PARTICIPATORY COMMUNICATION STRATEGY TO STRENGTHEN HOUSEHOLD AND COMMUNITY LEADERSHIP FOR THE REDUCTION OF CHRONIC MALNUTRITION, IMPROVED HYGIENE AND CROP DIVERSIFICATION

AcronymsAGEXPORT Asociación Guatemalteca de Exportadores

ALIANMISAR Alianza Nacional de Organizaciones de Mujeres Indígenas Por La Salud Reproductiva,NutriciónYEducación

ANACAFE Asociación Nacional Del Café

CNCG Clima, Naturaleza Y Comunidades en Guatemala

COCODE Consejo Comunitario de Desarrollo

CODEDE Consejo Departamental de Desarrollo

COMUDE Consejo Municipal de Desarrollo

COSAN Comisión De Seguridad Alimentaria Y Nutricional

CRS CatholicReliefServices

ENSMI Encuesta Nacional De SaludMaternoInfantil

FANTA FamilyHealthInternational

FUNCAFE FundacióndelaCaficultura para el Desarrollo Rural

GTC Grupo de Trabajo de Comunicación

HC3 HealthCommunication CapacityCollaborative

HEPP Health Policy Project

MSE Modelo Socio Ecológico

NUTRI-SALUD Proyecto Nutrición Y Salud

OSAR ObservatorioDeSaludReproductiva

PAISANO Programa De Acciones Integradas De Seguridad Alimentaria Y Nutricional Del Occidente

PCI ProjectConcernInternational

PF PlanificaciónFamiliar

PLANFAM ProyectoDePlanificaciónFamiliar

RA Rainforest Alliance

REDHOSEM Red Nacional De Hombres Para Las NuevasMasculinidades

REDMISAR Red De Mujeres Indígenas PorLaSaludReproductiva

STC SavetheChildren

SEGAMIL Programa De Ayuda Alimentaria Enfocada En Los Primeros 1000 Días

V1000D Ventana de los 1000 Días

URC UniversityResearchCo.,LLC

USAID UnitedStatesAgencyforInternational Development

WHIP ProgramaIntegradodelAltiplano Occidental

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CHALLENGES AND OPPORTUNITIES IN THE WHIP

EXECUTIVE SUMMARY The USAID Guatemala country strategy for the period 2012-2016 contributes to the developmentalgoalsofGuatemalansocietyandgovernment,specificallywithregardtothereductionofmalnutritionandpoverty,theimprovementofeconomicgrowth,localgovernanceandsocialdevelopment,andthesustainable management of natural resources tomitigatetheimpactofclimatechange.USAIDinitiatedtheWesternHighlandsIntegratedProgram(WHIP)whichbringstogethermultipleprojectsandimplementingpartnerstoaddressthesemulti-sectoralgoals.

Withinthisoverarchingprogram,USAIDGuatemalaenvisionedtheincorporationofSocial and Behavior Change Communication asaforceforunifyingandpromotingintegrationbetweenWHIPprojects,withtheaimofstrengtheningtheeffectivenessandimpactoftheprogramsandcreatingmorespacesforcitizenparticipationandtheinvolvementoftheindigenouspopulation,therebypromotingsustainabledevelopment.

USAIDGuatemalainvitedtheHealth Communication Capacity Collaborative (HC3), a global project based at the Johns HopkinsCenterforCommunicationPrograms,to design and implement a broad-based Participatory Communication Strategy for theWHIP.Thestrategycapitalizesonpre-existingplatforms,networks,andresourcesthatUSAIDhasdevelopedincollaborationwithitsimplementingpartners,andfillsingapsidentifiedthrougharigorousandcomprehensivesituationanalysis.Withaholistic,synergistic,andharmoniousfocusinitseffortsandmessages,theParticipatoryCommunicationStrategyaimstocreateafavorableenvironmentinwhichthedesiredimpactwithrespecttonormativeandbehaviorchangecanbeachieved.ThestrategybringstogetherthemultipleforcesofchangesetinmotionbyWHIPprojectsunderasharedvisionandharmonizedvoicetofurthercontributetothefulfillmentofthecountry’sdevelopmentgoalsandstrengtheninglocalcapabilities.

