Addressing malnutrition through effective
communication:
The case of Totonicapán, Guatemala
A Research Paper presented by:
Gabriela María Díaz Salazar
(Guatemala)
in partial fulfillment of the requirements for obtaining the degree of
MASTERS OF ARTS IN DEVELOPMENT STUDIES
Specialization:
Local Development Strategies
(LDS)
Members of the examining committee:
PhD. João Guimaraes
PhD. Nicholas Awortwi
The Hague, The Netherlands
November, 2011
Disclaimer:
This document represents part of the author’s study programme while at the
Institute of Social Studies. The views stated therein are those of the author and
not necessarily those of the Institute.
Inquiries:
Postal address:
Institute of Social Studies
P.O. Box 29776
2502 LT The Hague
The Netherlands
Location:
Kortenaerkade 12
2518 AX The Hague
The Netherlands
Telephone:
+31 70 426 0460
Fax: +31 70 426 0799
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Contents
Chapter 1: Introduction and Research Design
1.2 Background
1.2.1 Malnutrition in Guatemala
1.3 Making use of communication
1.4 Identification of the Problem
1.5 Research Objectives
1.6 Research Question
1.7 The Methodology
1.8 Limitations
Chapter 2: Understanding communication from different
perspectives and experiences
2.2 Models of Communication
2.3 Social Marketing
2.4 Experiences of Social Marketing and Health
2.5 Information, Education and Communication for Change of Conduct –
IEC/CC
2.6 Communication for Development
2.7 Experiences of Communication for Development
2.8 Methodologies and Techniques used in Communication for
Development
2.8.1 Outcome Mapping
2.8.2 The Most Significant Change
2.9 Analytical Framework
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Chapter 3: Study Case: Totonicapán, Guatemala
3.2 Totonicapán, Guatemala
3.3 Malnutrition in Totonicapán
3.4 Consequences of Malnutrition
3.5 Views about Malnutrition
3.6 Responses from Different Actors
3.6.1 Ministry of Public Health and Social Assistance
3.6.2 Government
3.6.3 Local NGO in coordination with International Cooperation
and other actors
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Chapter 4: Malnutrition and Communication
4.1 From Social Marketing, going through IEC/CC reaching
Communication for Development: the road to improve inter-sector
integration and participation
4.2 Integration of local actors in a territory
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4.3 Local Voices
4.3.1 Focus Group
4.3.2 Most Significant Change in Totonicapán
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Chapter 5: Conclusions
Income differences
Malnutrition
Communication
Totonicapán, Guatemala
Production and Economy in Totonicapán
Malnutrition in Guatemala
The Most Significant Change in Totonicapán, Guatemala
MSC in the Quality of Life (Parents)
Story 1: “That my children have a better life”
Story 2: “The value of herbs”
MSC in the Quality of Life (Local Actors)
Story 1: A speed recovery
MSC in knowledge and application
Story 2: I made my voice be heard in my language
MSC in the participation and coordination of an organization in
COMUSAN or Municipal Team of Communication
MSC in comprehension and appraisal of C4D
Story 3: C4D in the City Hall’s Plan
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List of Tables
Table 1.1: Ethnic Groups in Guatemala ................................................................... 1
Table 2.1: Intentional Design....................................................................................22
Table 2.2: Program Framework................................................................................23
Table 2.3: Overview of the approaches...................................................................26
Table 2.4: Indicators that lead to the integration of actors..................................27
Table 3.1: Municipality Priority, according to Quality of Life.............................29
List of Figures
Figure 2.1: Communication as a Process of Dialogue...................................20
Figure 2.2: Signals of Progress..................................................................................23
Figure 3.1: Totonicapán's Municipalities.................................................................28
Figure 3.2: Linking Local Actors..............................................................................37
List of Boxes
Box 2.1: Social Marketing Planning…………………………………………13
Box 2.2: Participatory Approach…………………………………………….18
Box 2.3: Signals of Progress………………………………………………....24
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List of Acronyms
SESAN
Secretariat of Food and Nutritional Security
Secretaría de Seguridad Alimentaria y Nutricional
COCODES Development Community Council
Consejo Comunitario de Desarrollo
COMUDE
Development Department Council
Consejo Municipal de Desarrollo
COMUSAN Municipal Commission of Food and Nutritional Security
Comisión Municipal de Seguridad Alimentaria y Nutricional
CODESAN Department Commission of Food and Nutritional Security
Comisión Departamental de Seguridad Alimentaria y Nutricional
MPO
Municipal Planning Office
Oficina Municipal de Planificación
OMM
Women’s Municipal Office
Oficina Municipal de la Mujer
CTA
Technical-Managerial Coordinator
Coordinador Técnico Administrativo
MINEDUC Ministry of Education
Ministerio de Educación
MIFAPRO
My Family Progresses Program
Programa Mi Familia Progresa
PRORURAL Programa Nacional de Desarrollo Rural
National Program of Rural Development
K’iche’
Mayas K’iche’, one of the 21 Mayan groups in Guatemala
MSPAS
Ministry of Public Health and Social Assistance
Ministerio de Salud Pública y Asistencia Social
CECODE
Centro de Comunicación para el Desarrollo
UNICEF
United Nations Children’s Fund
UNDP
United Nations Development Program
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Abstract
This research has been done in order to contribute to the Social Sciences from
Communication for Development. Communication for Development is a participatory approach of communication as process of dialogue. It is also a response to the Western way of doing communication, since its beginnings date
back from the decades of the 70s and from Latin American countries. There
has been an ongoing debate amongst the practitioners of communication as
mass media and the practitioners of Communication for Development. The
first ones have believed that what the products that they produce are the result
of communication. The latter, have claim the true meaning of doing communication and also take it as a citizens’ right. Therefore, the efforts are always prepared in the best interest of the people that the development project intends to
help.
Throughout the research three approaches to communication have been
analyzed, from the literature and from experiences, in order to assess which is
the adequate to address a particular social issue: malnutrition in Totonicapán,
Guatemala. Worldwide experiences have been included from the three approaches; an overview of the approaches has been made based on the literature. The case of Totonicapán, Guatemala has been chosen since it has been an
example of a participatory project from the perspective of Communication for
Development. The views and experiences from people of the area have also
been included to give relevance and importance to the local knowledge of the
area of interest.
Relevance to Development Studies
Communication as part of the Social Sciences is gaining importance in development projects around the world. Since the right to communication is also a
citizen’s right it should be promoted and respected. This research tries to contribute to the vindication of the right to communication in communities of Totonicapán, Guatemala. It is also a contribution to the importance of communication in development projects in order for them to be successful and not just
a repetition of previous experiences. The relevance of local knowledge is also
an important issue in the paper, which can be taken as an example for future
researches and professionals to be working in different contexts (from what
they know).
Keywords
Communication, information dissemination, Communication for Development, K’iche’, Totonicapán, Guatemala
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Chapter 1: Introduction and Research Design
This research examines the effects of communication addressing malnutrition,
but to understand the context, then it is necessary to understand the country
and its current problem of malnutrition of children. The research has also been
done to provide an explanation of effective communication with development
programs.
1.2 Background
Guatemala is located in Central America and it is politically divided in 22 departments and the departments make 333 municipalities. It has a population of
14,713,7631 . Guatemala has different characteristics that make it a unique
country, rich in cultural diversity since it is one of the Latin-American countries that still has a numerous indigenous populations from different groups.
