Vol. 2, Number 7 October 2006 (english) - BVSDE - PAHO/WHO

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Vol. 2, Number 7 October 2006 (english) - BVSDE - PAHO/WHO

Volume 2, Number 7

The Executive Committee of the Healthy Municipalities, Cities,

and Communities Network of the Americas meets in Argentina

BULLETIN OF THE HEALTHY SETTINGS UNIT, AREA OF SUSTAINABLE

DEVELOPMENT AND ENVIRONMENTAL HEALTH, PAHO/WHO

October 2006

Healthy Municipalities,

Cities and Communities

Marilyn Rice, Regional Advisor

for Healthy Municipalities,

Cities, and Communities, SDE/

HS PAHO/WHO

It is with great pleasure that we

present this edition of the

Healthy Municipalities, Cities

and Communities (HMC) Network

bulletin, with the results of

the last meeting of the Executive

Committee of the HMC Network

of the Americas, which

took place in Buenos Aires,

Argentina, on August 23 – 24,

2006. This event was held in

conjunction with the Argentinean

5th National Meeting of

Healthy Municipalities and

Communities that focused on

the theme "Healthy Spaces for a

Better Quality of Life."

In addition to PAHO/WHO

representatives, participants

from Argentina, Brazil, Costa

Rica, Cuba, Mexico, Paraguay,

Peru, Spain, and the United

States of the Americas were

In this edition

V National Meeting of the Argentinean

Network of Healthy Municipalities and

Communities: “Healthy spaces for a

better quality of life”

The Mexican Healthy Municipalities

Network meets in San Luis Potosí, Mexico

BUENOS AIRES AGREEMENT

Healthy Municipalities, Cities and Communities

Network of the Americas

present at the Executive Committee

meeting, representing various

national Healthy Municipalities

and Communities networks, municipalities,

universities, NGOs,

and Ministries of Health. During

the two days of the meeting, the

participants:

1. Approved the "By Laws of

the Healthy Municipalities,

Cities and Communities Network

of the Americas."

2. Agreed upon the contents of

the "Guide for Mayors to the

Millennium Development

Goals (MDG)" and contributed

ideas for dissemination

strategies once the document

is published.

3. Reviewed and discussed the

document "Criteria for Certifying/Accrediting

Healthy

Municipalities, Cities, and

Communities in National

Networks."

4. Signed the "Buenos Aires

Agreement," that reaffirms

essential values of the

strategy, and recognizes

the importance of political

will and social participation

in health promotion

actions at the local, national,

and regional levels.

5. Approved a plan of action

for 2006-2007

The documents produced in

this meeting are reproduced on

pages 3 to 6 of this bulletin.

The documents can also be

accessed on the Healthy Municipalities,

Cities, and Communities

Initiative webpage

(http://www.bvsde.ops-

oms.org/sde/ops-sde/bv-

Municipalities.shtml)

For more information on the

HMC Network of the Americas,

please contact Ms. Marilyn

Rice: ricemari@paho.org

Participatory evaluation of healthy cities, communities, and

environments: reflections on the Brazilian experience

Marco Akerman, PAHO

Consultant

"Anything that is worth doing is

worth evaluating!" And to

evaluate does not necessarily

mean applying a methodology

to analyze what has been done,

but to ask if “what we did and

want to do can bring us closer to

what we want to accomplish."

Promoting health is an attitude or

a policy that is always connected

to desires and wills of individual

actors or collective entities. The

desire for change can launch the

firmest bases for its support.

The "Multicenter Collection in

Health Promotion Evaluation:

the Brazilian Experiences", prepared

by the Brazilian Multicenter

Group on Health Promotion

Evaluation, is the result of the

articulation of actors that aim to

develop modes and skills that

(Continued on page 9)

2 By Laws of the Healthy Municipalities, Cities

and Communities Network of the Americas

2 Healthy and Productive Communities in

Uruguay: current status and future prospects

3 Institutionalizing Citizen Participation in

Health and Personnel Participatory Management

in Gualeguaychú, Entre Río, Argentina

4

6

8


V National Meeting of the Argentinean Network of Healthy Municipalities and

Communities: “Healthy spaces for a better quality of life”

Operations Unit of the Argentine Network

of Healthy Municipalities and Communities

"The municipalities and their communities

can be converted into the main producers of

health and healthy lifestyles, and not only be

consumers of medical care and drugs. It is a

priority to promote healthy lifestyles, without

`substance abuse`, a life of care and not only

of cure. To care for life itself and the area

where one lives is to work for a healthy municipality",

affirmed Dr. Ginés González

García, National Minister of Health, in the

5th National Healthy Municipalities and

Communities Meeting, "Healthy Spaces for a

Better Quality of Life", organized by the

Argentinean National Ministry of Health

(MSAL), with the support of the Pan American

Health Organization (PAHO).

The meeting, which took place in Buenos

Aires from August 24-25, 2006, acquired

the character of an important National

Meeting, in which more than one thousand

attendants participated, including representatives

from over 500 communities, 220

community leaders, provincial Health Ministers,

national authorities,

and representatives from

various networks of Healthy

Municipalities, Cities and

Communities in Latin America.