HC3carriedoutanmulti-componentSituation Analysis atmultiplelevelsoftheWesternHighlandsIntegratedProgram(WHIP),whichincludedananalysisofcommunicationactivitiesofWHIPprojects,anextensiveliteraturereview,theexecutionofrapidlandscapinganalysesofreligiousleaders,radiostations,andcellphonetechnologypenetrationintheWesternHighlands,andmorerecently,aformativeresearchstudyonfamilydynamics,futureaspirations,andpositivedeviants1.Allofthesestudiespointtoanexistingbodyofknowledge,beliefs,habits,andgendernormsthatsustainexistingpracticesinhealth,nutrition,hygiene,agriculture,foodproduction,andwateruse,manyofwhichpresenthealthriskstobabiesandtheirmothers.Thissystemofvaluesandbeliefsisreproducedinthehome,wherethegrandmotherfiguresprominently,andinmanycases,itisalsolegitimizedbysocialnormsinthecommunityitself.Thesenormsrepresent the biggest challenge to an open and informed dialogueinthehomeandcommunity.

TheimplicationsofthesefindingsunderscoretheimportanceoffocusingthepresentParticipatoryCommunicationStrategyonchangingthenormativeenvironment.ThisStrategyframesthepromotionofknowledgeanddesirablepracticeswithinthecontextofsparkingcriticalthinkingtochallengepreconceptionsand appeal to family aspirations. The Strategy operates throughinfluentialmembersanddecision-makersinhomes,thecommunity,andoncommunicationmediaplatforms,establishingbridgesofculturalrelevanceandemphasizingthereasonsandbenefitsofbehaviorchange.

TheParticipatoryCommunicationStrategywillcapitalizeonexistingopportunities.Oneoftheseisthepresencekey social actors, such as religious and indigenous leaders, civilsocietynetworks(REDHOSEM,REDMISAR),andcommunity-basedprojectfacilitatorswhohavehighcredibilityandrespectinthecommunityandhaveaninterestinseeingthetransformationandprosperityoftheirvillagesandthewell-beingoffamilies.

1 The term “positive deviant” is in reference to individuals or groups who find more effective solutions to heath and development challenges, despite having access to the same limited resources as those faced by their neighbors. http://www.positivedeviance.org

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These social actors exemplify “seeds of change.”Throughtheirlifestyles,practices,andaspirations,theyserveaslivingrolemodelsfortheircommunity,harnessingenormouspotentialtoinspireandguideotherstoreflectandchangetraditionsandbehaviors2.

AnotheropportunityisthegenerationalshiftinlifeaspirationsandfamilyrelationshipsintheWesternHighlands:“peopledon’tliveliketheyusedto”...“youngparentshaveadifferentmentality”3.Grandparentsrecallfromtheirchildhoodalifeofdeprivation,punctuatedbyalackofinformation,violencefromcivilwar,scarcityoffamilialaffection,extremepoverty,andtheabsenceofbasicservices.Fortheirchildren-thenewgeneration-amorepositiveattitudehasemergedtowardsthepossibilitiesthatlifeoffers.Lifeisperceivedaslessprecarious,duetoimprovementssuchasaccesstoroadsandpublictransportation,availabilityoffood,educationalopportunities,healthclinics,advancesincommunicationtechnology,andparticipationintheexportandcoffeemarkets,amongothers.Thisnewrealityoffersopportunitiesforgaintothosewhodare to try;inthiscontextthe“spaceofwhatispossible”4isexpandedfromapastlifeofsurvivalfarmingandmarginalincomewherefewdaredtodream,toayounggenerationthatdarestoaspirebeyondwhattheirparentsandgrandparentsthoughtpossible.Alongthesamelines,relationshipsbetweencoupleshavestartedtobecomemorebalanced,withvalueplacedonaffectionbetweencouplesandtowardstheirchildren.Thereisgreaterautonomyfromtheinfluenceoftheoldermembersofthefamily,givingwaytoaspirationsofpostponingmarriageuntilonehasenoughaccumulatedcapitaltoinvestinplansforthefutureandtodreamoftheirchildrenhavingaprofession.