Table 1.1: Ethnic Groups in Guatemala2
Ladino
6,750,170
60.36 %
Maya
4,411,964
39.45 %
Xinca
16,214
0.15 %
5,040
0.04 %
11,183,388
100 %
Garífuna
Total
The cultural diversity is important since the different groups make the
country. The Ladinos are the ones that do not belong to an indigenous group,
and it is said that are the ones who have a Spanish link. This group is also
known as the Mestizos, because in times of the colonization the Spanish people mixed with indigenous groups and created the “mix of cultures” the Mestizos. As the years went by, the term changed into Ladino, but it basically refers
to people who don’t have a specific indigenous culture. The Mayas on the other hand, were the settlers of the country with the other two; Xinca and Garífuna. The Mayas are the second biggest group in population of the country, but
have struggled since the colonization. After that period they lost their rights
and ever since it has been a constant battle to access a better quality of life.
Within the Mayas there are 21 groups that are spread in different departments
1
Instituto Nacional de Estadística http://www.ine.gob.gt/np/poblacion/index.htm August,
2011
2
Instituto Nacional de Estadística http://www.ine.gob.gt/np/poblacion/index.htm August,
2011, data from the last National Census of 2002.
1
and municipalities of the country. The Xincas; a smaller group in numbers but
it is also part of the cultural diversity; the departments where they live are the
East. The Garífunas are also located in one department of the country, in the
Caribbean area.
Whether big or small in numbers all these groups are recognized in by the
State. Although the country is still struggling to become a more inclusive nation and to be able to improve the access of the basic services, such as Health,
Education, Sanitation, Security, etc.
Guatemala is also a country with high inequality amongst its groups, which
can be one of the reasons why there are some groups that have access to all the
basic services and others have problems accessing them. Because the lack of
access to the basic services and other factors, the indigenous groups have suffered the consequences and are the ones who have more problems related to
health and nutrition, but also the ones with highest rates of illiteracy, low income, etc. These problems, together with other factors, have caused the country to remain as a developing country because when the population gets a different treatment the country’s growth will also be different. The opportunities
and the access to the growth opportunities have been different too. There are
some examples that illustrate the differences between indigenous and nonindigenous population in terms of access to basic services (Appendices Table
1).
Regarding the poverty, there are also differences between the two groups3.
In Guatemala 56% of the population lives in poverty, from this percentage,
58% of the poor people are indigenous. 16% of the population lives in extreme
poverty, from this percentage, 72% are indigenous people.
These indicators show a gap that has been increasing between the indigenous population and the non-indigenous population and also between the rural
and urban areas. The issues of inequality and the lack of access to basic services have been in the eye of the international community. Many efforts have
been done in order to improve the quality of life of these groups, by the Government itself and also with the help of the international cooperation through
different strategies.
The State, since 2002 and following the agreements of the Peace Accords
signed in 1996, the end of Internal Armed Conflict, approved the creation of
the Commission Against Racism and, the Indigenous Women Advocacy. Steps
have been taken into respecting indigenous people’s rights, but there is more to
be done.
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Diagnose of Racism in Guatemala, 2006
2
Guatemala has had a history of discrimination and racism, and the victims
of these actions have been the indigenous groups. After the sign of the Peace
Accords, attention has been given to reduce and eliminate discrimination and
racism. An example of this attention has been the UNDP’s National Human
Development Reports –NHDR- of the past years, more specifically 2005 and
2008. NHDR of 2005 describes and analyzes one of the basic dimensions that
define the nation; its multiethnic character. Guatemala has an asymmetry in the
inclusion of indigenous and non-indigenous people in the socio-economic
structure. “More than 80% of the indigenous population is located in the low
and extreme low strata. This means that 8 out of 10 Mayas, are in the bottom
of the social structure” (UNDP, 2005:98). Because of this the indigenous population is excluded from participating in highest social strata.
Income difference is also significant and, it has an important role since it is
the mediator between the economic activity and the access to satisfy the needs
that will lead to have a dignified life. Graph 1 illustrates the level of inequality
of the Guatemalan population (Appendices Graph 1).
Living in poverty or extreme poverty has been a situation that has affected
more indigenous people in the country. In 2004, 21.9% of the population lived
with less than $1.00 per day and, in relation to the indigenous rural population,
for the same year, 38% were under this category. When the country’s income is
concentrated in one group of the society it makes it difficult for others to have
the same opportunities.
International laws and agreements have been signed to reduce inequalities.
The Convention 169 from the International Labour Office –ILO- is the most
important framework referring to development, economy and cultural-ethnic
equity. “Establishes that the indigenous people should have the right to decide
their own priorities regarding the process of development, if affecting their
lives, believes, institutions, spiritual wellbeing and the lands that they occupy
and use. Therefore it warranties the right to control, as possible, their economic, social and cultural development” (UNDP, 2008:76).
Even though there are national and international documents, agreements
and more, there is always the chance for improvement. In the words of an
economist Maya K’iche’ “Very little has been analysed in the cultural-ethnic
dimension of the Guatemalan economy. This should be analysed due to the
importance of the historical circumstances of the country and considering that
the indigenous population is the one that presents the highest levels of poverty
and extreme poverty, low social indicators and less levels of public investment.
This dimension could be analysed in three aspects: a) the relation between cultural exclusion and economic exclusion, b) the nature of the culture and, c) aspects like the indigenous economy in the last years. To understand it better will
help the definition of measures so that the Guatemalan economy could be
more inclusive and sustainable” (UNDP, 2008:77). This shows that the notion
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of a non-inclusive economy is present and there is a need to work on it so that
the country can achieve the desired development.
Different strategies can be developed in order to address an issue, but the
results may vary. This research is focused in one issue that affects the majority
of the indigenous children in Guatemala, malnutrition. More specifically, the
research presents the findings of what the Ministry of Public Health and Social
Assistance has done over the past years and also was has been done for the last
two years by a local NGO. Also for a better understanding of the analysis, an
explanation of the ways for doing communication and sending information is
presented. The reason; it is important to recognize and identify the strategies of
information from the strategies of communication.
1.2.1 Malnutrition in Guatemala
According to the information provided by “Situational Analysis of Malnutrition in Guatemala: Causes and Approach” elaborated by UNDP Guatemala
2009-10, malnutrition associated to poor nutrition and other issues such as low
human development in Guatemala is understood as a vicious cycle. “It is recognized that malnutrition, as a visible expression of food and nutritional insecurity, it is also a barricade to growth and national development. The authors’
opinion is that the complex nature and the multiplicity of determinants and
factors that affect food and nutritional security, coupled with the limited participation of civil society in these efforts, makes the current models of governance poorly successful. This requires the strengthening of comprehensive view
in the adoption of strategies, constant commitment of society as a whole”
(UNDP, 2009-10:7).
Understanding malnutrition has had shift, it is clear that this is no longer
just a health problem but one that in the long run affects national development. And, it is not a new problem. The Analysis (UNDP) establishes that
