In PAHO HQ All PAHO PAHO + WHO

foto, pandillero

Reducing Violence in Selected Central American Countries
(A Technical-Cooperation Initiative):

Executive Summary

Introduction

The PAHO Program on Non-Communicable Diseases is proposing a group of three collaborative projects directed at reducing violence in selected countries of Central America. The three projects are aimed at applying interventions that confront problems identified both by experts and the communities, such as the following:

  • the fragmentary and incomplete attention that hospitals offer to victims of violence;
  • the appearance of juvenile gang violence and the anxiety that such gangs engender; and
  • the lack of social support networks to boys and girls who suffer abuse.

To face these problems, the design of the proposed interventions takes into account criteria both for health promotion and for the prevention of violent events. The health sector can play a role in providing leadership and coordination for the proposed interventions. With these, the initiative hopes to bring about active participation on the part of both victims and perpetrators, as well as of key actors at the government, NGO and community levels.

Objectives

  1. Preventing violence against victims who are patients in health-care facilities: The project proposes ways to avoid the recurrence of violence acts by implementing secondary-prevention activities in public hospitals in the four Central American countries involved in the project. To this end, it will invite the victims of violent acts, young people and women, to participate actively in a cycle of reflecting sessions to modify the conditions that lead to the recurrence of violent actions. Follow-up household visits should consolidate the support network that the victim needs in order not to be attacked again. This methodology has been applied in Boston, USA1 and in Cali, Colombia2. The project intends to modify the attitude of victims, their family and persons in their immediate social surroundings, including health-care-professionals, towards the origins and prevention of violence. The conceptual basis of this methodology is the theory designed by A. Bandera, stating that social violence is a learned phenomenon and, as such, is subject to "deprogramming." For this, the persons affected are exposed to a model of reflecting work that combines individual with collective aspects.3, 4
  2. Strengthening youth organizations for non-violence: This project will strenghthen those youth organizations that work to re-orient the activities of juvenile gangs through a process that combines outreach, discussions on alternative living, information, and putting the theme on the public agenda. The youth groups who participate in the project will do so actively, analyzing their situation to guide and strengthen their non-violent actions. This information will be shared at subregional conferences of groups working in the same field and with society at large, so as to bring the problem to the public eye.
  3. Neworks for the prevention of child abuse:The project will strengthen the networks of organizations dedicated to preventing violence against girls and boys, so that they can offer an integral approach to the problem and present the theme in the public debate, for preventive purposes. The project's main activities will include an analysis of the situation of violence against children and producing a directory with profiles of the organizations working in this area. Based on knowledge of the situation and how society responds, the formation of a network of institutions will be promoted (or strengthened). The project will work in support of the required judicial and administrative backup as well as the network's institutional development. By the time the project is over, there should be an established network uniting national or local efforts to prevent violence against boys and girls, at the same time offering them integral attention and promoting the public debate on the theme in technical and political fora.

Activities

The countries selected--El Salvador, Guatemala, Honduras y Nicaragua--all have high levels of violence, which are reflected not only in high morbidity and mortality rates but also in the effects these have on socioeconomic development and on the community's perception of violence. The four countries combine the conditions associated with the occurrence of violence: social inequity, a high proportion of young people in the population deprived of chances for education and/or job; rapid and unordered urban growth, recent armed conflicts, high levels of poverty and illiteracy and, in some sectors, a subculture of the use of violence as the solution to social or interpersonal conflicts.

The donor resources requested to implement this group of projects over a period of five years amounts to a little more than US$ 4,500,000. PAHO will contribute US$ 240,000 to this endeavor by providing a Regional Advisor to manage the projects, as well as consultants in each country. The matching funds from the countries, US$ 858,000, constitute an estimate of the time that public employees and volunteers will devote to carrying out the projects. Each of the countries included in the initiative will have a national coordinator to manage the technical and administrative side of the projects. This post should be filled by the national counterparts, thus allowing for the initiative's sustainability.

Expected Results

Once the projects are over, the social network working either directly or indirectly in violence prevention should have been strengthened. The projects will document experiences and develop studies on the situation to allow for the adoption of evidence-based measures. This will be one contribution towards guiding the actions of these projects and other like-minded initiatives as well as to other initiatives in each of the countries. Finally, the activities included in the projects will allow for increasing social visibility of the problem, thus beginning the mobilization of national and international resources to support preventive actions.

Notes:

  1. De Vos E, Stone DA, Goetz MA & Dahlberg LL. Evaluation of a Hospital-based Youth Violence Intervention. Am J Prev Med 1996;12 (Suppl 2):101-108.
  2. Concha-Eastman A, Espinosa R, Pineda ME, Melo LM, Becerra ML, Martínez LN. Health-sector-assistance approach for victims of violence in a developing country. Accepted for a workshop at the 10th International Sympsium on Victimology. Montreal, Canada, August 2000.
  3. Bandura A. Aggression: a social learning analysis. Englewood Cliffs, NJ: Prentice-Hall; 1973.
  4. McAlister A, Orlandi M, Puska P, Zbylot P & Bye LL. Behavior modification in public health: principles and illustrations. In: Holland WW, Detels R & Knox EG (eds) Oxford textbook of public health (2nd ed). Oxford: Oxford Medical Publications; 1991.