Innovations, lessons learned and good practices

Peru: Sustainable Human Development in the Indigenous Rio Santiago Area (Lessons Learned)

Year: 2007
Major Area: Young Child Survival and Development
Language: English

Summary

Like other indigenous communities, the Awajun and the Huampis who live in the Amazonian area of Rio Santiago are amongst the most excluded groups in Peru, with low social indicators especially for children and adolescents. In order to reverse this situation UNICEF, in a joint effort with its partners, initiated a comprehensive community-based programme that produced significant improvements in indicators related to health, education and child protection.

Lessons learned

The strategies developed and the results achieved through this programme demonstrate the possibility of progressing toward the fulfilment of children's rights, even in extremely remote and poor areas. The expansion of this kind of programme, coupled with higher public investment for indigenous areas, may help reduce the serious inequities that affect indigenous populations. 
    
Issue

Peru faces strong inequalities in social indicators amongst the different segments of the population. The indigenous communities of the Peruvian Amazon represent the most affected social groups, such as the Awajum and the Huampis (population 12,000), who live in the Rio Santiago district of Condorcanqui Province in the department of Amazonas, one of the most isolated and inaccessible regions of the Peruvian Amazon. According to the initial baseline study performed in 2002, these populations suffer from low social indicators especially for children, adolescents and women: 

• 58% of pregnant women were anaemic;
• only 6% of all births took place in health centres (compared to an average of 27% for the Amazonas region and 58% nationwide);
• the maternal mortality rate was 388 deaths per 1000 thousand live births in 1999 (according to the 2000 local census of the Rio Santiago district) compared to 185 nationwide (ENDES 1996-2000); 
• almost half of the children under three years old showed chronic malnutrition; 
• 25.5% of students between 6 and 17 were repeating a grade; and
• only 51% of all interviewees had a birth certificate.

Strategy & application

UNICEF – in partnership with the Ministries of Health, Education and Women and Social Development, the Regional Government of Amazonas, RENIEC, community organizations and indigenous federations – initiated a comprehensive community-based programme for the fulfilment of basic rights of indigenous children with special emphasis on health, nutrition, education, good treatment, identity and participation. The main strategies included strengthening the presence and capacities of public services in the 56 communities along the banks of the Santiago River, including health services and schools, in order to develop a network for child protection, and advocating the inclusion of these actions in local Plans and Budgets. Specific strategies include: 

• Maternal and child health and early childhood development: 1) strengthening of the capacities of the local health staff to provide primary care and preventive services, 2) cultural adaptation of health services, 3) implementation of a minimum package of activities in health services and for reducing malnutrition at the community level and 4) recent introduction of the rapid test technology for pregnant women in order to prevent mother-to-child HIV-AIDS transmission.
• Intercultural bilingual education: 1) development of a pedagogical approach in accordance with cultural norms, 2) improvement of the technical level of teachers and of their commitment to education, 3) promotion of parental participation in children’s education, and 4) infrastructure improvement and availability of pertinent educational material.
• Child protection: 1) support to a network of 30 Defence Centres in communities, which are staffed by trained indigenous promoters elected within their own communities, and 2) birth registration through Indigenous Registration Offices
• Strengthening of local governments: strengthening of capacities at the local level in planning, management and administration in order to include social investment in plans and budgets.

Results

Significant results have been achieved through this intervention as evidenced by the progress study performed by the end of 2006:

• The number of healthcare facilities increased, effectively shortening distances: in 2002, 20.8% of the people were one hour away from a healthcare facility while in 2006 this number had been reduced to 8%. Visits to health services increased accordingly, from 45.1% in 2002 to 61.8% in 2006 mainly due to an increase in demand for pregnancy controls and attention for diarrhoea and acute respiratory infections. 
• Prenatal check-ups rose from 57.2% in 2002 to 80.8% in 2006. Women were counselled on proper diet and signs of danger or complications during pregnancy.
• The rate of births in health care facilities grew from 6% in 2002 to 12.5% in 2006 mainly due to the creation of Maternity Waiting Houses, locations close to health facilities where mothers from isolated settlements can await the moment of birth.
• Exclusive breastfeeding increased significantly from 5% in 2002 to 23% in 2006.
• Vaccination rates against tuberculosis, diphtheria, tetanus and hepatitis B reached almost 100%.
• Grade repetition rates in primary and secondary schools decreased between 2002 and 2006 from 25.5% to 7.3%, a reduction of 18.2 %.
• Birth registration for the general population increased from 53% to 57.2% and from 32% to 59% in children under age 1 year.

Next steps

While important achievements have been made in children’s rights in these indigenous communities, strengthening the capacities of institutions and public services of the State is a priority for ensuring sustainability. For this reason, in the next two years the focus will be on strengthening capacities of the regional and local governments in order to develop investment projects that will enable the inclusion of these activities in public budgets. In parallel, advocacy strategies will be used in order to raise the awareness of society and of government about the situation of indigenous communities and to expand this programme into other areas with indigenous populations.