malnutrition has been society since the decades of the 30s and 40s. It was until
the late 50s4 when the characteristics (clinic, biochemical and pathological)
were defined, with children who suffered from malnutrition and also the recommended treatment and the prevention measures of nutrition and sanitation
were established. Since the 60s the attention on malnutrition kept increasing
and a proof of that is that investigations have been done to identify more details on the problem and also effects of malnutrition.
Information linked to the release of an African Report on Kwashiorkor around the
same time, 1955
4
4
The Analysis (UNDP) mentions studies from different years5 and “these
all agree on the attention that has to be given from the moment of the child’s
conception until the first three years of life. This being important because it
has been shown that it makes a difference in the potential of growth and human development, including development of intelligence, personality and social behavior, as well as physical and intellectual productivity in the adult age”
(UNDP, 2009-10:9).
Recent information is integrated in the “Third National Height Census”
from Ministry of Education in coordination with SESAN. This was done in
2008 and the goal was to elaborate a current diagnose to know the children’s
nutritional state, through the height indicator. This indicator, as stated in the
Census, measures the delayed growth size, it also establishes the degree of severity of chronic malnutrition and allows making a direct relation of social and
economic development of the family and community where the measured
children live in. The Census was done with children from First Grade from the
Official Sector a total of 459,808 children from the ages of 6 years 0 months to
9 years and 11 months.
According to the Census, 54.4% of the children have been classified as
normal in relation to their height and the other 45.6% are delayed in height or
with chronic malnutrition. From the ones with delayed height, 32.9% are moderate and 12.7% are severe. More in detail, information has been summarized
in: Age, Urban and Rural Areas and Language (percentages can be found in
Appendices Box 1).
UNICEF’s report entitled “El Enemigo Silencioso (The Silent Enemy)”
provided a view on the problem faced by the country. According to the Representative of UNICEF for Guatemala Manuel Manrique, stated that “chronic
malnutrition needs to be explained because it can’t easily be recognized like
acute malnutrition (children with swollen stomachs and the hair looks light in
color). A child who suffers from chronic malnutrition has an inferior height,
the health is fragile and the intellectual development is severely diminished”
(UNICEF, 2007:3).
About the efforts done in Guatemala, Manrique mentioned that “for years
Guatemala made an effort to face this reality, and as stated in the Policy of
Food and Nutritional Security, these attempts lacked of the political decision
needed and a methodological development with a multi-sector approach, because of these the result was not positive” (UNICEF, 2007:3).
1994: Rivera and Martorell, 2001: Fuentes, Hernández y Pasucal, 2005: Behrman,
Martorell and Stein and 2006: The World Bank., information from “Situational Analysis of Malnutrition in Guatemala: Causes and Approach” elaborated by UNDP Guatemala 2009-10
5
5
The problem of malnutrition has been a constant and, different Governments have developed actions, strategies and even policies have been approved
in order to address it. Whether or not these have been successful does not
mean that the problem has been neglected. This is one of the reasons for the
research, to analyze what has been done and is being done, from a communicational view, since it is also important in the development processes. Chapter 3
provides more information about other efforts done in Guatemala.
1.3 Making use of communication
On a daily basis, we make use of words, sounds, messages, technology, media
and other tools in order to make ourselves understood but also to keep in
touch with our surroundings. Many times all of the tools mentioned are put in
one same basket called “communication” but what most of the time is not
mentioned is that not all of them are communication. As simple as it may
sound, people do not always know the difference or meaning of communication and information. Both terms have been wrongly interpreted as meaning
the same. This clarification is a “must” because part of the problem of dealing
with issues is that the actions or strategies have not been the most accurate
ones. If the differentiation is clear and if people understand what it is that they
are doing, then the planning, the actions themselves, and the results may
change from what has been accomplished in the past.
Throughout this research communication is understood a process of inclusive dialogue, like it is in Communication for Development, were the people
involved become active Subjects of the process. Subjects meaning as presented
in Pedagogy of the Oppressed “subjects; this term denotes those who know
and act, in contrast to Objects, which are known and acted upon” (Freire,
1996:18). Communication for Development has its fundaments in different
methodologies for social change, for this research, the reference is to Pedagogy
of the Oppressed. This methodology, created to empower people through education, people that have been neglected by the social structure that oppresses
them. In Shaull’s words “those who, in learning to read and write, come to a
new awareness of selfhood and begin to look critically at the social situation in
which they find themselves, often take the initiative in acting to transform the
society that has denied them this opportunity of participation” (Freire,
1996:11).
The principal is the same, through participation people become aware of
their reality and with the proper communication tools and guiding them in the
process of improving their capacities, and they will become agents of their own
change. As oppose to other strategies which make use of media in order to
somehow manipulate these people by giving the impression of helping them,
but in reality what they seek for is to keep the social structure: the same; people
oppressing others for their own benefit and others being the oppressed, who
miss the growing opportunities. Dialogue and communication are very im-
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portant for Freire as well in Communication for Development, “dialogue
which is radically necessary to revolution corresponds to another radical need:
that of women and men as beings who cannot be truly human apart from
communication, for they are essentially communicative creatures. To impede
communication is to reduce men to the status of things –and this is a job for
oppressors, not revolutionaries” (Freire, 1996:109). In Communication for
Development, people’s right to communication is being vindicated so that they
are no longer the “recipients” of the people in power who want to keep control of the rest. Realizing that communication is a right, will give them the tools
to plan their own actions and strategies that will help them in the process of
social transformation.
1.4 Identification of the Problem
Malnutrition of children is the problem that has been addressed in different
ways, following different methodologies and techniques (with different results
and responses from people). The communication approaches that have been
used in the area of interest have not helped in making significant changes in
people. The reason being is that these approaches are not communication, but
information dissemination and therefore lack the interpersonal communication, hence people don’t show interest.
A positive aspect of information dissemination is that it can help in creating awareness of an issue. Changes will not happen, in this case in reducing
malnutrition if people aren’t interested in hearing what the experts tell them.
Effective communication will provide spaces for local knowledge to be linked
with the information shared by a facilitator of a developmental program. If
transmission of messages, alone was enough, then why is it that people have
complained of not having proper information on the issue? Something has
been missing, and as simple as it may sound, is the interaction between local
actors and experts (in the interventions). To clarify the results of both, transmission of messages and effective communication, Totonicapán, Guatemala is
a useful example, since it has received both approaches to address malnutrition.
Communication alone cannot change the problem of malnutrition, but it
can improve the knowledge, attitudes and practices through people’s participation in different spaces that will lead to improve the children’s health and nutrition.
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1.5 Research Objectives
General Objective:

