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lessons from the Field•
Integration of Population and Environment 11:Ecuador Case Study
ThiS boo~!et pre1entl fi,,:!ins;, from prckninJr, rcsc=rdl comp.l.,;ng the dkcti.cne....( fJmi:ypl~""ingllleallh programming with integrated health-agriculture programmIng in 12 commun,{iesnear Guaranda, Ecuador. The relearch was conducted by CEMOPlAf and the programming byCEMOPLAF and World Neighbors.
Foreword ..;;:;,;;;;::::::::====---lThis document is ~ working pilpt'f prl"lented at USAID's jan<;ary1999 meetlng, "Developing a StrategIC framework for Populationand Envi,onment. M It is conceived as a starting point lor an in-depthdiscussion aimed at:
• develop'llq a more coht!ll!flt set of 90<'15 10< popukltkln-envifOtlrnentinterventions;
• devising an appropriate evaluation methodology for such interventions;
,,'• developing an innovative .e:;earch and policy agenda for the field.
S~fal people and organizations are to be commended for their~ in making this program and the publicatioo of this report possible.Terel;> de Vargas of CEMOPLAF and Edward Ruddell, Pilar l6pezRuddell and julio Beingolea Ochoa with World Nl',ghbors wereinstrumental in creating the pfO<}ram. Ernesto Pinto 01 CEMOPLAFcoordinated the surveys and analyzed the resulb, and Teresa deVargas wrote the report. GladYI COlonel and lose Ninabanda of theBoIivar Integrated ~loplTH!nt Program provided invaluable ~adeMip
at the program level with the IUpport 01 CEMOPLAF clinic staffand dozem of volunteer promote~. Daniel Selener, PhD, 01 theIntemationallnstllute for Rural Reconmuet,on led an importantmid·term evaluation of the program.
Finarlcial IUpport for the Salivar program was provided at differentpoirlts by the Erik and Edith Bergstrom FoundatiOrl, the Tf\J1Irounddlion drld th~ rrO~pt'~t Hill Foundation, Geneldl 'UppOlt 101World Neighbors' reproductive health arld family plarlnirlg programscomes from the WilTiam and Flora Hewlell Fourldation and theScherman Foundation. Soth the Summit Foundation and the TurnerFoundation currently provide IUpport lor the ltudy and documenta·tion of lenOrlS leamed from World Neighbors' integrated populationand environment programs.
This publicat,on would not have been possible without Frank Zinn,PhD, and Mlta Sengupta Gibson of the University of MiChiganPopulation-Environment Fellows Program SerglO Knaebel conductedthe Englllh translatJOn, and Almee Balfe des,gned the publiCationPhotugr"phs "re World N~lghbors stalll'hotos,
World NeighbofS, lne.4127 NW t22nd StreetOklahoma Gly, OK 73120 USATel: 40S·752·97oo· Fa>;: 405·7S2·9393E-mail ' utionle"[email protected]'g
Table of ContentsEXECUTIVE SUMMARY .......•................uINTRODUCTION . . • •• .v
OPiNING REMARKS .................•.•...... I~
A NOTE FROM THE EDITOR .....•...............1
OPERATIONS RESEARCH REPORT ......•.•........ 1
I. BACKGROUND ••...............••.....••••••• 1
, . I INTIIOOOCTION •••••••••••••••••••••••••••••••• ,
1.1 Ol/fOMJ 11.3 SAMI'tING METHODS ••. .......•••..•..••••.•••.. 1lA SU~Vfr Mnl'fODolOGr .....•...••••••••••••••••• ,
""....... 11
./3.. .. 13
.....••.............. ,1
•
o
b
o
AGRKUIWIW. COMI'ONiNI •••.•.•••••••••••••••••1
Agrlcullllral A'fM'dl 2
Land U~ .2G~erol ChOfoctenltiCJ .J
c. Proj«t MtMlles . . , .5lm~ge 12fI~otlOnJh!p ~rwl'en World Nl'ighborl ondComm(Jnj/il'l ,
b, lmagl' Altriootl'IC. Vol(J(Jlion 01 5I'MU$ Rl'Cl'iv/'dd Covl'r091'
Opm>QII ooo..r WQI/d Nl'lfihborl' OffiCI' ...
2.1.2
11 AESULH Of TliE SruOy
2.12.1.1
2.1 HUITII COMI'ON!Nr .•.•.....................•.15
2.2.1 Charado:orhtk, of Womo:on lnto:orvlo:owo:od 15
2.2.2 Fo:ortlllty 152.2.3 Morbidity .......•.........................16
2.2.4 Motho:or and Infant Hulth ..................•..162.2.5 Fllmily Plllnnlng ...................•........172.2.6 Image .......•.......••...•..•...•..•...•.18
O.m:.'IQwG,'.I, wflh.Fr~r(ln: .18b. AlSl'$$mem of rhl' lI.~o/lOnlh,p .. . .. ... .. . . . .. 18
c. ValuatIOn of (lMOPLAf. . . . . . .. ,., , , .. '9d. SMlicI'$ to USI'r$ •••.••••• •10I' Covl'fOgl' of Sl'fvicl's 11f, Rxilit~l .. .11
Ill. CONCLUSIONS ........•••••••••••.•.•.•....23
.... , :.. ii~"".. ij .:-v....~""-"•.........•.............2;3.2 HUlrlj·O",r (o...",(JNmu .......•.....•.....•..23
APPENDIX .....................•.•..•..•••24
[" .J.:" ( ".LAI::CULlVI:: )UJlIJllar J
In fin effort to comlMll! .nd.~StiS ttw Im~ of "ngle"foc:u~
VI integr'led p<09I.mm'"9 on
(orrvnunot)' I~lh. t...."" pOMvW>yKCepYnc~, .nd commumtypm:eptJOn of~t prCMdtr1,Worid Netghbon IMrtMred WithCEMOf'LAf «enter few~Guidoln« .nd ~amily ~nning)
to imp.:"ltnt two clis\JnCt lotfVictdeWtfy wategoe .. 12 commomile louted in 8olMor P'!'ovInct,EWoldor SuI (onvnunot.oe p¥tlO
plledin~plogo.i"_g.nd Wt~ .. a br'oIdft'•..Ieg,.ted· progr.m~holth. Ignculturt. 1nl! nalural
resourct tnli'\IgtI1"itnt
He.tth Context
~ t r It WI'V't)'l ondattd "9"Mount holth p<oblems in bothsets of (ommurut!tJ Rouahlv.S~~ 01 chllcl.en _t .ttlol;ttd
With dllrrhea and 6O-70'lb Wllh
~'Icwy ptObItms In IdditJOn,~~ few womtn rKti\l@dproftuionJt flUisanct dunngchildbirth (bttwHn 2G-40'lb),.nd only .bout hlIlf the womtn
llI'oughl IM,' childltn to tiltht.lth (tnltr .lttr lithtry. Tht(ommunlt,es part'CIp.lI'ng'" lht"'tegrated P'09'am wtrt ~onulIy
"'urd. I Iht hUllh I,mu" Ai th~ btq nn rlg of Ih~
llud" k'll'witdgt ot bIrth (011'°'mNi'odl wallhtrt'u<t mud'I~, ;n Iht'l' (ommun tltl(3~ ) Ihan In Ihf' hta:lh-onl,c rn",un'CI{(,~ farn Id"
mng uw Wal fl'lCldfolt in thf'htfllth-only commun,tleS (around2S'Mo) find low (12'1l.) .moog thf'
,nlegr.ted prog••m IH'rt.oeopdnu.
Agrkultur. Context
Erosion, loss of lOll ffttjl,ty, andl1!duction of hum~ combinedWith popuIItIon growth to~lIfKt~food~.
ThlJ It.omWted !oeIsonaI outmogr.tIon of tnll6, lhon.H 1.10.pe ioI:h, .nd thf' culUVlitlon oflt~~ Doought findtJ<CeSlNe flintal 100 cootnbutedto soil HO\.lOI'I find tWturalreourct degrldltlon.
HNlt\h.OnIy Int~tk>n
Thr "" COfT"lUlllleS pirtiopIIng'" holtn-only progflmmroginoUlly focmtd on promotIng~..,~~~"~'~:"" -,:, ,-...~_ .._-IlK through commun,ty-b.lsed
distnbuton. Ounog tht ltCond.nd third )"'.n of ttw ltudy, ifl
ItlopOfUt to commuruty l1!qutStl,
tht progr~m eXlH'nded its -Kopeto tnromlMlS nutntJon (If'ICluding
vegt>yble gardening find ~a.t"
tt'f'd ng tr~;nl"9): t'Ch.lUllon.-bout .nd \1l!~~mf'I1llofd ..rrhe~.
mal"ul"t"", ~nd rtlp;'~tory
""('(I lOOS: and wo~'s 'f'I'.n-
t' l!' ,e"'Kt' d"tht \'Ulmtnl of rtproou(lI\tt'ac\ ,,,tcct'onl and rap tests)ldU(.ltlOn and ,erf'ff~1s \0CEMOPLAf'l Gu.Jrand~ (Ion"\\It,l' pro~idf'd bv CEMOPLA,I'. ned 1.'olu"lt" (OO1",unlllhe 'h p'o"'o~~-,
Integr.ttdlnter¥ent~
1l'lt ;nleg'~ttdprogr.m in tht
ull"" 'IX tOf ..... 'U:"lJI:,l. tUlIl.ll..t.·1J01 a~I broadtr ."tIIIhNIth oIftmg Ifld In~.v
fWIlural l1!SOUn:e component. 1l'ltIInn included soil and w.IHCcwuervlitJon; f.rmtO' txptnmHl
tltJOn Wlth ..~ of wht.t.bartty and poato; tht use ofCOYtf uopl .nd compost.vegwoble produetJon.; .00 smJIlIYtStod impl'O'UTItl'1. Tr'OfWlgIMId mtrJab wtre provodtd by'IOlun\ttl' (ommuruty iltalth and"9rtCulturll promottn. traootd byClMOPI.Af and World ~hbon
rt3ptC~.
---1l'lt commumues wert ldKted
through. _le of ~tJngl10
Otterrnlnl: l1lItI' 1e>-t:.0I "'*'911:»to p;lrticipllt in tht studyIntegflted commUrllt.oe _'f'flboo 11!qU~ 10 POSStiS communally owned IInd, Once tilt(ommurwt!tJ wt'I1! stl«ted, abtitlIne lUfYt')' wal IdfT\ln,nf'l1!'dto. i.Wii~oI~famil~:
tnllt M~dl of I>oul.rilok:l
.t-lponded 10 lIllf1(uhurt·,tlaled,nqUlna, .nd Itmaltl ot .epro--
,." '"'tl.11l'd q....n ons n,,1'f Y"J" tr,a loliQVo'up lU~ ",a, Wr>dtKll'<!,n t!le ~rT>F commun,\,c, ul "ganothe, ,aodom ~mplt 01 480tam,l,el
Executive Summary
Prellmlnill')' Results:Agriculture
P~rtiClpJnt1 in the integratedprograms ,ncreased melr use of
sustitiNble itgn(ullure technllluesand expressed p<Xltive alllludelaboot World Neighbors.
• The number of faffilffl usingerosion prevention tKhnlquesdoubled (from 23% to 50%).
• The number offa~ growingcarrots alw doubled (from26% to 52%).
• The number of farmen planting9r~n manure to improve soilfertility inueased from 0 toalmolt 40%.
• 85,*, 01 f;wrnen su~ 5<lid ilwas necessary and important to«Induct experimental triills toteM crop varieties and ltitilizen.
• 79% rated the quality 01 WoodNeighbon' servlces;u ~ry
good Of exc~lent, and 94%indicated lh~ would continuewort.ing with the organization.
Thest' '!lullS represent a signifi.cant improvement in the communlues' agricultural practices
and UJgge$l strong IlIPPOrt amongresidents for World Neighbon'programming.
Preliminary AeJlJlts: Health
Due to onlv modest chanoes ingeneral health status arld health.sef'king behaviors, su,h ilS
obt~,n,ng proteS>lonJI Js..>tJn,~WIth ch,ldb,rth Jnd visiting J
doctor lor 'hildhood tllnesses,the reseJrcher concluded thJIthret! yearl was not enough tJmeto observe signifi,ant ,hanges inthese Indlcatorl. However, there~ dramatic differenc~ in ramltyplilnnlng I<nowledge and a"ept·ance rilles betwef'n the ~Ith-only
and Integrated communitIes:
• The rate of women knowl·edgeable about biM contr~
methods rose from 35% to 78%in the integrated communitie.
• Oespite the hIgher Initial rateof undentanding In the health·only communtti~ (65%),knowledge levels among theseparticlpanll improved onlyslightly during the thref'·yearstudy.
