Most significant change


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Most significant change

  1. 1. Most Significant ChangeMonitoring empowerment for the right to healthThird World Relief Fund – Steunfonds Derde Wereld –Fonds de Soutien Tiers-MondeDecember 2010
  2. 2. This booklet has been produced with the financial support of the Belgian Directorate-General forDevelopment Cooperation (DGDC). We hope that it will inspire you in your own work, but if youwish to reproduce some of the texts on the Internet or in another publication, we would appreciateit if you could mention the original source.Contributors: Wim De Ceukelaire, Danny Claes, Anuschka Mahieu, Fanny Polet, Jayson Fajarda,Hans Schaap, Annelies Vermeir, Lien Jespers, Kaat Pierreux, Sylvie Luzala, María Erlinda Sandino,María Hamlin Zuniga, Gabriel García, Arturo Quizphe and Jorge Quizphe.Layout : Peter Zwertvagher (Brutal You!)Brussels, December 2010.Please contact us at: info@sfdw-fstm.beIf you want to find out more about MSC, please visit
  3. 3. Table of Contents1 Introduction 42 Experiences 6 2.1 Palestine 6 2.2 The Philippines 12 2.3 Latin America 18 2.4 Democratic Republic of Congo 343 General conclusions and recommendations 37 3.1 Final selection 37 3.2 Observations 38 3.3 Recommendations 39 3
  4. 4. 1 IntroductionAnyone who is involved in development work knows that monitoring and evaluationcan be challenging. It is no easy matter to measure progress and to communicateachievements and results in formal reports, especially for organizations that are notinvesting in bricks and mortar, but in human and organizational capital. lesson: ask people to tell stories and you’ll learn plenty of things that cannot be captured in indi- cators. Maybe it was also my first encounter with the Most Significant Change technique, long before I had even heard of it. During the same period, I met a development consultant who had returned from a field visit for an ambitious evaluation project commis- sioned by the Belgian government. “You guys know what empowerment is,” he told me. I was flattered, of course, but also curious. How had he reached that conclusion? He had been in- terviewing farmers all over the Philippines, he explained, and most of them were very shy andThere’s one anecdote about monitoring and hesitant when they were answering his questions.evaluation I’ll never forget. A couple of years “When I interviewed farmer leaders in yourago I was representing Belgian NGOs in the partners’ project areas, they stood up beforePhilippines. One day I found myself on the they answered my questions and they lookedisland of Samar working overtime with our local me in the eye while they made their points,” hepartner organization to come up with indicators averred.for our logical framework. It took us ages to findan indicator of poverty among the poor peasants This observation never made it into the con-we were working with. I had already tried every sultant’s final report but now that I’m lookingindicator I knew from training programmes and back on our initial experiences with the Mostmanuals but nothing seemed to be applicable, Significant Change technique, this anecdoteaccording to the director of the local partner seems very relevant. These kinds of stories andorganization. anecdotes often reveal most about the issues that really matter in our work: empowerment, health,On the verge of losing my patience, I finally well-being, rights, etc., and yet they hardly everasked her to tell me about a successful project make it into our formal reports.area she had mentioned earlier during the break.How did they know that they had been able to It was out of frustration that we decided toimprove the lives of the poor? She immediately experiment with the Most Significant Changestarted to enthusiastically tell me about their lat- technique. We had been struggling hard theseest visit to the village and the many changes they past few years to adopt results-based manage-had observed in the behaviour and living condi- ment techniques but often we had an uncom-tions of the local population. One of the most fortable feeling that something was missing. Westriking changes was that almost everyone was hardly ever heard the stories from grassrootsnow using sugar and cooking oil. level any more - that wealth of quality informa- tion that shows what matters most for people –There was my indicator. And I had learned my and for us. 4
  5. 5. 1 IntroductionWhen we read about the Most SignificantChange technique, we thought it might providean answer and we wanted to give it a try. Wecollected and selected stories with the help ofour partners in the Philippines, Palestine, theDemocratic Republic of Congo (DRC) andLatin America. Interestingly, in each of theseregions the process was quite different. In thePhilippines, a staff member from our local officeworked closely with Gabriela, one of our partnerorganizations, to conduct a try-out of MSC witha regional Gabriela chapter. In Palestine, wehad first-hand experience, as we collected andselected the stories ourselves, together with youthleaders in East Jerusalem. In the DRC, it wasthree interns who worked with the local partnerto collect stories, and in Latin America, a localconsultant assisted the local partner organiza-tion.We consider the diversity in the methodologya strength, not a weakness. It provided us witha wealth of experience to learn from in a veryshort time. We want to share these experiences– the good as well as the bad – with a broaderaudience involved in this kind of work and hopeit will enable them to improve their work in theservice of people’s health and development.Wim De CeukelaireCoordinator of the Policy and Partnership de-partmentThird World Relief Fund (TWRF) 5
  6. 6. 2 Experiences2.1 PalestineIn Palestine, TWRF works with Health Work Committees (HWC), a local NGO, striv-ing for the empowerment of young people in East Jerusalem. HWC is an importantplayer in Palestinian civil society in this part of the city and is well-establishedamong young people there. It organizes school health programmes in most Palestin-ian schools in the city and also runs a youth centre in the Old City, the Nidal Centre.The original building used by the Centre was closed down by Israeli security forcesin July 2009, so the Nidal Centre now organizes its activities from ad hoc venues.2.1.1 MethodologyWe scheduled the collection of MSC stories dur- Defining domains of change and report-ing a mission of TWRF staff to Palestine from ing period26 to 28 July 2010. The objective was to collectstories from the youth volunteers in Jerusalem Together with Daoud, the TWRF staff definedwho are active in the Nidal Centre’s youth four domains of change about which the volun-network (local community groups and theme teers were asked to tell a story:groups), school health committees and univer- • MSC in their daily livessity student groups. Due to time restrictions and • MSC in their views on healththe summer holidays we were not able to meet • MSC in involving peers in activitiesvolunteers from the university groups. • MSC in general (“open domain”)It was not our intention to carry out an assess- The reporting period was not the same for eve-ment of the programme. Instead, we wanted rybody. The volunteers were asked to talk aboutto learn about the impact of the activities on the period since they had become a volunteeryoung people by listening to the stories of vol- with the youth network (1-3 years).unteers concerning the most significant changein their lives and how their participation in the Participant selectionprogramme has changed their behaviour andopinions. Daoud selected the volunteers. Although selec- tion criteria were discussed in order to ensureBriefing that interviewees would represent the different target groups of the programme, most arrange-The MSC manual was sent to Daoud, the HWC ments with the volunteers were made at the lastyouth coordinator in Jerusalem, three weeks minute and improvisation prevailed over selec-before the stories were actually collected. At the tion. The volunteers were given a brief introduc-start of the TWRF mission, we discussed the tion in Arabic about the MSC technique, overobjectives and procedure of the MSC technique the phone or just before they were asked to tellwith Daoud, making use of a computer presen- their story.tation. 6
