Community empowerment: UNICEF's commitment to more sustainable and comprehensive interventions

Valentina* and Jorge Luis* are fraternal twins. They are 2 years 8 months old and live with their mother María in the parish of Angochagua, Kichwa territory in the province of Imbabura, Ecuador. According to the medical diagnoses, the twins' health is affected by hip dysplasia, cerebral palsy and acute malnutrition. They were born prematurely at 36 weeks gestation.

María*, 38, is a single mother and has faced difficulties in accessing services, housing and healthy food for her children. Until a few months ago, she lived in a makeshift 4x4 meter plastic shack, where she spent rainy nights hugging her children to protect them from the cold. These conditions have put the development and growth of Valentina and Jorge Luis at risk.

The twins and Maria are part of the 77% of the indigenous population that in 2020 lived in multidimensional poverty¹, that is, they suffer one or more deprivations in education, health, food, housing, work and social security. Poverty levels of indigenous peoples and nationalities are higher than those of other population groups. 

The effects of the COVID-19 pandemic have also had a major impact on the well-being of the rural population. As of October 2021, 55% of rural households with children and adolescents reported severe or moderate food insecurity², that is., they have difficulty obtaining food for household members. Before the pandemic, by 2018, the figure for chronic malnutrition in indigenous children under 2 years of age had already reached 39%³. 

So that children like Valentina and Jorge Luis can improve their health, nutrition and access to school, UNICEF Ecuador works in the province of Imbabura and the Cayambe canton in the province of Pichincha, in coordination with state institutions, local governments and community leaders, implementing comprehensive interventions based on community empowerment and social mobilization.

What does the comprehensive intervention consist of?

UNICEF carries out the following actions to promote comprehensive care for children:

• Supports the health system to reduce maternal mortality and ensure the best start for children, through the promotion of breastfeeding and comprehensive childbirth practices.
• Provides assistance to the Potable Water Boards to improve water quality and strengthen water and sanitation services at health centers. 
• Promotes intercultural bilingual education and contributes with infrastructure improvements and safe water supply in rural schools so that the most vulnerable children can return to classroom education.
• Encourages communities to build child development and parenting support spaces.
• Promotes community empowerment through the community health monitors model. Women, youth and midwives are a link between families and social services.
• Promotes coordination among the actors responsible for guaranteeing the rights of children, through the Intersectoral Roundtables.

One of UNICEF's major commitments, developed in coordination with the Ministry of Public Health, is the community-based epidemiological surveillance strategy, with the participation of community leaders who are trained to play the role of community health monitors in their territories. Their function is to identify possible cases of COVID-19 as well as situations of food insecurity and need for primary health care, timely immunization of children under five, maternal and child care, access to the education system and drinking water, among others.

In the case of Valentina and Jorge Luis, community surveillance made it possible to identify their vulnerabilities and address their needs to the Angochagua Intersectoral Roundtable, community servants and the health facility. The family received comprehensive care, including services such as access to vaccinations, nutritional counseling, food, medical care and basic services such as drinking water.

The intersectoral roundtables have been promoted by UNICEF for the last five years in indigenous territories of Imbabura and Pichincha. In these spaces, dialogue and community participation are encouraged and decisions are made to address situations that put the lives of children and adolescents and their families at risk. This initiative involves community leaders and other social sector actors such as the Ministry of Public Health, the Ministry of Economic and Social Inclusion and the Ministry of Education, among others.

Epidemiological surveillance and intersectoral roundtables represent successful local models of community collaboration that have been replicated by the Ministry of Public Health and the Ecuador Grows Without Child Malnutrition Technical Secretariat, standing out as best practices. The epidemiological surveillance strategy has benefited 7,131 families in Imbabura and Cayambe.

UNICEF Ecuador works in indigenous territories to reduce maternal mortality and ensure the best start for children through technical assistance and strengthening the capacity of professionals and health facilities to implement the Mother and Child Friendly Establishments (ESAMyN for its acronym in Spanish) standards which promote practices such as breastfeeding, birth control and free position birthing, among others.  

UNICEF supports the Kayambi People in the promotion of intercultural education through the Kintiku Yachay methodology implemented in the Child Development Centers. Indigenous children learn about their ancestral culture through elements such as the chakana, Andean puppets and the community garden or chakra. This methodology has benefited more than 6,000 children and will be replicated with the Karanki People in Angochagua, in the province of Imbabura.

Access to safe water is another key component of this fundamental comprehensive intervention. In the territories of indigenous peoples and nationalities, 8 out of 10 children simultaneously lack water, sanitation and hygiene services in their homes⁴.

Through a national assessment of water, sanitation and hygiene services, conducted by the Ministry of Education with technical assistance from UNICEF Ecuador, involving more than 15,000 educational institutions, it was identified that 39% of the institutions with intercultural bilingual education do not have safe water service.