Venezuela: the community spirit

28 World Health • 49th Year, No. l, Jonuory-Februory 1996 Venezuela: the community spirit Herncin Malaga Two urban municipalities in Venezuela have enthusiastically joined forces with the "Cities Towards Health" programme. Frequent meetings make it easier to identify the problems to be solved by the Healthy City proiecl. Social solidarity in Zamora I mportant changes have taken place in the health field in Venezuela in recent years. Even though there is still a tendency to think of hospitals as the key element of the system, the enormous impor- tance of preventive medicine and of the strategy of primary health care is being recognized again. In January 1994, the Healthy Cities Project was launched in Venezuela at Zamora Municipality, Falcon State. The project has made it possible to estab- lish a communication channel be- tween the civil population, the health team and local politicians. The PAHO Office in Venezuela has played an important role in the process, and by September 1995 no less than 13 municipalities were incorporated in the pro- gramme. In each case the strategy involves action aimed at promoting healthy public policies, favourable envi- ronments, community action, the development of lifestyles, and the reorientation of health services. Once a municipality or impover- ished area has been selected, the mayor and the local health authority agree on a strategy based on a pro- posal by PAHO. Later, meetings are held to sensitize the community groups involved, problems are identified and the health situation is analysed. Specific projects can then be designed for subsequent presenta- tion to potential donors and to the rest of the community. Zamora Municipality of Falcon State is in north-western Venezuela, and has 30 000 inhabitants. It is in a region of beautiful landscapes and coastlines, impressive highlands and many rivers and streams. One of the main characteristics of Zamora is its high level of community participa- tion and social solidarity. These have contributed to important achieve- ments, such as the building of an aqueduct, and the enforcement of health protection measures against a cement factory which operated in the . ommn znnoRn nUNI[IPIO Sl\LUDJU!Lr neighbourhood. Political support within the munici- pality finally led to the declaration of Zamora as a City Towards Health. personal skills, changes in The office of Zamora 's Healthy Municipality Proiect in Venezuela . After many meetings convened by the mayoress, attended by representations from several sectors of the population and with a carefully designed method- ology, it proved possible to draw up projects that re- flected the real needs and priorities of the community. These were formally made public in September 1994, World Health • 49th Year, No. 1, January- February 1996 of the most promising areas for tourism and industrial devel- opment. Traditionally, this State was devoted to agriculture and cattle, but it also has a great poten- tial due to its vast oil reserves. Half 29 at an event attended by the whole community, the Governor of the State, and representatives from the European Union, UNDP and other national and international coopera- tion agencies. The projects covered a wide range of needs, including fam- ily orchards, solid waste disposal, recreational activities, teachers ' development, classes in reading and writing for preschool children, early pregnancy, care of senior citizens, and preventive care. of the State's All the family get to work to make sure their orchard will thrive. The enthusiasm shown by the municipality and the community led to the constitution of a Healthy Cities Network in May 1995, linking Falcon with the rest of the country; the inauguration of a "Neighbours' House" as a centre for community work and follow-up activities to the programme; and the publication of a periodical on health promotion. A Permanent Technical Council was also created to oversee the carrying out of the projects. The Governor, the Dean of the University, and the Mayoress of Zamora and all the mayors who attended the original meeting were signatories to agree- ments putting these projects into effect. Improving a city's slums Maturin is the capital of Monagas State in north-eastern Venezuela, one population live in Maturin, which has about half a million inhabitants. Although a prosperous city with thriving busi- nesses, it is surrounded by slums where people live in extreme poverty. These slum areas were chosen to join the "Cities Towards Health" Programme. After a long series of meetings convened by the mayor of Maturin, the chosen set of projects were formally made public in May 1995. This event was attended by 85 par- ticipants from different sectors, including the Minister of Health and Social Welfare, the Mayor of Maturin and the PAHO Representative. The projects were prepared with a logical methodology and repre- sented a response to the most urgent and important needs identified by the community. These included Healthy Islands housing, sewerage systems, drainage of rain water, reservoirs for drinking- water, street and sidewalk repairs, solid waste disposal, aqueducts, adolescent lifestyles, communal drugstores, family orchards, and police precincts. By September, work had already begun on several of these projects. The municipality and the community are still seeking sponsors to finance their projects at the local, regional, national and international level. Of particular significance is the interest shown by the community itself and its willingness to participate in this initiative and to take a positive and open attitude towards health promo- tion. • Or Hern6n Malaga is the W HO Country Representative in Venezuela. His address is Senor Representante de la OPS/OMS, Oficina Sanitaria Panamericana, Apartado 6722, Carmelitas, Caracas I 0 I 0, Venezuela. The Yanuca Island Declaration on Health in the Pacific in the 21st century The Healthy Ci ty concept and approach , far from being limited in its applica tion to urban areas, can always be modified to suit local needs. In March 1995 on Yanuca Island, Fiji, the Conference of M inisters of Health of the Pacific Islands adopted the concept of "Healthy Islands" as their unifying theme for hea lth promotion and health protection. The Healthy Island approach can best meet the challenge of improving the health system, ensuring that health care processes become more integrated and holistic, creating stronger links through networking between the island nations, and paying greater attention to heal th promotion and protection, to environmental health and to intersectoral health initiatives . Furthermore, Healthy Islands can bu ild on the health resources that are avai lable, includ ing training institutions and programmes for the health professions. Among these are the medical, nursing and allied health schools in American Samoa, Cook Islands, Fiji, Guam, Kiribati, N orthern Mariana Islands, Marshal! Islands , Federated Sta tes of Micronesia, Palau, Papua New Guinea, Samoa, Solomon Islands, T onga and Vanuatu. The Ya nuca Isla nd Declaration endorsed agreements made in the areas of heal th at work, environmental health, and pharmaceuticals and medical equipment. National action plans will be d rawn up to meet the unique health and environmental needs of each country, and to identify environmental factors which adversely affect health. Healthy Islands is seen as an innovative concept that can help to mobilize people and resources to solve health and environmental problems, and that can give impetus to intersectoral action, policy development, health promotion, preparation of legislation and capacity-bu ild ing at a ll levels. The Declara tion emphasized that al l countries must work together by sharing information, technology and expertise aimed at improving the environment and raising the general status of health.