Analyze and compare different approaches to communication and information used in development-oriented projects, both from the point
of view of their assumptions and from that of their effectiveness.
Specific Objectives:


Identify and describe the elements that are key components of a
Communication for Development Process.
Study one region in Guatemala that has been subject to two different
approaches of communication to address malnutrition of children under five years of age.
1.6 Research Question
Research Question

How have Social Marketing and effective Communication for Development differed in addressing malnutrition of children under five years
of age in Totonicapán, Guatemala?
Sub-questions
1. What are the main criteria that should be satisfied by communication
for effective change?
2. What are the main characteristics of and differences between Social
Marketing and Communication for Development for civic driven
change?
3. How the current project in Totonicapán has helped to improve or not
the integration of different local actors to organize the efforts of
fighting malnutrition practices of the families?
1.7 The Methodology
The research analysis has been done with the information obtained by Primary
and Secondary Data Collection from the local NGO working in Totonicapán.
The information from the Ministry of Health and Social Assistance has been
provided by the representative of the Program of Promotion and Health Education from the Ministry. The Municipal Monitors from SESAN have also
contributed with the information. Testimonies, Most Significant Change Stories and focus groups of women, have been a contribution from the local
NGO.
Communication, as a process of dialogue and participation, helps empower people in the communities so that they can be agents of their own change.
8
Experiences around the world, but mostly from developing countries, have
given examples of how effective communication can help in social problems.
Communication for Development, although began since the early 70s has not
had enough attention and this research a contribution to the field.
To have a better understanding of whether and how the project helped in
the situation related to Food and Nutritional Security in Totonicapán, the ones
best to evaluate the actions are the local actors. For that reason the use of the
Most Significant Change, “a dialogical, story-based technique to facilitate program improvement by focusing the direction of work towards explicitly valued
directions and away from less valued directions” (Dart and Davis, 2003:137) is
important, as well as the interviews of the actors.
1.8 Limitations
To recognize that not everything is possible or easy is not a signal of weakness
but of ethics and professionalism. Therefore, it is important to clarify that one
of the limitations that affected the initial purpose of the research, was the fact
that I didn’t personally get the data analyzed. This was done with the help of
the local NGO and because of that I had to wait for the information to be
gathered and then sent. This partly affected my schedule. There were some
events that also made it difficult to get the information due to the natural disasters that took place in the country and affected the rural areas (Totonicapán).
Regarding the project mentioned, it is important to state that I had been involved in it, but needless to say that the information has been treated professionally to avoid bias in the results and the analysis.
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Chapter 2: Understanding communication from
different perspectives and experiences
This chapter tries to provide an overview of the different models of communication that have been the foundation for recent ones. Understanding communication may seem simple since we all make use of it in daily basis. There is a
need to go beyond of what has been understood, since different authors have
presented their own view of doing communication. This research has its focus
on two particular approaches to communication and their foundation. This
analysis can help the clarification on what has been done in terms of communication in a particular area of interest. Also in order to understand how the
two of them can complement each other, or not, it is necessarily to review
where they came from.
Communication is a term that even nowadays is causing confusion
amongst the practitioners and those ones that are trying to learn more of it.
For some people, communication is a synonym of mass media: television, radio, newspapers, Internet, etc. For others, communication is a process of dialogue that can make use of mass media for a specific purpose, but mass media
is taken as part of a more complex process. Another difference is how the
strategies and processes are planned from one view of communication or another (more on this to be explained in each approach).
2.2 Models of Communication
The social sciences have interpreted communication in different ways. As the
years have gone by, different communicational models have been presented
which respond to approaches or paradigms associated to social, political and
economic aspects from various authors. Each model presents a new element,
which helps understand better what communication is from the perspective of
its drivers. It is important to note that unlike what happens in the so-called
Rigorous Sciences, the challenge here is not to displace one theory with another, but to make them coexist at the same time. However, in many of these theories or models, communication is not yet conceived as a process of dialogue
and exchange (with all that the word implies).
The most common and well known models of communication are presented in the following section6. In each model, a new element can be identified and later an analysis will be given.
6
Díaz, G. (2009). BA Thesis, Universidad Rafael Landívar, Guatemala.
10
a) Schramm
SENDER
MESSAGE
RECEIVER
The traditional models, or the way communication began to be presented,
had a linear and simplistic perception where a Sender sent a Message to a Receiver without evaluating if there was an answer or if the message was understood.
b) Shannon y Weaver
SOURCE
ENCODER
MESSAGE
DECODER
RECEIVER
FEEDBACK
This model has an Encoder, Decoder and Feedback. The Encoder helps
to create the Message and the Decoder helps in the understanding. Although,
new elements are incorporated, the linear process is still present but the Feedback has been incorporated. This can be used to evaluate how the Receiver
behaves, for example: if a person buys certain product, then the message was
received, but this isn’t be communication.
c) Osgood and Schramm
Encoder
MESSAGE
Decoder
Interpreter
Interpreter
Decoder
Encoder
This model presents both sides as equals, Sender and Receiver, Encoder
and Decoder. It recognizes that Feedback can’t be just from the Receiver, but
that the Sender and the Message can be the source of it. Even though it presents a different view, it is missing the Channel, which is used to send the message.
This model is more dynamic one than the previous, but as some authors
explained “is clearly better suited to the description of face-to-face interaction
than to the more remote processes of the mass media, but remnants of the
same psychological interaction can still be seen in more distant communica-
11
tion” (Beck, et al., 2004:39). This could be a model closest to communication
as a process of dialogue; because it shows that a situation can change rather
than be still.
The approaches discussed in the following paragraphs are the ones being
used in development projects around the world, in the context of this research,
have also been used in Totonicapán, Guatemala.
One of their differences is in the way these conceive communication, Social Marketing is more an example of the linear process and, Communication
for Development makes use of communication as a process of dialogue and
participation. The importance of this analysis is to identify the differences,
strengths and weaknesses, and at the same time evaluate the results in a specific
context, as a combination of strategies from both approaches.
2.3 Social Marketing
Social Marketing; a term commonly used by organizations and institutions that
focus their work in social issues. Philip Kotler brought the term into discussion
and for that he is always a reference of the approach. The definition of Social
Marketing has been; “the use of marketing principles and techniques to influence a target audience to voluntarily accept, reject, modify, or abandon a behavior for the benefit of individuals, groups or society as a whole” (Kotler, et
al., 2002:5).
The marketing principles are present in what is done, by following the
Marketing Planning Process. Social Marketing even uses the Marketing Mix,
which is the 4Ps –product, price, place, promotion. There are three aspects
that social marketers keep in mind; selling a behavior, influence to change a
behavior, use of the marketing principles and identify target audiences.
Another characteristic of this approach is that goals and objectives are set
by the social marketer in order to meet what the organization and/or institution has established. “Marketers divide the market into similar groups (market
segments), measure the relative potential of each segment to meet organizational and marketing objectives, and then choose one or more segments (target
markets) for concentrating their efforts and results” (Kotler, et al., 2002:7).
The information above is the process of how the actions and decisions
that social marketers take are done. In comparison to commercial marketing;
social marketers sell a change in a behavior, in terms of the gain, they seek to
gain the greatest returns and regarding the competition, they study and analyze
what other organizations are doing in the same area. In Social Marketing feedback, is in the measure of results and it is used for improvement. The feedback
is for marketers and how they can improve next time.
12
This approach is related to Behavior Change, and is how marketers plan
their actions. In order to achieve a change in the behavior, marketers influence
people in different ways. A strategy that they use to address the issue and people is by using other people. Some experiences have made use of singers, movie stars, athletes or others, to reach a group of the population. This can’t make
a person do something but it can help in raising awareness.