STRATEGIC APPROACH TO TRIGGER CHANGE

Todate,manyoftheWHIP’seffortshavecenteredonyoungmothers,andtheirlevelofknowledgeabouthealthandnutritionalpracticeshasincreased.However,thereremainsagapbetweenknowledgeandpracticeofbehaviorsrelatedtotheFirst1000Days-exclusivebreast-feeding,complementaryfeeding,hygiene,sanitation,andnutrition-sensitiveactivities.Totriggerchangesinthesebehaviors,anovelstrategicapproachisneeded.Ratherthanplacingallresponsibilityonyoungmothersalonetobetheagentsofchange,toputtheirnewknowledgeintopracticeandtochallengeexistingbeliefsthatputthehealthoftheirbabiesatrisk,thisStrategygoesbeyondcommunicationdirectedatindividuals,andfocusesongroups of normative influence and decision-makers. These actors are capable of unleashing and inspiring broad change,legitimizingnewnormsandcapitalizingontheopportunityfordialogueandcommunicationofferedbychanging trends in generational aspirations.TheStrategyproposesfourlevelsofaction:

1. Strengthening the HOMEasthe“heartofchange”,wherethefamily,especiallythemother-in-law/grandmotherandyoungmother’shusband,willplayaroleinsupportingandprotectingthemotherandbaby.

2. InvolvingandsolicitingacommitmentfromcommunityLEADERSHIP (religious leaders, indigenous and communityauthorities,civilsocietynetworks)totakealeadingroleinactivelysupportingyoungmothers,theirbabies,andtheirhouseholds,tobringaboutchange.

3. EmpoweringandraisingtheprofileofthecommunityFACILITATORinordertoincreasetheirinfluenceandempowerthemtomodelchange,andcatalyzetheirworkforthewell-beingoftheirhomeandcommunity,bydemonstratingthatempowerthemtomodelchangeispossibleandbringsrealbenefits.

4. EnsuringtheparticipationofandallyingwithCOMMUNICATION MEDIAandsocialnetworks,openingupnewspacesofdialoguetoshowcaserealstoriesoflocalchangeanditsmainplayers,theseedsofchange-positivefordeviants,households,andfarmerassociations-therebylegitimizingdiscoursearounddevelopment,opportunities,andfamilywell-being.

2 Health Communication Capacity Collaborative, HC3 (2016). WHIP Communication Strategy Design Workshop. Guatemala March, 2016.3 Saenz de Tejada, S., Figueroa, ME. (2016). Perceptions, Aspirations, and Emotions related to Health, Nutrition, and Hygiene in Families of the high Andean plateau. Preliminary Results. Health Communication Capacity Collaborative (HC3) Guatemala. Financed by USAID Guatemala. 4 Fischer, EF (2012). The Good Life: Values, Markets and Wellbeing. Working Papers Series No. 14, Open Anthropology Cooperative Press; Fischer, EF and B Victor. High-end coffee and small holding growers in Guatemala. Latin American Research Review, Vol. 49 (1): 155-177.

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TheStrategyproposestheharmonizationandunificationofthesefourlevelsthroughthecreationofaNetwork of Support, Learning, and Actionaroundyoungcouplesandtheirbabies.ThegoalistomovethesegroupsofinfluencefromamarginalpositiontothecenteroftheconversationabouttheWHIPagenda,fromsimpleobserverstospokespersonsanddefendersofhealthbehaviors,nutrition-sensitivepractices,andincome-generatingactivities.Inturn,itishopedthatthisparticipationandcollectiveleadershipwillprogressivelylegitimizenewsocial norms of transformation and protection, bringing the communitytogetheraroundthewell-beingofyoungmothersandbabies.

COMPREHENSIVE APPROACH OF THE WHIP PARTICIPATORY COMMUNICATION STRATEGY

FIGURE 4: ComprehensiveApproachoftheWHIPParticipatory Communication Strategy

ItisimportanttoemphasizethatthecommunicationactivitiescurrentlybeingcarriedoutbytheWHIPimplementingpartnersaredirectedatyoungmothersthroughmonthly“nutrition/developmentclasses”andcookingdemonstrations,ortotheman(husband)inhispositionasanagriculturalleaderandmemberofaproducers’association.These activities constitute the foundations and points of convergenceforthenovelactionsandapproachesofthisStrategy.Asaresult,thestrategyensuresthatongoingactivitiesdirectedatindividuals,householdsandwithcommunityleadershipandprojectfacilitatorsareintegrated,capitalizingonthecomparativeadvantagesofeachactivity.Inthisway,theStrategytakesadvantageofestablishedrelationshipsandharnessesthepowerofongoinginterventions,amplifying and unifying the presence of the WHIP. In addition,theStrategyputsforthnew activities that fill gaps in current programming and offers innovative platforms for synergywithmassmedia,socialnetworks,andcommunitycommunicationforumssothatthechangeanditsleadersbecomeevenmorevisible,andthatthevoiceofsupportandthecommitmentofinfluentialgroupsismadepublic.

