Addressing malnutrition through effective
communication:
The case of Totonicapán, Guatemala
A Research Paper presented by:
Gabriela María Díaz Salazar
(Guatemala)
in partial fulfillment of the requirements for obtaining the degree of
MASTERS OF ARTS IN DEVELOPMENT STUDIES
Specialization:
Local Development Strategies
(LDS)
Members of the examining committee:
PhD. João Guimaraes
PhD. Nicholas Awortwi
The Hague, The Netherlands
November, 2011
Disclaimer:
This document represents part of the author’s study programme while at the Institute of Social Studies. The views stated therein are those of the author and not necessarily those of the Institute.
Inquiries:
Postal address:
Institute of Social Studies
P.O. Box 29776
2502 LT The Hague
The Netherlands
Location:
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Telephone: +31 70 426 0460
Fax: +31 70 426 0799
Contents
Chapter 1: Introduction and Research Design
1.2 Background
1.2.1 Malnutrition in Guatemala
1.3 Making use of communication
1.4 Identification of the Problem
1.5 Research Objectives
1.6 Research Question
1.7 The Methodology
1.8 Limitations
Chapter 2: Understanding communication from different perspectives and experiences
2.2 Models of Communication
2.3 Social Marketing
2.4 Experiences of Social Marketing and Health
2.5 Information, Education and Communication for Change of Conduct –IEC/CC
2.6 Communication for Development
2.7 Experiences of Communication for Development
2.8 Methodologies and Techniques used in Communication for Development
2.8.1 Outcome Mapping
2.8.2 The Most Significant Change
2.9 Analytical Framework
Chapter 3: Study Case: Totonicapán, Guatemala
3.2 Totonicapán, Guatemala
3.3 Malnutrition in Totonicapán
3.4 Consequences of Malnutrition
3.5 Views about Malnutrition
3.6 Responses from Different Actors
3.6.1 Ministry of Public Health and Social Assistance
3.6.2 Government
3.6.3 Local NGO in coordination with International Cooperation and other actors
Chapter 4: Malnutrition and Communication
4.1 From Social Marketing, going through IEC/CC reaching Communication for Development: the road to improve inter-sector integration and participation
4.2 Integration of local actors in a territory
4.3 Local Voices
4.3.1 Focus Group
4.3.2 Most Significant Change in Totonicapán
Chapter 5: Conclusions
Income differences
Malnutrition
Communication
Totonicapán, Guatemala
Production and Economy in Totonicapán
Malnutrition in Guatemala
The Most Significant Change in Totonicapán, Guatemala
MSC in the Quality of Life (Parents)
Story 1: “That my children have a better life”
Story 2: “The value of herbs”
MSC in the Quality of Life (Local Actors)
Story 1: A speed recovery
MSC in knowledge and application
Story 2: I made my voice be heard in my language
MSC in the participation and coordination of an organization in COMUSAN or Municipal Team of Communication
MSC in comprehension and appraisal of C4D
Story 3: C4D in the City Hall’s Plan
List of Tables
Table 1.1: Ethnic Groups in Guatemala
Table 2.1: Intentional Design...... 22
Table 2.2: Program Framework...... 23
Table 2.3: Overview of the approaches...... 26
Table 2.4: Indicators that lead to the integration of actors...... 27
Table 3.1: Municipality Priority, according to Quality of Life...... 29
List of Figures
Figure 2.1: Communication as a Process of Dialogue...... 20
Figure 2.2: Signals of Progress...... 23
Figure 3.1: Totonicapán's Municipalities...... 28
Figure 3.2: Linking Local Actors...... 37
List of Boxes
Box 2.1: Social Marketing Planning…………………………………………13
Box 2.2: Participatory Approach…………………………………………….18
Box 2.3: Signals of Progress………………………………………………....24
List of Acronyms
SESANSecretariat of Food and Nutritional Security
Secretaría de Seguridad Alimentaria y Nutricional
COCODESDevelopment Community Council
Consejo Comunitario de Desarrollo
COMUDEDevelopment Department Council
Consejo Municipal de Desarrollo
COMUSANMunicipal Commission of Food and Nutritional Security
Comisión Municipal de Seguridad Alimentaria y Nutricional
CODESANDepartment Commission of Food and Nutritional Security
Comisión Departamental de Seguridad Alimentaria y Nutricional
MPOMunicipal Planning Office
Oficina Municipal de Planificación
OMMWomen’s Municipal Office
Oficina Municipal de la Mujer
CTATechnical-Managerial Coordinator
Coordinador Técnico Administrativo
MINEDUCMinistry of Education
Ministerio de Educación
MIFAPROMy Family Progresses Program
Programa Mi Familia Progresa
PRORURALPrograma Nacional de Desarrollo Rural
National Program of Rural Development
K’iche’Mayas K’iche’, one of the 21 Mayan groups in Guatemala
MSPASMinistry of Public Health and Social Assistance
Ministerio de Salud Pública y Asistencia Social