• In the health-only communities,family planning usagf! remainedstable at approximately 25%,while In the Integrated corn·munlties usage increased rrom12% to 41%.
In terms of CEMOPW's image,both sell of communities 'atedservi=. highly; appro;<irnately 80%0( I'VOfTlm in both groups rated theorganintlon as good, very good,or excelient. Where differencesdid exist in terms of communItyevaluations of CEMOPLAF. theIntegrated communities tended<0 p<ov,u~ nly"~r r,,,my'. 'nlSoc,urred, for example, in thequestions regarding the likelihood
'"
or recommeno"'9 t.:bl.tu~lAf to dfriend, me hkehhood of continuingto use s.e",i,es ~nd me ,"tended
frequency of \'IS,ts. In Jdd'lJon,the Irftegrated communities ratedCEMOP\AF~ positively in ¥ea>
such as quality of Informationprovided, provision of se"'ices forlow·income peoople and ~solving
health problems effectively.
Condu$lons
While fuMer research Is neededto confirm these findings, thepreliminary re.sUlll indicate thalIntegrated se"'ice p.rovlsion canlead to .significant increases inramily planning knowledge anda"eptance In comparison totraditionalsingle-fccus appro;Khes,More won needs to be done inreplicating these findings. Forexample, it would be valuable to
explore more rigorous evaluationdesigf\.l that further control fordifferences among comparisongroups, as well as miJ<ed·methodology approaches thaluse focus groups and other tech.niques to examine the processesby which communities adoptrecommenoed praC!lCes.
For information on the morerecenl results of the integratedprogramming model, please seethe Appendix of this report.
A vil/agf' voIunt_llfoollh promoUr lroinro by tilt pro/«! (righl) chots wilh young mol~ dUring on ogriclJlloJrol flt!ld doy
Introduction
A Model for Reaching AuralUnduu~rYedCommunities
Six ye~r1 ago ~ small fam;!yplannIng clinic in the provincialtown of Guaraoda, Ecuador Wal onthe vl!'rge of dosing down. Thedinic, established to ~rve ruralQulchua Indianc~ in
B.,•• '" .... " ..n~~, h..J l...v r"" ....,1.to justJfy k~pln9 III doors op<!n.Today, the l;1me clink provides
m~ than 18,000 consultatIOnsper year - includong more mar>2,500 u~rl of family plannlng_and is looking for a ~rger locationla meet growing demand. (Iinioin other proVlOCes of Ecu.OOor andIn neighboOng 80livia alld P.m. arefI{ffl.setting up programs designedafter Guaranda's successfulapproach,
Testing the Beneflts ofIntegration
The key to Guaranda'sluccellis to ~ found in a rather unique
OPffiltions Researdl projKt carNdQUI from 1993_96. This study,published ~fe tor the fi~t Ifmt'.~an woth a simple hypothesis:that an integrated approach tocommunity~t_ whichresponds to local priorities suchas food s.,;urity, n~tural re.lOUrU~
m~n~gement ~nd public he~lth
willlud to greater well·beingarlO mgner a<t:eptance ot tamlly
planning than a" approachfocuS<!d on family plannirlgalo~.
Twelve rural communlues
tooo. pan", the Study. SIX wefe
irl~olved in an integrated com·
munlty development progr3mi"eluding sustainable agriculture,
rlatufal resource managementarld public: health activities as
well as reproductive health andfamIly planni"g educatIon andlel\'lCes. rhe otner llX commu'lll.1el
re<:<!ived only the reproductive
health arld family plann"'g com·ponent The study ther1 compared
the attitudes and practices offamilies in the two types of
communities.
WIth Encouraging EarlyReullts
Family planning a«eplance in
the six integrated communitiesgrew more than three_fold. from
11.6% in 1993 to 41.1% in 1996(a slatistlcally significant finding,
with a .05% margin of error). Inthe six communities re<eiving
health and family planning only,family planning a«eptarlce
dropped from 25% to 22.2%dur",':l th~ >3m~ Iknod \thischange Wal not statistically
significant). Many other findinglfrom the study point to strong
link.! betwet'n the integrated
development approach andacceptance of family plaMing~nrl clini, ",,,,ir... in n ..n..r~1
Project and clinic data since thestudy was completed further
undef$Core thIS relationship.
A Partnership with Promise
Behind thIS eXpe1"iment Wal a
partnenhip~ the Ecuadorianfamily planning organizationCEMOPtAF (Center ror Medical
Guidance and Family Planning),which operates the dinic In
Guaranda. and WOfId Neighborl,
~,\ ~ild"~~<J<\~1 v'':l~'''l~Lv'' ... ,lI.experience in people-centeredcommunity development. Prior
to the Guaranda lIudy, the twoorganizations worked together in
neighboring Chimborazo province,
where World Neighbors haddeveloped highly effective agri
cultural arld natural resourcemanagement methods well-suitedto the culture. climate arld condi.
tions of the region.
CEMOPLAF, founded in 1974as a non·profit maternal heallt1
and family planning organiZiltion,is now active in 21 provinces of
Ecuador - or half the cotlntry.Using a "multi·services" approach,CEMOPLAF's clinic.! provide a
wide range of OB-GYN, maternal
~altn aou ped,atnc lC"'~el onaddition to family planning.Medicalservicel make up 25% <ic~nlc visill, while family planningconstitutes 75% of lervices
nationally. CEMOPlAf offers acomplete range of family pl~ning
...-l"f~"('"'' ~~<l ..........."""••n<l i. ~
malor distributor <i contraceptivesthroughout Ecuador.
f-.ly pIMoning use In ECUKIorIs 1ncrnMg. In 1997. 6O'lIl of~COl~ lMd f.nly p/¥nng~t<, (WOpW twl~b" more SlKcl!'!sfulln deliveringfamily planning J.efVk1!'! !O urban,ladlno popuLatlonl Ihan to rural.Indigenow peopIt, Yet Indigenoularnl typically~ the highest~ 01 fertility and unmel IlH'dfor~ health and familypYnning l«Vic.es. In ao/rva'prow1<e,. few uample,~ ruralQudlua population hal I fel'tJlotyrite 01 S.l. Resistance to familyplanning~ In pIoI't from~ people's well·fO\.lftded
lU$f)iOOnS 01~ rnotJ'oI'rS of out·!'den. cUtmg from tht~rilKU of tilt' Spanan conq~Indigenous people In Ecuador IreYOalm~onmattel01 poIitiul and cultlnl lutonomy.~t,~, .I,n I'oolon r.,;"~"".
from 'eligloui aUlhorltlf,i In j.()rTM'
areas, including Bollva, Pfovioce.
The dinic In (.uarandl, estab~ in 198", had alwl)'l beffoundmJtilind and was Kheduledto~ .....nen Worid Neoghbonproposed w idN of In ""t~led
ptOgfam, Te<alI ~ v.~,
ClMOPLAf's b,t'<ut ~ Owtoctorvn,lI!'l.....nen she .eulh he'r ntJ,l1
"P'UP':": I ld andRuO~ "Ilhovohl ld and P,W'.....·f 0""Y Hovo. can _ If1\l'g'dlt
f~mll) pl.nno"'9 w,!tlacneuItUf~'~
H~. lhe "'I,m Wilt, ~ul'>de'iland,"g that tilt' PfOlKIWl bt c~"ied out .1 .n
OperltlOfU Re50tarch study tocOfTlplre !hot ompKt of IntegrltedWIth non-inl~rlled approaches.
World Nelghbon, " rlCl"H«t·lrian and non-profit ~nizatJon,has worf<ed In close partnel'lhipwith rural communities throughoulAsI•• ,t.Jrica IInd utln Americasince 19S1. World Neighbotl'goal Q "to strmgthm the capKityof margifllliHd people to meetlhl!il' basic ne«b and to~and WsUolO In equrLIbledr. elophleilt pro«:n.. By begin
nng wt!h F*Of*i'~ pr..0f'ftie5, Worid Neghbon P'otKuillre USUlIIy In!~rated in some~ - addraslO§l I range ofIlH'ds IInd recogniling the inherenl Connl!CtlOtlJ in people'J livelmong food 5«urity, natuflllresource maflllgement, family~llth. Ind rePfoductive health~nd family plafllW'g,
Through well.(locumentedSlKeel$l!l In Nepal, in plrtnel'lhlpWIth the fllmily Plf,nning Assoc'l·lion of Nepal. World Nl!ighbonhIId Jhown that irI'Ipn:lmg ........health. soil CoruetVIIuon. agrofO'e:S!')" and dt .... '9 wa~ S;'5l~
were II~ e-If«t_ st~ towa.d
rnharlc d 'ep"odI.Ict....e hu~"'" lam 1'1."n no,,, ""C'<,.,......
"', -he. 801.../1. Intrg.,lt<I ~-el-'rme.,!Pro;llillm" w~ desrg'ltd t •th'i Inttg.ate<! apPf"",h onlcuitdor UJII'Q quan!lla:.ve ><>ell!
'>(Cttn<e mfthoch
The OR Study Dellgn
The 12 commuMJl!S p'r1.lCi.
p,lllllg U\ 1I~ Opl'fduoru ~~dIUt
_rt' sel«ted by CEMOPlAf IndWoOd Nelghborl through a $frlesof ml'!l!!ingl to determine theirInte.est and willingnesl. Be<IIU$faclive p'rtidp.tion iJ essent;,I, ItWaJ not possible to r.e1Kt thecommunitie:s randomly. \''1thinthell! communiUl!'! /I b/l.seline sur·vey WillS uken before progr/lmIICtivitil!s begIIn w.th I randomJoIIITIf* of 400 fllmill6. Thrffye.if1 Ia'.er thf~ _ reputed
In thII! same COI11fTIUI'I!tJl usongllnother -.ndom sample of "SOl/lmrl!l!S. The Int~ exploredchanges in people's well-~ng.ther use of JuStaIl'llblr! agnc~practices. their u~e 01 familyplanning and other clinic lef\lices,and their perceptions 01 ClMOPlAf and Wo.1d Nflghbo"
The Programmlltk Appf'OHh
The approach 01 the PfOQ'illm,uetin to traon o;oIuntl!l!l' health
and agricultural pmmotM fromthe cornmunoUl!'! Thew C<:JurWI
~!hen crpk.ate<! In-~.
sIlops.1Pd bv!!>e o;oIunl"'l'l A
t,~'T1 of~ ' ..~.: me promc.:~'J
......""" • "" ,.., ..../1.... /I"''' """, ,"9' il'$"',l If1 t pl
•• •)W.up .nd ,uppert \h'ougll
'rgul~, COmmUnl!V V",!J Alte,
H\r '''Si yt'." all .rtvl<t'l Wt''''p'ov,drd In the C£MOPLA~ (I n
'a'"
IntroductionAddrening Ch.al1019ei In th~
~..lth-Onl)' Communltlel
lhI!' tw-~ltn-only P'09'3'" gotOff to ;1 \low SUit. ,n I.I~ p.l11
btuwe~wasa_~
Mlph,uis on family pUnning
~ did not resp:nf Wll!ll1O IMtopIC. esperirly on 910UP settlOgl.·Commuruty $U1WyI~
that ~ people"' ont_tJ~dlfferwll from 0UI1, We sU,rtl!ct
Dui 11'1 • tIlS/O'fltea 1TIMIneI'• .anathe fim-)'@M~ w«e wuk onIw~ • explA-led GI.Il¥ CortwleI,who _ as progr"''' mordInatQt
..00 health promoter The Iou'~~who _t tntoed asconvnuMy dostnbulQl'$ .-.d
9""ftl .. supply d (ontrK~(ptIIl.lnd cOlldoms) did not
dIStribute Mly'. MId U-~Wete~ to the cIatuc.