  7. 7. 2 Experiences PalestineParticipants: Circumstances in which the stories were col- lected:1. Meriam, 21 years old, third-year economic • The stories were collected by two TWRF staff science student at Al-Quds University, local members and documented in English. community group. • The TWRF staff members explained the2. Ihsan, 18 years old, just finished secondary objectives of the MSC technique and asked school, joined Nidal 18 months to two years the volunteers about the most significant ago, local community group. change since they had become a volunteer in3. Samoud, 17 years old, 5th year second- the youth network in the four defined domains. ary school, member of the “dabke” folk We also asked them to explain why it was the dance group. most significant change in their opinion.4. Mustafa, 16 years old, local community • The volunteers spoke Arabic. Daoud, the group, Shufat. HWC youth coordinator, translated everything5. Azedin, 16 years old, local community group, into English on the spot. Shufat.6. Bassil, 16 years old, joined the Nidal Centre Story selection three years ago, local community group, Shufat. After the story collection, the two TWRF staff7. Nadine, 17 years old, about to start final year members had a meeting with Daoud and three of secondary school, joined Nidal Centre four volunteer youth leaders on the last day of their years ago, local community group. mission to discuss the stories and select one8. Bashar, 17 years old, joined the Nidal Centre representing the most significant change within a year ago, school health committee. each domain. After reading the stories for one9. Bassem, 17 years old, volunteer for the past domain out loud in Arabic, the youth leaders four years, local community group. discussed which story they thought reflected the most significant change. The same procedureStory collection was repeated for each of the four domains. After each discussion, they explained in English whyEach volunteer talked for about 45 minutes. Not they had chosen that particular story.everyone told a story about all four domains,although most did. 7
  8. 8. 2 Experiences Palestine2.1.2 MSC storiesThe four selected stories were the following: Jerusalem. The audience had already arrived and we were ready to start. One hour before the performance, the Israeli police came and can- celled it. They had a paper on which was written that we didn’t have a permit. Everybody was upset and it made me cry. But it also made me more determined to continue and it boosted my self-confidence. Why was this the most significant change?Samoud, 17 years old: “dabke dancing I learned that we are living under occupationgave me self-confidence” and that I have to be strong. This is our country5th year secondary school, volunteer for three and they will not stop us from performing dabkeyears and organizing our activities. I was raised to love my country. When I was a child the Israeli armyDomain: most significant change in daily life arrested my father right in front of me, pointing a gun at him. I want to tell the world that theyBefore I got involved in the Nidal Centre, I are the terrorists, not us.didn’t have much contact with people outside myfamily. Through the Centre I have got to know The HWC youth leaders chose Samoud’s storymany new people and places in Jerusalem. I like because it is very comprehensive, both about thedabke dancing1, so I joined the dabke team. But activities and about society.that’s not all. I learned a lot about the Palestini-an case. We visited villages and cities in Palestine Samoud is a girl who didn’t have many friends482 (Israel) and also learned about the destroyed before. Now she has many contacts and friends.villages3. That’s why we decided to make a pres- The story is complete and shows how sheentation during our summer camp on the ethnic learned things at every stage of her life. It reallycleansing. During our tours in Jerusalem we demonstrates how she has developed as a wholelearned how Israel is changing the history of our person. That’s also how we understand health:city. Arab houses are turned into Jewish houses as a quality of life. Initially she only came forby removing Arab inscriptions of the Koran. In dabke. It changed her life, really!Silwan4, 1,500 people will be evicted from theirhomes (which will be demolished in order tobuild a park). The children appreciated this tourvery much.The most significant change in my daily lifesince I got involved is that I am more self-confident. I recall a dabke show we preparedtwo years ago. It was our first performance andwe invited all our friends and family. It was dueto take place at the National Theatre in East 8
  9. 9. 2 Experiences Palestine now. I also know a family that is in the same situ- ation. The HWC youth leaders chose this story be- cause it talks about visits to evicted families in Sheikh Jarrah. It’s a very important case that af- fects the Palestinians in Jerusalem. Because they lost their homes, they lost their right to health. Through this activity Ihsan understood thatIhsan, 18 years old: “People have to fight health is really a right for all and that the gov-for the right to health” ernment is doing nothing. In fact there’s nobodyJust finished secondary school, joined the Nidal to defend these people’s rights.Centre two years ago Another story in this domain was about drug use by young people. It was also very good, becauseDomain: most significant change in views on health these boys became aware that they were able to do something about this issue.With our group from the Nidal Centre we visitedfamilies who were evicted from their homes in Meriam, 21 years old: “I wanted my sis-Sheikh Jarrah5. These families are now living ters to have the same experience”on the street in conditions that are not healthy Third-year economic science student at Al-Qudsat all. When I visited this place I was shocked. UniversityThe families were thrown out of their homesand Jews are now living there. These people Domain: involving othersdon’t have anywhere to live, they have no foodfor their children. It was so unfair. To me, it I’m now more self-confident to invite others todemonstrated the contempt shown towards these join and I know how to invite them. I succeededpeople. It shows that the occupation forces really in getting my two younger sisters involved.want to take everything. Because of my experiences, which I shared with them, and because of the change in my behav-This visit taught me that health should be a right iour, they became interested in joining them-for all and not a gift. It is not because you’re a selves. Now they’ve taken part in the summergood man that you should be able to enjoy this camp and one of them is doing the leadershipright. I believe that everyone should have the training.right to live in good and healthy conditions andto have a house to live in. Initially, people are afraid to join but once they get involved we can see the change. Young peo-The visit to Sheikh Jarrah made me think: it ple don’t know the issues, so they’re hesitant atis the State that should ensure this right but it first.doesn’t. That’s why people have to fight for thisright. Why is this the most significant change?Why was this the most significant change? It’s important because I want them to have the same experience and to acquire the same skillsThis experience was very important to me and knowledge.because it’s one of the most important problemsPalestinians in Jerusalem are experiencing right The HWC youth leaders chose Meriam’s story 9
  10. 10. 2 Experiences Palestinebecause it shows the change in her own interests I’ve now learned how to relate to other peoplemakes her want to see the same changes in her and how to deal with them. I know how to showfamily. She succeeded and her two sisters are respect to others and I know people also respectnow very much involved. me.She also talked about how young people aresometimes afraid to join. But once they get in- Why is this the most significant change?volved, they continue. It’s a common experience.It’s not easy to convince them to join. You have No one is perfect but you always have to lookto find the key that fits the door. The three boys for people’s good side and for the knowledgethat were also interviewed are a good example. they can offer. A bad experience is not the endThey were among a group of 17. As soon as of your life. You should carry on and learn fromsome of them joined us, the others followed. this experience.Activities like the summer camps and dabkedance serve to attract young people. Usually This was important to me because I believe athey’re not very interested in educational activi- person’s opinion and attitude really matter. Theties at first. Actually, it fits in with the plan of the most important thing is not to be selfish.occupation forces to keep young people igno-rant. The HWC youth leaders chose this story be- cause it’s exemplary of the big change they seeIhsan, 18 years old: “I’m not shy any in the youngsters they work with. Initially, theymore” don’t know how to share among themselves.Just finished secondary school, joined the Nidal On the street they can be very tough but onceCentre two years ago they have to talk to each other, they are shy and silent. It is through our activities that they learnDomain: general to respect others, look for people’s good side and share their opinions.I used to be very shy and afraid to speak my Sometimes, even just introducing themselves ismind. I used to be so worried about what other difficult. It’s a problem of our society. In school,people thought of me. When I tried to give my young people just sit and listen. It’s the same atopinion, I thought others would disapprove. home.1 Palestinian folk dance.2 “Palestine 48” is how some Palestinians refer to the territory that is now recognized as Israel’s, as it was occupied in1948.3 In 1948, some 500 Palestinian villages were completely destroyed and its residents were evicted from the territory thatlater became Israel.4 Silwan is a