Representing the President

of Argentina, Dr. Néstor

Kirchner, the official opening

of the V National Meeting

of the Argentinean Network

of Healthy Municipalities and Communities

"Healthy Spaces for a Better

Quality of Life" was carried out by the

Vice President Daniel Scioli, who estimated

that the growth currently demonstrated

by the economy cannot be separated from

improvements in quality of life, healthy habits,

and care for the environment. "Our country

should have sustainable reindustrialization,

balanced with harmony in

social, economic and environmental

development. I

support all municipalities

that implement this strategy

to invest in the recovery of

values, family, solidarity,

friendship, in order to recover

our best traditions. In

order to achieve a Healthy

Argentina, all us should

assume the challenge of

caring about what is

achieved and planning for the future", urged

the Argentine vice president.

(Continued on page 10)

“In order to achieve a

Healthy Argentina, all us

should assume the challenge

of caring about what is

achieved and planning for

the future.”

The Mexican Healthy Municipalities Network meets in San Luis Potosí, Mexico

The XIII National Meeting of the Mexican

Healthy Municipalities Network took place

from September 5-7, 2006, in the city of

San Luis Potosí, Mexico. The central theme

of the meeting was "Challenges in Population

Health: Local Action."

The main objective of the meeting was for

mayors, members of municipal councils,

and health workers from Mexico and other

countries of the Americas to share experiences

and exchange solutions that, whenever

appropriate to each local context, allow

municipalities to develop policies to

address health determinants derived from

processes such as the rapid and rampant

growth of cities, loss of positive social networks,

inclusion of immigrants in

“negative” networks (inequitable work,

prostitution, drug traffic, organized delinquency),

and lack of infrastructure, among

others.

With regard to the XII National Meeting of

the Network held in Manzanillo, Colima, in

2005, there was an increase from 358 to

439 participating municipalities, 19 to 21

active networks, 71 to 75 municipal projects,

42 to 60 posters presented, and three

to six international speakers.

Among the meeting’s main results, the

following can be highlighted:

1. The high attendance totaling 1238

participants, which included 223 presidents

of the 439 municipalities attending

the meeting (20% of the countries’

total), the representation of 21 active

municipal networks, 615 health workers,

six State health secretariats, as

well as eight speakers from the federal

level.

2. Actions taken by the Municipalities:

• Three new resolutions were generated

by the National Health Council, including

the network’s participation in

the National Health Security Council

and progresses on the municipalities’

financing policies in regards to health;

• The Network Assembly reported advances

achieved in various areas

agreed upon with the National Health

Council. New health proposals were

presented to the highest national decision-making

body.

• The resulting program was extensive

and varied, capturing participants’

attention and promoting the exchange

of municipal experiences in areas such

as maternal mortality reduction, addressing

problems caused by rapid

urbanization, addictions and accidents

prevention, family violence reduction,

and migrant health, as well as planning

for responding to, and reconstruction

during disasters and sanitation risks.

• Sixty posters and 6 panels were presented

on healthy municipalities’ projects,

with 27 presentations by both

national and international speakers on

subjects relating to the theme of the

meeting.

• Among the progress reported, it was

documented that in municipalities

working on reducing maternal mortality

rates, to date, there were zero maternal

deaths where previously there

had been some (a 43% reduction) and

an absence of cases of canine rabies.

3. The challenges raised are:

• Health promotion processes in the

municipality should focus especially

on health determinants, such as: violence,

maternal health, health risks,

accidents, and planning responses and

reconstruction in the face of natural

(Continued on page 8)

Page 2

HEALTHY MUNICIPALITIES, CITIES AND COMMUNITIES


BUENOS AIRES AGREEMENT

HEALTHY MUNICIPALITIES, CITIES AND COMMUNITIES NETWORK OF THE

AMERICAS

Buenos Aires, Argentina

August 23, 2006

In the city of Buenos Aires, Argentina, on

the occasion of the meeting of the Executive

Committee of the Healthy Municipalities,

Cities and Communities Network

(HMC) of the Americas (August 22 and

23, 2006) and coinciding with the V National

Meeting of the Argentinean Network

of Healthy Municipalities and Communities:

"Healthy Spaces for a better

quality of life," representatives from

HMC Networks from Argentina, Brazil,

Costa Rica, Cuba, Mexico, Paraguay,

Peru, Spain and the United States; the

Argentinean Ministry of Health and the

Pan American Health Organization/

World Health Organization (PAHO/

WHO) Regional Office and office in

Argentina, and INCAP-PAHO, following-up

on commitments agreed upon in

the Manzanillo Declaration and:

CONSIDERING THAT

1. It is important to combine efforts

to continue to strengthen the HMC

strategy in the Region of the Americas

2. Technical cooperation among

countries in the area of HMC is vital for

the sustainability of the HMC Network of

the Americas

3. The diversity of experiences in

the HMC strategy is very rich in the Region

of the Americas

4. A collective reflection on the

Network By Laws proposal prepared in

the Manzanillo meeting was carried out

5. There are a variety of criteria to

certify municipalities as members of National

HMC Networks

AGREE THAT

1. The By Laws of the HMC Network

of the Americas have been approved,

which are attached and constitute

part of this Agreement

2. A proposal with basic criteria

for the certification of HMCs in National

Networks has been agreed upon

3. An action plan has been formulated

in which the members of the HMC

Network of the Americas commit to:

• Invite another country to consider its

adoption of the HMC strategy and to

participate in the General Assembly of

the HMC Network of the Americas in

2007

• Search for necessary resources for

promoting technical cooperation and

the sharing of HMC experiences

among countries

• Study the possibility of organizing the

next meeting of the HMC Network of

the Americas to coincide with meetings

of National HMC networks

• Carry out actions to position the HMC

agenda beyond the political transitions

of their countries

• Present in the next meeting of the

HMC Network of the Americas an

evaluation of the progress of each

country’s HMC strategy that includes

the agreed-upon criteria for certification.