AI. thl! end 01 the fw1t ye"',following "" ~llon laciI'Ultedby O,n.eI~. PhD, of lheInll!fNltton.! InstlWle 01 RuritlR«onwuctIon (lIAR). the progrMnt9m decided 10 broIden the hMlhmethodology 10 indude nutriuon.nd poit.naloll he,lth is~, A
study woos done of malnutritionamoog ctlll(lren under two ItnutnlK)n component WIJ lotrodIKed in tandem WIth ~bIe
ga~.ng. IS wel m trall'Hng Inbreast fHd.og and nutnuon lorchildren unde" two _ 'Mth .. focuson diarmu, malnutrilJon Ind
'I!productl~ehealth seMen WCff
also promoted. in particular thetreatment of reproductIve tract
~""""""'> ... 1<l.kl~'<.:.u., VI ~""'''"'''~r lhr uqh P"p' 'I;
Smoother Start Inlntegrat..d-ServlceCommunltlel
The ~r;al component~~ to communII:yneeds a"ld INdo! plO<.IbS from ~~wli '9 Dt:lptd a"ld ploo 'lOt."dby JuJoo kwtgeW.Ii 0c:h0.I. Worid. - . ..~~ ....................., -~~._.-
(cU.lidor, ~ progr.am promotedKlil.llnd w.liter conserw.litlOn,
f.lirmef ~.p«im«lUtlOn wothv_tiel d """-I, bMIey .andpot.Iito. the Uiol' d CO">'e" crops.Iind (OilipOlt.~ pmdi "1ion.IInd SlNQ ~Iod<~
lleiogolt.l ~tt:d ~~'pproKh by ft'ICOtIrotging thehulth .and .llgrialltunl promo~to be CoofidmlMkl~ bothttleme$.~~ plOIllOlB
IOW Nuwb6nd.l. who is bilingtwl.00~ WIthIn thecommun.ue, bK.Iinle .liCtiveIy~in.'~oftho!
he.rth c:om~t ,n tho! integrated comnM.ln'be _ 'nduding
proooOOlior' of family planmng.lJkew\H, tho! he.lth promot~
beca~ .n.IiC~ p.lii'tlC,p.anl ,nilgnc:ulwralli8::l day1 ;md b"a'nlO9~SSlonS
Subll~ FP M~uag~
G~n~,al~s Comfort, R~sults
The lum foond that althoughD'KusSlng lam'ly p!anniOg openlyin tht commun,tits was oftennot acceptable, ,nd,viduall andcooples coold be encour.ged 10
vii
(..,11\~ III l~ ~Wl.. ,n ...u", J"<.lJT1" ~ J"'en ., AtJu,il
<lnd Pf1"JI~ QfooentJl.lOt1 to repl"G
dud.tv~hu .h Jnd th~ lCf'vl<:tl..... aOUbIoe. In the commun,tIfi,tho! t~.am g~~ U~ tho! tmn.~ parmthood.' "Peoplt
m! inttreted on FMTWy~they ju" don't WArn to t.IiIlt lI'I
public:.' a.fysu~_"'TMycome here .and we dose the door
.Iso brought people to the dinoc
~WoIId Neoghbon-CWQ.Pl.AF P'09'"MTl otr,,~, l.Ib.IoIledwothin tho! CEMOf'lAF c:lonIc: II'l
~ becMne a drop-inclMter for people from the rutM
commurutM!'! whIM they~ to
lown. On tNr1I\et dqllnefl "'~;and walt. obvious/)' comforublep.liwng through the dinK. TOOwas • sign of the lrU:1t and.upunc:~ esubished throughthe int!grilted .pptOICh 'In theloin few ~¥l. 1T"IOf~ Nl"al PtQpIe.~ c:omang 10 the dinic," tMdysaffirmed. "Then! is. good~of truSt.p~ lull drop in,~tUlles to ullt .bout ~rperson.l problems.' By the thud,~;);. t.~ pr...~, ..m " .... .l1....... loJstrong reultJ ,n both he.lth ..-.dfamily pI.Inning and III ilgnculwn!and NWrIl n!SOtlIU~L
The thr_fold inc:r~al~ in fam,lyplann'ng acc~punc~ ~~IJ In th~
11. Integr411!d communltll!S was~IOtC,allv ItrikiOO .1 the studvShOWl.
I .......... J .......; .......IIUUUULLlUII
World Neoghbol"l and ([~1O.
PLAF "'ill e~p,ond the 60l" ..
progrlm in 199&-99 to I toUI cl40C~ in thfH rurlluntoou, .....lh support from ttwPrO!oJ*d HoII klulodouon.~oortnw.ritJes wiI~ in theintegrated progrlm lod therenainong 24 wiI partJCi!»tt n
the~ program. TIlt!integrlted program will combi~trllOlng In aglicultu~, loOiI andwater conservatIOn, animalhusbandry, and ~II healthalong WIth reproductM! healthand lamily planning training,cO\lnsellng, and services. Thelotal population of the expanded801lvar p'og,am a'ea is Ipp,oxi.mately 4,000 families. The annualbudget fo' thi! entlfe program isUSS60,OOO.
In .clef lIOn. CEMOPLAf hisplans to extend the Inlegrated
appr-oadl to IIJ other dnocs~ru,.t" .~....a~ onEc".oor TIlt! flrlt 'eplic.ilion~ hu begun n Cljlbamba,Chirroboiuo prOVInCe. withWotId Nr;ghbon support Ind a!JfJlnl from the Brush Founc:f.IItionCEMOPt,AF 1\ IIl.o prOOtK>ng ..educational~ based on theBoIrv'f e~jXf~" 8e)",ldE,wdor, WoOd 'Wog'CJo<'III UI'"91.'1II~".ida rTlOtiej to,lu"Tltd I IIJ P'09'IITIl e _rn,rr
L. "''''''''1('
World Nt-ighbonana ((',lUI v.;continue to
cpted and 10huItto only). The10 convnUnll>el
on lhf: onL,?.ttrllprogrlmacCounled lor36'11I 01 ID newlod 24'1(, cl Inronunuing flmilypLtrming ulffS Itthe clinic:. Theefindings artpresented in
grutrr dt~il '"Ihe Appendi. of
Ihls report.
Nvrt Step, forthe WorldNelghbon·CEMOPlAFPlort~hlp
"_0000.. •••tu,. 11",. ~t(on uc
(IIRR) 10 documtrll the prOft'Clapp v.u;h lInd ~~y ~Iom
If.atnr<!
IrYtyn IOd_.m.Gulrlndl~
II'l order toI~ute~
Ind repr.e,loon ..... thin ECUIdorlod beyond "pIl't.oc:'!»tof)' eo..,1.W1'Of'I prO(e» ~ being Clrriedout from December 1998 '
~ vends hive conl<nlle'dn the two yel" ..nee the 1100.
WI,S completed In 1997·98 the
•t~n 18. :00 "I to., ,ncluo,,'9
2 ~8S ......" 0/1,....,'" pl~n" "g",...ocel 8~ 1097 Iho' programroo ~'!»nck'd to 22 commun<ton
20 01 wh'ch were mon'tored 10(Onlln~ trac~",g the res"lu of\'" trltrg'dl{,d app'( ch (10 ''''~.
FM C£MO#'tNdtrIic.., <;wo... P"l"wlDol CGptdd 1dIva, Im btcOlhl! a gathmng pkKr lot Iot7owr1,np«JdIy on Inlrit1 dim
Opening Remarks
~ _. <ISi~ pI¥l
nir>g ...sLl.l.ot>Ol'ls, see ~elo "'Ioncapable cA rNChong our obt«.lnti .t the rur" md~Dylndogenoul IevoeIs beuwe 01common Cultural d'wllenges andlIc.k 01 edUUtJOn pttieflt in these",~n We thus must ~arch fatcom~tMyIU..tegoes, ~en ,f!~" ",-.' ,~" hp,I." c'~r'f'
order to g;ain community accep·loIn<t It Is pre<:isely !hil exptori.ence that CEMOPLAF war'lU toshale WIth others
In September 198<1 CEMOPI.AFcenter no. 13 was created in theCIty 01 Gu.vand<l, 6oliv..... Province.WIth m.1l)' pol.tlCal, SOCJai, Kc..nomic and rt'llgooul oblt.lcJe:s In.cXl,tion, !hen! Wit, .Jmost noto<l'U1'MJnIfy acceptance l.Ir'I(!
huJth on ~a1, ;IS w8I .IS
reptOdI>clM! M.llth,~ not f~1
nHdIat the cOfTl/JlUM)' Iewl.Clients. who~ very diffICult toawK\. yme for~lure .-d gtntr.Il~. butnot tor pmuul un Off~
p&annng. One hundred percent01 the citnb were from urt-o........ on "t"':~.,.l :J.c: :..... l ;/ ...1
Hriicl!:i _e~ on ruralMeu and ltwt the dinic: wasopen from TuncUy to ~turlUy toU1ke .uv.n~ 01 the~~.On mlny occaSKlm, CfMOPlAfwanted to~ W center.ndtramfer It to lnol~ <Ilea lince,at the bme, ,nstJlut;OI'1al 90",11toolc pre<:edenct over satJsfyingcommunity n~s,
1rl1991 ¥l~t atCooperlot>on.andT~AwlanCt w.-s~~Worid Negtlboll m C£MOPl.N
The genet3III obf«:wes ""'We:
,. to ir'lo'uW!~ hulthuw in Nral and ifldigenous~rt'as in 8oI;"'~r Provinc:e;
~ ,., ...:~,~,,,jl" ","'" ..,~(..m~pplylng an integrated com·munlty~t .JPPrOoKh.w.e.luding health and aogriculturt'components;
}, to promote Improved qualityof life 01 the indigenom population In 6o!;"'ar Province;
• to oHer t~hniul .advice whidlwould lead to self~tof the indigenous POPU"'tion....,thon the context 01 theircultural identity;
.5 to det~ the mpKt of_10 Ire<!~ pmdo"""""on l.mty plMwwlg~~te;
6 ¥Id to musure tIw impact 01the Integrllted prot«t on theIfNge 01 CEMOPl..AF .noWor1d Ne.ghbor1.
lhetfole, in IuIy 1994 a projectwas Slarte<! that would Integrate~ Health, Family I'lannIng..SeIf·OeveIopment, and lalel,Nulnuon
The proje<t ~nt through a~riel of changes al it gainedstatus Within CEMOPLAF, At the
I.
~mnong. ad,Ustmel'lU had tobe mIde to ITIlft eII«t1rd) l::Jndgethe health and agncultural cornponenu. Also, a lot 01 emphasiswas IOltlally placed on f.amiypl.aMlng. which w.as pn!tT'llturecomidtring WI our large! popubtion did nol yfl- identify it al ale;t need, In additIOn, there wefer ",,-I f" t' fT'\ "\P'"'C; ") 'n
the health leCIOr. The extensionagent was repl.a<ed three times,.nd we ~re not able to find abilingual person for lhe job. Wefo..nd that the propoled gOilI1were not realillk and did notfocus enough on the communitywor1t. Rather they empha~referrall to the multl._eCenter, whICh did not have theresoun:es to be.bIt to processan the rt'PO'U coming in fromthe different communities.
A.s the Integrated ptotKtde'oel~ and learned, d 01these-..~ MId obstKle-..e O'o'elWlTle, and bothCEMOPlAF Mld World Neghboo~ very posotIve restJIu. forex.ample:, CEMOPt..Af's iINge Iw!l"ntf••" ""p'.....t<I of> the ....uetNt~ pLKe on service!proY>ded by the org.iIni.l.allon
incre.aleS. Thu hti rt'SU1te:l inbetter one of e~tstlng resoun:es,Inae.ased Ule of local UopKrty, <I
higher level of sust.1inabdity atthe Center and OtqanizaUonaldew:lopment ami strengthening,Now~ have tM wuslactlon ofleNlng between 60 and 70clienU per day In the clink and
Il._ ..__ .__ ,, ..1..
upellllly l\eUI<H!O,-__
rI>t WofId N~hb0r5-C!MOPW legm in t~ lkJIivar provina, from ~ft: ProgromCoord'lIOtOi Glodyl- Comrw/; Agriru~urol Promolet loll NinQbond,,; !cu<Ulorl),rwClt for WofId N"i9hb0r5/u!.o ~ngok".
,
laboratory, of whom 70% are Iromthe rural area and 30% are trom IM:urb.1n area. Family ~rmlng succeededi" l-'''mi''9 ~ 1,,11 ,,"""<1 i" \11..
comm\lnities, overcoming barrle~
and common prejudices 01 localcullure and lI"adilions.
In lerml of the agriwltural program, there were changes in knowledge, attiludes and melhodl arour\dprolecting and improving soH fertilityand increaling crop production.~ changel stres5ed Ihe use 01local relOurceS rather than e~lernal
Inpul5 and finding waYI to prevenlenvironmental degradation. Wesuccf'eded In railing the awareness01 pealant tarme~ aboul Ih" impor\.<lrxe 01 nat",ral n'!5OUrce conservation,especially lOil and water. The5emelhodl include dive~ifying agricullural production U5lng conservationIe<hnlques. installmg proleclivebarriers using native and noticfort'l 1'1<11>15, PIOltd;119 1000al ","It'sr.eds. planting kitchen gardens anduSing green manure.
The presenl case 5tlldy exemplif16tr.e famoul ph",se, '"The end justil"16tr.e meanl: Now Ihis projecl isbeing replicated in other indigenoUIcommunities in Ihe same pro"';nceand in olher areal of Ewado<.