Palestinian part of Jerusalem adjacent to the Old City with a population of about 45,000 people. The areaincludes the archaeological site of what is said to be the City of David, or the original city of Jerusalem. It is one of themost contentious areas in Jerusalem these days because of plans to develop it as a tourist spot.5 Sheikh Jarrah is a Palestinian residential area located to the north of the Old City in occupied East Jerusalem and ishome to approximately 2,700 Palestinians. Given the area’s strategic location, Israeli settler organizations have madepersistent efforts to take control of land and property and establish a sustained presence in Sheikh Jarrah. Efforts bysettler groups have intensified in recent years and are often accompanied by attempts to forcibly evict Palestinian familiesand communities to make way for new settlements. In a recent series of evictions on 2 August 2009, 53 Palestinianrefugees, including 20 children, were forced out of their homes in Sheikh Jarrah by Israeli authorities following a courtruling. The properties were handed over to a settler organization that intends to build a new settlement in the area, plac-ing at least 24 other buildings and their estimated 300 residents at risk of forced eviction. When similar efforts in otherparts of Sheikh Jarrah are taken into account, the total number of planned settlement units rises to over 540, placing anestimated 475 Palestinians at risk of forced eviction, dispossession and displacement. (Source: OCHA) 10
  11. 11. 2 Experiences Palestine2.1.3 AssessmentAfter the story selection, the HWC volunteers • It taught us that it is possible to have a genuine(Daoud, Nagham, Ilham and Ahmad) assessed impact on young people and see real change.their experience with the MSC technique. These We actually need more of these centres.are some of the points they shared: • MSC is a useful method and we could also use it ourselves. We have experience with assess -• The stories are interesting and accurate but ments, but the difference with other they don’t reflect the entirety of the Centre’s evaluation methods is that it shows the real- work. We also offer human rights training, ity of young people’s lives under the occupa- alternative city tours, education about the tion. They are confronted with drugs, evictions, situation in Jerusalem, gender and sexual violence, and much more. It shows what really health training, etc., but these were not men- matters to them. Through the activities of the tioned. Besides young people, we’re also work- Nidal Centre, youngsters learn to deal with ing with women and children. these problems.• We should learn and study why it is so diffi- cult to recruit more young people. That’s a general problem for all organizations here, however. Actually, we have many more than other NGOs.• We knew these volunteers already because they are all active members but through this exer- cise we learned much more about them. It will help us to deal with them better in the future. 11
  12. 12. 2 Experiences The Philippines2.2 The PhilippinesIn the Philippines we work with different partner organizations, most of whom areactive in community health. One of them is Gabriela, a national alliance of women’sorganizations, with which we have been working on women’s and community healthprogrammes since 2003. They volunteered to try out the MSC technique with thehelp of our local country office staff.2.2.1 MethodologyThe TWRF country office prepared an MSC ly now that they are approaching the end of thestory collection guide in Filipino and sent it to three-year programme. Jayson from the TWRFGabriela. Obeth Montes, who has overall re- country office explained the different steps ofsponsibility for the programme, had read and the MSC technique.commented on the guide before sending it to theorganizers of the Iloilo and Roxas City chapters. Because of the number of participants, the facil-Actual story collection and selection in the field itators decided to divide the group into six pairs.took place from 17 to 21 August. Each pair was asked to exchange a story about the most significant change in the last threeGabriela Iloilo chapter years. The facilitators thought that it would be better to pair participants from different areas. The participants were asked to document their partner’s story. The pairs were then asked to choose which of the two stories they thought was the most significant. The pairs were given an hour and a half to exchange stories and document them. During the subsequent presentation, each pair was given time to present their chosen story. The partici- pants whose stories were chosen were then asked to elaborate to fill in the gaps in the documented version.The Gabriela Iloilo organizers expected 25members to participate in the MSC story collec- The six stories shared in the plenary session weretion, but because of unforeseen circumstances, the following:only 12 made it on the actual day. Despite theabsence of some participants, each munici- 1. Virginia Sumaguio, Leganes, Iloilo – on howpal chapter covered by Gabriela’s health pro- they use the herbal medicines that were cov-gramme was represented, however. ered in the training given as part of Gabriela’s health programme in Iloilo.Obeth explained the context of the MSC tech- 2. Hydie Sotela, Leganes, Iloilo – the frequencynique. She told the participants that it is a form of her asthma attacks was reduced after sheof evaluation process that they can use, especial- used the medicinal plant sambong, which she 12
  13. 13. 2 Experiences The Philippines learned about during a training course ry, as it aptly illustrated the Change in Attitude on herbal medicines. domain. Coordinator Lucy Francisco said that3. Gloria Galleno, Leganes, Iloilo – the way she she did not know Galleno’s story prior to the disciplines her children changed after attend- sharing. Apart from fitting into the Change in ing a training course on violence against Attitude domain, Dela Cruz’ story also indicated women and children. Her husband and chil- the progress of her work in the community. dren became supportive of her participation in the seminars and training organized Sotela’s experience was chosen from among the by Gabriela, to which they attributed Gloria’s many stories about herbal medicines because it change in attitude. highlighted the effectiveness of the use of alter-4. Rosalinda Guaro, Leganes, Iloilo – she did native medicine they, as health workers, are pro- not believe in herbal medicines before the viding. It also indicated a change in the quality implementation of Gabriela’s health pro- of her own life because of her improved health. gramme in Iloilo until she applied what she learned during training on her husband, who Gabriela Roxas City chapter was suffering from arthritis.5. Ma. Aleta A. Gamot, Sta Barbara, Iloilo – The lessons learned from the way the exercise she discovered the use of tawa-tawa (Euphor- was conducted in Iloilo led to modifications bia Hirta), a medicinal plant for people with being made to improve the procedure used in dengue fever. She recommended the use of Roxas City. The facilitators decided to proceed herbal medicines to her neighbours. with the group sharing with the participants6. Elena Dela Cruz, Pavia, Iloilo – she began to grouped according to their communities/lo- understand women’s issues, particularly cal chapters. With every member of the group violence against women. She has since at- familiar with how the health programme was tended to the needs of mistreated women in specifically implemented in their communities, her community who sought her help. they could better judge which story to select.In line with the guidelines of the technique, the The context and mechanics of the session weredomains were determined only after the MSC discussed by the facilitators before splitting thestories were gathered. This was done during the participants into groups. With three to fourassessment session involving the five organizers, women in each group, they were given two andincluding Iloilo Health Programme Coordinator a half hours for the sharing part of the exercise.Lucy Francisco, when the stories that most ac- Each group selected one story. The facilitatorscurately reflected the MSC of the Iloilo chap- and some of the organizers did not participateter’s health programme were identified. The in the sharing, but moved from one group toorganizers chose three stories they would like to another to observe and to make sure the partici-put forward to the Gabriela national office for pants understood and followed the instructions.further selection. Unlike the procedure used in Iloilo, the partici-Based on the stories collected, the organizers pants were first encouraged to share their storiesidentified the domains from which they would with each other before documenting them. Itbase their criteria for selection. The domains was observed from the Iloilo experience that theidentified were Impact of Services and Change documentation hindered free Attitude. The stories of Galleno, Sotela andDela Cruz were chosen by the five organizers. After the sharing, each group assigned a personThey were unanimous in choosing Galleno’s sto- to document the story that they had chosen. 13