According to Kotler, et al., 2002, social marketers have other ways to influence people’s behavior by using technology, economics, legal – political –
policy making and education. The way these are used is as follows: 1. Technology: can contribute and/or support the behavior change. 2. Economics: used
in the way to pressure people or as an incentive. 3. Legal-political-policy making: when other fails, then marketers turn to the law to make the change. 4.
Education: is used to communicate information, build skills, is more the Promotion (4Ps).
Social marketers also have their strategic planning or Marketing Planning
Process, although it has different steps to be followed (eight steps). The steps
seem as a marketing strategy, which demonstrates that social marketers try to
differentiate themselves from commercial marketers, but from what is presented, they aren’t too different.
Box 2.1: Social Marketing Planning
The eight steps followed in the Marketing Planning Process
1. Analyze the social marketing environment; campaign purpose.
2. Select Target Audience; segmenting the market and ends with choosing one or more targets (segment by behavior).
3. Set objectives and goals; social marketers decide what they want their
target audiences to do and what they may need to know and believe to
make the behavior change more likely.
4. Understanding the target audiences and the competition (oftenskipped step)
5. Determine strategies; following the 4Ps
6. Develop Evaluation and Monitoring Strategy
7. Establish Budget and Find Funding Sources
8. Complete an implementation plan
Source: Kotler, et al., 2002:34.
13
In the context of Guatemala, for years the way of doing communication in
order to address social issues related to poverty alleviation actions, has been
done from the Social Marketing approach. The approach tries to bring social
change by influencing the behavior of the audience (people in communities).
“Marketers know that what appeals to one individual may not appeal to another. They divide the market into similar groups (market segments), measure the
relative potential of each segment to meet organizational and marketing objectives, and then choose one or more segments (target markets) for concentrating their efforts and resources” (Kotler, et al., 2002:7). Social Marketing relates
to the audience by implementing and using the commercial techniques with
people. It also makes use of media in order to influence the behavior or other
techniques (group work) to tell people what they need and how to do things.
With this approach, the interventions have been done to convince people of
changing. Maybe in some countries experiences have helped in relation to
awareness, like stated before, but it doesn’t mean that it works in the same way
in every context.
In terms of resources, great amount of the money from the project is invested in mass media and campaigns, which can be useful to some extent but
what these strategies could also use is the participation from people who they
are trying to reach and money could be allocated in doing so (creating spaces
for dialogue). In the immediate future, in terms of the sustainability, after the
intervention is done the messages sent by mass media could be forgotten and
the efforts would have to be repeated with a new project.
2.4 Experiences of Social Marketing and Health
Experiences of Social Marketing and Health are commonly linked to
HIV/AIDS since it is a problem that has been affecting many countries
around the world.
In 2007 a Social Marketing experience was done in Zambia; “The Reach
and Impact of Social Marketing and Reproductive Health Communication”.
According to the report, to deal with health issues, several social marketing and
health communication programs have been implemented, but for this particular one the impact was focused on condom use, HIV/AIDS and reproductive
health.
How the experience worked? The campaign made use of radio and TV
programs about family planning and HIV/AIDS to increase and/or create
awareness of condom use because as presented in the report “95% of Zambians have heard of AIDS and know is fatal, a substantial fraction continue to
engage in risky sexual behavior” (Van Rossem and Meekers, 2007:2). The target groups for this experience were: women, adolescents, truck drivers, and
commercial sex workers.
14
The use of mass media has always been high and for the campaign, four
radio programs and four television programs were used. The findings showed
that the exposure to programs made a difference in males and their use of
condom. In terms of radio and TV effectiveness, the results on radio exposure
were positive and the TV results showed no significant effect. In relation to
condom use, the emphasis was on one brand and the advertisement of it
proved to be positive.
Information provided by a Zambian citizen also mentions a recent campaign to address HIV/AIDS. The Regional Campaign “One Love Kwasila”, as
taken from the web site7 “The campaign aims to get us thinking and talking
about our sexual behavior in this time of HIV and AIDS”. In the context of
Zambia “The national campaign aims to prevent HIV transmission through
Multiple and Concurrent (sexual) Partnerships (MCP) in Zambia by providing
basic information about the risks posed by MCP and generating thought and
dialogue about social issues that make people decide to have more than one
sexual partner. The primary target audience of the campaign is married men
age 25-50 years. The secondary target audience is women age 15-45 years (the
wives and girlfriends of the primary target audience)”. The mass media resource used in this experience is a 10 series-drama called Club Risky Business8
which “follows three male protagonists as they navigate their sexual networks
and learn about the risks therein”.
2.5 Information, Education and Communication for Change
of Conduct –IEC/CC
Information, Education and Communication for Change of Conduct is another technique that it is linked to Social Marketing. As stated in Minja et al., “its
main approach drew on basic principles of social marketing, namely that certain messages should be promoted together with a product carrying and appealing brand name and logo, and that the marketing should be consumeroriented and target specific segments of the society”(2001:615).
This is used around the word in order to achieve a change in people’s behavior and there are experiences that have shown positive results after the implementation of an IEC/CC intervention. Aggleton et al., 2005, comment on
the effectiveness “IEC programs need to be evaluated on two levels, both in
terms of their outcome (does an intervention influence behavior?) and, process
(how an intervention works and assists in developing and refining programs).
7One
Love
Regional
Campaign
(launched
in
2008)
http://www.onelovesouthernafrica.org/index.php/about/ September, 2011
8 http://www.onelovesouthernafrica.org/index.php/countries/zambia/ September,
2011
15
Studies also need to be undertaken which compare the effectiveness of intervention with and without certain IEC components” (2005:21).
In Aggleton et al. “HIV/AIDS and injecting drug use: Information, education and communication” it is stated that “IEC has an important role to play
in HIV prevention, though it should be combined with other approaches if it is
to prove effective. There are many different IEC strategies, including the provision of information about HIV/AIDS-related risks through posters, pamphlets, newsletters, videos, face-to-face work, and radio and television broadcasts”(2005:22). Even though this experience is related to HIV/AIDS the IEC
component is similar in other cases that have dealt with health issues. This experience explains that “IEC can be used to establish a policy climate supportive of working with injecting drug users –IDUs- and sensitive to the most effective approaches. It can do this through advocacy with politicians and
political decision-makers, religious leaders and community groups” (Aggleton
et al 2005:27). These are examples of how IEC can lead to a positive change
that can also be sustainable.
An experience in Vietnam illustrates the use of IEC, in combination with
other techniques) to transform IEC. Laverack and Dap “IEC in Vietnam is
widely understood to include strategies and approaches used in health communication and health education” (2003:364). An explanation is provided on how
IEC is understood in the Western and the Vietnamese context (Appendix Table 2).
In the context of Vietnam, IEC activities, in the past, have followed a topdown approach through the governmental apparatus that was the one “telling
people what to think rather than what to think about” (Laverack and Dap,
2003:364). According to the same information, IEC activities have been
planned in terms of resources, which also included the available funding; this
determined what was used and most of the time this resulted into the selection
of one channel. This approach has changed using other experiences regarding
health communication and education. The new approach “understands that
IEC can be more effective when a combination of activities and channels are
used as a part of the same intervention” (Laverack and Dap, 2003:366).
The approach was developed as a combination of the previous experience
and “the need to build on existing capacity for IEC including: mass media,
face-to-face communication, print material, and opportunistic activities, at the
provincial, district, commune and village levels. Also, the need to improve the
quality and delivery of IEC through better design; implementation and evaluation of interventions using a systematic and structured approach” (Laverack
and Dap, 2003:366). In terms of the improvements, sustainability is mentioned
but in relation to the cost of producing certain materials that can be used in the
intervention and that should be locally produced to reduce the cost. It shows
the ability to recognize what has been done, to evaluate it and to be able to improve in order to achieve the goals that have been set. Now the approach is
16
perceived as an interaction and complement of the activities, including the participation of village volunteers. The interaction between actors and sectors is
also recognized.
The authors identified the importance of building capacity and improving
coordination of key communicators, as a way to improve and transform IEC in
Vietnam. In doing so, they suggested that communicators should make use of