ANote from the Editor: Next Stepsby Frank Zi"n 0" ... '0' "f Ih~ Md' <jon Populm'''n F~r owl P""l'om
~ M~h'9¥l Popua.,tlOfl
f~...~ p,'>9'.... would 'e townl< World Neghborl ~ndCEMOPlA!' fOf thelr work ,nmaking th'l research available to~ 01 us commrt:l@d to e'>'alwlrlgthe potenll.1l1 for popul.ltlOn
~tJn~ration_ ThIsstud)- is .an ompolUnl fiN step in' ...... '"'!I" ...~ 1,1,", ......"',............ _
~ 01 hoIub( progrmunongttwt IS~ to CommtlrullM'
Sf'If.delined priorities O'1e( thatwhICh Is more SKlor.1 and
provider-driven.
Bec.w.M this~ is beong lM'd~ a~ IOf a diK'\lslOOI'l01~le i!YM.r.auon~~ for popul.ibOrlerMronmtl"ll programrnmg. tNFeJIow1 Program would like toshare a few comments on therese"rc.h lRs,gn and propo~ aseries oIMne.oct S~M for fulU~rese...m.
As ~thro poontm out In n.sntroWttlOn, 1hIs prqect wned notmemy 10 cOtlducl:." e>.ptl., .... ,l,.
but to 011" '~6. thMl"'d ,n OM!
by (;ommun,ty demand andeoisting infrutruc!l,lre. This issueaffected the researdl~n ilnd
must be f«:Ulred into '11)'
conduSlOtU about lho! value ofIntf'!jtat>on In p.ir1:lCWr. theSotiKbon 01 l~t Comtnll....bn w;M
0I'l\iffI ~s Dy~ Oftlb uwnby t~ communities themselvesWorld N\!,ghbors' partIcipatory
~ 1I"J9"'W INt onleIptfO
progr.unmong IS ooIy pos~ ".community is 111 fun agrftfTltill
WIlt! a pn:lgri1lTl'S !JOdIs, t mtmbM
are ugef to cooper~t~, ~nd Ifthey can commIt 10 offeringlime. ~gy .nd feedback.
~~u-'~• , a v>I-"'....., blal'" tP'.
ellpeul~ntllCOl'lUl1Ul"llt>~, grYe'l the prKlI(.dIfficulties of Im~lIng •PlIr~ ellpe"ment~1 ~pprO<l<h, It isimport.mt that th~ nut n~pCoruisl of I mulll.rnWMxlology
~. for ex.vnple, ~ WorldNf:'9hbon MId CEMOPl» _
more MId more tommunoW:J, itwiI be imporunl to~t grouplfor torr1pM1SOfI 1Nl on IS smiar ISpouibIe in ttrms of lOdo-«onorrOc:and d~mographlccharact~rbtics,
pre-vcisllng attitudes towlrd thesefVic;es being offered md IVlil...tlIe inmlUn.KtuI"f By comp...ringSIIT'IilM groupngs, we wiI nocloubl furth'tt dMify wtw:therprogrMN1WlIC WCCftS is due tothe vMIe of Iink.tge 01 .ttnbut.>bletu "",n~ "lh~. ~holf.Kt~">l..... lAth~ t~st communlti~. In addItIOn,10 truly t~st the VIIIH! of linugt',fut...r~ comp...risons could utiliL~ •'"healttHlnly" offmng~COfl\PO'l"'lS .~ from the beg....nirlg. idmll(. 10 the hulth"""""" '" ..... -.'!t"'Y"",.,f" , Ifoo. 'JTh<ey fTUghl .1100 providf! an·ag"cultur~·only" otI~nng IS animport~nt control,
In .hb(>o~ It moght be v......
10 COl'>dlKl p...rtlOp.Itory focusgroups in tI\ese commurut>e:s 10gam furthtr inslghl Into them«ha"bms tt1rough whichlink«! populauo"-«lvironmentwon. engendtf'l syne-gy
fin.1llty. to betW~ theHo" ,.. .K!<1f'd0 01 ' --' .>rn'
~ that futlR studiesiIdd.ess OO! only !he muftl butlhe cost of seclOI. comp.lred 10integrated programming
Though !here Is ctfUinlyroom for future WOf1l" !he resutu01 thls t.JrIy study on !he vllut ofII'IttgrlbOn ",re compding. Thtn!un be little doubt that fmuly~ xctptMKe in !he testcommunIties btntfiled from theIntegrated "atyre of the Interven·tions ami that holistic progrlm.ming betW c~ed programmtf'l' rnotiv't of support forcommunity wdI being. ThisIOdiurbon.llone $houId S!ImI.lIatefurth'tt won. in this Incipient,
though promt5ing. fitId. TIltU"rven;tv of M;chiqan WorldNelghbors, ~nd CEMOPLAf loo~
forw.rd to helpl"g to ma~e slJChcntiul won. ponlblt
Project CoordlnQtor (;/odyl CotrJrWI (!eft) did mvch of Mr rtptOdlKl"" I>ft]lth OWtoch for IM in/~rottd intm1'ntiol'll our Inth~ fil:Jd. H~~ l"" 10lkJ wirh 0 motfH" ond drwght~ dUrirJg 0 "lit to 0 tfit pIor of wfH'at V<I~I~.
Operations Research Reportby Uc. r~rrsa de Vu'gat Eur~l"·"DIf«lor- Qnd [rnell" Pinto 'iIJrJI1,cJOIl. CfMOPU;
l. BACKGROUND
1./ INTIffJOU(rlON
CEMOPLAF and World Ne!ghborljointly carried out this OperationalAss@umentof intl!'grated d~l.opment in the Guaranda regionof Solivar Province in Ecuador.Twellll! communities were pickedfor lh~ Itudv"
1. Si~ communIties where theemphasis Wal ()(l reproductivehealth - prov'dlr'\9 familyplanning and health services;"d
2. Si~ communit,es wtlere theemphasis wal on intl!'gratedcommunity development.Community d~lopmenlIncludes both lt1e reproductiveh.-aim component mentionedabolll! and 4gricultural devt'lopmen! activities. The criteriafor selKting these communiti@$were twofold: they had communally-owned lands, as wellal interest In and accept.1nceof the project.
The project hypothesis wallh.!inll!'gfated devf'lopment. wnichconllde~ community problemsI,~~ fwd ><:<.U('ly, Plldnd<j~"'''nt
of n~tur~1 rewurces, ~nd publiche~jth, would promote family_II-being. In addition, Wcommunity would ~how grnter~«ept~nceof CEMOPLAF'~health ~ervlces. would inoe~~e
dem~nd, and would improve ill,_._- _.,. --~,~.....~ ----.,-.. ,,~,,~ .,,~.~ '~""~'1 ~.~" .... ""'.~" ..
th~t focus on lUst one of the~themes
The prolect started In 1991, Asurvey of the ma,n projed areaswa~ conducted befOfe the plOiectbegan, With the ho~ of gettinga b~seline th~t would help insubj.j'(juent evaluations. Thesurvey w~s then re~~ted thl'e'eye~fll~ter, wnen the proje<:tended, to assess the adlievemenllof the proje<:1.
1.2 Of/fCrrVlS
The obi«ti~s of the studywere to,
~) ~lermine the imp~ct ofIn"e~5ing ~gricultural produc·lion on the rate of adoption off~",ily pl~nning me~sures;
b) Study W 5O<:i~1 pr09res5 ofthe p~"icip~n15 in integrateddevelopment programs andcomp~re It to that made bythe communities who justreceive f~mily planning ~rvice5;
c) Measure the Khievemen15 of\he; project among \he; popul~·tion and aness the Image ofCEMOPI..AF and WorldNeighboo; and
d) Determine the viability andeffectiveness of repliutlng anlntegrated oeveopment programIn other areas of ,cuador withan indigenous population.
1.3 SAMI'UNG MfTHOD~
Simple random samples wereLlken before ~nd ~fter the prolKtin Slage~ First a list of all familiesin the community w~s m~de, andthen fifteen families were randomlychosen to sample
WithlO the ~IKted families. ahealth survey was given to wOn'll'nand 4n agricultural survey to men.When it was not possible to doboth component.! within onefamily, another family was chosento do the missing component.
The flm survey Included 400fJmlhe~ and the second, 480.The\e ~1mpl~ llzes "iv" a 0S"I,confidence level in the result.! anda maximum error of O.OS.
/.4 SU~VH MfTHODOtOGr
DatJ collection was conductedby trained interviewe~ using aquenionnaire de~igned for thestudy_ The survey was carried outIn peopje'~ homes. Women ofreproducti~age were inter.viewed for the health componentand the male head of hou~holdwa~ Interviewed for the agriculturai component.
11. RESULTS OF THE STUDY
Resul15 are presented for twocomponel1t.! - health and agricultUn!. we do a comparatiw analysisoi the resutts oi the fim and 5eCond~urvey for both component.!. Inaddlt'on, we clan,ry commumuesaccording to the kind of prOjectactivities ",fried out: communitie~with health 3ClMties only (~health
only") and communities with bothflj>alth and agriculture activities(~integf~ted~).~ just Ioc*Jngat before and after resulll. wedl>O IOOx al (II(J~rences oetw~n
the two types of communities inthe same ume period.
AqrlcultuYdl Udtd
2.1 ACtlCUlTUAAt CO/04POl'/fHT Table I.' Information Regordlng Land Use
Graph I: Lond Arta (in H«torn) af Indiyidual Farms fk{ore andAfter ProJpct Implemenlation
0,18-075",
Afler
2,7601'"on,lS0
OlMI75
'"
&efore
% of farms % of Fam..klor" Alter
Land area 0.18-0.75 has 31.3 53.• (O)O.76·1.50hal 27.1 15.0 (0)1.51·2.75 has lOA 6.62,76 or more has 31.5 24.8
llInd 1001l0n One place only 60." 65.8Drtferent places 39.6 3".2Inside 7]..9 7]..$Outside 8.' 0.8(°)Inside and outlid... 18.8 26.7
llInd fallow ,,, 66.7 6$,8Numbf!r of mOl'
1 15.2 2.52 24.2 11.4(°), ,.. 31.6, 182 13.95·12 6.0 40.6(")
Farmers ItaVi' larld tallow alterhaT'Vi'SI Irl 1993. 75.8% of larldlwer... lallo_d 10' Orle to thrt'l'monthl; now lhe't is" ILlt'II",,'I)'siclrlili'lrlt d«rease irl Ihf. larldH,.,:, Idllo,,'ed h'", mOlltl", d"~
a ILlIJllKillly ~nI!l(arll trerld to 1 51.:'.15lallow I'elds lo! bNwt;('n 5 l~
month, 10 a )'ea,
,. Form area
~re is " tendency towarddeousi"og farm si=;(~)among the communitio!s. Ounngt~ b/lr.eline mealu'e, 31.3% ofr~pondenll had land holdi"g! inthe smallelt (.18-.75 ha) desig""tion, while at the end of theproiect 53.4% had holdings thissmall. This drop in land area hasI'l':SU~ed in less food being availabk>for Ig'iculturiru (~Table 1).
Farm larn:h are u~ mainlyduring the rairly IUK'n (84.9%).
:; Fmm Iormion
farme~' land Is located m<linlywithin the community. There Is altallnically significant tfend tonot p,m::hase land trom othercomm...nilies (8.3% vs, 0.8%).
3. R1110wl
In this ~tion we present the1~Io"nl .r~ujtl 01 tne study andprtMde brief descrip\iv'e comrnenbabout them.
2.1.1 Agrlcultu.,1 Aspects
o. LOrld Us..
,
AqncultUYal Data
Graph 1: Pt,CM/age of Land Area O~oltd fa Crops
% of F~nn, % of FarmsBefore After
Do you wish toproduce more?
y" 95.8 87.5(')
For whom do youproduce?
Marl<et ,2 26.7(')
Subsistence 16.7 38(')
""" 79.2 69.5
Where do you ~II?
Your plol '.1 O.8{')
Community 0.0 0.8
City 66.' 96.7Other 29.3 U
4 Land Vu
rhl'1"~ " J 11J~.IICJlly 1,<.;n,Ecant,nC'Ule In the use of land forgrowlll<} oop' (457% vI, 60\1%)(see'Table 2).
