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Case studies from Latin America

Seven case studies from five countries in South and Central America were selected to take part in the Mobility and Health Networked Research programme. covering the issues of Mobility and Health from a diverse range of perspectives and different contexts. They address issues of Mobility and Health from a diverse range of perspectives and different contexts. Use the list below to navigate each of the case studies. You will find a brief overview of the aims and objectives of each study, a biography of the lead researcher and a link to download the final case study report. Please note that the final case studies presented here have been reviewed but not edited for publication.

Argentina:

Bolivia:

Guatemala:

Mexico:

Peru:

Mobility, poverty and adolescent health in Argentina. The case of Buenos Aires peri-urban areas

Study by Andrea Gutiérrez and Diego Minuto

Background

The project seeks to link two new phenomena in Argentina (and the world). One, the formation of transitional spaces between the great cities and the countryside in which a dispersed rural population exists, a concentrated population in rural towns and a discontinuous urban population. The other, the increase in early maternity, with an increase in youth mortality in poor households.  

The case study offers singularities of interest. In the coexisting population with strong socio-economic and mobility disparities a growing feminisation of the AIDS epidemic and risks for adolescents can be observed. There is no literature or empirical evidence which associates adolescent health with the mobility of the poor population.

Overall and Specific Objectives

1. To increase knowledge about the impact of restrictions in mobility on the health of poor people.
2. To investigate the achievements of the existing institutional programmes in Argentina aimed at mitigating the impact of teenage pregnancy and AIDS (on mothers and children) according to the mobility conditions of young people from poor households in the Buenos Aires peri urban areas. 
3. To analyse and evaluate problems and needs in health and mobility applying to teenage pregnancy, maternal health, pre and post-natal health and AIDS.

Methodology

1. Map the preliminary conditions:
a. Review of current literature, methodology and indicators applied to the study of daily mobility practices and poverty.
b. Definition of the target territorial base (selection of a district of the peri-urban area according to statistical and cartographic data).
2. Define the target population in the territorial base:
a. Identification and classification of the population attended to in public hospitals and/or health units in the district through analysis of records and interviews with staff.
b. Identification and classification of the population affected in the area of study (young people exposed to pregnancy and AIDS, and experiencing greater deprivation), by means of data collection in local community organisations (schools, charities, NGOs, soup kitchens, etc.).
3. Select the focus group to interview through consultation with key informants from the local community organisations.
4. Analysis of the focus group by identifying and characterising daily mobility practices (“biographic” travel rounds).
5. Analysis of the existing governmental programmes and services in the study area associated with teenage pregnancy and AIDS by means of identifying location and mode of service reception (on the basis of the focus group and the health unit).
6. Evaluate the accessibility of health programmes and services associated with teenage pregnancy and AIDS according to their level of use (relationship between those affected and programme attendance) and means of attending the programmes (economic, physical, information, hours).

Expected Outcomes of the Research

1. To produce primary data on the mobility profile of the population affected and attended to in situations of teenage pregnancy / AIDS; to systematise and map secondary data.
2. To define and apply “measuring” methodologies, according to the populations’ levels of accessibility.  
3. To create closer relationships with institutions and organisations (state and social, local and national) associated with adolescent health and raise awareness around mobility as a key determinant in supporting the organisation and distribution of actions aimed at promoting health care and prevention.

Information Dissemination and Advocacy Strategy

The project results will be publicised trhough publication in scientific circles (national and international, such as CLATPU, ANPET, EGAL, etc.) and specialist magazines (national and international, such as EURE, ETS, Realidad Económica, etc). Also, in association with activities and programmes of the Outreach Secretariat of the Faculty of Philosophy and Letters – UBA – the department in charge of promoting academic production in society through concrete actions with community organisations (amongst them, the Open faculty Programme, which links work teams with neighbourhood assemblies, unemployed workers movements, firms taken over by workers, etc). 

FINAL REPORT:

Mobility, poverty and adolescent health in Argentina: The case of rural-urban areas in Buenos Aires.
By Dr. Andrea Gutiérrez
2008
Download: Word Doc 2198 KB

Participatory evaluation of the mobile health service in rural areas of Bolivia

Study team: Julio Sanchez U., Miriam Sanchez U., Vladimir Plata R., Martha Calle M.

Background

Mobile Health UnitIn Bolivia some governmental and non governmental institutions have set up health care services using mobile units, especially in isolated areas with greater levels of poverty. We wish to collect the opinions and suggestions of those benefiting from these mobile services, assessing alongside the communities' opinions also the impact on the general health of the population and collecting suggestions to improve these services. The work will be coordinated with the institutions that provide these health services so that the results can be internalised and taken into account immediately with the hope that the services improve as fast as possible.