participatory methods and materials, and this could be provided by development agencies to strengthen the capacity of their counterparts. Laverack and
Dap also identified the importance of the materials and the distribution and
regarding communication, “must be properly evaluated as an integral part of
the design using correct procedures and providing a critical analysis of the process and outcome of the intervention” (2003:368). Sharing experiences
amongst the actors of a territory can lead to improve the IEC activities. Therefore, spaces should be created to share the experiences in order to complement
what is being done, to learn from others and to organize efforts towards the
same goals.
2.6 Communication for Development
Communication for Development, the other way of doing communication, as
it’s known by its practitioners. This has been understood as an alternative way
from the traditional one. In this approach people are not considered as target
groups or audiences, but as strategic partners and as individuals who have
something to say. Also, doesn’t tell people what to do but works with them
since the beginning and, they are the ones who propose the changes and actions that are considered important to improve their quality of life. Participation in a real sense, where all have the chance to talk and listen, promoting a
process of dialogue is what makes this approach different too. In relation to
how the money is invested, this approach focuses on actions that are planned
by the people for the rest of the community. Communication for Development goes beyond the mere action of sending messages. People in the communities are the ones elaborating the messages and, this approach helps them
upgrade in communication skills, not just for one project or one particular issue, but helps them realize that can be used in daily life; work, home, school
and other spheres of their society.
This approach has not been used or recognized by different actors in societies, even though in 2006 the World Congress on Communication for Development was organized by the Food and Agricultural Organization –FAO- in
order to establish what was going to be understood when talking about this
process but also recommendations were reached as reference to undertake this
approach. In Latin America and, other developing countries, this approach has
become important since the 70s and, nowadays institutions which were used to
Social Marketing (or others approaches) are shifting into Communication for
Development.
17
For people working in Communication for Development projects, “communication can create a favorable ecology for development programs by relinking and facilitating interactions between economically, politically and culturally disconnected groups and ideas-between indigenous knowledge and science, elite national policymakers and rural communities, donor agencies and
local NGOs, men and women, and didactic pedagogy and participation”
(Inagaki, 2007:2).
The established methods, the way communication has been wrongly presented has its fundaments in the modernization paradigm and are the example
of top-down, one-way dissemination. These methods “tried to resolve Third
World problems by facilitating the transformation –through information
transmission in mass media- of pre-modern and “backward” attitudes and
practices of “traditional” societies into modern, rational and Western ways of
life” (Inagaki, 2007:5). Modernization paradigm can be found in Social Marketing, Entertainment-Education; mass media for persuasive messages.
In response to this paradigm, participatory communication approaches
have emerged since the early 70s in Latin America. “The problem of underdevelopment in Third World countries was created not by the endogenous factors in these countries but by the international political economic order subjugating the South to the advanced capitalist states in the North” (Inagaki,
2007:7). By criticizing this political order -dependency theory- and also the
one-way flow of information, the Latin American countries have come up with
communication approaches that emphasize in participation.
Box 2.2: Participatory Approach
Participatory Model of Communication
1. The participation of the intended beneficiaries in different or all of the
project-cycle stages.
2. Horizontal dialogue rather than vertical information transmission.
3. Cultivation of trust and mutual understanding rather than persuasion.
4. Local-level actions rather than national-level programs.
5. Local knowledge.
6. The role of development specialists as the facilitator and equal participants rather than decision makers.
7. Communication process rather than specific outcomes.
8. The use of communication to articulate deep-seated social relations.
Source: Inagaki, 2007:7
18
The action of participation, which is a key element of these processes, has
also been subject for discussion, because it should be defined who gets to participate and how real is that participation. As presented in Inagaki 2007, participation is a term that in different projects and experiences it can have different
meanings and writes about four: 1) participation in decision making, 2) participation in implementation, 3) participation in evaluation, and 4) participation in
receiving benefit. Experiences have shown that sometimes participation is just
a word in the project but is not exercised by people and if so, then the project
shouldn’t be associated with Communication for Development.
The interest is growing amongst the practitioners of development strategies; successful experiences (from different countries) have been documented
to show this side of Communication and Development, for that matter. This
approach is also vindicating the real meaning of communication so that it will
no longer be confused with dissemination of information or as GumucioDagron in Fowler and Malunga stated “none understands the role of communication as facilitating dialogue, enhancing participation in the decision-making
process and ensuring sustainability of social and economic change” (2010:
303). His observation is related to NGOs, multilateral organizations or bilateral
agencies that imagine or understand communication as other actions that also
need to be done, like propaganda, institutional image and not as a tool to
achieve social change.
According to Quarry and Ramírez “Communication for Development is
the use of communication processes, techniques and media to help people toward a full awareness of their situation and their options for change, to resolve
conflicts, to work towards consensus, to help people plan actions for change
and sustainable development, to help people acquire the knowledge and skills
they need to improve their condition and that of society, and to improve the
effectiveness of institutions” (2009:9).
Sometimes the meaning of communication gets confused, even amongst
practitioners of it. The activities related to communication are also assigned to
almost anyone in the organization and shouldn’t be this way, because it requires the attention of a person who knows the difference between communication and dissemination of information. As Quarry and Ramirez pointed out
in relation to all that surrounds the meaning of communication and the actions
that are related to it is that “what matters most is to have clarity around the
purpose of the communication initiative –the overall intent. What is it that the
communication initiative is trying to do and what do we hope it will achieve?”
(2009:18). As long as the organization and people who practice communication
have these points clear, then they can define what is the purpose or the function that communication is trying to help.
19
In Guatemala, efforts have been made in order to help with the clarification of the concept and practice of Communication for Development, one way
of understanding it is explained by Gularte9 “has its focus in the emphasis on
the decision-making of the subjects, they are the ones who make the conscious
decision of wanting to change a situation that affects them. It is based on full
respect for the person as an agent of its own change, orderly facilitates the
tools to succeed in achieving a change. For this, there are some techniques that
have to be followed, clearly, but techniques that have been improved from
other participatory projects or that have been developed within a project”.
From this perspective, communication is understood as an exchange process
between the subjects that have the capacities needed for it and in terms to improve their quality of life.
In relation to the projects from Communication for Development, what is
sought is to strengthen the right to communication so that the subjects can be
able to put it into practice in order to change their reality. This is something
that is entirely up to them (people in the municipalities and/or communities),
in any case the intention is to find out how to strengthen a process so that it
can be effective and help improve people’s life. Figure 2.1 illustrates how to
understand the process of communication in Communication for Development.
Figure 2.1: Communication as a Process of Dialogue
Shared Code
Medium /
Resource
Transmitter
Percipient
FRAMEWORK
Source: Adaptation from CECODE Guatemala
Eduardo Gularte, President of Centro de Comunicación para el Desarrollo –
CECODE-, Guatemala. (Interview via email, September 21, 2011)
9
20
2.7 Experiences of Communication for Development
Some experiences of Participatory Communication for Social Change have followed the principles of Communication for Development. Related to empowering people with knowledge and strengthening local capacities, there are several experiences around the world. Some have vindicated the use of mass
media, since it has been used as means of providing the knowledge. For some
of these experiences, local media has been used and strengthened in most of
the cases.
The production of information is a shared activity amongst the ones from
the experience and people of the territory where it has been held. Experiences
have been presented in different ways and countries, Making Waves –Stories of
Participatory Communication for Social Change10- is an example of where to find
them. These selected experiences are the ones that had a participatory approach. The action of participation was also included in these experiences, in
the author’s words “these examples show that the beauty of participatory
