7th International Meeting onIndigenous Child Health

“Child, Family and Community: Generatingchanges from within; an experience with

Wayúu indigenous groups in La Guajira, Colombia”

Luz Angela Artunduaga. Child Survival and Development Specialist

UNICEF-Colombia

31 March - 2 April 2017. Denver USA

Disclosure

• Luz Angela Artunduaga has no relevant financial relationships with the manufacturer(s) of commercial services discussed in this CME activity

• The author does not intend to discuss unapproved/investigational uses of any commercial products in this presentation

Where is La Guajira?

Context of La Guajira

Population (2015) 874,532Rural population 45.0%Indigenous population 56.4%Under 5 years 3.8%Women of childbearing age 56.4%Unmet Basic Needs (NBI) 65.0%Rural water coverage 22.0%

Indigenous population 91.35%

Colombia La Guajira

IMR/1000 Live births (2013) * 17.25 31.49

IMR/Acute Diarrhoeal Disease/< 5/1000 * 3.5 10

IMR/Acute Respiratory Infections/<5/1000 * 16.1 22.4

Maternal Mortality Rate (2013) * 58.59 234.69

Acute Malnutrition (2015)** 0.9% 3.2%

Chronic Malnutrition (2010)*** 13% 50-60%

IMR

Source: *Data from Sinfonía/UNICEF;**ICBF/Ministry of Health; DANE  

Strategy integrating 13 key practicesCaregivers strategy

HEALTHY ENVIRONMENTS

IMCIWCFI

Background

Improve maternal and child health and nutrition care practices

Mortality and morbidity, and the quality of care that children receive at the Health Services and at home Provide protection

against health threats, allowing expanded capacities and development of autonomy.

2010 2011 2012 2013 2014 2015

IMCI Integrated Management of Childhood IllnessWCFI Women and Child Friendly Institutions

Caregivers is an interventionstrategy that seeks to promotechanges within families andcommunities regarding early childcare and upbringing.

Caregivers strategy

1. Prioritize behaviours that can be changed and those that generateimpact.

2. Change is achieved by example and from within.

3. Changes and their follow-up mustbe evident to families and communities.

Strategic approach

Is based on…

Family and Community

Rights

Ethnic & Gender Focus

Educationand Action

Social Mobilization

Improve maternal and child health.

Promote men’s participation and their role in child rearing and development.

Promote behaviors and spaces that support affection, stimulation, play and communication towards children.

Promote high quality and hygienic food intake.

Expand appropriate behaviors in basic sanitation and hygiene in households and their surroundings.

Generate community participation and empowerment processes.

Advocate for timely and quality institutional responses

1

2

3

4

5

6

7

Objectives

Identify the family and the current

state of practice

Prioritize and plan with

family and community

Support and educational

activities

Lobbying and

advocacy with

authorities

Monitoring and evaluate actions and

results

Phases

• Home visits• Education and

ongoing support at home

• Set an example• Recreational

activities with families and children

• Creation of support networks

• Social mobilization

• Coordinated work with local institutions

• Baseline survey• Two additional

measurements per year and evaluation at family and community level

VolunteerCommunityEducational

Agent

First group: Taking care of ourselves Practice 1: Providing support to pregnant women with

proper care

Practice 2: Ensuring that children have the appropriatevaccinations for their age

Practice 3: Sharing spaces of affection, stimulation, play and communication with children

Practice 4: Providing care and proper treatment to children

Second group: Taking care of ourselves when eating

Practice 5: Breastfeeding as the only food during the first 6 months of age

Practice 6: Complementary feeding without interrupting breastfeeding up to 2 years

Practice 7: Adopting healthy measures in the preparation, manipulation, conservation and consumption of food

Práctica 8: Washing hands with soap and water at key moments

Practice 9: Ensuring that girls and boys receive the necessary care for good oral hygiene

The key practices

Third group: Taking care of ourselves at home Practice 10: safe drinking water and personal hygiene

Practice 11: Household cleanliness and proper management of excreta, solid and liquid waste

Practice 12: Protecting families from flies, cockroaches, mosquitos, rats, bats and other animals that pose a health hazard

Practice 13: Taking appropriate measures to keep the kitchen safe from risks and prevent accidents in the home and the environment

The key practices

The initial diagnosis of each family’s practices is summarized as a traffic light:

Support offered to households is based on a joint assessment of the thirteen key practices between the family and the education agent– “what ought to be”-and their respective behaviors “as they actually are”

• Yellow (medium risk): Less than half the behaviours are not practiced by family.