Since fa.men do not haveCrop mo,e land fOf pla"ting (fOpS,65~ they tend to uSl!' land d~icated
10 pallure, which happens to beOIl 'let'p SIOpel. This will ~lull in,'gnif;unt erolion of loih if a so,1
'n\,'" lh,,, :,,-1, ., ;"'r'~
mented.
b Gf'fIerol Ch,mxurist,cs
I Produaion
Fewer f~rmer$ w~nt to in(re~'e
production (95.8% VI. 87.5%)bec~ule prices 01 their producu~re low. They wilh to producemore for sale to marl<et th~n in thepall (4.2% VI. 26.7%, ~ <ignificantdifference). ~nd incre~Slngly forcitlel (66.6% ~nd 96.7%). Thert'W~l ~ st.1t1stjc~lIy signIficantrf!Cluction in the number 01 fa~who grow crops only for lUbsistence (16.7% v,. 3.8%). Thistrl!l1d il due to dirKt marbtinfluence, on f~rmers,
After
"""".c."...
8...10'"
Table 1: ProduCl/orl Information
""",..
Graph J: Puunfagt of formtrJ' Product/onDtstlnfil for Mar.tf and/or to MtttSubsisttnu Nttds Btfort and Afttr ProjtctImpltmtnfotian
"~
1-· -, ~
•, ~
•• ~
~..•
(0) SfOti,licolly Ii9n1fi<am differena or 0 9096 confidence ~~~
3
Bdore % Aft", %
Who migrates out7M," 72.9 75.0Woman 2.1 08Neither 25.0 2-'4.2
For what purpose?Wo_ 70.8 96.7(")Other reason 2.1 3.3No responst' 27.1 O.3{")
How long Is he/she away?01 M,"'" 301 15.4(°)1 Month 25.0 11,0(°)2 Mornhs 11.1 30.8(')3 MOrllh~ 22.2 19.84.12 MOrllhs 11.6 23.0(»
2 MOrllh~ 0' Mo'e 45.9 73.6
Agricultural Data
2. Migrotion Ta/)I~ J; Information Rf'gardjng Migration
~rf' is <I h;gh t~ndency forpeople from the (Ommu"ities tomigrate to Clttes (75'1ot.). Mon of~ migrants '''~ men, ami therehas ~n a slight Inc~lst overtime (72.9% vs. 75%). Womenmlgrale much less, and the raIl'Is decreasing (2.1 % vs. 0.8%).People migrate mostly for work,and the~ has ~n a significantinc~ast In the perCe<1tagemigrating for this purpost(70.8% vs. 96.7%).~ durationof work Sla~ hal increas.ed ISwell ("'5.9% vs. 73.6% lilayingtwo months or more). As <I ,ewlt,women have greater roles to playin their families and communities.
(0) SIOlislicol1y ligrlificom differf'fJCe or 0 9096 confidmce~.
Graph 4; Perc:erlloge of Men ond Women who hove MigrOled,Befo~ ond A.fttt' Pro/eet Implementollon
80
"80
80
~,""•80
""
01.lan
,
• BeTo'e L ATte,
Woma"
Aqnculturdl Ddtd
,1 ..... , ....
~fQlI! 'lIo After ""
00 you prated your wil?y~ 229 50,0(")
How do you protect ItlP..sto mftn (PhNns tuberouo) S04S ...Rod< or de.cl wood feoc:e 00 1.7
Or'~UNI~ 182 1.2
Slow.fonnong If'ITK~ 0.0 20_~:~~
... !.4,',~; ,~
(" s.r,,~~ rM'frietU or" 90"10 Qh'idmu Wwl
Graph S- "nutlro~ 01 Rdpondmb 'ridiculing Wham and HowThq f'rot«f TMiT SolI. 8don and Aftn Pro/Kt Impkmmtation
}<JOI :onKf\<l~1OI'I
Th«r is a \l.lIJ~!UIIy S1grl,fl(oIl1(
ll'Kft<lse ,n the pe'u,,~ rnporLIne" of protectltlg~ fromtfOSIOO (11.9'Nl V1 SO...) Thepmftnd methods IOf pm.oml.lOgtImIOn ...e pWlbng the grUJ elpoIno rMlin (F'tWIrn luberos.I)(54 S'llt Vl. 64 .. 'Ij,). »ow-lonn.lg~oKl!:i (O'loo vt.. 203...). And~. '" "J'" .If'l1h' tI booworthwhile to CMry' out~If..rung in ordef [0 rexh menfarml!f1 ;and thus protect menwolli from~,
1~,,.
.............""..
SIc 10011_0;11~.. ._
".."'" ""'...
ArterNo,.. ,.-
,
, . ,. ....&qncullurdl Udld
(") Stati,tically 'i9nifi<;aflf dJHerenu 01 0 9(l96 eonfirknce~
Table 6: Informorion abolll GTl!tn MonUTl!
8efore % After %
Plants Home Gardens?
". <15.8 51.?
'yp<C"rrots 26.1 51.6 (O)Onion 56.5 33.9 (0)Lf'lIuef' " ..,C"bb"gf' 0.0 '.0,~" 0.0 "Other " 0.1
Why do you plant?Subsisteflce consumption N' 32.3S"If' a1 mari<f'l N' 35.580th N' 32.2
J. Green monllre
Not mllch waS known aboutgreen man lire at the time of thefim study, bllt by the secondItudy 38.3% of farmf'rl plantedgreen manure. They use SWfftpn (Plsillm sativum). lupin(Lupinu! mutabilis), ancl vetch(Vieia saliva). All faflTlers wereconvinced of the importarlee ofplanting gr1!en manure in orderto improve soii fertility.
1. Hmrw gardens Table $: Informotlon obollt Home Gardem
PlantillQ home gardens illCfNsedsomewhat (<15,8% vs. 51.7%),"';'h ~ 'IMio;ti~ally ~;g'1;f;ca"t
incre~ in the Cllllivalion ofcarTOb (26.1% vs. 51.6%), alwell M cabbage and beets. ~rewas a statistically significantdec",ase In the cultivation ofonions (56.5% vs. 33.9%). Homegardens '"' planted fof sublisteocecoosumption. for sale in the mari<etOf both.
Before % Aftf'r %
Have you pl.tnled green marourfO:?0.0 3831~
Crop used as green manure:
'"5weet pea (Pulum sativum) N'Lupine seed (lupinu! mut"bills) N' 239
Veteh (Viel" s.ali~aJ N' B.'
h it necenary to farm theseeropl?
100 (01,· ". '0. , ,
,
Agricultural Data
(.) 5la!1llicafly s,gmf"anr d,ffffnlCt0/ 0 90'16 ronfidnICt I<>vtf,
~L
.-. ::J-- »0
!• »•
"
Craph 0, Perunl".;e ~i farmer! '\lbo Had Recf,ofd formal framing 4. ...M) :.;
There W.1I ,1 ItJtlltiCJlly ~'gnl~·'.
cant incruse in the farmer! whorecefl/ed tl'illnmg (6.3% VI. 42.5%).Of lho>e trained, molt pilt\Jcip.ltedin trainmg about home gardem(92.2%), followed by soil canser·vatiOfl (!fO.2%1. improvement ofcorn (86.3%), v.pffimenLllte1u(82.4%), and green manure(76.5%). They alia partkipatedin training about fertilization,dqi" 11]... c,n ,11, pi In'in!J of thegralS pasta melln, A·frame, andcomposting.
Toblt 1: Information about Training There il a lot of interelt inreceiving training (93.8% lIS. 90%).The topics that peopie want tolearn about are how to growparticular crop~ (68,2%), fertllll-en(16.6%), cattJt ranching (6.0%),era lion (5.3%). and other topk.llike irrigation and plant protection.
Farmffl think that traininglhould take ploKe In the commu·niti~ (98.1 %),
Training hal been one of thefundamental pillars of the proje<:t,and our re1uJU indiate thatfarmen greatly value these.Ktivitiesand want to be trai~ in thecommunity, on lpe<:ifk topicsweh a$ how to grow particularcroP$, fertilizers, calliI.' ranching,am:! crOlicn control,
8efore % After %
Old yau receive training7
", ,., 42.5(")Topics:
A.frame N, 60.SComervation N' 90.2Drainage canab N' 66.7Palto melin (Phalaril tubero$,l) N' 64.7FertiliUtion N' 70.6Green manure N' 76.5Compo~ti"9 N' 41.2Expefimentallliall N, 82.4Home gardenl N' 92.2Corn improvement N' 86.3
00 you wl$h to receive training?
'6 93S '"Topics:CultivatiOl1 oIlpecifk crOpl 60.7 6S.2Fertilizers 8.' 16.6&o5ion 0.0 5..Cattle ranching " '.0Plant protection U UIrrigation 5.0 0.'Otherl ,.7 1.,UOn (~now >' "
Where should training be held?In the communi" 91.7 98.1,
LAgnculturdl Udtd
After %
H/lVe you partklpoated In experimental trials?,,, '19.2
With Which Crops: -"BarleyCornPotato
Is It ~essary to hll~ experimenllll llials?,,, 85.0
re ete CSOlOCj<g
Before % After %
Variety OOrada oe 57,9Duchicelll 20 10,5(')Others 20 31.6
Seed Use? From previouscrop BD 78.9
Boo'lht:~ 1~.~(')
80thCull r.eeds? ", :~ ~~.8
NoDisinfect seeds? ", " ~~.~(O)
Nonl1age depth Superficial "'" 73.7(0)
Medium , 15.B
"'"" 0 10.5Type of fertilizer OrganiC '" 21.1(')
Chemic~l , 316(')Both
~~5,3(')
Ne,ther '"Org~ni< ferltlizN Cc. " m 0~I,l'(p 0 '"Both 667 so
Chemicallerlilizer u,(~ , 28.6Pho~pr.ate ''''' 714:·)
" , "I· ,,11 , n··"Q"td~'", CO"" [D.of'dencr I~~
.s. frperimen/ol rrials Tob/~ 8: Information ooo"r fxptrlm~nrol Trlo/f, Aft~r ProJ~d
Ex~rifrn'ntal trials _r~ carriedo~ with th~ imporunt crops ofthe region, lu,h as wneat, o,lfley,com, and potatoes. Nearly half('19.2%) of farmers participatedW1 the plarri"og.. planting. oAtivation.and harvest 01 expe1imernal crops.~ experiments compared _ralcrop varieties and the ~ffect ofthe type of fertilizer used.
MOlt farmers (85%) think it isn«enary and important to (lrTYout experimental trials in thecommunities.
6, Crops Table 9: Information about 80rl~ Cultivation
6./ Borl~
Commonly planted varieties arestill being used. Alter the experi.mental trials it was determmedthat the Clllkuchlma vanetyresulted in good yields in allcommunities. But because it wasattacked by pests, it was notpromoteo by thC plojec!, nor dlOtilt Nationallmtitute of AgricvlturalResearch (Instituto Nacional deIn~ltigaci6nAgropecualia)decide to promote it, The use ofthe Duchkela varnoty decreased(20% vs. 10.5%, a statislitallysigniflunt diffeOl'nce) as peopleSubstituted other varieties
Farmers use the.. own leedsources (80% and 78.9%), butthere IS a lIatist1cally slgnifocant,', I,,..,,, '.I~'" ·ds~d (10"" a,,015 g I Th~le"
alia a" ",creaM' I" the praC!lce ofwll"'9 M't'd\ belo" 1,,~nt"'9
(10% \'s 3680;.,),
Farmers tend to \liI theirlOilsmore deep I)'. and the practice of(, '19 ll>ilsupt'l"flCjall" showed a
"
Aflri<:ultural pramol~r Ja.~ Ninabanda andProgram CoordrrlOlor C/0dy5 CoroMI """*as a lMm in aJllt"alnIng•. Hffl! r~ ~<JtrliM
s~ to bf, UW In an 119nrulturallnl pial.
AqricultuYdl Ddtd
8 ..for~ % After %
Yarl~ty Cll,mboralo 52.9 25.3(O}Cojitambo 0.0 58.3(°)Tunu9urahu~ 17.7 0.0(°)Olhen 29.4 16.4
Seed Use? Horn prevOOOI<rnp 68.4 75.0
BO\Jght 21.1 25.0Bo" '".< 00
Cull Iceds! ,,, 31.6 25.0No • 750
Disinfect seeds? ,,,~~.~ 1~?'No
nllage depth Superficial 73.7 66.6Medium 26.3 16.70.. 16.7
Type of fertltller Organic 10..$ 16.7Chemical 15.8 0.0Neither 71.7 '"Organic fertilizer C~ I~.~ 0.0Sh~ '00 0
Chemical fertilizer U~. 33.3 N'Phosphate 66.7 N'
9
llJmtKJI.y "y<l""Jnt (j,:veJ>e(100% v~_ 73 7%).
There IS also <l ltalllliC.llly llgnif_icant Increa>e in the use of Of9anicand themical fertilize!>. The moltcommonly used organic fertil~ isa mix 01 cow and sheep manure.The farmeo undel>land theimportilnce of fertilizing barley.