Reaffirming commitment to the essential

values of the HMC strategy and recognizing

the importance of political will and

social participation in health promotion

actions at the local, national and regional

levels, the undersigned subscribe to the

present Agreement in the city of Buenos

Aires, Argentina, on 23 August 2006.

Nemecio López Vargas, President

Executive Comité of the HMC Network of

the Americas

Elizabeth Jojot de Gneiting, President

Paraguayan Network of Healthy Municipalities

Amilcar Huancahuari Tueros, Vicepresident,

Ayacucho Healthy Municipalities

Network, Perú

Noria Liset Pupu Avila, Coordinator

Cuban HMC Network

Carlos Vizzotti, Sub-secretary for Health

and Health Research, Ministry of Health,

Argentina

Alejandra Mendoza, Coordination Unit,

Argentinean HMC Network

Pablo Rodríguez, Sub-Director for Health

Curuzu Cuatia Municipality, Corrientes

Province, Argentina

Raul Rodríguez, Mayor of Malargue, Mendoza

Province, Argentina

Helena Peton, Operations Unit, Argentinean

HMC Network

Ana Maria Girotti Sperandio, Coordinator,

Network of Potentially Healthy Municipalities,

Brazill

Carmen Cecilia Arroyo, Nacional coordinator,

Healthy and Ecological Cantons, Costa

Rica

Luis Andrés Lopez-Fernandez, Technical

Comité, Andaluzian HMC Network

Mary Beth Riner, Co-Director

PAHO/WHO Collaborating Center in

Health Cities

Celeste Cambria, Health Promotion Consultant,

Amares Project-European Union

Antonio Pages, PAHO/WHO Representative

in Argentina

Marilyn Rice, Regional Adviser for HMC

and Urban Health Team Leader, PAHO/

WHO

Maria Helena Romero, Regional Associate

Consultant, PAHO/WHO

Sandra Murillo, INCAP/PAHO/WHO

Luis Roberto Escoto, Family and Community

Health Consultant, PAHO/WHO Argentina

VOLUME 2, NUMBER 7

Page 3


By Laws of the Healthy Municipalities, Cities and Communities Network of the

Americas

Considering people’s health and well-being

as a priority, the Healthy Municipalities,

Cities and Communities (HMC) Network

of the Americas proposes to strengthen the

commitment and political will of mayors

and local authorities to, jointly and collectively,

improve health conditions and quality

of life of the inhabitants of the Region

of the Americas and to position health promotion

on the various development agendas

of regional and sub-regional entities

and local authorities, associations, and governmental

and non-governmental institutions,

the scientific community, academia,

and civil society.

VISION

Article 1º. The HMC Network leads the

development and strengthening of the

HMC strategy and positions health promotion

on the political agenda of the member

countries in order to contribute to sustainable

local development, improve the social

determinants of health and strengthen the

conditions of equity and peace in the Region

of the Americas.

MISSION

Article 2º. That the HMC Network of the

Americas constitutes the main and model

advocacy forum of the Region of the

Americas for healthy public policies,

strengthening partnerships at continental

level, articulating HMC networks’ activities,

and promoting the sharing of experiences

and solidarity among its members,

thus ensuring the sustainability of achievements,

improving conditions of equity and

quality of life, and facing new challenges.

VALUES AND PRINCIPLES

Article 3º. The values that sustain the actions

of the HMC Network of the Americas

are:

Equity: in support of all networks

Solidarity: vision, mission and objectives

that are jointly shared and defined

Social Justice: Decision-making will be

objective, prioritizing common good and

human dignity and trying to contribute to

more just and equitable social systems

Transparency: advocate for ethical and

responsible conduct in activities of the regional

and national networks

Respect and acceptance of the diversity and

of the political, cultural and ideological

differences among countries and national

networks involved, as well as to the priorities

that each network decides to collectively

address

Democracy in respecting and considering

members’ opinions and contributions, and

in giving right of voice and vote to the representative

of each HMC national network.

Empowerment of people, communities,

countries and networks in order to achieve

greater individual and community control,

political efficiency, improvement in quality

of life and social justice.

