Attachments
Experience of the International Organisation for Migration’s (IOM) Migration & Health Programme in La Guajira
Background:
Brief context on how Community-Based Surveillance is a community engagement strategy.
In Colombia, the Public Health Surveillance System focuses on processes implemented by health institutions (health secretariats and hospitals) to identify, analyse and respond to events of public health interest, such as outbreaks and epidemics.
Taking into account the strategic role of the community in identifying and raising early warnings to situations or risks that are health threats, since 2023, the National Institute of Health, hand in hand with local health authorities, has been enhancing the implementation of the Community-Based Surveillance (CBS) strategy. i
CBS is a progressive capacity building strategy for community agents to identify and manage potential public health concerns in the territories, especially targeting ethnic groups (indigenous, Afro, Raizal, Rom, Palenqueros) and populations located in rural and dispersed areas at subnational border levels.
It is an early detection tool in order to provide an effective response to public health emergencies that leveragesthe knowledge and engagement of local communities. This approach allows to quickly identify outbreaks and unusual health events, while empowering communities, fostering a culture of prevention and improving communication and cooperation between community members. ii
Thus, training male and female leaders as community managers and health champions allows them to collect information from their communities through available channels, as well as activate care pathways and a timely response from health secretariats to the reported situations, mitigating and controlling risks.
The strategy underscores and recognizes the capacity of communities to respond to the health problems they face on a daily basis, further bolstering the link between the community and the health system by promoting a healthier environment that relies on hearing the voices and active participation of communities.
The department of La Guajira has been a key territory for IOM. Here, in 2023, the National Institute of Health and local health authorities began implementing the CBS strategy with the staunch support of female and male leaders from three Community Health Networks, created and strengthened by the IOM since 2018, in the municipalities of Riohacha, Maicao and Uribia. CBS strategy implementation will be extended to the rest of the country in 2024.
1. ¿ How were you working before Flagship, and what actions have been reinforced as a result of the initiative?
IOM has been working with the national government, local governments, partners and communities in response to migration flows from Venezuela since 2018. Under this framework, the M&H Programme identified the need to strengthen the voice, meaningful participation and empowerment of communities in La Guajira as drivers of their self-care. To address this need, IOM, among other actions, created and strengthened three Community Health Networks (CHNs) in Maicao, Uribia and Riohacha. These CHNs are comprised of 87 female and male Venezuelan migrant and host community leaders, of which 40 are Wayuu indigenous people.
The Flagship initiative scaled and reinforced these actions, highlighting the leading role of communities as active managers of their own solutions, rather than aid recipients. By strengthening their capacities and participation in the Community-Based Surveillance Strategy, they decisively contribute to the protection of maternal and child health as they are now able to identify children at risk or with malnutrition, as well as pregnant women at risk or unable to access health care services, becoming key actors in protecting and saving lives in their territories.
These actions are based on a participatory local assessment, where communities are heard, issues are prioritized, and initiatives are designed by the communities for the communities. Undoubtedly, female and male leaders’ voices are central to implementation. With the Flagship initiative,iii we continue to reinforce our vision of championing their voice, without judgement, with a beginner’s mindset and ensuring we are the best active listeners, iv immersing ourselves into different and relevant perspectives and experiences.
2. ¿What specific actions are being carried out to implement a change from the Flagship approach?
IOM has strengthened the construction of community processes that allow beneficiaries to move from being aid recipients to advocates of more durable solutions, favouring trust, resilience and the sum of contributions and voices, building bridges between communities and institutions, generating socio-culturally-tailored responses, through dialogues of knowledge in their own times, spaces and languages, redefining local goals and purposes together.
To this end, IOM has developed novel methodologies that recognize the culture, expressions, and knowledge of populations. For example, the female and male leaders of the Ayatajirawaa Community Health Network have been participating for the last two years in a strategy called “Composing to Take Care.” Through music, rhythm and melody, the CHN collectively build key messages based on everyday situations on maternal and child health care, as well as on preventing gender-based violence, under the premise of respecting the ethnic and differential approach of the territory.