Overall and Specific Objectives

1. To contribute to the knowledge in political decision making circles about the priorities and requirements of rural communities with respect to health service needs. 
2. To acquire a perspective from the point of view of the inhabitants in the rural sector about the evolution of the health services, taking the last ten years into account, and their expectations for the coming years given the conditions currently available.
3. On the basis of the results, make suggestions for the improvement of health services in rural areas.

Methodology

1. A participatory evaluation will be carried out among the rural population who benefit from mobile health services in Bolivia’s four macro ecological zones.
2. The data collection methodology will use qualified sampling, semi-structured interviews, analysis in community workshops, community economic stratification, community history, participant observation and qualitative classification techniques.
3. The research work will be coordinated with the institutions that provide the mobile health services who will subsequently be able to use the results of the research for their planning.
4. The results will be presented for consideration by the health service providers for their evaluation and appropriation.
5. The results will be publicising via written media; a final report and an information sheet. But also it is proposed to hold a workshop to discuss the results with the institutions concerned, organisations working in the area of health, political authorities, etc.

Expected Outcomes of the Research

1. To ascertain the opinion of the population in rural areas about the mobile health services and their perception of their quality, effectiveness and relevance.
2. Identification of the advantages and disadvantages of the mobile health services in rural areas from the point of view of the beneficiaries.
3. To ascertain how beneficiary communities assess the mobile health service as an alternative to the conventional health services such as the area’s health post. 

Information Dissemination and Advocacy Strategy

The results will be publicised by means of :
1. A final report which will be distributed to participating institutions, government offices and “non governmental” health service providers, the region’s town halls and prefectures.
2. An information sheet with the most important information from the results which will be distributed to the rural population, trade unions, territorial health organisations and the public that requires it.
3. A final workshop to present the results, to which will be invited political and health authorities, as well as social communications media.

It is intended that during all the phases of the research the organisations involved and those responsible for health are kept informed and are aware of the intermediate results. 

Final Report:

Participative evaluation of health attention through mobile brigades in the rural area of Bolivia
By Julio Cesar Sanchez Uzeda
August 2008
Download: Word Doc 465 KB

Mobility and maternal mortality in Bolivian indigenous healthworker networks

Study by: Germán Delgadillo Vargas and Cecilia Bellido Carranza

Background

According to data from the WHO Bolivia has the highest maternal mortality rate in South America - 390 mothers die for every 100,000 live births. The results of the 2001 National Census show that only 17.92% of the indigenous population gave birth to their last child in a health centre. In other words only one out of six births has been attended in a health centre. The above indicators demonstrate that amongst the indigenous population the problems continue to be related to the areas covered and to access to the health service.

Overall and Specific Objectives

1. To identify the causes of the high maternal mortality rate in health networks and indigenous populations and to propose corresponding interventions in accordance with the location, access and coverage of the networks.
Specific objectives:
2. To carry out a participatory analysis that will allow the identification of the problem in the indigenous population concerning maternal mortality and the high incidence of home births.
3. To propose actions that will create greater functionality of existing and new health infrastructure compatible with the indigenous population’s cultural characteristics and means of transport. 

Methodology

Based on the Bolivian Guide to Participatory Planning the methodological process is made up of the following stages:
1. Construct the problem under investigation and organise the process. Initial analysis of the problematic situation and the theoretical framework of the research. Promotion and organisation of the process.
2. Field work: data collection, recording and storing. Primary and secondary data collection from community workshops, interviews of key informants and existing bibliographic and statistical documentation. Data storage.
3. Consolidated Analysis: Organisation, analysis and interpretation of the data. Systematisation, technical analysis and validation of the data. Analysis of the current situation.
4. Analysis and communication of the findings. Production of a document containing the information gathered, its conclusions and recommendations or proposals according to the agreed methodology. 

Expected Outcomes of the Research

1. Actions in the transport sector compatible with the existing health networks have been defined and put forward.
2. Instruments have been designed that allow for transport networks to be considered a priority when creating health institutions in future.
3. Actions have been put forward that allow for the creation of differentiated public health policies for areas with dispersed populations and/or deficient road infrastructure and transport services.