OBJECTIVE

Article 4º. The HMC Network of the Americas

is formed to fulfill the following objectives:

General objectives

1. Promote the creation and the strengthening

of national HMC networks in the

Americas with a health promotion perspective

2. Promote healthy public policies, decentralization

and democratization of local

governments

3. Improve local capacity for the implementation,

management and evaluation

of HMC initiatives

4. Integrate the work of sub regional networks

with other initiatives linked to

integration, political, economic and

social processes, seeking joint efforts

and consolidation

Specific objectives

1. Advocate for political commitment and

the creation and sustainability of national

and sub regional HMC networks

2. Promote the contribution of the health

sector and other government sectors,

jointly with mayors, private sector,

scientific community, academia and

civil society in the development of

healthy policies

3. Exchange and disseminate theories,

experiences, good practices, and information

about actions, projects and international

declarations

4. Identify sources of potential funding

and develop resource mobilization

and international technical cooperation

strategies

5. Strengthen surveillance systems and

monitoring and evaluation capacities

to generate evidence of effectiveness

of the HMC strategy

6. Support and promote actions and

well-defined projects that are based

upon solid evidence, are feasible and

generate results that are perceptible

by the community

7. Facilitate communication among

countries about health and emergency

situations

ACTIVITIES

Article 5º. The HMC Network of the

Americas will carry out the following

activities:

1. Hold a regular forum/meeting of the

HMC Network of the Americas to

promote sharing of experiences and

strengthen the political role of the

Network, taking advantage of the

various national network meetings to

convene the meetings of the network

of the Americas and that of its Executive

Committee

2. Develop and maintain an interactive

virtual forum (Website) of the HMC

Network of the Americas

3. Prepare, obtain consensus about,

keep updated and disseminate an

orientation guide for National Networks.

It will propose accreditation

and certification mechanisms that

cities, municipalities and communities

will follow in order to join national

networks of the Americas.

4. Maintain up-to-date information on

the members of the HMC Network

of the Americas

5. Prepare and disseminate an annual

work plan of the HMC Network of

the Americas and maintain informed

the countries comprising the HMC

Network of the advances in the

plan’s implementation

6. Prepare pertinent technical reports

for dissemination through the network

VOLUME 2, NUMBER 7 Page 4


By Laws of the Healthy Municipalities, Cities and Communities Network of the

Americas

7. Establish incentives to recognize

successful experiences in Region

8. Identify and inform Network members

of potential sources of financial

resources and opportunities for technical

cooperation with national and

international organizations

9. Promote inclusion of the HMC strategy

on the political agendas of various

meetings, summits and international

forums in the Americas

10. Facilitate the creation of observatories

on different aspects of the HMC

strategy

STRUCTURE AND FUNCTIONS

Article 6º. The HMC Network of the

Americas is comprised of:

A. Executive Committee formed by a

representative from each one of the sub

regions, with the goal of representing the

cultural diversity of the Americas. The

sub regions are: Southern Cone, Central

America and the Spanish-speaking Caribbean,

Andean Region and North America.

The president of the HMC network of

the Americas will be one of the national

network representatives linked to the

national network.

Southern Cone: Argentina, Brazil, Chile,

Paraguay, Uruguay

Central America: Costa Rica, Cuba,

Dominican Republic, Guatemala, Honduras,

Nicaragua, Panama

North America: Canada, Mexico and the

United States

Andean Region: Bolivia, Colombia,

Ecuador, Peru, Venezuela

B. Technical secretariat coordinated by

the Pan American Health Organization’s

Area of Sustainable Development and

Environmental Health, which will coordinate

with other entities the articulation of

the secretariat’s activities pertinent to the

Network.

C. General assembly consisting of a

representative of each one of the national

networks of the Region of the Americas

that has been integrated into the HMC

Network of the Americas

Functions of the Executive Committee

Administrative

1. Devise instruments to facilitate communication

about technical issues

such as bulletins, reports, activities to

exchange experiences and communication

with the countries’ national

networks

2. Organize meetings and special events

of the HMC Network of the Americas

3. Disseminate international agreements

(example: Ottawa and Bangkok Charters,

the Millennium Development

Goals) among the national networks

so that they are made operational in

the countries

4. Facilitate the articulation of the Network’s

activities among the members

of the network and with other agencies

and sectors

5. Maintain a liaison and communication

with the national networks in the

countries

Technical:

1. Recognize and disseminate experiences

of the national networks and

encourage good practices

2. Position the agenda of the HMC Network

of the Americas on the agendas

of the national networks

3. Articulate and bring together the network

members and other government

sectors and international cooperation

agencies

4. Promote the development of the network

members through trainings, exchange

visits, etc.

5. Identify entities and opportunities in

the countries that still do not have an

HMC Network to advocate for the

creation of new national, state or local

networks.

6. Build consensus on matters of common

interest to the network’s members

and on regional and sub regional

priorities

7. Propose, develop, share and comment

on guides that promote the development

of HMC initiatives and compilation

and evaluation of the various

experiences of national HMC networks

8. Create commissions or working

groups to carry out activities and specific

studies that fulfill the objectives

of these By Laws and the work plan

Functions of the Technical Secretariat

1. Coordinate and support the activities

of the HMC Network of the Americas

2. Establish collaborative mechanisms

with other entities such as collaborating

centers and centers of excellence

3. Prepare, in collaboration with other

entities, an annual report of the activities

carried out by the Network

4. Prepare and disseminate the quarterly

bulletin of the Network

5. Manage and maintain updated the

Web page and the electronic list of

contacts of the HMC Network of the

Americas

CRITERIA FOR MEMBERSHIP IN

THE NETWORK

Article 7º. The requirements to be included

in the HMC Network of the Americas are:

1. Participate in the Network’s meetings,

events and activities

2. Present an official request signed by

the network’s representative and the

PAHO country representative expressing

a desire to be part of the

HMC network of the Americas

3. The Mayor (municipal president,

elected representative, etc.) as representative

of the national network in

each country will be the official representative

to the Assembly of the HMC

Network of the Americas. In addition,

he/she will maintain contact with the

technical secretariat or the coordinating

unit in each country and the

PAHO office in each country.