3,62 Whtat
\'lith regard to vilnety, wenoted t~ J1 'h:~ '-1\ J \~J\ 'I ul1ysignificant decruse in the use ofChimborato and Tungurahuavarit'be5, but there was an increasein the use of the Cojitambovariety (O%~. 58.3%). a newvariety that i' very well adaptedto these condition,.
Farmel"' are u'ing their ownseed (75%) and do not disinfect~s (100%). A third of farmel"'cull seeds.
To pant whea~ farmers are tillingtheir soil to greater depths thanthey did in the pa'L Mon farmendo not fertilize (73.7%~. 83.3%),ar'ld if they do, they use organicfertilizer, (16.7%).
· ..&qrlCultuTdl Udtd _
6.3 Com
Farmen lend to use the 81~n(o
(white) vaf~ty of corn the mo~l
(70.4 ~. ~1.2'1t1. 5L111~lltaily
signif"",nt). Experiment-'I trialsshowed that I"IClfle of !he introduc@dvarietie:l wrp.used the loul variety.
farmers use their own ~5(87.7%) and do not dIsinfect~s bef~ planting (96.5%).Theft has ~11 a 5utistiullysignificant dKr!'ase in the numberof farmers who disinfert seeds(48.1 % vs. 3.5%) and a slmilllrdecrusl' in the percentage offafTlll'n who cull their seedsbefore planting (63% vs. 24.6%),
Mosl farmers (6<1.9%) do notfeftjlczl' at all. There i.. a statisli.U1lly lignif.unt decreoue in theuse of ctMomical fertilizers, andthe use of organic fertilizers hasbHn maintained (33.3% vs.24.6%). The prelened fe<tilczer iscow manure (25% vs. 62.$%).
Toble ": Information about Corn Culrival/on
Before % Alter %
Variety 81anco (White) 704 91.2[")
c~;un lfllComrT\Ofl 296 8.8
Seed use? from previouscrop 92,6 87.7
Bou ht ,Cull seeds? ,,,
~~'~ ~:.~(")N
Disinfect leeds? <e,:~~
3,5(")No 96.5
nllaoge depth 5uperlkiaol~~.~
71.9Medium '"Type of fertilizer Organic 33.3 24.6Chemkal 556 7.0
So'" 11.1 ~.~N..ithef
Organic fertilizer Cow 250 62.5(")
~~:p 75,0 37S
Chemlcaol fertitlzer Urea 167 334Phosphate 833 666
(") Stor'lricol'Y JignjficOfl! Mle"",e 01 0 90% fOllfkJern:e I....el
family farm, In /laJM:Jrpro...nce, nt much 01 t/windigenous highland or~5 ofEcuador,~ bHn divkkdmiD ~r ,,"ol!tr pIotl 011000""rh todl gl'fltf(lri<m
Aqrlcultural Data
r"bl¥ /1. InFo,ma/lvlJ about Pawta eU/tWIlItOIl
Before'lo After %
Variety Maria 41.5 36.7Gab'iela 41.7 S3.1Others 166 10.0
Seed U,,'? From previousClOp 16.7 56.7(°)
Bought 50.0 36.7Bom l~.~ 66Exchanned 0.0
Cull seeds' Y~l ~?6 70.0No 10.0
Disinfect seeds? y"~?~ :?.7
No 31Tillage depth Superficial 25.0 56.7(°)
MedIum7~..~ 13'
O~ 300Dlstilnce betwun 40 cm 33.3 10.0row. 50 cm 16.7 26,7
60 cm 8.' 23.3Other 41.7 40.0
Type of fertilizer rgamc 8A 6.'Chemiul
~~.~ 8~.~(·)80th
Organic fertilizer C~ 00 25.~ to,Sh«" 100.0 75.0 •
Chemical fertilizer Urea 0.0 17.8Phosphate 100.0 82.2(°)
(") Srar,sticol/r significant difference or 0 90911 coofirknct~.
11
,,_~ hlul"'"
The mOlt common vJriety .,Gabnela (51.3%), dnd farmer..prefer la use their own leedID'''I:es (16.7% VI. 56.7%). S«dsare di~nfecled by 46.7'% of farmersand culled before planting by70% of them.
Only 30% of farmers IJII theirsoil 10 a depth g~ter than 40 cm,and there is a growing tt~nd
toward rTlQre shallow tillage. At
me outset, mey WOUIO leave 4U
to 50 cm between rows (50%)and now it is mOlt common toleave 50 to 60 cm betwe-en rows(50%),
There was a Jignofkant ;ncru~in the use of chemicalfertHizers(58.3% VJ. 86.7%), pm'lcipallyphoJphatel. Only 6.7% usedorganic fertilize.s,
Toble 13; Re$pondentl' ASltllmenr of Relotlomhlp between WorldNelghborJ and the Communi/ies In which Ir Works
Quality of servkelVery good/E.>ccellent 78.7%
SatisfactJon with servlc:esSatisfiedJVery latisfied 91.S%
Would re<omlMnd Work! NeighbonVery probab~/E.>ctrelMly probable 85,1%
Would continue worl<lng wilh World NeighbonVery probable/E.>ctrelMly probable 93,6%
ATIRIBUTES TolallyAgree (%)
Ha! widespread a((epumce within the commumty 61,7
Offers more collaborauOfl and !UPlXlrt than othero'9an,zatlons ~O:
Provides good information to commun;ty memberl 55.3
Keeps Its promises 57.4
5taff is friendly 63.8
Distinguishes itself by the quahty of ,ts !taft 68.1
Proy;de! good service to community ITl('mbt'rs 66.0
H"I", tho'" in meMel! Tlf'td 70.2
Help! the commuOlly 5'i16
Ha! welt.trained and plofe!s,onal !tall ,,,Treats community membefl equally 660
· . .l-Agrlcultural Uata ~
2.1.2 Image
We interviewed people aboutthe ima<:H' of l~ program incommunities where WorldNeighbors has wOfl<ed. AmOrlgtho§e inte~, 39.2% mentioned having been visited byWand Neighbors. The followingresults a~ t»sed on interviewswith this lubgroup.
Cl. Relaliomhip ilt'twffll WorldNl'ighbon and Commvnitks
Among indigenO<,ls communities, 87% say their relationshipwith World Neighbors il animporunt and poli~ one. Amajority (78.7%) lllJ,O think that Table' 4: Image Attributelthe attentiOn they re<e~ is verygood or e~cellenl, and 91.5% arel<llJ5fLl'd with the §ervkes WorldNeighbors provided. As. a result,85,*, would recommend WorldNeighbors 10 other commullil~l
and 93.6% expre~ed a desire toco~.:bur \·,~rti"g \", :!'l W~,:~Neighbofl.
b. lmogt ....UriLwtel
In the qualitatIve nudy_established 11 attributeslelatedto image that we then <!Valuatedempirically, k Tab~ 14 shows,63% 01 the project be~iciaries
perce'Yed World Neighborlposit;yely
"
Aqriculturdl Md
rabl~ Ij; Inue. R"lalo'd 10 Se,wets Received
Resolves doubl.l whom thew are expressedV. oodfExc~lent
Has .kills and knowledge to amwer question,,. ,.v. IExcellentn..::.~ are providing a.slltance M1! courteous .".Ve oodfucellent
Staff are available when they are neededVery good/Excellent 81.9%
In generJI, 80% or thole whohave had cOfltact with WorldNe,ghborl comider the se(VlCesre<:eived to be very good orexcellent.
d. Coverogl'
Regarding the c~rJge of service" 89A% of people consider Itto be vel)' good to eJ(ceHenL
SERVICES Very Goodluu~lIent (%)
Exnerimemallriab 78.8
Cultivation of green manure 70.3
Cul\;vauon of home garden! 87.3
Cultivation of wheat and/orb~ 83.0
Cultivation of tatoes 65.9
Cultivation of corn 70.2
Soil conservation: Drain.. e canals 76.6
Trainina 85.1
Construction and maintenance of A.frames 63,8
Use of animal manure 80.9
ImpfO'(@meotof corn 78.9
OffKI'
The jmpre~sion that users haveof the office where service" areprovided generally influences theprogram's image. Of those interviewed, 57.5% thought WorldNeighbors' faohties were verygood or excellent.
Table 17: Inues Relottd 10 Officr: and Fodlifies
76.6
SER'/ICES Very Good,EJccellent (%)
Location of World Ne" hOOr. office 59.5
Ease of gelling to World Neiohbor. office 61.7
Appearance of World Neighbors office 61.7
Ughling of World Neighbon office 65.9
Comfort of World Nejghbor~' wailing room 63,8•I Acce~1 to World Ne'ghborl off,cel
~'-~-.- -I
•
-------
-, .~-, ..
••
ProjKl Coordi""ror GIady:l Coronrl <Rmonltrol~ tducolioool moltriol3 IJIW In the program This polr~ rompar... the wrthwith (]...:Im<l" and srr"'U3 the impcmanct of ~Irh fOI good rqxodlKlron
Health Data
2.2 Hu"" COIWPOM",
In !hI> mO<.lu~ we d>d not JnJI~leme health SlatuI oIl11e poptJk1tionbecau~!h" WiIS done through tht!fil'il w~. which found pfl'Carioushealth conditiollS. !mteold. Ihecurrent analy1il tries to \.«whether there were any (hang~
in health three years after theproj«l" inception - and to seewhether the change might bepartlY anributJb~ la the i1']ricul·lural component 01 the prOject.
2.2.1 Characteristics of WomenInterviewed
ruble Id: CilorucumllCl 0/ R.:produClmt·Age Women Interviewed
HEAlTHt INTEGRATEO*'
Educlltiof>None 31.3'*' 39.S,*,
Some primary HI'*' 21.1,*,
Completed primary 20.S,*, H3'*'!leyond primary 2S.0% 16.3,*,
Average Age 29.S 32.1
r InltMeWS ....,th commuml,el ....here only~ hN/lh componenf WOl on placeJ /nle",~;n commumtlt3 ....here both the heollh ond agncu/rure ComponenlSwere ,n pkJce.
Table 19: ReJpofllel to QueJt;onJ about Reproductive Goo/s fromPregnant Reproductlve·Age Women
BEFORE (%) AFTER (%)
Health Integ. Health Inleg.
Currently pregnant " 9.' 8.1 9]
Wanted last pregnancy '" 82.4 73.3 70.7
00 not want futt!~
~....~ 9S.6 92.3 93.7 78.9
The charactefillKS 01 the womenintervIewed before ItJrtlng theproject and those interviewedafte!ward 5hawed §OlT1e natilticallysignificant difference. in educa.tionallevel and age. This made itnecel'>llry to standardize theUNclur... 01 tile two samples inor<U!f to compare resull$. Web.1sed the ItI\Kture on the fil'it
survey.The women inte~ in the
heallh-only communities had ahigher educationallev~ and wereyounger th<J,,, the WQfTlen in theintegrated communities (seeTable 18). The aforementioneddifferences ale due to the factIn..! lh" 'nlegrdtO!<J COflHl".m,tJ"lare more rural and datant fromthe mun,ciPilI capItal.
2.2.2 Fertility
8etween 8 and 9% of womenwere pregnant at the time of thesurvey. The women from the inte91at.-.o Conlll1ul1lll"l nave "'9"""
tHrth rat<!:$ than women in theheaJth.ony communitie:l;. howeve',the differences ar@not statisticallysignificant.
With regard to reprotluctM': goals,in the health-only communitiesthe proportion of women whowanted theIr last pregnancylncreMed, whereas in the integratedcommunities the proportiondec~ased. The ob~ed changesare not natininlly significant.
"
The desire to lIVoid pl'@9nancy ishigh-more than 90% do not wishanother pregnancy. The differencesa~ oot statistic.-.1Iy significant. exceptIQr ".,m~n in Uk int~!:Iral~J
communities In the second survey.where the proporoon of womennot Wanting a future pregnancy is78.9%.
Health Vata _
2.2.3 Morbidity
We measured the morbidity ofIht' last child younger thin .syeaD, U5Ing the last three monthsas the reference~. The rail'of prevalence 01 dilll'1'tM.'a Is Iowtoramong children In the health-onlycommunities, and thl! ~1s haw:remained more or less thl! SlImet>erween the two pffiods and thetwo communities (the drtferern:esare not natlstkally Jignifocarn).~ habiU about talUng children10 the doctor remains the loame inboth types of communities.
Respiratory infections lImongchildren have increa§ed in bothcommunities (not statisticallysignff"ount), Dnd the rates oftaking children to the doctorhil~ nOI changed 0Vl!' lJme.