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GUIDING PRINCIPLES OF THE PARTICIPATORY COMMUNICATION STRATEGY

1. To capitalize on the strengths and existing networks built by variousWHIPprojectsinordertofill gaps, complement, and expand thelocalactivismthathasbeengenerated.

5. To start with emotions and aspirations as the catalysts of change,exploringnotonlycognitiveaspectsassociatedwithpracticesbutalsoframingaspirationswithintheuniverseofopportunities.

2.Tofocuscommunicationactionsonindividualswhoareinfluentialorwhoarethedecision-makers atthelevelofthe home/family, couples, and community.

6.To raise the profile of endogenous trends of change by socializing life histories,testimonialsof“positivedeviants”,andparadigmaticcases.

3.TorecognizeGuatemala’smultiethnic, multicultural, and multilingual nature,withcommunicationthatestablishesanatmosphere of respect, exchange ofknowledge,andvaluingdifferentwaysofbeing.

7.To strengthen the voice of the community and raise the profile of local solutions through the co-design and co-production of the communicationstrategy,itstools,andprocessesforimplementation.

4.To focus on the home as the producer of health and well-being, recognizing that there is accumulatedlocalknowledgeandwisdom.

8. To integrate a focus on transformational gender fairness creatingopportunitiestoquestionthestatusquoandtherootsofgenderinequalityinthehome,community,services,andstructuralenvironment.

9.Toofferavoice and a unifying conceptforthecollectionofWHIPprojects,tyingtogethervariousactionsunderoneinclusive vision of cultural belonging and a call to action that invites change.

SELECTION OF COMMUNICATION SPACES AND PLATFORMS

TheWHIPParticipatoryCommunicationStrategyproposesthe integrated use of mass media, community communication, mobile technology, and social networks,takingintoconsiderationboththecharacteristicsofthedifferentaudiencesselectedaswellastheplatformsthathavethegreatestpenetration,preference,andcredibility.

• Interactive Radio: Platform for Convergence and Unification of Activities. Thecoreofthestrategyisanewinteractive radio platformthatfeaturesengagingradiodrama,testimonialsandlifestoriesofthosechampionsandpositivedeviantswhohavechangedtheirbehaviorandexperiencedthebenefits,andalivelyinteractionbetweentworadiohosts–agrandmother/mother-in-lawandacommunityfacilitator.Theradioprogramispositionedasthehub,wherethecollectionofWHIPactivitiesconvergeandareunified.ItseekstopromotedialogueandcollectiveactiononWHIPissues,andmakethe“spark of change” visiblethroughthevoicesoftheprotagoniststhemselves.Theradioprogramwillhaveclipsonlife stories of change,entertainmenteducationvignettesmodelingdesiredbehaviors,interviewswithcommunityleaders,grandmothers, and project facilitators, announcements of community eventsofthevariousWHIPprojects,andthepromotionofatelephone and text message(SMS)advicelinethroughwhichtheaudiencecanchannelitsquestionsandproblems.

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• Community Facilitators and Promoters: Seeds of Change with a Tablet in Hand! InadditiontotheactiveparticipationofWHIPproject community facilitators on the radio as programhostsandspokespersonsfornewbehaviorsand a future of prosperity in the community, thefacilitatorswillalsohaveaninnovativecommunicationtoolthatwillelevatetheircredibilityandauthorityinWHIPissues.Capitalizingontrends of progress in digital technology, a Tablet Applicationwillbedevelopedwhoseintuitivedesignwillallowthefacilitatortoenhancetheirworkwithdiscussiongroups,homevisits,andfollow-upvisitstodemonstrationsites.Theapplicationwillcoveravarietyofissues,puttingcorrectandcreativelypresentedinformationatthefingertipsofthefacilitator,takingadvantageofmultimediaformatstofacilitateexplanationofcomplextopicstomembersofthecommunity.