Article 8º. Once accepted into the Network,

a certificate of membership will be

granted and it will be valid for two (2)

VOLUME 2, NUMBER 7 Page 5


By Laws of the Healthy Municipalities, Cities and Communities Network of the

Americas

years starting with the date of its award.

Upon delivery of the certificate, the incoming

Network will sign the present By

Laws as a guarantee and a commitment to

fulfill the objectives, procedures and requirements

that comprise the Network.

Article 9º. When changes occur in the

administration of national networks, the

new management should communicate

through a letter to the Executive Committee

of the HMC Network of the Americas,

expressing the intention of continuing

to belong to the Network, as well as

the name and contact information of the

new representative of the National network.

COMMITMENTS TO THE NET-

WORK

Article 10º. The commitments assumed

by the national networks to be included in

the HMC Network of the Americas include:

1. Maintain an active and committed

national network that includes mayors,

other local authorities and sectors,

and key actors to support the

HMC strategy

2. Guarantee and strengthen community

participation during the planning,

implementation and evaluation phases

of the HMC initiative in each municipality

that integrates the national network

3. Make health promotion and improvement

in quality of life priorities in

management of national government

as well as collectively through the

principles of intersectoral collaboration

in municipalities

4. Advocate for the development of

healthy public policy at local, regional

and national levels

5. Prepare and implement a strategic

plan of the national network that includes

the results from previous stages

6. Develop and implement a follow-up

and monitoring plan with intersectoral

participation in the implementation of

the national network’s strategic plan

in the country

7. Submit an annual report of the national

network’s activities to the

HMC Network of the Americas

8. Contribute at least one article annually

to the bulletin of the HMC Network

of the Americas

BENEFITS

Article 11º. The benefits of being a member

of the Network include:

1. Mainstreaming technical cooperation

among countries

2. Accessing state of the art information

on HMC implementation methodologies

3. Sharing and disseminating experiences

among countries

4. Transferring technology among countries

5. Voting and being elected to the Executive

Committee

6. Influencing the development of proposed

plans and regional and intercountry

programs

Healthy and Productive Communities in Uruguay: current status and future

prospects

Dr. Roberto Salvatella, OPS-Uruguay

Dr. Mario Gonzalez, OPS-Uruguay

Introduction

The Uruguayan "Healthy and Productive

Communities" strategy spearheaded by

the Ministry of Livestock, Agriculture,

and Fisheries (MGAP), the Ministry of

Public Health (MPH), municipal governments,

other national organizations, and

with technical cooperation from PAHO/

WHO, is contributing to overcoming

poverty through the implementation of

local productive projects through a comprehensive

health promotion approach

that incorporates active participation from

organized civil society.

At the end of the 2005, during the "First

National Meeting of Healthy and Productive

Municipalities" held by the Montevideo

municipal government, the strategy

was consolidated, reaffirming a commitment

to move forward with ongoing ex-

periences that involved nine municipal

governments and one Brazilian border

municipality, included in a bi-national

experience.

By the end of the 2006, advances and difficulties

in these experiences will be determined,

as well as activities developed to

respond to the interest in new initiatives

aimed at contributing to inclusion and social

equity, and generating productive and

healthy populations.

It is vital to identify strengths that can be

shared, as well as difficulties and shortcomings

to be overcome in order to promote

a strategy that contributes to national

policy guidelines and establishes a productive,

supportive, and healthy country.

Current Status

At present, the following initiatives have

been identified and are at different levels

of progress:

1. Canelones: community strengthening

in the northeast department for a productive

and healthy community.

2. Colonia: articulation and improvement

of the production of rural artisan

cheese.

3. Lavalleja, Durazno, Treinta y Tres

and Florida: development projects in

seven rural populations.

4. Montevideo: development of market

and commercial opportunities for local

livestock production, articulation

of initiatives with cultural emphasis,

and comprehensive health plan based

on a health users’ movement.

5. Rivera: Healthy Borders Strategy

(Rivera-Libramento)

6. Tacuarembó: Development of

“indigenous” tourism (Cuchilla de

Laureles)

VOLUME 2, NUMBER 7 Page 6


Healthy and Productive Communities in Uruguay: current status and future prospects

New local initiatives have also been identified:

1. Cerro Largo – Yaguarón: rabbit

breeding (Tupambaé), cultivation of

olive-trees (Frayle Muerto), smallscale

fishing (La Charqueada), beekeeping

(Arbolito), artesian craft production,

and improving recycling (Río

Branco-Yaguarón)

2. Florida: beekeeping and

integrated development

(Sarandí Grande)

3. Maldonado: productive development

and cultural tourism

(Gregorio Aznárez)

4. Paysandú: productive rural

family small businesses

5. Río Negro – Tacuarembó:

exchange of good practices

between the two municipalities

6. Rocha: integrated departmental food

safety and livestock production programs

(Cebollatí)

7. San José: rural production projects

8. Treinta y Tres: projects articulating

production and culture in several localities.

Advances

Intersectoral local teams have been formed

to conduct assessments and implement

activities.