communication is that is can adopt different forms according to need, and that
no blueprint model can impose itself over the richness of views and cultural
interactions" (Gumucio-Dagron, 2001:6). This is an example of the strategies
that can be successful moving away from the social marketing view. What is
also represented throughout these experiences is that the community showed
that they had appropriated the initiative, which means is now sustainable and
organized by some of its members. Another aspect taken into account here is
that in the experiences people have been part of the different stages and/or the
complete process. Because the ones who initiated the project weren’t looking
to gain visibility, which is the case of some international organizations and that
is one of the reasons why they always rely on mass media, advertising, etc.
These experiences of participatory communication have been developed
in many countries, but mostly in the Third World, and even more specific,
most of these first experiences began in Latin America. Because communication has been neglected in development projects, as mentioned in GumucioDagron, 2001, these experiences show that communication can’t be ignored
and should be interpreted as dialogue to be able to understand the cultural and
ethnic view, that other project neglect for being too general to be accepted by
all.
Gumucio-Dagron, A., 2001: a collection of fifty case stories from three specific regions Latin America, Africa and Asia.
10
21
2.8 Methodologies and Techniques used in Communication
for Development
In order to achieve the goals established in a Communication for Development
Project there are a series of methodologies that can be used and/or improved,
based on previous experiences. A participatory methodology and a monitoring
and evaluation technique are presented here; Outcome Mapping and The Most
Significant Change.
2.8.1 Outcome Mapping
This is a methodology that explains in a different way how the results can be
achieved in a process of change, not from the linear logic of “X” leading to
“Y” as a cause effect, but as from “X” to go to “Y” there are multiple ways,
multiple actors and factors and it is more dynamic the process. Outcome Mapping is different from other ways of planning since it represents the difference
between giving the answers (external action) as oppose to give the tools to create elaborate the answers (internal action) from a participatory approach. It is
also different because, as explained by Briggs (2010) it promotes transition, is
flexible (adapts to its variations), is participatory (promoting commitment with
change and the responsibility per result), allows to visualize the process of
change from its multiple dimensions and outcomes.
Table 2.1: Intentional Design
Why?
Vision
Whom?
Direct partners
What?
Desired outcomes and progress
signals
Wow?
Mission, map of strategies, practices of the organization
In the case of the Outcome Mapping, the Direct Partners are the ones that
the project will be working directly with. These actors are direct partners because, even though the project works with them to promote a change, they are
not under the project’s control, they always have the power to exercise an influence on the development.
22
The desired outcomes are the most significant changes in behaviour that
the direct partners are able to achieve with the project’s support. These outcomes are the effects that the program will achieve with its intervention, with
the emphasis in the way that the actors behave as a result of its influence.
These are stated in a way that will reflect the how an actor will behave y relate
to others if the program uses its potential as an agent of change.
Table 2.2: Program Framework
Vision
Mission
Direct Partner 1:
Outcome 1:
Direct Partner 2:
Outcome 2:
Direct Partner 3:
Outcome 3:
Direct Partner 4:
Outcome 4:
For each direct partner and outcome is established in consensus with the
people who are participating in the planning. The signals of progress are set in
a gradual manner. That is to reach and Outcome it can’t be done overnight and
it acknowledge that it will take time to reach a difference from the reality until
the Outcome. This should be coherent to the Direct Partners’ capacities. Outcome Mapping suggests three levels for the signals of progress: 1. It is expected
to… 2. It would be positive to… 3. It would be ideal to…
Figure 2.2: Signals of Progress
10
9
8
IT
WOULD BE
IDEAL TO…
7
6
IT
WOULD
POSITIVE TO…
BE
5
3
4
IT IS EXPECTED TO…
2
1
The Signals of Progress are a participatory step as well. The local actors
are the ones who know best their situation, reality and context, therefore are
the ones who can set their goals in a realistic manner. They are explained what
is the difference between each signal, and then they are able to establish what
would be expected, positive and ideal.
23
Box 2.3: Signals of Progress
It is expected to…
These are signals that make reference to reactive changes, that have priority
because can activate the actions for change in the process.
It would be positive to…
Signals that make reference to more elaborated changes, result from the learning and transformations from exchange and new experiences.
It would be ideal to…
Signals that make reference to changes from initiative of the partners inspired
in the changes already achieved.
Source: Beatrice Briggs, International Institute for Facilitation and Change
Map of Strategies, are resources that the program has to support the
changes undertaken by the direct partners, which are also expressed in the Signals of Progress. The strategies should have a satisfactory process of concentration with the ones that will be using them. The kind of strategy is different
depending on the use. The strategies directed to people: are to support the
changes undertaken by people. The strategies directed to the context: are to
create favorable conditions in the context so the changes can happen and can
also remain.
2.8.2 The Most Significant Change
The Most Significant Change –MSC-, according to Dart and Davies “is a storybased technique to facilitate program improvement by focusing the direction
of work towards explicitly valued direction and away from less valued directions. It can make an important contribution to evaluation practice, its unusual
methodology and outcomes make it ideal for use in combination with other
techniques and approaches”(2003:137). In this technique the terms to be used
when talking about the ones involved is important. Therefore, to talk about the
beneficiaries, in MSC the proper term is participant, instead of intervention, is
program and instead of donors are funders.
MSC is a technique of Monitoring and Evaluation. “Monitoring in the
sense that it occurs throughout the program cycle and provides information to
help people manage the program. Evaluation in the sense that it provides data
on impact and outcomes that can be used to help assess the performance of
the program as a whole” (Dart and Davies, 2005:8). In monitoring, “MSC is
suited to monitoring that focuses on learning rather than just accountability.
24
For staff, it can help them improve their capabilities in capturing and analyzing
the impact of their work” (op.cit.:13).
Dart and Davies, 2005, have also identified purposes on why to make use
of MSC, from identifying unexpected changes, to identification of values, as
well as being a participatory form of monitoring that requires no professional
skill. Also, it encourages analysis and data collection, builds staff analytical capacity, gives a rich picture of reality and monitors and evaluates bottom-up initiatives.
As indicated by Dart and Davies, “MSC represents a radical departure
from the conventional monitoring against quantitative indicators that is commonly seen in the sector and involves the regular collection and participatory
interpretation of stories about change rather than predetermined quantitative
indicators” (2003:138). Because it is a technique, there are some steps that can
be followed in order to use it; 1) Raise the interest, 2) Define the domains, 3)
Define the period (from when to when), 4) Collect the MSC stories, 5) Selection of the MSC stories, 6) Feedback of the process of selection (give back the
stories), 7) Verifying the stories, 8) Quantification and, 9) Monitoring the system, secondary analysis. Step 8 and 9 are optional. Quantification has been
used in order to keep track of the number of activities or people who have attended an activity. Also to be able to tell what kind of effects have been made
and how many people have recognize to have made a change.
When defining the domains (step 2), it has been suggested to leave an
“open window” domain and it is recommended to use between three and five
domains. In the Step 4, the information included can be divided into three categories; “1) Information: about who collected the story and when the events
occurred, 2) Description: of the story itself (what happened) and, 3) Significance: (to the storyteller) of events described in the story” (Dart and Davies,
2005:25). The first category later can help as a follow up of the stories.
Because the technique uses a question to generate the telling of the story,
which usually is “During the last month, in your opinion, what was the most
significant change that took place for participants in the program”, sometimes
it can be confusing for the person responding. If this is the case, then it is recommended to “re-phrase it carefully and, once a good way is found in the local
language, one must stick to it” (op.cit.:46).
For MSC to be successful or to be used properly, an organization may
have to evaluate if it has what is needed. Dart and Davies, 2005 consider strategies that can help, a) building the capacity of the champions, b) building the
capacity of the staff and, c) consideration of costs and time.
25
2.9 Analytical Framework
The theory and experiences presented are valuable from their own perspective
and as everything else that has been done; it has a reason for being a certain
way. Table 2.3 gives an overview of the approaches. These are the ones that
have been implemented in the area of Totonicapán in different years and
through different interventions. The elements identified from the literature are
the ones analyzed in the case through the experiences of the MSPAS, the Government and the local NGO.
Approach
Social Marketing
IEC/CC
Table 2.3: Overview to the approaches
Actions

