Bill & Melinda Gates Foundation

How One Panamanian Health Initiative Prepares for Major Change

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March 21, 2013

We recently visited the communities of Narganá and El Tigre, in Panama’s Kuna-Yala Territory. This particular Kuna People’s settlement is located in an archipelago of small islets on Panama’s Caribbean Sea, not far from the border with Colombia, and surrounded by impenetrable rainforest.

Kuna Yala is one of several indigenous territories in Panama where the Salud Mesoamerica 2015 (SM2015) Initiative is about to start implementation of a large-scale performance-based program that aims to improve the health of women, newborns and girls and boys under age 5 years.

As we arrived to the “El Tigre” community, we were greeted by local community leaders and met local community health volunteers as well as mobile front-line health workers who travel from island-to-island. Together they exemplify the typical core providers of primary care health services in remote, mostly indigenous communities across Mesoamerica.

At the local school-cum-health post, we met Lubielis Brenes, a local voluntary “Health Monitor” who said her job energizes her because it provides her with an opportunity to work with young infants and children.

 We were glad to also observe our partners in Panama getting ready for implementing what amounts to a major change in health policy and practice that ...will lead to improved family health results such as immunization rates, and coverage and quality of primary health care.

Her job is to provide “teachings” to local women about proper diet, breastfeeding, and prenatal care. She also knows how to demonstrate infant care to mothers and measure young infants’ weight and height. She said that at present she is poorly equipped to deploy her skills for lack of basic supplies such as a measuring tape, a reliable scale, or durable teaching materials that survive the region’s wet climate and sudden storms. She reminded us that, in fact, El Tigre’s health post was swept away long ago by one of those storms. Therefore, the local school has to double up as a health facility whenever the Ministry of Health’s mobile team comes to the island.

As we toured the island of El Tigre and later on the more densely populated small islands of Narganá and Corazon de Jesus, we learned that the Inter-American Development Bank and Panama’s Ministry of Health are about to complete SM2015’s baseline. Surveys are been collected in households across the poorest Kuna and Emberá territories in Panama and all over the eight countries where SM2015 is being implemented. Future improvements in performance will be measured against these baselines and against pre-agreed upon targets for improvement in various indicators of maternal and child health.

We know that baselines matter to set up the starting point in the race for improved health status for the most disadvantaged communities in Mesoamerica. We were glad to also observe our partners in Panama getting ready for implementing what amounts to a major change in health policy and practice that we all believe will lead to improved performance in family health results such as immunization rates, and coverage and quality of primary health care and community-based services across nutrition, maternal, neonatal and child health.

As we pondered on why we felt that the energy we saw was a source of great hope for what is to come, we reflected on what “getting ready” for large scale system change means. First, we believe these teams are aware of the challenges that program implementation will bring and that they know that change tends to be messy (neither dull nor linear).

While they can anticipate many unexpected events, surprising turns, and obstacles, they also have a few elements in their favor. First, there is evidence of commitment from the government in terms of significant allocation of resources to co-finance this program and even expand it to the rest of the indigenous communities in Panama. In fact, the small amount of external funding provided by SM2015 has already been multiplied five-fold by the Panamanian government, a catalytic effect if there ever was one!

Also, the program has deployed major efforts to monitor and evaluate progress as implementation starts, a practice that has proven time and again to be a useful source of feedback and learning for rapid program improvement.

But, perhaps in a unique example of what this “getting ready” is about, the Ministry of Health and domestic policy makers appear to have decided that the status quo needs changing. That the health inequalities that have prevailed among indigenous communities are indeed preventable through innovations that respect local culture while introducing new policies and practices like universal vaccination coverage, oral rehydration, zinc, and micronutrient powders.

During our visit we were given the opportunity to observe in “live form,” as it were, some things that left us with an optimistic outlook into what implementation may bring for Lubielis and her local community in the Kuna-Yala Territory. We look forward to our collective hopes for the future soon being translated in measurable improvements in the lives of poor families and communities throughout the Mesoamerican region.

Meeting Lubielis, health instructor in Guna Yala (Panama) from Salud Mesoamérica 2015 on Vimeo.

 
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