Other local forces have progressively come

together to form intersectoral partnerships

with public and private institutions, communities,

and NGOs (education, nutrition,

environment, tourism, recreation and sport,

culture).

Although the majority of community consensus-building

strategies have started

through work related to agricultural production,

interesting experiences are taking

place in the health and cultural sectors as

well.

Social organizations have been mobilized

to work with this strategy and new spaces

have been created that have contributed to

bringing together stakeholders that, up to

now, had traditionally not worked together.

In the rural environment, above all, this

had been fundamental to breaking down

isolation and disillusion.

Understanding local reality has improved

through surveys about social organizations,

inhabitants’ lifestyles, perceived sanitary

problems, types and numbers of rural and

peri-urban producers, nutrition practices,

production and market feasibility analysis,

and adaptations of

community work

“It is vital to identify strengths

that can be shared, as well as

difficulties and shortcomings

to be overcome in order to

promote a strategy that

contributes to national policy

guidelines and establishes a

productive, supportive, and

healthy country.”

strategies.

Numerous training

processes on various

subjects contributed

to increasing

knowledge

among members of

small and isolated

communities: horticultural

production,

animal husbandry,

food preparation,

hydroponics, packaging for marketing, etc.

Health promotion-related trainings are under

way emphasizing healthy nutrition.

In socially excluded rural areas, community

initiatives– an expression of bottom-up

movements – have reported involvement

with the strategy as a way of overcoming

inequities through developing collective

networks.

There are examples of achievements associated

with collective work, which can be

characterized by "empowerment" in negotiating

with local management (growing ties

with community organizations and official

agencies, acquisition of tools and machinery,

resources management, etc.)

Rural women’s movements are beginning to

stand out due to the formal establishment of

networks.

At the United Nations Agency level, interagency

approaches have intensified through

the thematic Rural Development and Food

Security group (DERSA).

New actors that may be future collaborators

(such as ROTARY) are demonstrating interest

in knowing more about the strategy.

Goals for the Future

It is truly a national challenge to contribute

to the articulation of experiences in development

in order to make the strategy sustainable.

There are expectations that, based

on these experiences, a new model for

healthy and productive communities will

be defined, that will promote health and

environmental protection, and that will

emphasize a "culture of what is productive"

and contribute to the goals pursued

by national authorities.

It is necessary to coordinate at the highest

national level in order to make Healthy and

Productive Communities (HPC) guidelines

cross-cutting at the Ministerial and municipality

levels and within a decentralization

framework.

The public school, which constitutes the

natural center of community congregation,

is a facilitator that should be articulated

with the HPC strategy. The Healthy

Schools Movement (HS), which is currently

under development, provides optimal

opportunities to strengthen community

achievements that are participatory and

sustainable in nature. The implementation

of HPC will necessarily imply the articulated

development of the HS strategy in

order to optimize comprehensive health

achievements.

It is also necessary to create a United Nations

interagency technical assistance follow-up

process at the local levels that supports

continuity, helps to address the difficulties

and contributes to the documentation

and monitoring of the experiences.

Continuity is also required in technical

contributions to local actors spearheading

the processes, assisting them with training

and guidance on the processes taking

place.

The creation of a centralized bank of local

experiences will make it possible to report

on progress and successes achieved, as

well as to identify strengths that permit

horizontal cooperation among the stakeholders

at the national and regional levels

(cooperation among bi-national areas).

For more information about the Healthy

and Productive Communities Initiative in

Uruguay, contact Dr. Mario Gonzales

(gonzalem@uru.ops-oms.org) and Dr.

Roberto Salvatella (salvater@uru.opsoms.org)

VOLUME 2, NUMBER 7 Page 7


Institutionalizing Citizen Participation in Health and Personnel

Participatory Management in Gualeguaychú, Entre Río, Argentina

Angela Moranelli de Zárate*, Carlos

Anigstein*, Viviana Kerai*, Amelia

Acosta*

* Gualeguaychú.Health Directorate

Introduction

Social participation is the capacity to

"intervene in decision-making aimed at

planning, managing, and controlling the use

of the resources”.

Citizen Participation in Health (CPH) is the

right of the people or communities to have

access to correct, sufficient, and useful information;

to be consulted on issues that

affect quality of life, to participate in deliberation

and consensus-building with decision-making

capacity, in planning, programming,

execution, control, and evaluation of

sanitary programs; and citizen action to

influence public health agenda.

CPH and worker’s participatory management

are both a means and an end, and they

provide an opportunity for positive feedback

on actions taken, creating a cycle that optimizes

the management model and Primary

Health Care.

This initiative is in agreement with the commitment

that the government assumed from

the beginning of its municipal management

related to population health.

Objective

To implement modalities of Citizen Participation

in Health at the macro, middle, and

micromanagement levels

that are sustainable and

recognized by the community

and in municipal

legislation.

Population

The entire population of

Gualeguaychú, and especially

the most disadvantaged

sectors of the community

in the programmatic

area of the Primary

Health Care Centers

Suburbio Sur Local Health Comittee

meeting

(CPHC), municipal personnel, municipal

staff members, extra-sectoral institutions,

social organizations, and non-governmental

organizations.