  14. 14. 2 Experiences The PhilippinesThe participants whose stories were chosen were tive because the stories touched on the differentasked to narrate their story during the plenary aspects of the programme, such as awareness-session. After each participant had finished, the raising, organizing and service delivery. Theseorganizers, facilitators and other participants three aspects were identified as the domainsasked her questions to clarify a few details or to in determining the most significant change inallow her to elaborate. Roxas. The group decided to forward all sixThe following were the stories presented during stories for the national office to assess.the plenary session: As in Iloilo, some of the stories were not known1. Lorna Coronado, Barangay Cogon, Roxas to the organizers. They appreciated the method, City – she became aware of the rights of as it became a vehicle for them to learn of these women and advised a neighbour who was be- stories, which will help them assess how the pro- ing beaten by her jealous husband. gramme impacts on people in the communities.2. Dolores Mijares, Barangay Libas, Roxas City – she reprimanded a relative who was hit- ting his child. In the process of averting further violence, her hand was cut on the knife wielded by her husband, who was defending her against their relative.3. Emma Pedrano, Barangay Culasi, Roxas City – thanks to the Gabriela organization, the community became united and was in spired with the courage to fight for their land. The organization raised the awareness of community members about the issues threat- ening their community, such as demolition and mining.4. Marivie Arguelles, Barangay Dumolog, Roxas City – the herbal medicine training given by Gabriela helped her community, especially during the outbreak of dengue fever.5. Cristina Alcones, Barangay Baybay, Roxas City – the leadership training she received in 2009 helped her lead her community in the campaigns against hunger, poverty and price hikes.6. Elma Deanon, Barangay Dinginan, Roxas City – before, she was meek and sensitive to taunts. As the Gabriela chairperson in Roxas City, she became determined and gained the strength to fight against injustice and oppres- sion.After the presentation, the organizers assessedthe stories shared and how the sharing was con-ducted. For the organizers, the process was posi- 14
  15. 15. 2 Experiences The Philippines2.2.2 MSC storiesAfter reading the collected MSC stories from Iloilo demolish our own homes in exchange for a paltryand Roxas City, TWRF Country Representative sum. The organization exposed the fact that theHans Schaap chose the stories of Emma Pedrano document some of us had signed was null and void(Roxas City) and Gloria Galleno (Leganes, Iloilo). because we had signed it against our will.For Hans, Emma Pedrano’s story is a “clear expres-sion of community empowerment”. He selected I thank the organization for its help in forging unityGalleno’s story, as it was an “admission of personal among us to defend our land and in finding waysweaknesses and attitudinal change brought about to improve our lives. Through the organization, weby the programme”. were able to inform other people in our community how to deal with our situation. Gabriela organ-According to Hans: “The stories as a whole are ized discussions and training for us to understanda good indicator of the health programme of our situation. We did not give in to the threats andGabriela, and of the fact that the programme goes harassment because we had the organization tobeyond health and addresses elementary aspects of count on.the struggle against poverty and no right to health:empowerment of the basic sectors through organ- Gloria Galleno (Barangay Buntatala,izing and education.” Leganes, Iloilo)Emma Pedrano (Barangay Culasi, Roxas I was very strict with my children when I disciplinedCity) them. I was easily angered when I heard rumours about their wrongdoings from our neighbours. I of-I came to know about Gabriela because of our land ten hit them and pulled their hair; I put them insideproblem. Our views and attitude have changed a sack. Then I received information on violencesince the organization helped us. Apart from that, against women and children. I came to understandthere are many things that the organization has that it was not the way to discipline our children.given to my family and to our community, not least I realized that what I was doing was wrong, andits role in raising our awareness and giving us the that children also have rights. I used to think that Icourage to face our problems, particularly our land am the mother, and they should obey me. I used toproblem. think that they are just my children and they should do what I say. I learned from the organization thatA private company was claiming ownership of the as a mother I should build a relationship with myland where our houses had stood for many years. children.Our homes were threatened with demolition, butbecause of the organization, we were able to stop I often fought with my husband because of how Ithe process. Through the organization, we lobbied treated our children. I know now how to handle ar-the appropriate government agencies to give us the guments with my children and husband. They arepreferential right to stay on our land. all supportive when I attend seminars and training organized by Gabriela, to which they attribute theBefore, we had no guidance on what actions we change in me.could take. We did not know which agency couldhelp us. We were on our own, we were not united. GABRIELA National OfficeSome fell for the deceptions of the claimant, who The MSC story collection was facilitated in coor-connived with local officials to entice some of us to dination with Gabriela’s national office through 15
  16. 16. 2 Experiences The Philippinesits programme director Obeth Montes, who was (2) Elma Deanon (Roxas City)present throughout the whole process. She pre-sented the selected stories from Iloilo and Roxas As Gabriela Roxas City chairperson, DeanonCity to the National Secretariat. They discussed the reflects the change in her views in her story, whichstories and chose the following as representing the also indicates the impact of the whole programmemost significant change in their programme areas on her as a leader. She demonstrates how she is andin Iloilo and Roxas. will remain committed to work for change.(1) Hydie Sotela (Iloilo) Elma Deanon (Barangay Dinginan, Roxas City)Sotela is a barangay1 health worker who works forthe local government-funded health centre. Her Before, I always cried whenever I heard aboutstory showed Gabriela’s relationship with local things that I didn’t approve of. I was reluctant togovernment agencies. Through the programme, get involved in issues that affect our society. NowGabriela was able to access the barangay health that I’m part of the organization, I know our rights.workers and further enhance their skills in health Thanks to the seminars and activities organized, Iwork. This story also depicts the change in attitude now know what we can do. I try to understand alland views on health. It shows the impact and ef- the information I’m given, and learn from it so thatfectiveness of the services provided by the women’s I can pass it on to the communities where we arehealth programme. working.Hydie Sotela (Barangay Buntatala, I learned from all of this that we should not keepLeganes, Iloilo) mum about injustice; we should not allow people to abuse or exploit us, because we all have rights.I am employed as a barangay health worker and I now know that I should fight back. Everything Iday-care teacher. Before the Gabriela health pro- learn, I give back to the people, especially the poorgramme, I depended mainly on Western medicine and the oppressed. We poor souls do not often getprescribed by the doctor. When I joined Gabriela, the attention of the authorities, while the rich getI learned how to use herbal medicines. I became what they want. I told myself that one day thingsaware that, apart from the drugs available at the would, the plants around us are alternativemedicines that can improve our health. I now ap- When I became an organizer, something changedply what I learned from the training whenever any in me. I began to stand up not only for myself butmember of my family is sick. also for the organization and the communities I am serving.Before, I couldn’t sleep at night because of myasthma. I now use herbal medicine to treat the (3) Emma Pedrano (Roxas City) – see above.symptoms. After taking it for a year, I now get fewerasthma attacks. I also use it to inhale. Since I started Her story reflects how the programme and theusing herbal medicine, it has helped my family cut organization empower women in the community tothe amount spent on mainstream medicines. take action to improve their situation.1 A barangay is the smallest entity in the Philippine government administration and refers to a village in a rural area. 16
