's civil war (1960-1996). A rebel group established its headquarters there; hundreds of civilians lost their lives. Not surprisingly, the people of the Ixil Triangle have learned to be wary of outsiders. At the same time, the disconnect between them and social services has exacted a toll, as indicated by data such as the following (cited by Save the Children):
- 82% of residents live on less than US$2 per day (versus 52% nationwide).
- More than 60% of Ixil's girls do not attend school and a mere 20% complete their primary education.
- Maternal mortality is estimated at 277 deaths per 100,000 live births (the national average is 153).
- Infant mortality rates reach 66 deaths per 1,000 live births (versus 47 nationally).
- In Ixil, girls marry young - some as young as 12 - and experience an average of 10 pregnancies before the end of their reproductive years.
- Studies from 2002 and 2003 revealed that just 20% of women in Ixil had healthy birth spacing, and only 28% were using any form of effective contraception - even though 56% did not want to become pregnant in the next year.
- Just 13% received information on SRH during visits to their closest health post, which in some instances was as far as 38 miles from home.
According to organisers, "Often, health workers in rural Guatemala are trained to dispense contraceptives upon request, but they have not learned to counsel and inform, or to consider cultural taboos, the sensitivity of the issue, and the gender divide between the (typically) male service provider and the (typically) female contraception seeker."
Endline research (2009) found that, by the end of the 4-year project, the number of couples using safe and effective FP methods had more than doubled, and the contraceptive prevalence rate had surpassed 33%.
Save the Children, MOH, COTONEB, APROFAM. Funded through a subgrant from the US Agency for International Development (USAID)'s Flexible Fund.
Improving Family Planning by Creating Community-Service Provider Partnerships in Guatemala [PDF], Save the Children - forwarded to the CORE Group Child Survival (CS) Community listserv, December 2 2009. Photo credit: ACME Producciones/Hugo Gonzalez
Implementing Best Practices (IBP) Knowledge Gateway on September 14 2009.
Using Geographic Information System Tools to Address Disparities in Access to Family Planning Services and Commodities in Latin America and the Caribbean
This paper from the United States Agency for International Development (USAID) | DELIVER PROJECT demonstrates a methodology that Latin America and the Caribbean (LAC) ministries of health can use to g
Implementing Best Practices (IBP) Knowledge Gateway on March 9 2009.
University of Bradford
This 66-page Institute of Development Studies (IDS) Working Paper (#274) explores civil society participation in two contexts of chronic violence.
Using Radio for Budget Advocacy: Stories from Azerbaijan, Guatemala, Georgia, Indonesia, Kenya, and Uganda
This article, published in the International Budget Partnership's bimonthly newsletter (Volume 39, May-June 2007), describes civil society organisation efforts to use radio as part of larger budget ad
International Budget Partnership website, Bimonthly No. 39, Newsletter, May - June 2007; and ACCU website, April 19 2010.
The Global Communication & Marketing Team's activities focus on health communication and marketing strategies, eHealth, and emergency and risk communication. Sample projects include:
Health Communication & Marketing Strategies
- Conduct KAB [knowledge, attitudes, and behaviour] survey and test messages and materials in support of a rabies prevention and control communication campaign (China)
- Implement targeted communication of hospital infection control guidelines (Kenya)
- Develop a communication and marketing strategy for micronutrient food fortification to improve maternal and child health (Central America)
- Pilot the use of new ICT networks for health communication in rural settings (Kenya)
- Support use of ICT for training and communication with the public health workforce (HIV/AIDS monitoring and evaluation (M&E) - China, Laboratory Biosafety - Central America, Hospital Infection Control - Kenya)
- Collaborate with partners to test mobile communication technology methods to support Directly Observed Therapy of tuberculosis (TB) patients (Kenya)
- Pilot use of mobile short message service (SMS) technology to support blood donor outreach (Kenya)
Emergency and Risk Communication
- Assess emergency communication system capacity (multiple countries)
- Develop and implement exercises to test risk communication plans (Central America)
- Test US-based emergency risk communication principles for cultural appropriateness (China)
- Conduct emergency risk communication training and planning workshops (Kenya, Nigeria)
- Conduct survey of health communication needs of earthquake survivors (China)