2.2.4 Mother llnd Infant Heatth
Among women from both kinds01 communities we did not~"'9"d,,:.mt dlol''9l3 ,n """.leLl'mUUhaving to do with the mol~shealth. Conditions afe better inhealth-only communities than InIntegrMed communities.H~r, the proportion ofwomen taking their children forWl'1I-child vi~ilS to the doctorirocrea~ed iro lhe I~lte'
Table 20: ReJponJrJ 10 QurJtiom Rrlotrd 10 lrofonl Morbidity, fromRrproductl~r·Agr Womrn
6HORE (%) AFTER (%)
Health lrotrg. Health lnteg.
""- -i8.0 52.2 44.1 53.8
Took to he~1th centerldoctor for diarrtle.t 50.0 63.6 53.4 61.9
Re5pi~to<yproblemJ 67.6 61.8 72.7 70.5
Took to he~lth ceroter 38.9 50 56.6 58.5for re:spir.ltory problem~
Tablr 21: RrJpomrJ about Mothrr·lnfonl Hrallh Inun, fromRrproducrivr·Agr Womrn
BEfORE (%) AFTER (%)
Health lroteg. Hnlth Integ.
ProfeWot\;lj lmirulrocewith childbirth 38.3 20.8 38.7 21.5
Took child to healthceroter 57.7 47.8 51.3 556
LLShm,ly~
\\Iomtn from~ aim
rnuniIle5 Ne! ~1~~~.tx!ut brrttI<onlfOt methods~ comPMed to womenfrom int""9Rted oommurubes(6S'III V1. 3S" resptCti<el).Three years I.It~ we notICed a11'9'" and stlusuuly signifiuntI'lct'use (up 10 71"') In women'skncM1tdge lbout birth <Otltro!,lI"'IO<'q~ from ~ lmMf3!fficommunitIeS, The ~mt cln bitSJid for tht use of birth control.While In tht! hellth-only communlll~ the rale remllns It 22,2'Hl,In integrated communltlts rntrIle 1I 41 "'.
Among women from both type!of communities, tht proportionthal wnh to bit netililtd haI~ althcughnot~.ThIi! proportIOn il lower in htalthorYt~ INn in irugr.JtedcommUnltie (26'" VI-. 34"'l·
•• .- -•
<• •,• -•
••"• - .
Graph 7: "~rctntage of RtprodUCllvt·Agt Worntn with Knowltdgtaf Birth Cantral MtthodI
ra~ 11: Rnpot'}D about FamJtr Plannmg luun, _R~pradrJCt'~t-A~ Womm
SHORE ('lOo) MnR (""')
He.allh lnt~ HeAlth lnt~.
Know 11ll!'thach ..., '" ". 71.7(°)
Clol'rel'ltly IM them 2S,0 116 22.2 41.1(°)
IMsh to be uriml 1S.2 27,} 2S1 34.2
· .
GrGph &: "t1UfIt~ of Rtproduc.m·Agt Womm UIJng BirthCantral MtthodI
•-,
-, .", J.••
"•
-~
.-.-
17
Hedlth Ddtd,__~ _
,~~ ....I
,
•
t•••
Graph 9: Client AsJtssmtnl of CfMOPLAF
':[
Table 24: Responses 10 Questiom Relaled 10 Inlended Relatiomhlpwilh ClMOPLAF, from Reproductive-Age Women
Table 23: Responses to Questiom about the Quality of CfMOPLAF'sProgram, from Reprodu<tlve-Age Women
H"",lth (%> Inleg. (%)
RecommendsVI' r n'obable!Extremelv n,obilble 57.9 75.1
Would continue using\'t'''' DrawL,.· 0.11<'''.', " bJU' •• ., ,
0' ~
Willlncruse f~quen<y01 visitsVery probable/Extremely probable 52.6 87.2(°)
Heallh (~) IUlt-Q'.;l.led ('kI)
Received assistance 15.8 13.3
Quality 01 assistanceVery aood/Excellent 100.0 93.6
»:,s,~~ Ie~e5al;sfied/Ve'" sallsfled 94.8 87.5
F~,
Low/Verv low 68.4 62.6~ral1 evaluation
GoodNery good/Extellem 78.9 81.3
2.2.6 lm.!l~
As with Wood Neighborl, _a,,~« ..d CEMOPl"'~'~ im~9~
From I~ qualitative study "'friedout wit!'l people Irom the samecommunltlf!s, we discovered cer·taln local processes that could ~used 10 anen image. Image wasaue§5ed by interviewing peoplewho had received CEMOPlAfassistance within the 11Ist 12monthl (15%).
a. Overall QlJollly of Ihe I'rogram
Regardlr.g the deliwry of s.eMcesto the population in the study.we ob~~ that (EMOPLAf ishighly valuffi in terms of thequality of ~cel and use' satisfaction. More than 63% of thepeopk! who h.~ received aui,.lance conside' CEMOPlAf's feeslow or ~ry low. People are quileple;ued WIth the q~hly of lefVKes
~~ for the amount t~ haveto P~),
There are no significanl dfffer.enc,"s in lhl!' general illStllmentof CEMOPW's services betwNnpt!Ople from the two types ofcommunities in the study.
b. Asselsmtnl of IM Rl'lalionlrllp
In general. the use's from Inle
9'~ted tommun,lles lelld la 9"'1'9,eater vallJe la the 'elaliomhipw,th CEMOPLAf. There " 9,eate," ,,!" it' Ct'.~,:"rL:"
among U>~" f,o", "'tt-~rdl~d
tOm'l1Untl,e, than those f,omht-alth-onl) (ommunilie' ih'9tol\'i9rtihcartt d,!feren(e).
Health Data
ra/}I~ 2~. Pcrcenlage 01 People Inrerli'fWed who ore In .Igreemc'lllwith rhe Following Statements about CEMOPLAF
ATIRIBUTES TOTALLY AGREE (%)
Hulth Integrated
• Has widespread a"eplance withmthe community 63.2 875
• Provides profeuional ... "d ul.efulservices 63.2 87.5
• P'ovld~ good informatIon topatJenu 737 100.0(°)
• ..eo:pl ,U p<om,,/,S aliA ~o.3
• Staff IS friendly 68.4 81.3• Designed !Of low·income people 42.1 7$,0(')• Advertises its services 63.2 68,8• Attends patients_1I 57.9 75.0• Has good equIpment 26.3 56.3• Helps those in greatest need 42.1 688• Helps the communIty 42,1 81.3 (.)• Has well·tralned. profenionalltaff 57.9 62.5• Oflers services lor the whole family 36.8 62.5
(') Stotl<tKol1y "gmficon! d,lf"mu al 0 95% coofideflu ~I.
Graph 10: Valuation of (fMOPUF by Reprodu(llv/'·Agl' Women
n ...1QPlAF naS a betkr Im..g..dmong inlegtaled-commun,tywomen, who value the good;nforr'nallOn provided by theorganization, who pen::elve thatCEMQPW i\ 10< people of loweconomic re~rces. and whofind it helpful in the community.
19
Health ~ata _
Users Irom int~raled commur'liti~~ have 11 Deller image ofClMOPW tnan those froml>ealth-only communities~nconsidffing specific W!Mces. Thestatistically signifiUlnl diff~ncesof opinion concern the solution ofhealth problems, the hours 01operation, and tho! faTrneu of fees.
Table 26: Responses to Quest/onJ about the Value of CEMOPUfServlu5, from Reproductive·Age Women
155UES VERY CiOOD/E).CELLENT
Health (%) lnl"9_ (%)
• Rewlves health plob~ms 52.6 93.8(')
• P<!Ople allending are COUrtl'OlJ5 79.0 87,5
• S<!lVice is quic~ 31.6 56.3
• Hours of operation are in two shim 526 87.5(')
• Fees are rear.onable '" 87.5(')
• Home visit! 47,4 68.8
(0) Statistically 1'9llificom d.tferern:e or 0 95% conf'cknu ~I_
Croph I I: Valuation of CEMOPLAF Services by Reproductive-AgeWomen
•,ror
~1--
0 ~
~'---.....••,~ ro•,.. •-,•,
~
••~
Health Data
rabl~ 27; Rl!spotlil!S 1O Qu<,sllom aboutlhe V,,/u<, 01 Hav"'9 C",lall1Sel"lj,~ Available through CEMOPLAF, from ReprodllCtive·Age Women
ISSUES VERY GOOOfEXCElLENT
Hullh ('Ill) Inleg. (%1
• Prle9n~ncy c~re 78.9 75.0
• Care for children under .5 yearl 47A 31.3
• Adolescent care 36.9 62.6
• Post.natal Care 84.2 938
• Family plan"ing 579 87,6(')
• LoboralO<yexaml 52.6 938{')
• Availability of medicines 57.9 B7.6{")
• Pap Imear5 52,7 93.8(")
(') StolJllical1y s>gmocor1l diffnf'tKt at a 9S9/i confidence ~tI_
Table 28: Responses fa Quell/OnJ about the Value of CEMOPLAF'sFacilities, from Reproductive-Age Women
ISSUES VERY C;OOD/EXCELlENT
Hulth ('*» Inleg. (%)
In general 47.4 81.3(*)
• Location 68.5 62.5
• Ealt of getting to din;c 63.1 81.3
• Appearance 52.7 81.3
• lighting 47.3 87.6(')
• Comfort of waiting room 42.1 93.8(°)
• Aceel. to onoce! 30.9 og.i:l(')
(") SlatlJrKCal1)' "9niocanr dilterm!:r at 0 9596 conrideMe level,
Women from ,ntegr~l~d (om·rT\llI1ItIe!I v<llue the variety oi Sol!(VJ(C
offered by CEMOPW more thanthos!!' in health-ooly commumtleS.Sbtbwlly $igrufl(.1lnt d,fferencesbetween the two groops are:family planning assistance andthe ~vaililb;lity of a lab, medicinesand Pap smears.
f, FoeililJeS
In general me users Iromintegrated communities valueCEMQPLAF facilities more thoseIn the health-only communities.
.01 "Olum_ promoln uplain! l~ impottonct of fomily planning ond dtsa1~! lilt mtlllod! /1VQi/ol1!t lhmugh(fMOPW dunflg 0 comb;Md htalrh.ogriculrurt lwinlng ffi.tion in /It. >1I/ogt.
Concluslonl
Ill. CONCLUSIONS
• Th~fe i~~" ,ntrN~,n'l tenden.cy toward small·holdl'f landownership, leaving httle landfor farmers to plant (r0pl. Al aresult, farmeo are turning toareas belter lUlled for grazing,WhKh ale on e,mion-pronesleep slopes.
• F........er hlme!"; wan! to IncreJ~e
productIOn beuuse mariletprices are low, At the sametime, il farmers gel higheryields. they wish to UR' thesurplus for the market and notlub:>4ltence.
• 1hefe~ high rates 01 migr.llion01 farmerJ to the cities, and theincrease in migration means thatwome<l <\re aSlumlng greater(@sponsib,lilies in the hon1f! andin their communitie5.
• There were dlanges ir'l ~~'lkn~edge. attitudes, andp.actice5 with regard to theneed for training and la pro-teel and maintain wil fertility.Also, there was an increasedde~re la IncrUle yield, usingtechniques that do not requireexternal inpuu, but instead Ul.l!
local r~rces that do notcarnage (ne enVlronmen(.
• Imututionallmage il enhancedwhen health and agricultural~icel are integrated,becau~ It allows for a holistic~eption of community-levelaction. The combination bringsthe r~atiomh,p betweennature and humans into view,
• In general we observed slightchangel in health levels in thecommunitIes in this study,although these were not Slgnill_Cartt. we think that thr""" rear! isnot enough time for CEMOPlAF'sHealth Information andEducation Program to effel:tliql'lillcant chanqe
• In the integrated communities,which were more dist<mt f,omthe municipal capital and more"rural," CEMOPlAF offeredhealth lervices that It W(luldnot have othervoise. If it werenot for the project. many ofthese women might nil! notmow about family planning orbe uSIng birth control.
• Ofteflng ~'Cel to the community in twQ integrated componenu undoubtedly benefiuthe population, while at thesame time improving theIm<lge of the InstltutlOflIinvolved. CEMQPlAF has amuch bener image amollg thecomml,mitjel with inteqratedMaitn ana agnculture lervlCelthan ill the communi tIel whereonly the health componentwas oftered.
Young Quichua g,rls ,n tM VlIIag~ 01 Cawlch~ In BoIivar. Tht fK09r<1m """*1closer with sdloo/ ttoChefl to promote OWOrenell of hto/th and Wlloi"oble"mural 'tlource Ule
23
by lethro Pettit, D,rKtor of Intemot,onol ProgromJ, World Neighbon
The Operl.tlons Research firxlingJr~portffi ~re ar~ supportffi bvrno<e recent program ,eporU anddata on clinic usage provided byWorld Neighbors and CEMOPlAf,8<!:1ow is a summary of year-endprogram ~port:llnd clinicdata from 1996_97 Ouly.June),followed by I brlef JUmmary ofdinic data from 1997·98 OulyJune).