  17. 17. 2 Experiences The Philippines2.2.3 AssessmentReflections from the national office and from • The method also brought to light the impor-Iloilo and Roxas organizers: the use of MSC tance of following up on the development ofas an evaluation method was beneficial to the the members of the organizations at the localorganizers and the programme staff. They were level. These stories were not reported in theenlightened as to what still needs to be done in conventional method of monitoringorder to improve the method adopted or re- programme progress at grassroots level.ceived confirmation that it is an effective method The MSC technique will complement the datain a particular community. reported in formal assessments. • The spontaneity of the participants’ narrationFor the organizers in the local chapters, the of their MSC stories is important. The par-stories shared helped them gauge the level of ticipants should be able to freely express themconsolidation of the members and the capability selves. One crucial factor is the language theof the leaders. Through MSC, they were able to participants used. The local organizers helpednot only assess the impact of the programme but in translating the instructions and the storiesalso indirectly appraise their organizing capa- shared from Filipino to Hiligaynon (primarybility, and learned valuable lessons on how to language in Western Visayas) and vice versa.further develop that capability. • There is a tendency for participants to enumer- ate the benefits they enjoy from being a memAssessment points ber of the organization. There is a need for the facilitator to reiterate to the participants• Since the MSC technique was quite new as a to focus on only one significant change. method of evaluation, the facilitators were still • For the Iloilo chapter, the stories helped assess grappling with the process. They were worried the progress of the health programme. Most about how it would be used and appreciated of the stories were about how members had by the participants. The way in which the benefited from the programme. Dur- MSC stories were collected was in itself a ing the process, points were raised about how learning process - for the participants, the to advance the programme. community organizers and the facilitators • In Iloilo, most stories shared were about the themselves. use of herbal medicines as part of the service• The facilitators were able to see how to modify provided to the communities. The initial analy- the procedure used in Iloilo after the assess- sis was that there is a need to put emphasis on ment. Adjustments and modifications were empowering members in the communities. made to improve the procedure applied during The local chapters, however, are more the session with the Roxas City participants. advanced and assertive when engaging the lo-• The Gabriela organizers in Iloilo and Roxas cal government on the issue of violence against City appreciated the MSC as an evaluation women and children, but this was not reflected method because they felt the stories reflected in the MSC exercise. the impact of their work, which was not usu- ally reported in formal assessments.• The facilitators decided to make the collection of MSC stories a group activity to involve the members of the organizations in the selection of stories. 17
  18. 18. 2 Experiences Latin America2.3 Latin AmericaIn Latin America we work with a network that is part of the global People’s HealthMovement. The Movimiento para la Salud de los Pueblos (MSP) is building the grass-roots movement for the right to health across the continent. In consultation with theMSP-LA, we decided to ask a local consultant, María Erlinda Sandino, to help us withthe introduction of the methodology. She worked with a coordinating team consistingof María Hamlin Zuniga, Gabriel García, Arturo Quizphe and Jorge Quizphe to pre-pare her report: “INFORME VALORATIVO. Basado en Testimonios de Cambios MásSignificativos (CMS)”. The rest of this chapter consists of translated excerpts fromthis report, which is available as a PDF document.2.3.1 MethodologyFrom 2008 to 2010, the Latin American People’s regional change about the most relevantHealth Movement (PHM-LA) has been fostering people’s health issues that have an impactactions in the framework of the project “Net- at the personal and societal for the Right to Health in Latin America”, 3. Use this experience to implement andand is currently at the stage of developing new understand the MSC methodology andplans. form a small group of people in PHM-LA who can act as facilitators of the MSCAlong these lines, the PHM-LA has decided to process in the near future.evaluate the work from 2008 to 2010, using theMost Significant Change (MSC) technique, as The first step was to form a technical team, madethe groundwork for monitoring and follow-up up of María Hamlin Zúniga, Arturo Quizphe,on the work being done, based on individual Jorge Quizphe and Gabriel García (Septemberand group reflection, institutional learning, and 2010). An external facilitator was hired, who hadsynergy among stakeholders. experience with the MSC technique in different countries in the region, to aid in collecting andThe general objective of this exercise was: To editing the most significant change stories andaid the organizations in the PHM-LA to iden- support materials.tify, collect, and select Most Significant ChangeStories (testimonios) about the experiences facili- A review was done of documents on experiencestated with the support of the movement during related to the PHM and of background materialthe period 2008 to 2010. on the MSC technique. A “Guide to Collecting Most Significant Change Stories” was designedSpecific objectives: and revised, and shared with a group of repre- sentative stakeholders. 1. Introduce the use of this methodology in the PHM-LA, to strengthen leadership During October, MSC stories were identified structures and promote grassroots partici- and collected about the following experiences: pation in the movement. 2. Visualize, share, and mobilize, using per- • Experience with interculturality at the IPHU sonal narratives and stories of local and course at ASECSA in Guatemala. 18
  19. 19. 2 Experiences Latin America• Defence of Mother Earth and the criminaliza- written, which systematizes the Most Significant tion of protest: Experiences from Guatemala Change Stories about selected experiences. The and Ecuador. stories have been grouped into a number of• Right to health: Health Forum in El Salvador. main domains of change:• Living, thinking and feeling nature: The expe- rience of Laicrimpo in Argentina. • Domain of Change 1: Advocacy Capacity Building.Because the people and activities of PHM-LA • Domain of Change 2: Political Advocacy inare located in different countries and territories Defence of Mother Earth and Against Crimi-in Latin America, MSC had to be used crea- nalization of Protests to Defend the Land.tively; the collection of stories and feedback • Domain of Change 3: Political Advocacy foron the results were done online, using e-mail the Right to Health.and Skype. The story of Crisanta Pérez, on the • Domain of Change 4: Paradigm Shift incriminalization of the struggle to defend the, was put together from documents and afilmed interview with Crisanta. It was not pos- Finally, feedback with the results of the MSCsible to get her story in person due to a tropical process will be provided to the participants,storm emergency in Guatemala. PHM-LA member organizations and the Third World Relief Fund.Using this input, this evaluation report was then 19
  20. 20. 2 Experiences Latin America2.3.2 MSC storiesDomain of Change: Advocacy Capacity Building – IPHU Course1Most Significant Change Stories about the IPHU Course: Inclusion of an InterculturalApproachStory No. 1 attended us in our process as people assimilating, seeing and sharing these painful realities. They gave us the best they could for facilities and accommoda- tions, and also in human warmth; but the spiritual accompaniment was missing. In Chimaltenango, there was another way of ac- companying, of knowing that they were there for us, not only the organizers, but also the forces that we invoked each day so that our classes would flow in the best possible manner; we gave free rein to the flow of emotions that are also part of what makesVivian Tatiana Camacho Hinojosa, us human and produce health in us.IPHU-Guatemala Course Facilitator.From Cercado, Cochabamba, Bolivia. From the beginning, we were received by the ances- tors who had been waiting for us; it didn’t matterThe most significant change for me as a how each of us decided to express our spiritualityfacilitator and student at the International or what name we gave it. Each person had the op-People’s Health University was the ap- portunity to connect with this other part that is veryproach used for the course, including the ignored by the Western hegemonic perspective.ritual accompaniment during the entire This other part is now the strength of our peoples;event. Mother Earth makes herself strongly felt in our hearts; she makes hope arise, even when we think itI participated in the short course in Havana2 on the is lost. She will make us, despite everything, keep onsocial determinants of health and in Chimaltenan- defending and caring for life, starting with ourselves.go3 on the topic of interculturality and health. Ifelt a big difference, starting with the structure of According to Vivian, rituality was an extremelythe classes; not only because of the syllabus, but important part of the learning process in thisalso because of the way we shared our feelings and experience. She put it this way:thoughts. “This is the most important thing for me, not only as aHavana was a marvellous course for meeting with doctor but also as a living human creature within the webvaluable, courageous people who talked about the of life, because of the relevance of ritual. A sense of con-health situation in their countries, which in some nection with that which each one considers sacred, withcases is very difficult. Something similar occurred respect, going beyond fears, prejudices, racism, discrimi-in Chimaltenango, but the difference is that the nation; I was capable of encountering the other personaccompaniment was essential. In Cuba, each day as a human creature and we would become brethren inwas very intense and I did not feel that the setting that sentiment, going beyond the differences that we might 20