Information Dissemination and Advocacy Strategy

Given that it is a process which involves the indigenous peoples’ organisations and the Municipal Governments, the investigation has the possibility of using the distribution media belonging to and associated with these institutions: 
1. Publication by the Bolivian Indigenous Organisation (regional level)
2. Publication on the web in institutional pages which belong to the municipal network (national level)
3. Municipal radio space with rural coverage (regional level)
4. Presentations to the Federation of Municipal Associations (a body to which the Municipal Governments belong) (national level)
5. Informative newsletters of the Municipal network (local level)
6. Publicity posters (local level)

FINAL REPORT:

Mobility and Maternal Mortality in Indigenous Health Networks in Bolivia
By Verónica Delgadillo V, Claudia Subieta P, Germán Delgadillo V
January 2008
Download: Word Doc 1032 KB




Impacts of mobility in the health of displaced vulnerable groups that live in the rural zones of Huehuetenango department of Guatemala


Study by: Marco Aurelio Colindres, Rebeca Orellana, Lisandro Morán, Silvia Judith Quan, Arturo Aguilar

Background

The armed internal conflict in Guatemala caused the displacement of the rural population (71% indigenous, ethnic) to the border of Mexico-Guatemala.  New generations have returned to Guatemalan territory, but they cannot count on access to goods and services. There is not only movement of immigrants travelling North from the Center and the South but also deportees returning to Guatemala. The region is influenced by the geographic, political and administrative conditions that characterises borders. The populations are affected by a lack of, and increase in costs of access to transport and health services.

Overall and Specific Objectives

1. To identify, analyse and report the means of accessing health services
2. To identify other elements that affect the health of the inhabitants
3. To propose a mobility plan to reduce the rate of maternal mortality in the border zone of Mexico-Guatemala

Methodology

1. Visit and identification of groups at risk in area of study
2. Identification and selection of bibliographical material related to the area and subject of study
3. Identification and analysis of sources relating to mobility and health (infrastructure, territory, gender, environmental impact, national policies, programs and projects) within the area of study.  To include the results of the national poverty reduction strategy papers (PRSP), Millennium Development Goals, the National Policy of Promotion and Development of Guatemalan Women, the Fairness of Opportunities Plan 2001-2006 and the Guatemalan National Human Development Report 2005.  It will also include an analysis of the four "Delays", particularly "Delay 3" that forms part of the Ministry of Public Health and Social Assistance’s National Plan of Maternal Mortality within the medical attention program.
4. To evaluate the commitments and outcomes of the Firm and Lasting Peace accords (signed in December of 1996) particularly in regard to the socioeconomic and agrarian aspects as it relates to mobility and health and the communities affected by the internal armed conflict.  And to evaluate the national and international legal system (law of decentralization, law of social development, international human rights, etc) according to the Kelsen pyramid.

Expected Outcomes of the Research

1. To establish a mobility strategy in relation to health
2. To establish a guide to sensitising local communities and governments
3. To establish an alternative proposal for addressing the health issues of the local and travelling populations.

Information Dissemination and Advocacy Strategy

1. The use of radio, television and print media at the local level
2. Promotion of the issues to civil society organisations
3. Promotion and dissemination of the study to different local religious groups
4. Promotion of the study to the Ministry of Health and Social Assistance and their National Plan of Maternal Mortality within the medical attention program
5. Promotion to academic circles and electronic networks and Communities of Practice.

FINAL REPORT:

Mobility Impacts on the Health of Displaced Vulnerable Groups, Established in Huehuetenango Department, Guatemala, Central America.
By the Political Committee on Accessibility to Physical Spaces and Transport in Guatemala (CPAT). Research team: Marco Aurelio Colindres, Rebeca Orellana, Silvia Judith Quan and Francisca Ixcol
January 2008
Download: Word Doc 5932 KB (Note: Large file download)




The mobility of rural women in attending health services. Case study from the municipality of Pinal de Amoles, Querétaro state, Mexico

Study by: José Alfonso Balbuena Cruz, Patricia Fernanda Briones Medina, Martín Enrique Saucedo Uuh, Charlotte Vizzuet Montoya, Martha Patricia Herrera Barbosa  and Rosalío Aguillón de Jesús.

Background

Girl with DonkeyIn rural areas, health is crucial in carrying out the multiple daily activities necessary to the progress of low income families: fetching and carrying water and firewood, agricultural subsistence farming and voluntary community work, amongst others. When the health of these families is affected and their access to medical services is restricted the chance of them recovering from their ailments is compromised, sometimes to the extent of permanent physical disability or death.