1996-97 Family Planningand Reprodudlve H~alth:
Actlvitl~s and R~sults
In 1996-97 the program caniedout the following health andfamily planning activities:
• 21 community leaders weretrained in reproductive health,family planning ilnd agriculture.
• 1,635 women participated Incommunity-level courses,
• lam'l} plannlng ~erv,,~. ",t,tprovided through the chniclocated In Guaranda,
• Qutreach teams made 55Bhome vi§ils, held 81 communityvisits, 56 vidw pr6entations.~e 75 edocational tallu, andheld 53 sessions on Infant~a!th al'll nutflt,on.
• Brochures distributed include499 on Pap, H9 on f~ry,,'y
plannlnq methods. 109 onIl,>'f' )"~ tJ'l' I'~'~' ',[1"'00, ~'"
139 on meJ'tal !.HVlCel,
• ReprodU{\lv~ r,,' themel wt"f
add'elsed in the \ra",m9 01thp 21 mdlgenous healthP'OmO[l'fl, indud,ng
_ prenalal ca.e.
white discharge: causes,wmptoms nrf'Venlion andtrUlmenl;
cerviul cancer and the Paptest;
importance of vegetables innutrition.
• In addition to the use of familypla"ning services, 1,094 vilitswere made to the Guararnladinic for family health servicps,incllKli"g genelal medicme,pediatriu, gyrIC'Cology andprenatal ca'e.
• 11,134 laboratory tests werecompleted.
The followi"g reproductivehealth and family pla"ni"g resultswere recorded for 1996-97:
• A toUoI of 1,402 new familypla"ning UsefS, from all lettorsincluding the town of GUllranda.
• A total of 1,283 contmumgfamily pla"ning Ulerl, againfrom all sectors.
• 474 children telted for para litesin the WN_CEMQPLAF projectcommu"ities.
Food S~curity and NaturalResource Management;Activities and R~sulu
Soil erol,on, 1015 of 1;011 fertility,olll} .~d"(\Il"\u; Idm IICel (0,
blned With population gro"1h.afje<;t~ family food ~e<;urily alldIlKrNJ.eS the need for leal;Ooalout-migra\lon and cultl\'~t'onofstee~ ~Iopes. Drought a"de~cess"'e ra,nfall are pa,t of thep~lle'n of lOil erO"Qrl aod n~tur~1
'~mu'(~ oeg'adat,o"
"
Activities in the program yearincludffi'
• 1Sfamilies and one communiI)'made demonstration plots forImproved cultivation of wheatand barley.
• 7 families did experiment-alfield trials to test varieties ofwheat and barley.
• 21 communiI)' leaderl weretrained 10 Improving foodsecuril)'.
• 15 communiI)' leaders weretrained in QUlnel pig production.
• 31 famiiies and one commu"il)'implemented mil a"d waterconservation measures, uSI"g5Iow·formatio" terraces a"dfiltration ditches.
• 150 families planted gree"manures to Improve 1011 fertlrol)'.
M"a'u.~t>I .. r"'ult' "I th.. 1('>f'l(1letunty program for 1996-97were as follows:
• AgriCultural productio"increased by 50'*' i" thedemomtration plots,
• The numbef of participantsn.:reased, and more communitiesare solicitIng ~rtidpiltion.
• The e~p"nme"tal held tnail aredemonllrat'''g "ew \'aroet>elthat increase production.
• 10" of tam I an t, lum ,gvegetables,
• ~8.532 \.Qu~r( m(!rrl of I~nd
were prote<;lpd by .oil a"dw~ter co"ser\,at,o" meaSU11'1.
Appendix: Recent Proqram Data. 1996-98
A v()\mIHf~1lfI>~" promoltr b:pk>irIllllt COO«!lIlf 01 lilt 1/Itr"lOITlfrer10 plNtic!pOfl11 ill IIv viibgf·bolft! frommg COII/lf
"
1996-91 Clinic Record,
TT Ix prog'Jm 'l ....I!
wpponed by dontc r«ords fromC£.\tOI'l.Af-Gwr¥>d.i pn;Mded III
"ugtm 1997. 0vIer... theft W'l• 75'lf. ,ncre.~ in the num~ 01falnlly plMInIng users i' theGwrand.J dnoc sin« the~was fl!abli~, lh<M.>g/'l not aU ofthem from the program are•.Betwffn 1984-93, tile avet"otgl!numbel" of conlra<eptJVe Uien~ y...., """1 l,lD4(rltW ..nocontmu,ng). from 199).96, thlliocrused to loll~~e 01 2.9G4Use of the clinic: tOl' other servicessuch ~ 9)'"KoIogy. 1ftN~~.Jnd pedI.Itnu lncru5ed evenmore - from ...~~ 01 783clofIIC vu.u ~r)'l'M to more th.In2,500. The numbel' of lM)o<<1torytens conducted more Ih.1ndoubled, from approKlmately5,000 to 11,000.
It mUll be remember«! thuthe Coo.AorMld.l clinic~ a muc;h
'NIdrf Ale•• both rur~ ¥Id urtwon,INn the 12 pn:Ilpm~
Thee cornmun.tJe iotCOUflI lot1S9to of the tI)t.lIIlUTlb« 01 f.nlypLJnrwlg usen,. nrw Mw:! cononuing.Of the 403U~ from programcommunities, 63% (29' users)_re from int~",ted VIllages,wtd~ l7'1/, 1109 ""'1'\\ w.,.I'01m~alth-onlyvillages. The lIl~rated
communotit'J .ha lTUde more useat the dmtt fQr Olhef m«IiuI~ Koounting IOf 58'110 01dinil; "'loIts.
1998 Clinic Aec:onh,,, lQCl7.011 , .... ~ ....~M. n;..;..;
re<::eivfl:l over 18,000 "'I'U,in<ludm9 2,S85 users of famIlypjannmg services. 8y 1997 th~
p'oyr~m had ~~p.lnalld la 21mm!.n r'fi, 20 of thti@ ",er~
/TlOfIltal"ed h7~ of IT.wr.g~ r5.1lts of th(o r'tgrJted.PP'Wd1 (10 on~.ted.oo 10he.1th only). 36'llo 0I.Ml .......... ;w>d
241io 01 ..con~U5I!t'l ..t!he dnoc: UITlII! from 20 commu.nrWS p.ubCip.otmg In the \VorIdN~Ighbon·CfMOPl.AF program(twQ integrated commun,ties ar~
not Included In the r~portm9
pr< , , 'er po.'TO\" ~ 'IT'1=,)r "',
~~~ fMTII1y pIarvW1gacceptM1oc~ ratl!:i between inl~
9ra~ M>d health-«lly commufloWS. the number 01 UWf'l in1997·98 was 87'11> nogher In
Integrated~ than he.olthonly vi~ (881io higher for ..........UH'fS and 86'111 higher for contm·u,ng uH'fs). Tables 1 ilnd 2 sum.m.riz~ the program's r~lults forlhe p.lst }'~ar r~la~ to fam~y
p1annrng and other dink use.
Out' to ,ncrused dem.nd ror~ic~s from n...1.ren ,n8ol,~,}f pro.,nc~, CEf"tOPLAfplJf"l to purch..lse aM rentJVJle........... bcMe !of tIw c....a.andi dnc.Thu wme clInoc WiU on tIw ve'9t01 dow>g dol! to poor .ttendanc~
five ~.lIrs AgO. Two Mkli~promoten were ;o<!ded in JulYt 998, and th~ program wilt beextended to 18 mor~ commun'llf:iIn 1998·99, lor a tOlal of 40.CE',IOI'W In(J ',':or'd ",,0';"00"will .lIlso repllUll! the p<ogr..m Inthe ne;ghboring provinc~ 01Cho"lxuzo bII!gio_. '9 in 1991-99,budding upon key~ fTomthe Ilafiyar upe> id ICl!.
A~_ ......... j: ...t\~~eIIUIA. l(ecenLProqram Uata. IY%-Yti
Table J. ComporlJQn of Clinic UJoge In 10 Integrared ond 10 Healrh-Only Commllnjrie~, WorldNelghborJ-CEMOPu'F, Bolivar Provinu, ECllodor, 1997·98
ACTIYITl($ hL Quarter 2nd QUJr:.cr 31d Quarter 4th Quarter Tolal
H H.A H H.A H H.A H H>A H H.A
FP new users 32 63 46 15~i " ~:
69 :~~ 230FP conHnllinn user~ n " " 78 " " , , 250Total " '" m " 85 " '" 258 460
'"Other Servkes " " " " " 92 " '06 '" ".Pap Smear 22 " " " " " 8 37 62 notabo.atory
~~ I " " " :~22S
~~98
~~ '"Pha.ma 57 " " " 72 263To(al 1081 '" 82 '" '" '" '" m 506 1197
H", I>tall/>-only vill~s H~,A,", integrar~ Mall/> and agriculture villages FP", lamily pkm",ng
Table Z, Total Clinic UHJge,,A,1/ Servius, CfMOPLAF, Guaranda, Ecuador 1997-98
ACTIYlTlES Nllm~. of patients
FP flew users '"<0 ~"M;.,,,:,,,, l"-'" 1 ~11
Total 2585
Other Services 2,853Pap Smear 830Labo.atory 9,565Pharm."'; 2,506Total 15,75~
'.
World Neighbo" 'I a people-to-people, non-profito'g~nila\lOn worldng ~t th" fore/ront of worldwideeffort< to elim,nat" hU"9"r, disea,,, and poverty inAJia, Af'ica and laM Ameoca.
Wo<Id Neighbon ~ltirm, !he dl'ttrminaUOll, i"9lffi1J'tyand Inher"nt dignity of ~II people.
Bv II'ffigthrnin'lth"ir p';m.,rv relOutel'l. pl'Opll'arl' hl'lped to anaiyzl' and soNl' thl''' own probl.,.",SuceelS i~ il(hil'V1'd by dl'Vl'Iop<n.g, te~~ng and",tend,ng slmple technologies ~t the commun,ty leveland trainir>g loc:~lleade" to su,ta,n and multipiyrelulu.
Program prionu", ~re food prodUCtion. commumty.based health, family planning, water and sanitauon.ffiv",onmenl.11 con",rv~uon. and 'mall !JU,on"'l.
founded ;'1 1951 and rootl'd ''1 the IlJodeo.ChrislJantradition of ne;ghOO, helptng neighbo" WorldNe<ghbors is a non_l&tanan. ,etf-hl'lp movemffitIUpportl'd by private donat,ons. WOOd Ne<ghbondoes not ~Idt or accept V.S. government funding.
1'1'1. julio Beingolu OdloaN~tional DirKtor
World N"ighbon, EcuadorAptdo M-Ol-1 ~o6
Riobamba, EwadorTel/Fax: 593-3·968799
E_mail: jbov"mun@«uan"x.n"t.ec
CWOPl.Af, Center lor Moedw:al GUIdance and F.orro!yPlanning, i, a p,ivate. non-proHt, apohucallnnnut,onotfenng ,eproduc~ health and famiiy plann"'g 'l'fVICe,lor low-income populations in Ecuador.
Since 197~, CWOPW ha, 'KeNi'd rKognition forthe reliability and Int"9nty 01 its ~"'. Th" inllitutlonhas earned ,ts cJients' tonHdence and app,oval fo' th"quality wilh which thl'V Ofe ,el'Vt'd
Objl'ctl"e,
• To promote matl'mal and child health.
• To encourage Respom,ble PMl'nthood as fund~.
mental for the well-being of families and ,odety
• To ,ecogn,ze a couple'l freedom and right todec'de the number and sp"Cing 01 the childrenlhey de"'e
• To rai'e awarene.. through I'ducauon about thehIgh riSl abortIon presents to a woman'l health~nd me.
• To detKt e~rty ,ndiuuoos of uterine ~nd cervicalcancer through regular P~panicolaou eums.
• To succeed in ,alsing awareness that "Every childIhould be wanted and _leome."
Lie. Teresa de VargasExecutivl' Director
CEMOPLAFCuero y Caicedo 258 • (Aptdo 17-01-35401
Quito, EcuadorTel: 593·2-230519 • Fax: 593-2-582435
f·mail: [email protected]
World Nelghbor~, Inc.
4127 NW 122nd Street
Oklahoma Cily, OK 73 120 USA
Tel: 405-752-9700' fax: 405-752-9393
f-mail: [email protected]