  21. 21. 2 Experiences Latin Americaconsider profound when speaking of spirituality. Because, Story No. 2if we know and we experience the connection with thelife force, that will ensure that our direction, our walk, ismore coherent with the environment surrounding us and ingeneral with ourselves.”Vivian said that several physical elementspresent during the course enabled a connectionwith what she calls the “life force”:“The circular arrangement of the chairs facilitated William Hernández M., IPHU-Guatema-another way of sharing, each one learning from the other, la Course Facilitator. From Managua,modelling an egalitarian structure instead of a hierarchy. Nicaragua.The flowers in the centre reminded us physically of thatwhich our eyes cannot see—the presence and force of our I was invited to participate in the IPHU inancestors—also as part of our learning together. Chimaltenango, Guatemala in April 2010 on the topic of Interculturality and Health,It is in this coherence of knowing, feeling and as a facilitator.doing4 that we find motivation, courage and strength tobelieve that we are capable of creating that other possible This time, the course had a smaller, though suf-world, knowing that there are also immense cruel forces ficient, group, a syllabus that addressed topics thatthat are doing all they can to destroy; the personal, inter- turned out to be the experiences of the vast majori-nal coherence makes us trust that each of our small steps ty of the participants, all from the same region, withis also part of the great march toward that dignified, free similar conditions and speaking the same language.and mutually supportive life for all that we love, even for Even though some spoke an indigenous languagehuman brothers and sisters who we don’t know, who will or Portuguese (those from Brazil), we all communi-come after we are gone. Brothers and sisters of all living cated in Spanish.species, we are all part of the Community of Life. I had already participated in the first session of theAmong all of us, we are making mutually supportive International People’s Health University (IPHU)efforts to not weaken. Among all of us, we are building in July 2005 in Cuenca, Ecuador. That first sessionhope with our hands and with our hearts, with our steps; was held during the Second People’s Health Assem-knowing that what we see and that which we cannot see bly. At that first course, we encountered a tradition-but can feel, are also life within life, as is each and every al academic programme as far as organization goes,one of us.” but the subjects addressed were anything but. In Ecuador, the course was characterized by a largeInvolved in this story of change were the Maya number of students, from different continents,hosts, the Fathers and Mothers, who conducted speaking different languages, which required athe welcoming and farewell ceremonies and whole set-up for simultaneous translation. It wasaccompanied us each day; the participants; and held on a university campus, and most of thethe organizers of the IPHU, who made the en- participants were PHM-LA activists or people newtire event possible. to the movement, who were graduates of different health fields.This experience took place at ASECSA, in Chi-maltenango, Guatemala, in April 2010. In the experience in Chimaltenango, the general topic of the course lent a certain academic level 21
  22. 22. 2 Experiences Latin Americato the session on “Political Economy of Health.” transmit knowledge to a receiving group.All the academic formality was transformed into The Guatemala course used a model that was collectivea diverse collective, keen to share experiences and and multi-directional. We all learned from all of the ex-thirsty for information, based on the personal stories periences presented there, coming from different geographic,of the participants themselves, with collaboration social, cultural and academic places, which formed theand guidance from a group of facilitators, which, basis of the my opinion, was the right decision by the organ-izers. We experienced the situation of the native peoples of Guatemala, which led us to take on collective and individ-In telling his story, William also said that this ual commitments to work for a world with more solidaritychange is the most relevant one because it in- and harmony that produces life with health.”volved an approach based on the personal expe-riences and reality of those involved, integrated The IPHU organizing committee, the partici-into an academic environment: pants and health activists from different peoples and countries were involved in this change,“When we are talking about a place where community which took place at ASECSA, in Chimaltenan-health activists can share their experiences and obtain go, Guatemala in April 2010.knowledge tools in the framework of a university, it isnot possible to maintain the traditional, one-way educa-tion model in which teachers, from a position as superiors,Most Significant Change Stories about the IPHU Course: Technology InnovationStory No. 3Gabriel García Salyano, San Cristóbal de Earlier, the events held in Porto Alegre and inLas Casas. From Chiapas, México. Havana had been conducted in the classic manner;Using communications technology for live that is, only the participants were part of them—inbroadcast over the Internet, and using the case of Havana because of the difficulties fromopen-access software, along with link-ins the economic blockade and in Porto Alegre becausewith local radio stations to bring the IPHU- it seems that it simply wasn’t something to take intoChimaltenango course to more people consideration. In general, information and commu-throughout the Americas and broadcast nications technology is underused in the PHM-LA;to rural Guatemala through a network of perhaps because people don’t know the potential itcommunity radio stations. has. In addition, practically everyone is limited to using proprietary software, whether because theyThe experience in Chimaltenango dem- don’t know about other systems or because of a fearonstrated that the use of this technology of change.and open-access software is not just for“experts” and that it is within the reach of According to Gabriel García Salyano, IPHUall the organizations and individuals in the courses are opportunities for the sharing, discus-PHM-LA and that it is useful for empower- sion and evaluation of proposals for action froming and disseminating their activities. and among different grassroots and academic sec- tors and at the level of civil society organizations. However, he said that earlier, this opportunity was 22
  23. 23. 2 Experiences Latin Americafor “favoured” individuals and was conductedonly as an on-site course. Another element that makes the use of com- munications technology so important, accordingThe course in Chimaltenango, Guatemala was to Gabriel, is that the organizing and facilitationthe first time that different presentations, plenary committee was comprised of people from differ-sessions and discussions were broadcast live, ent countries: Guatemala, Nicaragua, El Salva-which meant that people from different parts of dor, Mexico, Ecuador, Argentina and Bolivia.Abya Yala could follow the course and send in Different Internet-based tools enabled them totheir comments and opinions about the subjects define the selection criteria for the participants,and how the course was being taught. develop the subjects and content of the academic programme, define the roles of the participantsThis is important because there was a large and organize the logistics, while decreasing envi-number of applicants to the course, which was ronmental and economic to 50 places; this meant that making thecourse available to people who were off-site was a Those involved in this change were Virgilio Me-spot-on decision. dina, Jorge Contreras, Hazel Ríos, María Hamlin Zúniga and Edy Rolando Siritit Quisquina. TheGabriel said that the teleconferences were of live broadcast of the event took place in Chi-good quality. They had the necessary equip- maltenango, Guatemala, with teleconferences onment, which was available to the institutions and 12-14 April 2010, following preparations includ-groups present and which facilitated making an ing the purchase of necessary equipment andimmediate audiovisual record of the event. This training of the people involved (March 2010).was posted on the website along with all the otherinformation, making it available to everyone visit-ing the site.1 International People’s Health University.2 The IPHU in Havana was held in November 2009.3 The IPHU in Chimaltenango was held in April 2010.4 Allin Yachay, Allin Munay, Allin Ruway = Allin Kawsay or Sumaj Kawsay. This means that to know well, love welland do well (with good thoughts, good feelings or a good heart; with doing good, in a good way) builds allin kawsay, thegood life; this also merges with sumaj, which means most beautiful life; that is, living beautifully in a good way is SumajKawsay, in harmony with all forms of life. 23