• Green (no risk): All of the behaviours are practiced by the family.

• Red (high risk): Half or more of the behaviours are not practiced by the family.

Rating the Community

Classification of risk of communities at territorial level, according to compliance with the practices

High riskLess than 60% of the families evaluated practice the behaviour

Medium riskBetween 60 to 89%of the familiesevaluated practice the behaviour

Without riskBetween 90 to 100% of the familiesevaluated practice the behaviour

What happened in 2015 - 2016?

General information

• Seventeen wayuu communities• Language: Wayunaiqui• Poor availability of food• Difficulty in accessing basic

health services, education, water and sanitation

• Social división of labor• Absence of adolescence, is

passed from childhood to adulthood

• Early pregnancy• Child deaths associated with

malnutrition and infectious diseases

CoveragePopulation Trained human resources

FamiliesGirls and boys

Pregnant and nursing mothers

Adolescents and youth Professionals Education

agents

375 486 189 60 15 27

0

20

40

60

80

100

120

2015 2016

Without birth registration 

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

50.00%

Nutritional risk Diarrhea Respiratory/flu

2015 2016

Results

Evolution (%) of families fulfilling each practice

Monitoring

Taking care of ourselvesPregnant women

with proper care

Child Vaccinations

Affection, stimulation, play

and communication

Childcare and proper treatment

Base line 36 98 56 47Second 42 96 82 77Third 62 90 75 68Fourth 92 100 92 93

Evolution (%) of families fulfilling each practice

Monitoring

Taking care of ourselves when eating

Breastfeeding Complementary feeding

Preparation, manipulation, conservation

& consumption of food

Handwashing

Oral hygiene

Base line 70 37 8 8 17Second 76 56 15 18 57Third 87 97 45 32 42Fourth 95 99 73 62 75

Evolution (%) of families in each practice

Monitoring

Taking care of ourselves at home

Safe drinking water

Management of excreta, solid and

liquid waste

Protecting families from flies,

cockroaches, mosquitos, rats, bats and other

animals that pose a health hazard

Safety from risks and accident

prevention in home and the environment

Base line 5 1 4 62Second 15 6 5 90Third 34 12 15 82Fourth 68 27 31 98

Summary of changes identified in families

28.3% of families with the support of voluntary educational agents strengthened their performance in key practices for early childhood care, going from 49% in 2015 to 77.3% of families who are no longer in risk, seven of the practices are without risk.

The practices (7) preparation, manipulation, conservation and consumption of food, (8) washing hands, (9) oral hygine, and (10) safe drinking water, on average 30% of families are at medium risk

There are still two practices in which families are at high risk, (11) management of excreta, solid and liquid waste, with 73% of families and (12) vectors protection with 69% of high-risk families.

The care and upbringing of girls and boys falls to mothers.

ConclusionsChange is generated when Information is internalized and appears as a practice within one’s own family. This is best achieved through “learning by doing” in situ.

Change occurs over time and this requires accompaniment. Evaluation must be done jointly by the family with the Extension Agent, who should be a community member.

For family practices to become cultural norms, they must be socially legitimized. This is where participation and social mobilisation become crucial, as they serve to legitimize and reinforce change at the family and societal levels.

How has this project affected the indigenous Wayúu world?

• Emergence from historical neglect.• Feeling more served, protected &

accompanied.• Increased confidence in themselves, from

working within their own communities andfinding their own solutions to identified needs.

• Increased credibility in the eyes of theoutside world, thanks in part to the institutionalsupport (hospital).

“These behaviours should be taught just as we teach weaving, from generation to

generation, so that they turn into habits.” Female community leader from Tawaya

¡¡Thanks!!