• Communication at the Home and Family Level. At home, the Grandmotherwillbepositionedasanactiveagentofchangewhoparticipatesinthenetworkofsupport,learning,andcollectiveactiontoprotectthehealthandgrowthofhergrandchildrenandherdaughter-in-law.TheGrandmotherwillhaveherowndiscussionforum-The Grandmother’s Club -onthepracticesoftheFirst1,000Dayswithinaframeworkofa“dialogueofknowledge”.AsthecollectiveidentityoftheGrandmothersstrengthens,theirinvolvementwillbesoughtintheregularactivitiesoftheWHIPproject,suchasthemonthlyNutrition/DevelopmentSchools,meetingsofProducerAssociations,cookingdemonstrations,amongotherthings,givingGrandmotherstheopportunitytolearnindepththebenefitsoftheWHIPagendaandplayapartinpromotingit.TheStrategyalsoproposestoinvolvemen, and recognizing the challenge to reach men, the Strategy intendstousespacesthataremostfrequentedbythem,suchasproducer/farmerassociationmeetings,networksoftuk-tukdrivers,informalpoints of business, barbershops, stores for charging cellphones,Internetcenters,etc.Shortforumsfordialogues between menwillbeorganizedinthesespacesusingimpactfulandinnovativeactivitieswithaguerrillamarketingapproach,deliveringpromotionalmaterialandinvitationstocommunityactivitiesandradioprograms.

• Community Level Communication: “Dialogue of the Wise” for Collective Action.TheStrategywillpromoteanetworkandDialogue of the Wisebetweenthevariousbodiesthatmakeupthelocalcommunityleadership,identifyingsimilaritiesbetween:1)BehaviorspromotedbytheWHIPagenda;2)thevalues,principles,andwisdomoftheMayaworldview;and3)theteachingsofreligiousdoctrinesrepresentedinthecommunity.TheobjectiveistoarriveataconsensusforanAction Planthatreflectsthecollectiveeffortstocreatethenetwork of support, learning, and collective action formothersandtheirbabies.ThisActionPlanwillbepubliclydisclosedinthecommunity(inlargeprint)signedbytheleaderswiththesupportoftheentirecommunityanditsresolutionswillbepromotedontheradio.Inaddition,communicationactivitieswiththesegroupswillcapitalizeontheusualforums and points of congregationofthevariousleaders(churches,civilsocietynetworkforums,communityassembliesandmeetings)andtheStrategywillofferleaderstrainingeventsonWHIPIssuesandcommunicationtoolsforsharinginformationabouttheseissueswithothers.Finally,midwives, manyofthemgrandmothersandmothers-in-law,willreinforcetheirknowledgeonissuesrelatedtothehealthofpregnantwomen,breast-feeding,complementaryfeeding,hygiene,andnutritionforbabiesduringtheFirst1,000Days.

• Set of Materials Reinforcing Integration of WHIP Messages and Activities. Aspartoftheefforttopositiontheunifyingconceptof“Together We Prosper. We Dare. We Advance.”, the Strategy includesthedevelopmentofasetofmaterialstobeusedforcommunicationandcommunitymobilizationactivitiesinthehome,community,media,andsocialnetworks.Thesetofmaterialswillbeversatile,adaptedtothecommunicationactivitiesandaudienceprofiles,culturallyrelevant,andespeciallygearedtowardscommunityfacilitatorsandtechniciansoftheWHIPprojectsusingthemintheirregularactivities,supportingandstrengtheningtheirwork.

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FIGURE 6:UnifyingConceptFavoredbyTechnicians,Facilitators, and Community Participants

FIGURE 7:Visualization of the Strategy’sCommunication and Media Platforms

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FORMATIVE RESEARCH AND MONITORING OF RESULTS

TheStrategywillhavetwocomplementaryresearchactivitiesthatservetostrengthenthestrategyanddocumentitsachievements:formativeresearchandmonitoringofresultsandevidenceofchange.Thefirstwillseektoidentifynormative,psychosocial(aspirations,emotions,motivations),andbehavioralfactorsthatinfluencechildnutrition,feedingandhygienepractices,aswellasdynamics at home and the influence of opinion leaders(positivedeviants,religiousleaders,spiritualguides)thatfavorsuchpractices.Theresultsofthesestudieswillhelpreinforceandrefinethecontents,actions,andmessagesoftheParticipatoryCommunicationStrategy.