  24. 24. 2 Experiences Latin AmericaDomain of Change: Political Advocacy in Defence of Mother Earth and Against theCriminalization of ProtestMost Significant Change Stories about the IPHU Course: Inclusion of an InterculturalApproachStory No. 4 Rocío feels that this change is the most impor- tant one because the women have successfully fostered political advocacy activities pressuring local, regional and national authorities, which has led to changes in the law (amendments to Ecuador’s constitution). Before this, women were ignorant of their rights; but now they are organ- ized. They belong to the Defenders of Pachama- ma Women’s Front and continue their struggle to defend women’s rights, environmental rights, social rights and human rights in general.Rocío Pérez, Leader of Victoria del Por- As a result of their organizing and advocacytete Community and President of the capabilities they have counteracted the nega-Defenders of Pachamama Women’s Front tive impact on the environment of transnational mining companies: natural disasters, pollution,Community MSC Story: deteriorating living conditions, squalor andWe women organized, supported each other, built poverty.our awareness and educated ourselves; we created ajuridical and legal entity to be able to protect, train Rocío Pérez says that her struggle has enabledand inform ourselves and to train women lead- the people living in the community of Victoriaers who are part of the Defenders of Pachamama del Portete to enjoy a healthy environment: “WeWomen’s Front, from the communities of Tarqui, can still breathe pure air and drink pure water and weVictoria del Portete, Molleturo, Limón Indanza, can also continue to enjoy our beautiful landscapes.”Gualaquiza, Gualaceo, Cuenca, and others. However, she emphasizes that they must con- tinue the struggle and advocacy work, as says theMy community has not let itself be moved to the following: “That we should never give up and that westage of exploitation, thanks to the resistance of will be ready to fight, come what may.”the Defenders of Pachamama Women’s Front.We maintain our love of life and nature, and also This significant change took place in the cityfor learning about the rights of women and of all of Cuenca, Ecuador and involved Rocío Pérez,people. leader and grandmother, together with other grandmothers, all of them fighters, active andPersonal MSC Story: militant in community action and defence ofI have learnt that I can help my community, defend their land in Victoria del Portete, Cuenca, Ecua-the water, land and life in general.... I have grown as dor.a woman and as a person. 24
  25. 25. 2 Experiences Latin AmericaMost Significant Change Story about the Experience with the Criminalization of Pro-test: “We are All Crisanta.” San Marcos, GuatemalaStory No. 5Crisanta Pérez, San Miguel Ixtahuacán official document to the company (Marlin Mine) where theyAdapted from conversations with Crisanta asked the company to take the posts off my property and myPérez and from the stories of struggle, “We neighbour’s property.are All Crisanta,” a living history of women So the company asked for another three months, but we toldleaders in defence of Maya land and dig- them to take the posts away before the rains came becausenity. when it rains the soil softens up. They had not removed the light poles at the time when the rains, I made upIn 2008 and 2009, Crisanta Pérez became my own mind then to block the company’s electricity and nowa role model for many women in several the struggle belonged to the people. There were the people withcommunities of San Marcos in defending the cracked houses, those from the spring, the people with skintheir rights, and they have raised the slo- disease.”gan, “We are All Crisanta.” The reaction of the company and of the Guatema-According to written information and from talking lan government has been to issue arrest warrantswith Crisanta Pérez, the problem is part of the ex- against Crisanta Pérez, Crisanta Hernández, Patro-ploitation of natural resources by the Marlin Mine, cinia Mateo, Catalina Pérez, Olga Hamaca, Maríarun by the Montana Exploradora Company, a Díaz, Crisanta Yoc and Marta Pérez. Since then,member of Gold Corp, in San Miguel Ixtahuacán, these women live in hiding, going from communitySan Marcos, Guatemala. to community where they are protected.In 2007, eight women from San Miguel Ixta- “Because they were angry that I didn’t make an agreementhuacán, led by Crisanta Pérez, demanded that with them they put an arrest warrant out for me. Here in Santhe Montana Exploradora Company respect their Miguel, there are no people who speak Spanish so they askedproperty after it ran electric lines for the mine over me to talk to the company manager to get them to take thefamily-owned lands and high tension lines over their machinery away.”homes without prior authorization using manipu-lated procedures, putting their lives at risk from According to personal accounts, the company wasradiation and high voltage. able to successfully install itself and strip-mine for gold because they used force and deception, andThe company’s lack of respect and its arrogance, were supported by the Guatemalan government.and the local people’s desire for safety, motivated This is seen as a continuation of colonialism andthese brave women to knock down the electric poles as an act of arrogance and racism. The pillagingleading to the mine. Crisanta continues explaining: continues and the local communities are not seen as meriting any consideration or having any rights.“They did not keep their promises, so what the woman did Most of the people are against the mining.was to remove the anchors from the post, and by taking theanchors away, the post flipped over, and the electric lines go by “The company people came and I talked to them. I told themthe corner of my house, so that worried me a lot, because if what the problem was; why the people were against them—the post were to fall it would damage my house. that they were defending their water sources, they didn’t wantWhat we did was file complaints with town hall, with the them to pollute their springs and their rivers where they washseal and signature of all the authorities from all the communi- their clothes. The company didn’t obey and again issued anties.... It was signed and sealed by them and they submitted an arrest warrant for me. I was at home when they called me 25
  26. 26. 2 Experiences Latin Americato say that the police were already there.... I had to leave the the government is the guarantor of the respectmunicipality of San Miguel.” of that right. Nevertheless, the country’s large landholders use deception to strip peasant menCrisanta Pérez, pregnant, decided to return to her and women of the land they own. Their com-community to give birth. Shortly after giving birth munal lands and indigenous lands are expropri-she was detained by National Civilian Police officers ated, in violation of their right to their territoryand taken out of her home. The news spread quick- and of the international legal framework thatly through the communities; the people sounded the protects indigenous peoples—International La-alarm and blocked all roads out of town. In one of bour Organization (ILO) Convention No. 169.these communities, an organized group of peoplestopped the police and freed Crisanta Pérez. The positive significant change is Crisanta’s“When I was pregnant, I was somewhere else; I was not fight, and that of other women and men fromin San Miguel because there was an arrest warrant out for San Miguel and other communities, to try tome. They looked for me here in Axil, so I had to leave and I convince local authorities to defend their proper-was three months pregnant when I left here. I returned in late ty and the natural resources of their indigenousDecember; my daughter was born. One month after I had my territory. This has motivated other women andbaby they caught me. I had spent six months somewhere else, men, not only in Guatemala, but also in otherand in December I came back home again and after being countries, to keep their struggle alive, and tohome for a month, they caught me. advocate in defence of their civil, political, social and economic rights, as well as the collective andThis worries me a lot because my children are still small.... If territorial rights of the Maya people.I didn’t have little kids, well, I say, I would give my life for mypeople.... Thank God I’m not alone; many communities aresupporting me.”Crisanta is still being protected by the local peopleand the fight to defend their land continues, underthe watchword, “We are All Crisanta.”This story expresses a positive significant changeand at the same time a negative significantchange.The negative change is the conditions of exploi-tation, deception and lack of protection underwhich the local people—women, men, youngpeople, children—live, as well as the destructionof the environment in different communities inSan Marcos, due to the arrogant, disrespectfulattitude and intrusion of the Montana Explo-radora Company with the Marlin Mine, eventhough it is in violation of national (Guatema-lan) and international law.According to Article 39 of the Constitution ofGuatemala, private property is guaranteed and 26