Methods and Material

The initiative was implemented at 3 levels:

1. The Micro Level, where a network

strategy mobilized by community promoters

was developed, improving quality

of care to move a peripheral physician's

office to a truly CPHC.

2. Middle Level or

CPHC management where

deliberation and consensusbuilding

spaces were created

with community participation

and personnel

participatory management,

denominated Local Health

Councils (LHC);

3. The Macro level of

health and political management

that refers to State

interventions to increase

equity and correct market dysfunctions,

in which modalities of intersectoral

(Continued on page 9)

The Mexican Healthy Municipalities Network meets in San Luis Potosí,

Mexico

(Continued from page 2)

disasters;

• Serious consideration should be given

to reforming the health

system through collaborative

agreements that promote

municipal control of

the fulfillment of rights

and duties related to

health, including health

peculiarities in urban areas;

• Need for increased capacity

to develop broader

Healthy Communities

projects;

• The exercise of municipal leadership to

work towards community empowerment

and social participation, in accordance

with the principles of the Operational

Health Promotion Model;

• Strengthening of the Healthy Communities

fund and of links with congressional

Health Commissions.

“The greatest challenge, as

health promotion leaders, is

to make people understand

that investing in health is the

same as producing health,

and collaborating to the

reduction of poverty”

The event included the presentation of 38

municipal experiences in

health, with ten simultaneous

sessions, the completion

of five working

meetings of the Mexican

Network of Healthy Municipalities,

four workshops,

and four plenary

conferences.

Additionally, the

"Professor Gustavo Alberto

Vázquez Mountains"

award was granted for the second

time to the best work presented, which was

conferred on the "Ruiz municipality working

for the prevention HIV/AIDS" presented

by the Ruiz municipality in Nayarit.

With the same purpose of promoting creativity

and advancing the position of healthy

public policies, symbolic awards were

granted to second and third places in municipal

presentations, and to the best three

posters on exhibit. Upcoming network

meetings include a regional meeting to be

held in the state of Nayarit in January 2007,

and a national meeting held in 2007 in Baja

California.

As in all meetings of the Network, this

event received technical and financial support

from the Pan American Health Organization

country office in Mexico. Thanks to

this support, outstanding experts from various

Latin American countries and the

United States were present and contributed

experiences, concepts, and successful solutions

to problems related to the topic of the

meeting.

For more information about the Healthy

Municipalities and Communities initiative

in Mexico please contact Ms. Graciela de

León through the e-mail address: leongrac@mex.ops-oms.org

VOLUME 2, NUMBER 7 Page 8


Avaliação participativa de municípios, comunidades e ambientes

saudáveis: a trajetória brasileira – memória, reflexões e experiências

(Continued from page 1)

critically look at their own experiences in

health promotion. These actors, connected

to their respective institutions, in different

Brazilian States, comprised a multicenter

network to construct methodologies to

evaluate health promotion initiatives, address

problems, and improve these initiatives.

The first activity developed by the group

was the field test of the "Participatory

Evaluation Guide for Healthy Municipalities,

Cities and Communities" (PAHO,

2004), a material prepared by the "Working

Group on Evaluation of Healthy Municipalities,

Cities and Communities," coordinated

by the Pan American Health Organization–

PAHO/Washington. Eight institutional actors

were involved in this activity (NGOs,

governmental organizations, and universities):

Tocantins State Health Secretariat

Municipal Health Secretariat of Campo

Grande, Curitiba, and Goiania

Universities such as PUCPR of Curitiba,

UFPE–NUSP of Recife, UNICAMP/IPES of

Campinas

NGOs such as CEDAPS of Rio de Janeiro

and CEPEDOC of São Paulo

Field testing of the guide was carried out in

seven Brazilian states: Goias, Mato Grosso

do Sul, Parana, Pernambuco, Rio de Janeiro,

São Paulo, and Tocantins. PAHO/WHO

Brazil accompanied the field testing process,

supporting the establishment of workshops.

The Brazilian Ministry of Health was present

from the beginning and established the

foundation so that the health promotion

evaluation process had continuity through the

financing of a new phase of the multicenter

study.

The first set of results recently published and

entitled "Participatory Evaluation of Healthy

Cities, Communities and Environments: the

Brazilian path–memory, reflections and experiences",

is the result of this multi-center

application of the Guide and it is subdivided

into five parts:

1. Historical review of the evaluation of

healthy cities, communities and environments,

from 1995 to 2005, outlying

aspects of the movement worldwide, as

well as in Latin American and Brazil,

with emphasis on efforts, initiatives

and publications related to evaluation

methodologies;

2. Dialogue that took place among the

project’s teams during the 4 workshops

that contributed to the formatting of

instruments and strategies for the field

test of the Guide;

3. Presentation of eight field test experiences

of the Guide;

4. Cross-referencing of the field reports in

order to identify similarities and differences

in the application of the Guide;

5. Presentation of potential new initiatives

were constructed based upon the

articulation around the field test of the

Guide.

For more information on the work of the

Brazilian Multicenter Group and on this

publication, contact Marco Akerman via

email: akermanm.ops@terra.com.br

Institutionalizing Citizen Participation in Health and Personnel

Participatory Management in Gualeguaychú, Entre Río, Argentina

(Continued from page 8)

CPH were implemented, and included

representatives from civil society organization

and the State.