Mexico is home to a rural population of 24.6 million people (51% women), whose access to health services is essential for a minimum quality of life.

Overall and Specific Objectives

1. To identify and analyse the travel patterns of women of child bearing age attending the health services available in the municipality of Pinal de Amoles in the state of Querétaro, Mexico.
2. To determine which factors limit the mobility of the health service users.
3. To suggest features which might support the creation of actions and programmes associated with transport or health services aimed at improving mobility so that needs might be attended to as and when they arise.

Methodology

Methodological design (within the methodological structure of research as a network proposed by IFRTD):
1. Documentary and internet research on the health services available in the municipality.
2. Household surveys will be designed and a sample of women of child bearing age will be defined.
3. Collection of socio-demographic information and other information related to travel patterns and barriers to mobility in two situations: appointments with a doctor and emergency cases.   
4. Interviews with local authorities will be carried out to obtain information on local health programmes and actions and women’s access to them.
5. Creation of databases and the use of maps of the region.
6. Use of a conceptual model which links the routes generated by inter-relation between the transport system and the system of activities (in this case health) in progress.
7. Description of the results from the project (estimated to be of eight months duration) which will lead to a research report as its final product.

Expected Outcomes of the Research

1. An increase in the critical mass of the issue’s importance within different bodies leading to similar investigations being undertaken. Concrete actions in improving rural mobility to reach health centres or requests from the rural population for travel in accessible and efficient transport alternatives.
2. To contribute empirical evidence to further understanding of the range of factors which improve or worsen the symbiotic relationship of transport and health.
3. To initiate a debate within academic circles on: how to improve the rural population’s mobility to health centres; the proposed methodology for its replication in other low income rural areas in developing countries; and in what form transport impacts on the quality of life of the low income rural population.

Information Dissemination and Advocacy Strategy

1. Production of an article to be published in the external information review of the Mexican Institute of Transport, “NOTAS”. 
2. To publicise the report “in full” as one of the MIT’s technical publications, both on paper and in “pdf” format for the Web site www.imt.mx/Espanol/Publicaciones. The above with prior authorisation from those responsible for the mobility and health programme.
3. To participate in the respective convocations of the Pan-American Congress of Traffic and Transport Engineering and of the United States Transport Research Board with an article about the research undertaken.   
4. Others as defined by the IFRTDAL.

FINAL REPORT:

Rural Women's Mobility Towards Health Service. A Case Study in the Municipality of Pinal de Amoles, Queretaro State, Mexico.
By M. I. José Alfonso Balbuena Cruz
February 2008
Download: Word Doc 2859 KB

The role of river transport in accessing conventional and traditional health services in the rural rainforest of Peru

Study by: Diógenes Ampam Wejin

Background

From an intercultural and gender perspective the case study concentrates on the role which river transport plays in the access Amazonian rural populations in Peru have to conventional and traditional health services, particularly women of child-bearing age, girls and boys and people in situations of greater poverty and exclusion.

The study, which will be carried out in Awajun native communities in the Amazon region, has a two-fold purpose. On one hand it aims to serve as an instrument for recognition of the problems indicated by the native communities, local and regional authorities and regional health and transport service providers; on the other as an instrument of community action to demand that the State complies with its responsibilities in relation to the population’s right to health care. 

Overall and Specific Objectives

1. To analyse the relative importance of river transport in accessing health services, in particular to do with mother and child health in native communities of the Peruvian Amazon.
2. To identify the local supply and demand characteristics for transport services and conventional and traditional health services.
3. To associate the local problems of mother and child health with the quality of the health services provided and access to means of transport.
4. To endow the community with greater knowledge of the existing relationship between mobility, access to health services and the characteristics of mother and child health problems.

Methodology

The research methodology to be used in the study will have as a priority obtaining primary information by holding workshops with the native communities, carrying out surveys and interviewing key informants. This data will be put into context using secondary data relating to the socio-economic and cultural framework of the region, to health and transport indicators, as well as state policies, programmes and projects relating to the problems in question.     

Expected Outcomes of the Research

1. A research report which contributes to knowledge of the role and importance which river transport has for the Awajun population’s access to existing health services in the region.
2. A better knowledge on the part of the Awajun community of the relationship between mobility and access to health services will empower their ability to bring about the improvements they consider necessary.

Information Dissemination and Advocacy Strategy

We foresee that the research results will strengthen the empowerment of the Awajun community in as far they can obtain from the public authorities and their own organisations the actions necessary to improve the population’s access both to the means of transport and services and to the region’s existing health services.

