Municipal efforts to improve access to health care can reduce existing inequalities in Central America and the Caribbean, says Agustín Muñoz del Guayo.
Since last century, cities in Central America and the Caribbean have grown in number. Urbanisation in the region has reached 80 per cent and is expected to increase even more in the upcoming years. Hence, cities have become a critical component for national development. They have to offer housing, jobs, and opportunities and improve living conditions in terms of health, equity, and sustainability at the same time.
Equity is a big issue in Central American and the Caribbean. The region has high overall scores on inequity indexes not only regarding socio-economic criteria, but also in terms of health. Since projections indicate that health disparity will increase in the next decades, governments are facing the challenge to provide cities with adequate instruments to improve healthcare and sustainability. One powerful strategy with the potential to improve this disparity is the “Healthy Municipalities” approach, which could transform entire national healthcare systems if it is implemented as a national strategy in Central American and the Caribbean countries.
The term “Healthy Municipalities” describes a policy across sectors that involves citizen participation and community empowerment. It is a policy that addresses all the influencing factors that could affect public health, pays particular attention to social factors, and develops cross-sectoral policies to reduce existing inequality gaps such as infant mortality, access to drinking water, and measles vaccination. Healthy Municipalities initiatives consist of a strategic, cross-sectoral agenda, establishing citizen participation as an essential part for their success. For this purpose, following recommendations from the Pan American Health Organisation (PAHO), policymakers have identified four phases:
- Phase I – Awareness raising phase: The national government encourages local authorities and communities to participate and commit. It promotes good health practices to improve the quality of life for the whole community.
- Phase II – Organisational phase: The national government searches to strengthen and support local governments to make them capable of leading programs and carrying out the processes of diagnosis, planning, and evaluation for all Healthy Municipalities strategies such as technical meetings, public debates, and best practices for Urban Health.
- Phase III – Participation phase: In this phase, local health authorities will draw up a local healthcare plan based on a diagnosis of living conditions and indicators for health, education, and socio-economic development. The plan also takes into account the social determinants of health, such as low levels of education and poverty.
- Phase IV – Participatory implementation phase: This phase consists of the development of local healthcare plan activities, as well as the promotion of public health initiatives that can contribute to the Healthy Municipalities policy.
The local health authority will be not only responsible for the development and implementation of all components of the programme, but will also write an official report aimed to share experiences and earned lessons that will serve as an example for other policymakers in the region.
What Can Be Included in the Local Health Plan?
Urban healthcare initiatives can involve working on some of the following topics:
- Healthy recreational activities
- Smoking prevention
- Workplace accident prevention
- Waste sorting and recycling
- Proper handwashing
- Community projects
- Sewage treatment
- Greening of public space
- Spaces for culture and arts
Cuba and El Salvador are among the countries in Central America and the Caribbean that have initiated successful Healthy Municipalities programmes.
In Cuba, for instance, 54 per cent of the 168 municipalities belong to the Network of Healthy Municipalities. The initiative set a significant milestone in the Cuban healthcare system. In cooperation with local governments, it has created healthy spaces, incorporated social determinants in healthcare national policies, and used indicators for policies evaluation. Among these are systems for monitoring food and nutrition as well as hypertension (high blood pressure) for all inhabitants.
In El Salvador, the Pan American Health Organisation (PAHO) together with the local and national government has promoted the National Urban Health Model, which resulted in significant intersectoral health policies with the participation of local citizens and the execution of priority projects.
Nepaja and San Marcos: Two Examples of Sustainable Communities in El Salvador
Nejapa and San Marcos are two municipalities in the Salvadorian metropolitan area with successful Healthy Municipalities programs. Their local governments, the OPS, Medicus Mundis, ICSU ROLAC, the Council of Mayors and the Planning Office for the Metropolitan Area are carrying out specific actions for urban healthcare.
Through Nejapa’s occupational therapy programme, participants learn to grow their own food. It aims to enhance integral healthcare and to promote home gardening by training family members in mulch use, small-scale farming techniques, and sustainability practices. As a result, the program has improved the population’s quality of life, contributed to environmental protection, and reduced their cost of living.
San Marcos has carried out an urban public space recovery program aimed at promoting quality family time and violence-free environments. This implied working to recuperate recreational and communal spaces that used to be marginal and unsafe.
Mexico, the Dominican Republic, Nicaragua, and Guatemala also are setting initiatives regarding urban healthcare systems and are developing a Healthy Municipalities agenda. However, they are currently lacking the investment needed to implement a comprehensive approach.
Governments in Central America and the Caribbean should promote good urban health practices and emphasise healthy environments, just like the United Nations Economic Commission for Latin America and the Caribbean (ECLAC) is requesting in the Urban Agenda 2016-2030 guidelines, and the Pan American Health Organisation in the Report on Urban Health in the Americas.
It is necessary to exchange experiences among the different municipalities in the region. This exchange of learned lessons should not only be about results, but also about how to get there—which processes and regulatory frameworks have proved to be successful. For the purpose of creating healthier cities, it is necessary to promote local and national technical cooperation to reinforce community participation, and to create working relationships between local governments, citizens, and private companies.