CECODECentro de Comunicación para el Desarrollo
UNICEFUnited Nations Children’s Fund
UNDPUnited Nations Development Program
Abstract
This research has been done in order to contribute to the Social Sciences from Communication for Development. Communication for Development is a participatory approach of communication as process of dialogue. It is also a response to the Western way of doing communication, since its beginnings date back from the decades of the 70s and from Latin American countries. There has been an ongoing debate amongst the practitioners of communication as mass media and the practitioners of Communication for Development. The first ones have believed that what the products that they produce are the result of communication. The latter, have claim the true meaning of doing communication and also take it as a citizens’ right. Therefore, the efforts are always prepared in the best interest of the people that the development project intends to help.
Throughout the research three approaches to communication have been analyzed, from the literature and from experiences, in order to assess which is the adequate to address a particular social issue: malnutrition in Totonicapán, Guatemala. Worldwide experiences have been included from the three approaches; an overview of the approaches has been made based on the literature. The case of Totonicapán, Guatemala has been chosen since it has been an example of a participatory project from the perspective of Communication for Development. The views and experiences from people of the area have also been included to give relevance and importance to the local knowledge of the area of interest.
Relevance to Development Studies
Communication as part of the Social Sciences is gaining importance in development projects around the world. Since the right to communication is also a citizen’s right it should be promoted and respected. This research tries to contribute to the vindication of the right to communication in communities of Totonicapán, Guatemala. It is also a contribution to the importance of communication in development projects in order for them to be successful and not just a repetition of previous experiences. The relevance of local knowledge is also an important issue in the paper, which can be taken as an example for future researches and professionals to be working in different contexts (from what they know).
Keywords
Communication, information dissemination, Communication for Development, K’iche’, Totonicapán, Guatemala
1
Chapter 1: Introduction and Research Design
This research examines the effects of communication addressing malnutrition, but to understand the context, then it is necessary to understand the country and its current problem of malnutrition of children. The research has also been done to provide an explanation of effective communication with development programs.
1.2 Background
Guatemala is located in Central America and it is politically divided in 22 departments and the departments make 333 municipalities. It has a population of 14,713,763[1] . Guatemala has different characteristics that make it a unique country, rich in cultural diversity since it is one of the Latin-American countries that still has a numerous indigenous populations from different groups.
Table 1.1: Ethnic Groups in Guatemala[2]
Ladino / 6,750,170 / 60.36 %Maya / 4,411,964 / 39.45 %
Xinca / 16,214 / 0.15 %
Garífuna / 5,040 / 0.04 %
Total / 11,183,388 / 100 %
The cultural diversity is important since the different groups make the country. The Ladinos are the ones that do not belong to an indigenous group, and it is said that are the ones who have a Spanish link. This group is also known as the Mestizos, because in times of the colonization the Spanish people mixed with indigenous groups and created the “mix of cultures” the Mestizos. As the years went by, the term changed into Ladino, but it basically refers to people who don’t have a specific indigenous culture. The Mayas on the other hand, were the settlers of the country with the other two; Xinca and Garífuna. The Mayas are the second biggest group in population of the country, but have struggled since the colonization. After that period they lost their rights and ever since it has been a constant battle to access a better quality of life. Within the Mayas there are 21 groups that are spread in different departments and municipalities of the country. The Xincas; a smaller group in numbers but it is also part of the cultural diversity; the departments where they live are the East. The Garífunas are also located in one department of the country, in the Caribbean area.