In this sense, the main publicity efforts will be aimed directly at the indigenous populations, via their national and regional organisations, at the local and regional authorities involved in the study, as well as health personnel, local health promoters and health centres in the region.

In the same way, the diffusion of the study’s main conclusions to the academic community will be pursued through their publication in portals and printed media specialising in the issues of human rights, the Amazon, transport, rural development, public and reproductive health.

FINAL REPORT:

The Role of Fluvial Transport to Access Conventional and Traditional Health Services in the District of Cenpea, Amazonas Region, Peru
By Ampam Wejin, Diógenes and Bravo Hernandez, Silvia Isabel
January 2008
Download: Word Doc 1562 KB




A comparative gender-inclusive analysis of the Rural Roads Programme in Peru. The effects of mobility on health conditions in sierra and rainforest communities

Study by: Juan Contreras Sepúlveda, Carolina Tarqui Mamani

Background

Since 1995 the special project on Rural Transport Infrastructure RURAL PROVIAS has developed a set of actions oriented towards improving conditions of use and connectivity of rural roads (rural paths) in the 12 poorest departments in the country. The programme has been based on concentration criteria which would allow it to reach the poorest sectors of the target population, whilst at the same time promoting geographic areas with important economic potential.

Through the integration of scarcely accessible rural areas via rural paths, access to various social services, amongst them health, has been improved. In this sense the research proposal seeks to produce case studies of community initiatives which have been put into practice in the absence of accessibility or in cases of extreme inaccessibility to health centres. The study will comparatively identify the resulting changes in accessibility presented by the rural paths.

Overall and Specific Objectives

1. To identify and systematise the practices developed on the subject of health in communities benefiting from the presence of rural roads, especially those relating to mother and child health and people with disabilities.
2. To identify and evaluate the gender perspective in the community health initiatives and in formalised health practices.
3. To design and put forward strategies which will allow for the improvement of an integrated approach to rural path programmes with a health component. 

Methodology

The methodology will be based on a comparative analysis of Peruvian rainforest and sierra communities and will have an empowerment perspective as a cross-cutting issue. The investigation will cover rainforest and sierra regions of Peru with the aim of establishing comparative analyses. A total of 10 communities belonging to the departments of Cusco, San Martín and Cajamarca will be studied. All the selected communities are ones that have benefited from the presence of one or more rural paths within the Rural PROVIAS Programme and correspond to areas of greater relative poverty in Peru.

Methodological Procedure
1. Identification of the strategies and results obtained by Rural PROVIAS
2. Collection and classification of data from other sources
3. Interview phase and collection of experiences in the selected communities
4. Data analysis phase
5. Discussion of the Preliminary Report
6. Definitive Report of the research and cross-referencing of experiences

Sources of data collection
1. Secondary Information. Documentation on the approaches intervention strategies and operational proposals of national and international experiences. A review of the existing documentation on formulation, progress and evaluation of the experiences which associate mobility with an improvement in health conditions.
2. Primary Information - Interviews with Rural PROVIAS officials at directive, advisory and operational levels, Interviews and focus groups with leaders of social organisations, Interviews and focus groups with members of the participating communities, interviews with authorities and public and private officials from the communities selected.

Expected Outcomes of the Research

1. Comparative information on sierra and rainforest communities is made available relating to the effects of mobility on health conditions, as well as the effects caused by the presence of rural paths.
2. The information provided by the research serves as a parameter for the Ministry of Health and civil society organisations when designing training, awareness raising and organisational procedures to deal with said consequences.
3. Gender indicators are made available that allow for the improvement of Rural PROVIAS and similar institutions’ monitoring systems which measure the effects that rural paths have on women’s personal, family and community activities related to health issues.

Information Dissemination and Advocacy Strategy

The results of the research will be shared through:
1. Sending electronic copies of the investigation to: Local governments, Provincial governments, health sector NGOs, Rural PROVIAS, Departmental PROVIAS, Decentralised Health bodies, The National Institute of Health
2. The presence at forums, seminars and others held by the above mentioned institutes concerning the results obtained in the research and preparing the research results in Power Point
3. Each institution will be required to take on commitments to strengthen the strategies identified and establish ways of communicating the results to IFRTD.

FINAL REPORT:

Mobility Effects on the Health Conditions of Mountain Range and Forest Communities. An Investigation Focused on Gender Equity. A Comparative Analysis from the Peru Rural Roads Program.
By Juan Contreras Sepulveda
January 2008
Download: Word Doc 984 KB


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