5) Description of health product/service offering: Tipitapa is a village of 130,000 with surrounded by free trade zone sweatshops employing in excess of 30,000 workers earning less than $3/day. The impact has been an increase in unemployment due to the large population influx, increase in poverty and malnutrition and reduction in services in the community. The Environmental Health Promotion Project has introduced the training of health promoters/brigadistas from each of four barrios, the use of community medicine boxes to provide for low cost preventive medicines in the community, and education of families regarding diseases and use of costly medical services when necessary and where available. It began to be noticed that people wanted to spend money on private health services while failing to address community issues. Organizing at the community level to improve conditions has been a primary tool.

6) Description of innovation: In a community that values traditional medical services (despite their lack or perhaps due to their non- existence), the challenge has been to use capacity, organization, coordination, monitoring and evaluation as means to demonstrate that another way is possible--less costly and more productive. One interesting example of innovation is that when families were introduced to means for monitoring child developing using plastic toys, the families determined that these items can be made from gourds and other objects at no cost. The other innovation which may not seem so is the conduct community diagnostic assessments before proposing social solutions. This not only identifies community need but engages the community in identifying the need for intervention. Further, the health promotion project is a means toward assuring community organization. It is not just about service delivery or education but what parents can do together to help their children. So as a result one community has now set up a child nutrition center as critical to improve community health. Another community has organized a pre- school and still another has built a potable water project. The pattern is to de-segmentize services and demonstrate that without literacy you can't have health, without organizing around effluence from factories you can't have health and without addressing family violence as a community issue you can't have health. Also by empowering natural community leaders, people on the margins become engaged as well.

7) Operational model: There are four sets of health educators supported by an infrastructure that includes an Executive Director, a Financial Administrator, a supervisor of child nutrition and education, and a coordinator of community health, early childhood stimulation and child health. In addition there are 25 mothers who service on the Comite de Madres and 35 community liaisons who work through the Mothers Committee and the Health Promoters.

8) Human resources: There are 57 health promoters who generally are well- respected community members--some were trained during the Sandinista period and mourned the loss of their services in the 1990s. There is a paid staff of 8 persons (see above plus 4 pre-school teachers)

9) Key operational partnerships: The partners include: o The Nicaraguan Ministry of Health (MINSA) o Ministry of Cultural Education and Suport o ENACAL (which regulates the water systems) o The Municipal Government o Other non-governmental organizations that work collaboratively to reach all segments of the community

10) Financial Sustainability

          • Fees charged to clients?: No

          • How do you assure affordability?: There is no charge for health promotion services; the social pharmacy charges below market prices that have been affordable. Where necessary such products are provided at further reduced costs.

          • Earned incomes as a percentage of operating costs: 10

          • Other funding sources: The majority of funding comes from foundations and individual donors in the US. Local support comes from the below market price charged for medications. COMPALCIHT is investigating local support.

          • Strategy for long-term sustainability: It is not clear how this project could continue without fund raising in the United States. Dos Pueblos has been very successful in finding both foundation and individual donor support.

11) Current and Future Impact

          • Total number of clients: 9,824

          • Clients in the past year: 637

          • Percentage of low-income clients: 100

          • Impact: The Ministry of Health has been responsive to this project by providing educational materials, collaborative relationships with the health promoters, and services where they exist. Other government agencies have supervised the potable water projects that are critical to health. The child feeding centers receive some government services and meet appropriate standards for nutrition and health care.

          • Overall "market": The demand is tremendous. With a population of 130,000-- 75% are under 15 years of age--it is critical to expand services by training trainers to deliver services in as many barriers as possible. The critical needs are environmental intervention, prevention and treatment of dengue and malaria, attention to mental health and family violence and pressure on existing medical services to provide care when needed.

12) Scaling up strategy

          • Stage of the initiative: Scaling Up stage.

          • Expansion plan: Dos Pueblos continues to seek foundation funding and to encourage COMPALCIHT to do the same. The people's pharmacy is one source of income. Further, we are about to embark on an ambitious plan to involve global health physicians from the U.S. who are dedicated to prevention while assisting in health service delivery as part of their training and supervision of residents.

13) Policy change: Nicaragua needs to return to a model of free, public education, health care for all, and basic social services for a population whose poverty in the region is exceeded only by conditions in Haiti. Further it needs to set its own course without direction and control from forces not necessarily acting in the interest of poor people.

14) Origin of the initiative: Eduardo Gamez Cuevas has been leader of COMPALCIHT since the early 1990s and has been the driving force for a program of health promotion particularly addressing the needs of children. He is a remarkable person worthy of recognition. Our January delegation of U.S. residents left in awe of his analysis of community, politics and problems within the context of optimism and hope. This award would mean a great deal to him, to his U.S. supporters and to his community in Tipitapa that so admire his work.

Contact Information:
Eduardo  Gámez Cuevas
President
COMPALCIHT (Asociación Coordinadora Municipal De Proyectos De Ciudades Hermanas De Tipitapa); partnered with Dos Pueblos: NY-Tipitapa Sister City Project
(NGO in Nicaragua/partner is a 501(c)(3) in the U.S.)
Dos Pueblos: NY-Tipitapa Sister City Project, 2576 Broadway, #305, New York, NY 10025; COMPALCIHT, Apdo 54, Tipitapa, Nicaragua
Nicaragua
Tel: 646-610-2215 (NY); (505)295-3275 (Tipitapa)
Email: dwf@tipitapa.org
Website: http://www.interconnection.org/compalciht/ and www.tipitapa.org