Whether big or small in numbers all these groups are recognized in by the State. Although the country is still struggling to become a more inclusive nation and to be able to improve the access of the basic services, such as Health, Education, Sanitation, Security, etc.
Guatemala is also a country with high inequality amongst its groups, which can be one of the reasons why there are some groups that have access to all the basic services and others have problems accessing them. Because the lack of access to the basic services and other factors, the indigenous groups have suffered the consequences and are the ones who have more problems related to health and nutrition, but also the ones with highest rates of illiteracy, low income, etc. These problems, together with other factors, have caused the country to remain as a developing country because when the population gets a different treatment the country’s growth will also be different. The opportunities and the access to the growth opportunities have been different too. There are some examples that illustrate the differences between indigenous and non-indigenous population in terms of access to basic services (Appendices Table 1).
Regarding the poverty, there are also differences between the two groups[3]. In Guatemala 56% of the population lives in poverty, from this percentage, 58% of the poor people are indigenous. 16% of the population lives in extreme poverty, from this percentage, 72% are indigenous people.
These indicators show a gap that has been increasing between the indigenous population and the non-indigenous population and also between the rural and urban areas. The issues of inequality and the lack of access to basic services have been in the eye of the international community. Many efforts have been done in order to improve the quality of life of these groups, by the Government itself and also with the help of the international cooperation through different strategies.
The State, since 2002 and following the agreements of the Peace Accords signed in 1996, the end of Internal Armed Conflict, approved the creation of the Commission Against Racism and, the Indigenous Women Advocacy. Steps have been taken into respecting indigenous people’s rights, but there is more to be done.
Guatemala has had a history of discrimination and racism, and the victims of these actions have been the indigenous groups. After the sign of the Peace Accords, attention has been given to reduce and eliminate discrimination and racism. An example of this attention has been the UNDP’s National Human Development Reports –NHDR- of the past years, more specifically 2005 and 2008. NHDR of 2005 describes and analyzes one of the basic dimensions that define the nation; its multiethnic character. Guatemala has an asymmetry in the inclusion of indigenous and non-indigenous people in the socio-economic structure. “More than 80% of the indigenous population is located in the low and extreme low strata. This means that 8 out of 10 Mayas, are in the bottom of the social structure” (UNDP, 2005:98). Because of this the indigenous population is excluded from participating in highest social strata.
Income difference is also significant and, it has an important role since it is the mediator between the economic activity and the access to satisfy the needs that will lead to have a dignified life. Graph 1 illustrates the level of inequality of the Guatemalan population (Appendices Graph 1).
Living in poverty or extreme poverty has been a situation that has affected more indigenous people in the country. In 2004, 21.9% of the population lived with less than $1.00 per day and, in relation to the indigenous rural population, for the same year, 38% were under this category. When the country’s income is concentrated in one group of the society it makes it difficult for others to have the same opportunities.
International laws and agreements have been signed to reduce inequalities. The Convention 169 from the International Labour Office –ILO- is the most important framework referring to development, economy and cultural-ethnic equity. “Establishes that the indigenous people should have the right to decide their own priorities regarding the process of development, if affecting their lives, believes, institutions, spiritual wellbeing and the lands that they occupy and use. Therefore it warranties the right to control, as possible, their economic, social and cultural development” (UNDP, 2008:76).
Even though there are national and international documents, agreements and more, there is always the chance for improvement. In the words of an economist Maya K’iche’ “Very little has been analysed in the cultural-ethnic dimension of the Guatemalan economy. This should be analysed due to the importance of the historical circumstances of the country and considering that the indigenous population is the one that presents the highest levels of poverty and extreme poverty, low social indicators and less levels of public investment. This dimension could be analysed in three aspects: a) the relation between cultural exclusion and economic exclusion, b) the nature of the culture and, c) aspects like the indigenous economy in the last years. To understand it better will help the definition of measures so that the Guatemalan economy could be more inclusive and sustainable” (UNDP, 2008:77). This shows that the notion of a non-inclusive economy is present and there is a need to work on it so that the country can achieve the desired development.
