[COUNTRY STORY]

Meaningfully engaging community stakeholders to respond to COVID-19

Ecuador
Photo: PAHO / WHO Country Office in Ecuador Mariana Canelo, indigenous Kichwa community and community communicator for the Voice of CONFENIAE
Empowering indigenous women as “agents of change”

Ecuador is a multi-ethnic country with wide cultural diversity, including 18 indigenous nationalities and 14 traditional and diverse indigenous villages which are distributed in different geographical areas of the country. In many cases, entry into these communities, especially in the Amazon region, must be by river or air, which, among other socioeconomic realities, presents challenges to accessing health services. Populations in these areas are highly vulnerable to public health threats such as COVID-19. The WHO Regional Office for the Americas, the Pan American Health Organization (PAHO), selected and engaged with two local civil society organizations, Fundación Pachamama and the Confederation of Indigenous Nationalities in the Ecuadorian Amazon (CONFENIAE), to mitigate the impact of the pandemic on indigenous communities. The PAHO/WHO Country Office in Ecuador provided support to both civil society organizations through jointly planned interventions to scale-up their community assistance programs. Assistance was provided as part of a global initiative financially supported by the COVID-19 Solidarity Response Fund which aimed to train and equip communities and health workers to prevent, detect, and treat COVID-19, and strengthen the readiness and resilience of communities to face future public health emergencies.

It is expected that improving the access to information, continued support for essential health services and promoting inclusive community participation will strengthen the Amazon’s indigenous communities’ immediate response to COVID-19 and beyond, increase vaccine uptake and reduce morbidity and mortality in these isolated communities. Actions implemented in Ecuador under this initiative, together with other country-led efforts, have already contributed to slowing down the transmission of the disease and reducing COVID-19 incidence in the targeted provinces (Pastaza, Morona Santiago and Tungurahua). Between the epidemiological weeks EW17 and EW43, the number of new reported COVID-19 cases in these provinces decreased by 96.5% from 1,748 confirmed cases reported in May 2021 to 262 new cases reported in October 2021. In the longer-term, it is expected that community-led interventions will enhance more resilient communities and health systems in their preparation and response to all health emergencies - not just COVID-19.

How did Ecuador do it, and how did the Secretariat support Ecuador?

  • By having a strong framework for action - All COVID-19 Solidarity Response Fund countries were guided by the “3E’s of commitment”: “Enable”, “Empower”, and “Engage”. Ecuador enabled local civil society organizations to empower indigenous Amazonian women in becoming “agents of change” and engaging their communities against COVID-19 and future emergencies.

“I feel proud to walk around as a health promoter and I want to invite all the sisters and women to be part of this empowerment and fight for our rights. I want us to be strong women and fighters.”

Indigenous Health Promoter on Maternal Health, Fundación Pachamama

  • By working with organizations that are already well-established in the community and had a relationship with the PAHO/WHO Country Office - Fundación Pachamama has been working in the south-central Amazon of Ecuador to support indigenous organizations for over twenty years. CONFENIAE is made up of 11 indigenous nationalities spread out in 6 provinces in the Amazon region, belonging to 23 grassroots organizations and federations. CONFENIAE has a coverage of over 100 000 people in over 200 indigenous communities.
  • By improving access to information - The only radio station that reaches indigenous communities in the native languages of the Amazonian region is “La Voz de la CONFENIAE”. To increase radio listenership and steer programming of relevance to COVID-19, PAHO/WHO supported CONFENIAE in expanding the FM radio frequency of “La Voz de la CONFENIAE”, and the development of radio production plans. As such, CONFENIAE took on the role of amplifying the national response to the COVID-19 pandemic to these hard-to-reach communities, conveying messages relevant and culturally appropriate to the indigenous communities to help deal with vaccine misinformation and hesitancy, including building trust in the country’s immunization The result was 30 radio scripts that were co-written in the native languages and transmitted through seven local, CONFENIAE-affiliated radio networks. In parallel, as part of the risk communication and outreach efforts, PAHO/WHO Ecuador collaborated with CONFENIAE to distribute 600 copies of the translated book “My Hero is You” ("Naatka Muruitme” in Shuar language) to school children and their families to provide mental health support to cope during the pandemic.
  • By supporting better hygiene and the continuum of essential health services - Better access to information would have not been as impactful at reducing COVID-19 infection and disease if it had not been supported by activities that enabled local communities to comply with COVID-19 public health measures. Fundación Pachamama organized a series of workshops to build capacity in local communities, training 223 indigenous community health workers in the Shuar and Achuar communities in Ecuador’s Amazon Region. Trainings on safe deliveries to prevent maternal and neonatal deaths were supported through the distribution of 400 childbirth kits. Trainings on COVID-19 awareness and health promotion were supported by artisanal soap production training, enabling 20 local women from the Shuar and Achuar provinces of Morona Santiago and Pastaza to become agents of hygiene change while generating a source of sustainable income.
  • By being gender inclusive - As Fundación Pachamama’s workshops evolved, their programme included, for the first time, a training for only indigenous men as a way to deal with and end the cycle of violence and better address gender-based violence. A total of 31 men from the Shuar indigenous community participated, including community and faith leaders. The news of local men becoming allies for women’s and family health was welcomed by the community.

Building resilient national and local health systems, as well as communities that are resilient to emergencies, is in line with the WHO Triple Billion Goals. Ecuador demonstrated that community-based and inclusive interventions can effectively bridge the disproportionate vulnerabilities of remote communities through the application of culturally appropriate risk communication activities. This intervention also showcased the empowerment of local communities through the diverse trainings for indigenous community health workers as midwives to ensure the continuum of essential health services through a pandemic. Overall, the civil society organization engagement initiative showcased the need to step up systematic engagement at the community level to facilitate quality service delivery to communities within the global commitment to Sustainable Development Goals and Universal Health Coverage.

Photo Credit: © PAHO / WHO Ecuador Country Office

Photo Caption: Children in the Shuar Community receiving the book “My Hero is You” translated in Shuar language as “Naatka Muruitme”.