  27. 27. 2 Experiences Latin America Domain of Change: Political Advocacy for the Right to HealthMost Significant Change Story about the Experience of the National Health Forumwith Political Advocacy. El SalvadorStory No. 6 The objective of this strategy is to facilitate citizen participation in community health around the country, through staggered regional consultations with local actors, primarily from civil society, who would then participate in a national conference to strengthen, accompany and manage the process to transform and develop the national health system. According to Margarita, following the Peace Accords ending the civil war in January 1992, several civil society organizations working on behalf of community health met, and in 1993 formed the Action for Health in El SalvadorLuz Margarita Posada, San Salvador, El (APSAL) network.SalvadorInclusion of our proposals and recommen- Since then, they have been engaged in oversightdations in the official document “Building and political advocacy with citizens’ proposalsHope: Strategies and Recommendations regarding medicines and health reform.for Health 2009-2014,” particularly Strat-egy 4, “Social and community participa- The network’s member organizations used totion,” which says, “Create structures and present their proposals and initiatives to theprocedures for community participation in Ministry of Health and Social Welfare andprimary health care at all levels of the Sys- would engage in lobbying and dialogue, buttem.” This is being done through advocacy, were never able to enter into talks: “We never hadlobbying, dialogue and negotiation, sup- the opportunity to meet with anyone in the Health Minis-ported by the National Health Forum and try. The receptionist would just accept our correspondencethe new authorities, as part of Comprehen- in the presence of the press, which we would convene, butsive Health Reform. we would never get a response.”With the arrival of the new health authorities in During the Social Security Institute strike inJune 2009, task forces were created to discuss health 2002, the number of supportive organizationspolicies and strategies. advocating against the privatization of health care increased and the Citizens’ Alliance AgainstLater, at an event in September 2009, Minister of Privatization in Health was formed. This newHealth Dr. María Isabel Rodríguez swore in the forum again took up the issues of health reform,Organizing Committee of the National Health medicines and the national budget.Forum, chaired by Margarita Posada, Coordina-tor of the Citizens’ Alliance against Privatization in Following the March 2009 elections, the pres-Health. There, the minister explained that Strategy ident-elect was lobbied to appoint Dr. María4 was included in response to constant demands. Isabel Rodríguez as Minister of Health, which 27
  28. 28. 2 Experiences Latin Americahe did. It was then that civil society was finally Margarita: “This has enabled having instruments andable to establish dialogue with the new health discussion mechanisms for social auditing. The docu-authorities. On 20 September 2009, the Presi- mentation will be given to the authorities, from whom wedent of El Salvador spoke about Comprehensive will demand concrete changes in personnel and in healthHealth Reform and connected it to one of the care mechanisms.” The idea of this is to ensure theeight strategic areas of his administration—Citi- good functioning of the health system and tozen Participation—and the National Health ensure compliance with health reform.Forum was created as a mechanism for thisparticipation. Involved in this change were the civil society organizations belonging to the Citizens’ AllianceMargarita says that this change story is the most Against Privatization in Health: APROCSAL,significant one because it has facilitated the ASPS, APSIES, Las Mélidas, Comandos deorganizing work currently going on around the Salvamento, Union of Physicians of the Salva-country in 138 of the country’s 262 municipali- doran Social Security Institute (SIMETRISSS),ties. Secondary School Students’ Movement (MES), Consumer Defence Centre (CDC), CIDEP,In addition, for each municipality, 10 three- FUMA, “Salvador Allende” Professionals Move-member community committees are being or- ment, Medical Society of El Salvador, PROVI-ganized, for a total of 1,380 committees, which DA, Medicus Mundi Andalusia, INTERVIDA,are expected to cover 50% of the nation by PROMESA, independent professionals, MinistryDecember 2010. of Health authorities (minister and vice minis- ters), and local organizations working around theIn this way, the public is becoming empowered country.and working for the people’s right to health fromwithin organizing structures and participation This change took place from September 2009opportunities being implemented at different to May 2010, and included the establishmentlevels: of the convening committee for the National I. National Health Forum (NHF) Commu- Health Forum, the Regional Forums (April-May) nity Committees and the First National Health Forum (28 May II. NHF Municipal Intersectoral Coordinat- 2010). ing Committees III. NHF Departmental Coordinating Com- mittees IV. Regional Health Forums V. NHF National Convention 28
  29. 29. 2 Experiences Latin AmericaDomain of Change: Health ParadigmMost Significant Change Story about the Experience of Laicrimpo: Living, thinkingand feeling natureStory No. 7 all its elements are present in our group, in our community. When, symptoms, diseases or conflicts appear with- in ourselves, the group or the community, harmony is lost. But, by realizing this, by being conscious that we hold everything inside ourselves and that we are able to interrelate with everything, we have the possibility of recovering that harmony. In essence, we are an interrelated ALL, and the health and life of each and every living being depends on each and every living being. We are Life within Life.Marcela Bobatto and Gerardo Segovia, ElDorado-Misiones, Argentina At a certain point along the way, and with the essen- tial support of indigenous peoples, rural communi-Our way of understanding, thinking of and ties and the sharing of different practices, knowingfeeling health and life changed. Our stance and doing, we realized, we experienced, we becametoward life and daily living changed. Our conscious, of our “being nature,” that WE AREway of thinking about our “being or stay- healthy” changed. Our way of relatingto “everyone” changed, because they are We are not outside, nor above nature, we are not itsno longer outside of us, they are not others; owners, we cannot do what we want with it, neitherrather they are part of us and us of them. are we “part” of nature; rather, we are one withIt committed us more to defending Mother nature. During this process, we shifted our conceptNature, the environment, life as a whole. from an anthropocentric paradigm to a biocentric paradigm. We began to experience OUR nature, toWe used to use a broad, comprehensive concept of feel that we belonged to the cosmos; to understand,health, thinking that health “is everything,” it is the perceive and experience that I am and we are water,relationship with oneself, with everyone else, with wind, fire; that we are earth, that the elements thatGod or the transcendental, and with nature. How- are in nature pass through us, belong to us, are inever, we still located ourselves outside of nature; our make-up, they are in us and we are in them.even though we were already thinking that “we arepart of nature,” there was a step missing, which By feeling ourselves as trees, earth, plants, moun-was to feel ourselves as nature. We are wind, we are tains, being responsible for the stewardship ofearth, we are fire, we are trees, we are water, we are Mother Earth and all living things with which weseeds. share Life emerges more strongly.Now, to be in harmony with oneself, among our- Therefore, when the current capitalist model, whichselves, enables increasing the harmony in the all. revolves around accumulation and profit, promotesThis harmony occurs when nature’s diversity and 29