Perspectives in Health Magazine The Magazine of the Pan American Health Organization Volume 8, Number 1, 2003

The residents of El Salvador’s Villa Centenario have built a whole new "healthy community" to replace the homes they lost to the earthquakes of 2001

PAHO engineers developed the prototype for Villa Centenario’s 100 houses.

The first two months of 2001 were a living nightmare for the Osorio family, as for thousands of Salvadoran citizens. On the morning of Jan. 13, a 7.6-magnitude earthquake struck, centered 100 kilometers off the country’s Pacific coast. Its force was felt as far away as Mexico and Panama, but it hit El Salvador the hardest, collapsing homes and buildings, destroying roads and bridges, and setting off mudslides and landslides throughout the country. Thousands of aftershocks followed, one of which—on Feb. 13—was strong enough to be considered a quake on its own. In the end, more than 1,200 Salvadorans were dead, nearly 9,000 were injured and some 1.6 million were left homeless.

Before the earthquakes, Carlos Osorio, his wife María Ester Echeverría and seven of their 10 children had been living in poverty as caretakers on a large farm in Acajutla, in Sonsonate department in western El Salvador. Their house—a rickety structure of stick-and-mud walls and a makeshift plastic roof—was destroyed by the earthquakes. Used to hardship, the family now began a truly desperate search for new work and someplace else to live.

PAHO Director Mirta Roses Periago meets with community leader Carlos Osorio.

"I thought I was going to die and that my children would be left fatherless, just as my father left me when I was a child," Osorio recalls with tears in his eyes.

But six months to the day after the first earthquake, the Osorios found new hope back in Acajutla, this time in the small village of Suncita. They were among the first of 100 families who would join an effort to build, from the ground up, a whole new community to replace their lost homes. Their town, named Villa Centenario in honor of the 100th anniversary of the Pan American Health Organization (PAHO), would become a model "healthy housing" project built with support from PAHO, El Salvador’s ministries of housing (which donated the land) and health, foreign donor countries, local missionaries and the Municipality of Acajutla.

Most important, however, was the active participation of the 100 families who are the project’s enthusiastic beneficiaries.

"It’s a miracle that God and all the organizations that helped us would give us our own house," says Osorio.

From shortage to crisis

Residents of Villa Centenario built their own houses and now meet regularly to discuss ways of improving living conditions in their community.

The Osorios’ plight in early 2001 was typical of thousands of Salvadoran families who lost their homes in the earthquakes. According to the National Emergency Committee, the quakes affected nearly a quarter of the country’s housing, with more than 180,000 units damaged and 150,000 units destroyed. The brunt of the impact fell on the rural poor, whose poorly constructed houses in precarious locations stood little chance against the quakes’ force. What had already been a serious shortage of adequate housing was rendered a full-fledged crisis by the earthquakes.

This presented a major challenge to the government and citizens alike: to rebuild not just houses, but entire communities that would be stronger and healthier than those destroyed.

"It was an opportunity to rethink rural housing and rural communities and to introduce a new concept of healthy living even in the context of poverty," says Horacio Toro, PAHO representative in El Salvador. "It was a chance to come up with solutions to enduring problems like the lack of basic sanitary services and the unhealthy human behaviors that accompany poverty and poor living conditions."

The task of developing a prototype of healthy housing was taken up by a group of sanitary engineers in PAHO’s country office in San Salvador. PAHO helped secure funding from donors including the Bahamas, Canada, Italy, Norway, Sweden and the Pan American Health and Education Foundation to finance the first 60 houses, while the Marist Brothers religious order raised funds to finance the remaining 40. The goal was to make Villa Centenario a model that shows it is possible to have healthy housing and healthy communities even in the poorest rural zones.

The core of Villa Centenario is its 100 houses, built to withstand earthquakes and also to ensure healthy living in a low-income setting. Designed by PAHO sanitary engineers as a prototype of antiseismic, low-cost and easy-to-construct housing, each home was built by future residents themselves using simple tools and durable materials such as concrete blocks and metal roofing. Each house has three small bedrooms, a kitchen and a social area, all in a space of 440 square feet. Conveniences include a water storage tank and purification filters, a shower, a kitchen-laundry sink, a wood-burning or gas stove, a latrine and a system for eliminating wastewater. Fine mesh screening covers the doors and windows to keep out disease-carrying insects. The total cost of materials: just over $4,000.