Results

In April 2004 the CPHC Participatory Management

Groups were put in place and incorporated

Center personnel, local authorities

and, as of 2005, representatives of

LHC, to deal with issues such as management,

performance, and trainings.

In June 2004, the Intersectoral Healthy Municipality

Council was launched, which

included participants from different municipal

areas, NGOs, various institutions

(National Entre Ríos University, hospital,

Children’s Council and Institutes, schools),

social organizations (such as “Corriente

Combativa”), and LHC representatives, to

address health problems affecting the municipality’s

population.

In March 2005, meetings of the Local

Neighborhoods Health Councils started,

focusing on the CPHC programmatic area.

These were discussed and consensus built

by including the participation of neighbors,

representatives of neighborhood organizations,

institutions, health authorities, staff

members from different municipal areas and

CPHC personnel; these meetings normally

dealt with issues related to the determinants

of health: running water, sewage, garbage

dumps, rodents, etc.

In July 2006, in light of the recognition and

public legitimacy of CPH initiative, the

Honorable Deliberative Council prepared

and approved Ordinance 10906/2006, File

Nº 2525/2006-HCD that institutionalized

this modality of participation.

Conclusion

The implementation of CPH modalities, that

were recognized by relevant stakeholders

and were sustained for three years, generated

the necessary consensus so that authorities

of the Executive and Deliberative

Council approved an Ordinance that formalized

and institutionalized its operations, and

in turn, has contributed to the improvement

of quality of life of the population.

For more information about this initiative,

please contact:

Angela Moranelli de Zárate, dirsalud@gualeguaychu.gov.ar

Carlos Anigstein, canigstein@intramed.net

Institution: Gualeguaychu Health Directorate.

Bolivar 985, Gualeguaychú (2820), Entre

Ríos, Argentina. Tel : (03446) 4204411.

VOLUME 2, NUMBER 7 Page 9


BULLETIN OF THE HEALTHY SETTINGS

UNIT, AREA OF SUSTAINABLE

DEVELOPMENT AND ENVIRONMENTAL

HEALTH, PAHO/WHO

525 23rd St, NW

Washington, DC

20037

www.paho.org

This bulletin is a trimestral publication of the Healthy Settings Unit, Area of

Sustainable Development and Environmental Health, PAHO/WHO. The content

can be reproduced, as long as the source and author(s) are cited.

Dr. Luiz A. Galvão, Area Manager, Area of Sustainable Development and Environmental

Health

Marilyn Rice, Regional Adviser for Healthy Municipalities, Cities and Communities

Editor: Maria Cristina Franceschini, Consultant for the Healthy Settings Unit.

Send your suggestions, questions and comments to: francesm@paho.org and

ricemari@paho.org

To submit articles for publication in this bulletin, please contact Maria Cristina

Franceschini (francesm@paho.org) and Marilyn Rice (ricemari@paho.org).

Website: www.bvsde.paho.org/municipality

To subscribe to the listserv of the Network of Healthy Municipalities, Cities and

Communities of the Americas:

http://listserv.paho.org/archives/red-mcs.html (Spanish)

http://listserv.paho.org/archives/carib-hmc.html (English)

V National Meeting of the Argentinean Network of Healthy Municipalities and

Communities: “Healthy spaces for a better quality of life”

(Continued from page 2)

The 5th National Healthy Municipalities

and Communities Meeting included various

thematic forums in which municipalities

conveyed their experiences and expert

speakers discussed environmental

issues, health determinants, and healthy

public policies.

In the two days prior to the 5 th National

meeting, the meeting of the Executive

Committee of the Network of Healthy

Municipalities, Cities and Communities

of the Americas, organized by PAHO,

was held. At the meeting, which was attended

by representatives from nine countries,

as well as by officials from MSAL

and PAHO, advances in the activities of

the national networks were discussed, and

the "Buenos Aires Agreement" was

signed, which approved the "By-Laws of

the HMC Network of the Americas" and

the 2006-2007 Plan of Action.

According to the organizers of the 5th

National Meeting, the exponential growth

of the HMC strategy in Argentina was

confirmed by the high level of participation

by mayors from all over the country,

as well as by the important political support

the movement has generated in the

central government (See Boxes). In this

regard, with 182 municipality members

and another 200 waiting to join, it is certain

that the Argentinean Network of

Healthy Municipalities and Communities

– which grew out of the work conducted

by the communities- generates an evergrowing

amount of activity and social

energy, and is presented as an innovative

management tool for those who are avidly

committed to improving the social and

sanitary conditions of their communties.

For more information about this event

and the Argentinean Network of Healthy

Municipalities:

http://municipios.msal.gov.ar

TOWARD A NATIONAL PLAN FOR

HEALTHY LIFE

The Declaration "TOWARD A

NATIONAL PLAN FOR HEALTHY

LIFE” was an important act signed by the

24 provincial ministers who met at the

Federal Health Council (COFESA), and

later ratified by the participants at the 5 th

National meeting.

This plan holds that healthy public

policies should occupy a central place in

local government agendas, in order to

advance toward an effective approach of

health determinants and conditioning

factors, and to develop a multi-sectoral

and participatory action approach at the

local level, involving the community in

the health promotion.

Páge 10

HEALTHY MUNICIPALITIES, CITIES AND COMMUNITIES

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