By Natalie Walter
AMOS Health & Hope Communications Coordinator
At AMOS, we love telling the story of a community coming together to recognize a problem they face and decide how to use their own resources, knowledge, and passion to solve their community’s challenges. And we love to hear your stories about your work, too! That’s why we held a special webinar on September 5th so we could all share knowledge on how communities can change their own health outcomes and make the world a better place in the process.
On the call were be AMOS Co-Founder and Medical Director Dr. Laura Parajón, and world-renowned public health expert and professor at Johns Hopkins University, Dr. Henry Perry. Watch a recording of the webinar here so we can reflect on what we want the story of health for all to look like!
In the spirit of the discussion, we’d like to share a firsthand example of the powerful impact of the model of community-based primary healthcare. And to read the series of articles discussed in the webinar, click on the link below!
For Health For All
AMOS utilizes a model called the Census-Based, Impact-Oriented Methodology (CBIO). This methodology uses a process that helps guide communities through a cycle of decision-making to help be good stewards of our resources, give the most to those who need it the most,1 and makes sure that we reach every person, especially those who are traditionally marginalized and hardest to reach.2
The first step in this methodology is always a relationship formed between a community and the organization who accompanies them – in this case, AMOS.3AMOS works with communities when they invite us to do so. Some of our relationships with communities started over 50 years ago, dating back to when Dr. Gustavo Parajón first started his community-based primary healthcare work in Nicaragua.
The second step is to work with the community to discern the most pressing health problems they experience.4These are tracked by a detailed process of census taking in every community we work in. We count every person, because every person counts.
Focusing efforts on the priority problems is the next step.5Once the priority problems are determined, we can address them, together: the community, AMOS, volunteers, and with the support of the local government. This is where the cycle of community-based primary healthcare really beings! Through a process of monitoring and evaluation, we assess how well we are addressing these priorities, and if the communities’ priorities change over time.6 And then the process starts back over again to take action to address the identified problems!
In the upcoming AMOS webinar on September 5th, you’ll be able to hear from Dr. Henry Perry, who recently concluded a 10-year-long systematic research review which demonstrated the true efficacy of community-based primary healthcare.7This exhaustive review looked at hundreds of cases that document the evidence to show that this model really works. And AMOS’ own experience—in communities all over Nicaragua—is also evidence of the model’s success!
Anemia: Quick fixes are NOT how lasting change is created.
Over the past few months, community leaders in El Bambú, a remote and dispersed community in the South Caribbean Coast Autonomous Region of Nicaragua, have been working alongside AMOS staff and volunteers to address a problem they noticed in their community: anemia. This is not an unusual problem in Nicaragua, where 20% of children under 6 years old have anemia.8 9
Even when working to address such a widespread problem, leaders in each individual community will best know the manifestation of that problem in their own context. And AMOS extensively trains community leaders so they will best know how to address their communities’ health challenges. After working with AMOS volunteers and staff to conduct screenings for indicators of malnutrition in both April and July of this year, community members in El Bambú learned of the high rates of anemia in their children and wanted to do something about it.
Because of the relationship that AMOS has built with the community over the years, we were well-poised to get to work. There are many ways to address anemia. The easiest would have been to have simply given iron supplements to the children who were identified as anemic. However, quick fixes are not how lasting change is created. El Bambú and AMOS wanted to go further in their intervention, and we will be there to accompany them every step in the cycle of community-based primary healthcare.
Together with a team of AMOS staff and interns, the volunteer mothers and health promoter conducted what is called a positive deviance study. Looking at the results of the malnutrition screening and at census data, we identified several children of families with fewer resources who who did not have anemia, and conversely, children of families with more resources who who did have anemia.
We visited several of these families with fewer resources and healthy children to learn about their feeding and care practices – these are the practices that would be replicable for other members in the community. Once we had gathered this information, several volunteer mothers devised recipes incorporating those practices, and since then have been teaching their neighbors how to make them. They know their communities’ problems, and they know where to look for the solution within their own community as well, so that they can take action together with their neighbors. We will continue to monitor the progress of the children in the community to see how well the intervention works, and how we should adapt it if necessary.
Stories Give Us Hope and Teach Us
This story was made possible by the AMOS model of community-based primary healthcare, supported by the Census-Based Impact-Oriented (CBIO) method, which you can see illustrated in the infographic below. To learn more about these methods and hear more stories, make sure to watch the recordng of our webinar!
There’s a reason that we at AMOS love telling stories like these so much: they give us hope for a better future, and teach us how to help us make that future a reality.
1. Shanklin, David S., and Sillan, D. The Census-Based, Impact-Oriented Methodology: A Resource Guide for Equitable and Effective Primary Health Care. Curamericas, Raleigh, North Carolina, April 2005. 1.↩
2. Ibid, 3.↩
3. Ibid, 4.↩
7. Perry, Henry, et al. “Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health.” Journal of Public Health 7, no. 1, (2017). ↩
8. Gagnier, M. C. (2015). Malnutrition in Mesoamerica: The distribution and correlates of stunting, wasting, underweight, and anemia (Master’s thesis, University of Washington, 2015). Ann Arbor: ProQuest LLC.↩
9. Mujica-Coopman, María F., Alex Brito, Daniel López De Romaña, Israel Ríos-Castillo, Héctor Cori, and Manuel Olivares. “Prevalence of Anemia in Latin America and the Caribbean.” Food and Nutrition Bulletin 36, no. 2_suppl (2015).↩