Today, less than two years after construction began, Villa Centenario has, besides its 100 homes, a community center, a central plaza, a park with a playground, a sports field, a medical dispensary, a bakery and a nixtamal, or corn tortilla, mill. Children attend school just a kilometer from town, and the Municipality of Acajutla provides the community with garbage collection. Recently the community finally got its own electricity and water services.

The focus on healthy housing (vivienda saludable, or VIVISAL, in Spanish) is critical, but the emphasis on social participation is equally important. The country’s president, Francisco Flores, highlighted this fact in a speech delivered at the community’s inauguration: "It’s worth noting that the community’s design also takes account of the kind of social spaces needed to stimulate harmonious coexistence among the residents, with special emphasis on the spatial needs of children and adolescents."

For Francisco López Beltrán, El Salvador’s minister of health, Villa Centenario represents "the new approach that ministries of health are taking, bringing programs to the communities and making Salvadorans the true protagonists of health."

Toward that end, Villa Centenario has an elected city council, volunteer health and sanitation brigades, community training programs, several income-producing projects and community nutrition initiatives supported by PAHO’s Nutrition Institute of Central America and Panama, or INCAP. A number of government and international agencies and nongovernmental organizations have helped organize community campaigns for mosquito control, childhood immunization, animal worming, vitamin supplementation and adult literacy.

Model community

Villa Centenario has already served its purpose as a model for healthy living. El Salvador’s Vice Ministry of Housing has adopted the VIVISAL concept as the basis for construction of some 50,000 new homes in rural areas, incorporating both its sanitary features and its focus on community participation in health.

As for the town’s own residents, their "transformation"—from earthquake victims to protagonists of social change—can be seen in the Osorio family. One of the first to contribute to the construction of Villa Centenario, Carlos Osorio is today a well-known and respected figure who has taken on considerable responsibility in the community. He has served as president of the city council on five occasions, he holds primary responsibility for the functioning of the community center and the central park and he supervises the bakery and the tortilla mill. He also attends courses on family and community hygiene and participates in a hydroponic orchard program sponsored by INCAP.

His wife has a paid job in the bakery and in a local women-run microenterprise, and volunteers in one of the community health brigades. Their two youngest children are once again in school.

Yet the transformation is by no means complete. "To build a successful, sustainable community, there must emerge a strong sense of belonging among the families—who didn’t know each other before—so they can identify the problems they share and come up with common solutions," says Maritza Romero, expert in health promotion in PAHO’s country office in San Salvador.

Children from Villa Centenario gather outside the adobe archway that welcomes visitors to their community. “OPS” is Spanish for PAHO.

"This helps them transcend individualism and begin to build representative and participatory structures as well as a commitment to work for the common good. That process may take years, even decades." She adds that while adequate housing is a necessary prerequisite for healthy living, success also depends heavily on advances in other basic areas of human development, including literacy, education and vocational training, gender equity and perhaps above all, employment and income.

"Villa Centenario is a successful model community in terms of environmental health, but it still faces the intractable problems of people living in extreme poverty," notes Gerardo Merino, a nutrition expert and INCAP consultant in El Salvador. "Some of the residents are apparently so undernourished, for example, that they lack the strength or motivation to participate in community activities or training."

Osorio is living proof that the lack of employment sources is perhaps the most difficult and necessary obstacle still to surmount.

"My main problem is economic, because I don’t have work," he says. "I depend on what my older children give me to support the rest of my kids. Sometimes we only have corn to eat, and often we go to bed with empty stomachs. I give thanks to God and to all those who have supported us, but I hope to find work soon because I don’t like to beg."

Jorge Jenkins Molieri is an environmental health advisor and head of the disaster program in PAHO’s country office in San Salvador.

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