Development of a community-specific health promotion plan to improve children's health in rural Guatemala

Abstract

The WHO Health Promoting School (HPS) approach embraces a comprehensive, integrated construct of a health promotion strategy aimed at the specific participation of the local school, health services and other stakeholders. The objective of this study was to initiate the development of a community-specific health promotion plan for the primary school in Llano Largo to reduce hygiene-and sanitationrelated health problems among children. Participatory Rural Appraisal (PRA) techniques and Argumentative Policy Analysis (APA) were applied to assess the underlying causes of health-related problems and to initiate the process of social learning among stakeholders, including parents, teachers, the village committee and representatives from the local hospital, local NGO, local government, and the village church. Stakeholders defined five core problems: 1) serious lack of hygiene; 2) no doctor and a lack of medicines; 3) hunger and malnutrition; 4) absence in school as a result of child labor; and 5) no discipline in school. Lack of communication, organization and education seem to be the underlying causes of these problems. In line with the HPS concept, a community-specific health promotion plan was constructed. A ''Social Communication Work Group'' was elected to execute the plan. In conclusion, PRA and APA techniques were successful to implement a HPS plan in Llano Largo. Followup studies should determine the long-term efficacy of the plan. rhea rates in children is abundant. A systematic review and meta-analysis summarizing data on water, sanitation and hygiene interventions by Fewtrell et al.(2) confirmed that hand-washing interventions are effective for reducing the frequency of diarrhea and disease. Water-supply interventions and water-quality interventions are also effective in reducing diarrhea rates. For example, flocculant-disinfectant can reduce the number of diarrheal episodes in children under 5 years of age by 50% (3).School health promotion on potential health risks can lead to positive changes in health-related behavior. However, the need for an intersectoral approach to establish collaboration on communication between different stakeholders, particularly the local population, is an important factor determining the success rate of an educational program (4-7). The World Health Organisation's ''Health Promoting School'' provides the tools for an organizational and structural systematic approach to improve school health, which, in turn, increases the learning capacity of students (8). The health promoting school (HPS)