Different strategies can be developed in order to address an issue, but the results may vary. This research is focused in one issue that affects the majority of the indigenous children in Guatemala, malnutrition. More specifically, the research presents the findings of what the Ministry of Public Health and Social Assistance has done over the past years and also was has been done for the last two years by a local NGO. Also for a better understanding of the analysis, an explanation of the ways for doing communication and sending information is presented. The reason; it is important to recognize and identify the strategies of information from the strategies of communication.
1.2.1 Malnutrition in Guatemala
According to the information provided by “Situational Analysis of Malnutrition in Guatemala: Causes and Approach” elaborated by UNDP Guatemala 2009-10, malnutrition associated to poor nutrition and other issues such as low human development in Guatemala is understood as a vicious cycle. “It is recognized that malnutrition, as a visible expression of food and nutritional insecurity, it is also a barricade to growth and national development. The authors’ opinion is that the complex nature and the multiplicity of determinants and factors that affect food and nutritional security, coupled with the limited participation of civil society in these efforts, makes the current models of governance poorly successful. This requires the strengthening of comprehensive view in the adoption of strategies, constant commitment of society as a whole” (UNDP, 2009-10:7).
Understanding malnutrition has had shift, it is clear that this is no longer just a health problem but one that in the long run affects national development. And, it is not a new problem. The Analysis (UNDP) establishes that malnutrition has been society since the decades of the 30s and 40s. It was until the late 50s[4] when the characteristics (clinic, biochemical and pathological) were defined, with children who suffered from malnutrition and also the recommended treatment and the prevention measures of nutrition and sanitation were established. Since the 60s the attention on malnutrition kept increasing and a proof of that is that investigations have been done to identify more details on the problem and also effects of malnutrition.
The Analysis (UNDP) mentions studies from different years[5] and “these all agree on the attention that has to be given from the moment of the child’s conception until the first three years of life. This being important because it has been shown that it makes a difference in the potential of growth and human development, including development of intelligence, personality and social behavior, as well as physical and intellectual productivity in the adult age” (UNDP, 2009-10:9).
Recent information is integrated in the “Third National Height Census” from Ministry of Education in coordination with SESAN. This was done in 2008 and the goal was to elaborate a current diagnose to know the children’s nutritional state, through the height indicator. This indicator, as stated in the Census, measures the delayed growth size, it also establishes the degree of severity of chronic malnutrition and allows making a direct relation of social and economic development of the family and community where the measured children live in. The Census was done with children from First Grade from the Official Sector a total of 459,808 children from the ages of 6 years 0 months to 9 years and 11 months.
According to the Census, 54.4% of the children have been classified as normal in relation to their height and the other 45.6% are delayed in height or with chronic malnutrition. From the ones with delayed height, 32.9% are moderate and 12.7% are severe. More in detail, information has been summarized in: Age, Urban and Rural Areas and Language (percentages can be found in Appendices Box 1).
UNICEF’s report entitled “El Enemigo Silencioso (The Silent Enemy)” provided a view on the problem faced by the country. According to the Representative of UNICEF for Guatemala Manuel Manrique, stated that “chronic malnutrition needs to be explained because it can’t easily be recognized like acute malnutrition (children with swollen stomachs and the hair looks light in color). A child who suffers from chronic malnutrition has an inferior height, the health is fragile and the intellectual development is severely diminished” (UNICEF, 2007:3).
About the efforts done in Guatemala, Manrique mentioned that “for years Guatemala made an effort to face this reality, and as stated in the Policy of Food and Nutritional Security, these attempts lacked of the political decision needed and a methodological development with a multi-sector approach, because of these the result was not positive” (UNICEF, 2007:3).