This is how meetings are held on different themes, which allow female and male leaders to acquire skills that enhance their community work, through games and rhythmic understanding, motor skills and coordination dynamics, male and female participants reflect on body recognition, strengthening their ability to provide information to their communities through music.
Based on the “Composing to Take Care” workshops and the training provided by the National Institute of Health in CBS to the Community Health Networks, female and male leaders decided to compose a song related to malnutrition and maternal health, giving rise to the song “Act NOW.” For this artistic expression, they composed the song, highlighting ideas of health prevention and promotion, defined the rhythm, had to practice singing and finally recorded the song. The song is currently being disseminated among their communities.
JAYEECHI:
(spoken) this is a story we want to tell the boys and girls of our beloved Colombia. Walking through La Guajira, so warm and full of life / I met a beautiful boy, no older than five (years).
He seemed tired, his hands were yellow/ his face sad and with a blank stare.
Although I perceived he was crying, there were no tears in his eyes/ and he was so skinny that I was speechless.
I walked him home and asked him what was wrong/ and I saw that his little brothers were exhibiting the same symptoms (X 2).
My neighbour Margarita/ tells me she is pregnant, so I advise her on how to prevent risks.
She should go to her check-ups/ take her supplements, get her vaccinations/ watch what she eats. The verses are part of the song “Act NOW.” The lyrics effectively capture the signs to identify children at risk of malnutrition or malnourished, as well as to recognize warning signs for pregnant women.
3. ¿What has been the community impact?
What is the positive aspect of these actions from the Flagship approach? The lack of information and information not based on evidence increases risks and myths. It also prevents communities from adopting or maintaining self-care and collective care habits. Approaching the CBS strategy by giving community participation centre stage facilitated building trust, recognition and community ownership of surveillance processes.
Usually, health communication strategies are designed vertically, from institutions to communities. However, in this case, it was the female and male leaders who built the whole process, evidencing changes in their behaviour. They collectively define the key health messages and dissemination mechanisms, ensuring the messages reach the entire community, including literate populations and indigenous languages, employing clear and accessible language to all.
Thus, the power of music in health communication in the Wayuu community reflects its own ethnic (jayeechi) and cultural (vallenato rhythm) approach. Jayeechi is a song from La guajira that narrates the life of the community, the daily work, the shepherding; it means to give an opinion about what you see, abundance or scarcity, as well as love and tragedy. This musical composition tells the reality of La Guajira and how to identify risk, ask for help and save lives.
4. ¿How do these actions reflect a response to the call of communities through the Community Manifesto?
It is important to listen, learn and recognize the history of communities through their participation. It is essential to understand their struggles, priorities and visions for the future, rather than simply informing them and making decisions for them. It does not impose unsustainable themes and actions, instead it aligns with the actual needs and priorities of communities.
This approach also recognises the diversity of knowledge and the power of the communities, reflecting their capacity for self-management together with all the actors present in their territories. The aim is to involve them throughout the entire process, not just portions of it, and to ensure that each action is built collectively. Likewise, actions and information must be delivered through channels, spaces and media that are tailored and available to the communities, culturally relevant to their needs, priorities, beliefs and possibilities.
i Toolkit for collective risk management in outbreaks, epidemics and events of public health concern. Retrieved September 17, 2024, from https://www.ins.gov.co/BibliotecaDigital/etapa-1-1-sistema-de-alerta-tempranavigilanciabasadaencomunidad-generalidades.pdf
ii INS community-based surveillance strategy attracts international community (n/d). Gov.co. Retrieved 17 September 2024, from https://www.ins.gov.co/Noticias/Paginas/Estrategia-de-vigilancia-basada-en-comunidad-del-INS-atrae-a-lacomunidad-internacional.aspx
iii Flagship: The Flagship initiative is a commitment to transforming humanitarian coordination and response in Colombia. It is a vision of change towards a community-centred humanitarian system.
iv IOM Health Territorial Liaison.