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Background

For over twenty years, the Healthy Municipality Initiative has been a powerful strategy of participatory health promotion at the local level in Latin America. The movement arose from the need to effectively address the economic, social, and political determinants of health. The focus is on empowering and mobilizing the local level to improve the health of 

communities. The movement implies the support of local government in the establishment of healthy public policies, active community participation, the creation of supportive environments, the reorientation of health services, and the promotion of healthy lifestyles.

Concept

A municipality is said to begin the process of promoting health in the geographic space and with the population groups involved, when local organizations, citizens and elected authorities enter into an agreement and implement a plan of action that will continuously improve the social conditions that produce health and well-being for all of the people that live in that space. In essence, a healthy municipality is a process that requires strong political conviction and support together with equally strong community determination, participation and action.

Framework

In the Americas, PAHO (WHO/AMRO), has adopted a participatory development framework . The commitment is between the mayor, local government (all sectors) representatives and the people (community leaders, representatives of community groups and organizations. The following activities were observed to be common in the process of building healthy municipalities in the Region of the Americas:

  1. Aspects in the initial phase of the process:

    • Meetings of local government authorities and community leaders to understand the concept of healthy spaces and the settings approach to health promotion, these were many times initiated by the health sector,
    • A public statement and joint declaration of the commitment of local government and community organizations to build a healthy municipality,
    • An organized intersectoral planning committee with representatives from community groups,
    • Participatory needs assessment and analysis of problems and needs,
    • Building consensus and determining priorities for action.

  2. Steps in the planning phase of the process:

    • Participatory training of intersectoral committee and task forces in every sector to understand the concept of healthy, the settings approach to health promotion and participatory methodology (needs assessment, planning, evaluation and health education),
    • Developing a plan of action with broad based consensus between local government authorities, representatives of all sectors and of community organizations,
    • Developing and presenting specific projects to improve local conditions, health, education, housing, employment, recreation, and psycho-social and physical environments,
    • Mobilization of resources (personnel, material and financial) to implement the plan of action,
    • Establishing an information system, a directory and a plan to monitor and evaluate the process and results of building a healthy municipality (starting a data base).

  3. Moments in the consolidation phase of the process:

    • Implementing activities in the plan of action and specific project chores,
    • Establishing health promoting schools, work places, market places hospitals and other healthy environments,
    • Implementing communication campaigns and health education programs to create healthy lifestyles and prevent risk behaviors and conditions,
    • Systematization and evaluation of experiences, quality of participation and participatory approaches, and of the results of the plan of action: improvement in health conditions and quality of life,
    • Sharing knowledge and experiences with other municipalities, cities, towns and communities, establishing local and national networks,creating healthy municipalities project offices, newsletters, workshops, seminars, etc.

The movement faces many challenges as it presents many opportunities to continue strengthening health promotion approaches in the region. Without exception there is a need to continue strengthening community participation, both in the planning and evaluation phases. The networks and projects need to continue to build consensus and alliances with the many institutions and organizations within the health sector and with other sectors.

It is important to continue to be aware of the risks of political party manipulation, and to develop negotiation skills to deal with conflicts that may arise over ideological issues. The movements in all of the countries strongly defend the need to accept local government representatives from all political parties. The movement also needs to continue to be aware of the risks of excessive control from the health sector. Health promotion requires the leadership and full participation of all sectors, many strategies and activities go beyond the capacity of the health sector. The health sector needs to continue embracing health promotion approaches, and needs to build its capacity to implement health promotion activities.

The need to mobilize internal and external resources continues to present many limitations to implementing the plan of action in most countries and to deliver technical cooperation at the regional level. The reorientation of health services is an important challenge and a fundamental opportunity to be pursued in the context of this movement. As local government and community leaders understand the concept of healthy municipalities and health promotion goals and approaches, it is plausible that more resources will be allocated to the major challenges facing public health today.

Without a doubt this movement presents a fundamental opportunity to establish healthy public policies at the regional, national and local levels. The movement is supportive of the decentralization processes, it requires decentralization of decision making processes and strengthens local capacity to make decisions and control the use of resources. The healthy municipalities movement requires strong and determined community participation and action and it provides a concrete opportunity to continue strengthening and consolidating democratic processes in the region. It also contributes to build peoples capacity to participate in "reinventing government" and provides opportunities for people to participate in public choices and in decisions concerning them, their family and their community.