Monitoringofresultsduringimplementationwillaimtodocument changes that occur in the determinants and practicesoftheFirst1,000DaysandnutritionsensitiveactivitiesasaresultoftheStrategy.Themonitoringofresultswillfocusondocumentingchangesthatoccuratthelevelofmother-in-law/grandmother,husbandandwife,religiousleader,communityfacilitator,indigenousleader,communityauthority,andmidwife.Additionally,theeffectthatthesechangeshaveonthefeedingactionsofpregnantmothersandonthehygieneandfeedingofthechildrenwillbedocumented.Finally,theresultsofthemonitoringwillprovidetheimplementingpartnersoftheWHIPwithfeedback,aswellasacommunicationprogramwithwhichtoreinforceandpromotethechangesobserved.

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INITIAL IMPLEMENTATION PHASE

HC3Proposesaninitialimplementationphaselastingapproximatelysixmonthsthatallowsfortestingandreviewingthecommunicationtoolsdeveloped,adjustingtheprocessesforrollingthemoutinthefield,andbuildingskillsandstrengtheningactionsforcoordinationandalliancewithWHIPimplementingpartners.IntightcollaborationwithUSAIDandtheimplementingpartners,thefollowinggeographicareaswereselectedfortheinitialphaseofimplementation.

InordertoensuretheeffectiveimplementationoftheStrategy,HC3willseektoestablishamechanismforcoordinatingwithWHIP’Simplementingpartnersandwithmunicipalauthorities(MinistryofHealth,indigenousmayors,religiousauthorities,civilsocietynetworks)andradiomediainMomostenagoandNebaj.Thegoalwillbetoensure everyone’s solid involvement, active participation, and commitment to reducing chronic malnutrition, improving the health and well-being of the family, and community development.

CONTINUOUS LEARNING

Justlikeotherinterventions,theParticipatoryCommunicationStrategybenefitsfromandisstrengthenedbyacontinuouslearningprocessbasedonfeedbackfromWHIPcommunitiesandexperiencegainedduringtheimplementation.ThroughmeetingsestablishedwithUSAID,WHIPimplementingpartnerstaff,theWHIPimplementationCommunicationWorkingGroup(GrupodeTrabajodeComunicación,GTCinSpanish),thegroupofWHIPcommunityfacilitators(CF),andprogramparticipantsinthisinitialexecutionphase,theprogressandchallengesdiscoveredduringtheimplementationwillbediscussed.Adjustmentswillbemade,inadditiontoofferingstrategicorientationforscaled-upimplementationoftheParticipatoryCommunicationStrategy,whichshouldfollowtheinitialphasedescribedhere.Finally,thesetwogroups(GTCandCF)representhigh-valuesocialcapitalfortheWHIP,notonlyfortheirknowledgeandtechnicalexpertise,butalsointermsoftheirexperience,wisdomandproficiencygainedinthepromotionofanintegratedagendaandbehaviorchangethatrepresentstheveryessenceoftheWHIP.

TABLE 4:GeographicalFocustheInitialImplementationPhaseintheWHIP

GEOGRAPHICAL FOCUS WITHIN THE WHIP AREAQUICHÉ DEPARTMENT TOTONICAPÁN DEPARTMENT

Municipality: Nebaj(IxiArea)Communities: La Pista, Acul, Xexuxcap

Municipality: MomostenangoCommunities: Xequemeya,SanJoséSiguilá,Rachoquel

IMPLEMENTING WHIP PARTNERS IMPLEMENTING WHIP PARTNERS

• Paisano• Agexport• ProducerAssociation:ASONAM• PlanFam• Nutrisalud• HEP+

• Reshosem• Redmisar

• Nexos Locales• Leer y Aprender

• Segamil• Agexport• ProducerAssociation:APROSIP• PlanFam• Nutrisalud• HEP+

• Reshosem• Redmisar

• MásFrijol• Nexos Locales• Leer y Aprender