Information dissemination.

Planned Activities (from a
central level)

Elaborated messages

Production and distribution of
materials

Target groups / audiences

Communication = information

Identifies audiences.

Elaborated messages.

Transmission of messages.

Production and distribution of
materials.

Provide spaces to access information.

Communication
for Development


Desired Goal
Influence a target
audience to change
their behavior.
Change people’s behavior.
Strengthening the
capacities of local
actors and provide
Participatory planning of activuseful information
ities.
so people can make
Participatory elaboration of
the decision to
messages.
change a behavior.
Spaces for dialogue.

Key and/or direct and strategic partners.

Right to communication =
dialogue.
Social Marketing and some activities are analyzed by the actions and plans
from MSPAS. IEC/CC has also been identified in the actions from the Government, especially in the ones by SESAN and is also analyzed. In the case of
26
Communication for Development, is identified in the project of the local
NGO. The main difference within the three approaches lies in the understanding of communication and participation.
The literature showed that in Social Marketing and IEC/CC, participation
is not as relevant as it is in Communication for Development. Following these
approaches, the actions have been implemented in Totonicapán achieving different results. The one of Communication for Development is in the interest
in order to analyze in depth the participation and integration of the local actors
in a project. Table 2.4 is a summary of the indicators identified from the literature in each of the approaches and that can be found in the study case as well.
Table 2.4: Indicators that lead to the integration of actors
Indicator
Social Marketing
IEC/CC
Integration of a Commission of Communication

Plans of Communication
C4D




*
Production and distribution of materials


*
Monitoring and Evaluation


*
Audiences



Partners



To achieve Local Development in a territory, it can’t be done from the efforts of just one institution, organization or a single actor. The participation of
all the local actors, who are sharing a territory and therefore a reality, has to be
taken into consideration for the strategic planning of future activities. To recognize the experience from each local actor is a must when planning and to
value these experiences and respect the background will contribute to reach a
consensus to address the issues that affect the territory.
From the Communication for Development approach (*), the plans of
communication are planned together with the local actors that have integrated
the Commission of Communication and that are assuming an active role.
27
Chapter 3: Study Case: Totonicapán, Guatemala
This chapter gives a description of the department of Totonicapán, which is
the area of interest. Brief context information is provided followed by the information related to malnutrition in Totonicapán.
3.2 Totonicapán, Guatemala
Figure 3.1: Totonicapán’s Municipalities
The population in Totonicapán, in its majority is Maya K’iche’, and therefore the language that is used the most is K’iche’. Most of them live in the rural
areas, but there is also a considerable number living in the urban areas; rural
population 64% and urban population 36%.
Within the economic activity of the locality, the industry is diverse manufacturing; fabrics, furniture and pottery. The population density, the low
productivity of the land and the inadequate use of it, makes the family maintenance a problem. This has caused the population to seek for other or additional occupations, even temporarily migration to the plantations in the Coast Area
of the country, in order to make the family budget. In the department there are
28
great forest extensions in which fir and pines trees have been abundant. In the
Appendices (Table 3 and 4) more information of Totonicapán can be found
regarding its characteristics and the economic activity.
3.3 Malnutrition in Totonicapán
According to the Nutritionist from the Ministry of Health for the area of Totonicapán, chronic malnutrition is when children have an inadequate height for
their age and she explained that in Totonicapán, 69.7% of the children have
chronic malnutrition. It is has been mentioned that one of the reasons for this
problem is because people in the communities don’t have good access to food
and also because the families are numerous. Language has limited the access to
information and to reach more people. There are some cases of severe malnutrition in Santa María Chiquimula and Santa Lucía La Reforma (the information in detail of percentages of malnutrition can be found in Appendices
Tables 5, 6, and 7). Table 3.1 illustrates where these municipalities stand compared to the rest of the country. The order goes from 1 to 333 (the number of
municipalities in the country) and 1 stands for lowest.
No. of
Order
Table 3.1: Municipal Priority, according to Quality of Life
Population
Projection
Quality
Municipality
Criteria
(2002)
(2008)
11
Very low
Santa Lucía La Reforma
13,479
18,862
27
Very low
San Francisco El Alto
45,241
57,926
40
Very low
San Andrés Xecul
22,362
30,272
46
Very low
Momostenango
87,340
113,120
54
Low
Santa María
Chiquimula
35,148
43,562
155
Average
San Cristóbal
Totonicapán
30,608
35,326
168
Average
San Bartolo Aguas Calientes
8,684
14,432
186
Average
Totonicapán
96,392
120,250
339,254
433,750
TOTAL
29
3.4 Consequences of Malnutrition
Information provided by the Nutritionist from the Ministry of Health for the
area of Totonicapán, indicates that the consequences can be intellectual deficit,
when the children grow up they will be less productive, in the childhood they
tend to fail the school year, and all of these because their development has
been affected. About the causes of malnutrition in Totonicapán, the situation
of poverty and extreme poverty in which families live in, is part of the reason.
Mass media has also been identified as a cause because of the constant advertisement of diverse products. Families also tend to sell what they produce but
don’t leave enough for family consumption and the cultural practices also have
a role in this situation.
It has been recommended and suggested that the mothers should take
their children (under 3 years of age) to the health services to get the checkup
they need. This has also been promoted so that the children will receive the
micronutrients and vitamins they need (is given for free).
From the information provided by UNICEF, 2007 “The Silent Enemy”,
Manuel Manrique explained some of the consequences of malnutrition “a
chronic malnourished child will have learning difficulties as well as problems to
use the intelligence and physical performance. This condition will be present
for the rest of his/her life”. Later in the same report from UNICEF, it is stated
that if the brain of a child is not saved before the third year of age, the implications in the physical and emotional development will be negative” (UNICEF,
2007:9). The consequences of an insufficient nutrition are serious, especially in
children under five years of age.
UNICEF’s report entitled “La Niñez Guatemalteca en Cifras – Guatemalan Childhood in numbers”, explains that the problem of a low food intake
during a child’s first years of age not only affects the child for life but also
makes him/her more vulnerable to diseases, poor educational performance,
which in the future can be translated into low productivity of the human resource, for that in low income. This will lead to repeat, from one generation to
the other the same situation of poverty that, most likely, has been the reason
for malnutrition” (UNICEF, 2007: 47).
Guatemala at a regional level has had the highest rates of malnutrition. Information from 2002, used in “Guatemalan Childhood in numbers” 2007, presented the rates of malnutrition in the Latin American Region, Guatemala had
49%, followed by Honduras with 29%, Bolivia with 27%, Ecuador with 26%,
Perú with 25% and the lowest rate in the region was 6% of Costa Rica.
From the information provided by the Third National Height Census of
2008, it positions Totonicapán amongst the departments in Guatemala with
30
high prevalence, 69.4% and the National Average is 45.6%. (More information
is provided in detail in the Appendices).
Coincidence or not, the departments with high prevalence are the ones
that have majority of indigenous population and are all located at the West Region of the country. In the case of the departments with low prevalence, the
majority of their population is non-indigenous and the departments have are
located in the East Region. Although in 2002 the first Nutritional Emergency
was in two municipalities of an East Department, which still have high prevalence; Jocotán: Total 72. 8% and Camotán: Total 63.5% and the department
Chiquimula: Total 50.5% of prevalence, about 5 points above the National Average. It is needed to be clarified that this is also a department where most of
the population belong to an indigenous group. In comparison to Totonicapán
the difference is 18.9, so this can be a relative successful example of how a department can improve in terms of nutrition.
3.5 Views about Malnutrition11
Information provided by the Municipal Monitor from SESAN, identifies the
lack of information as one of the reasons for the problem. There aren’t enough
inputs in order to be able to have good nourishment within the households,
there’s no availability of resources. According to the institution, out of the
eight municipalities, two are the most vulnerable ones: Santa María Chiquimula
and San Bartolo Aguas Calientes.
According to the Coordinator of the Program of Projects Support from
the Ministry of Education, regarding the nutritional insecurity there are some
factors that influence the continuity of this situation. It is recognized the lack
of information on the matter and as stated by Mr. Tzul –Coordinator- “there
are families that have some kind of nourishment, but they miss a proper orientation on how to consume the food, therefore real information is needed to be
delivered to people so that they can bring it into practice”.
He also mentions that the school attendance is affected due to a proper
food intake. The performance is affected and can be seen in the low attendance and eventually children drop out of school.
The Catholic Church in one of the municipalities has a program that supports families with undernourished children. Mr. Pú López, from the Church,
identified that “there isn’t enough access to food, because the stores in the
communities do not sell fruits and vegetables and for people to be able to buy
The testimonies mentioned in this section were provided by CECODE Guatemala/
Auditoría de Información y Comunicación de Totonicapán
11
31
them, they have to travel to the urban area of the municipality (sometimes is
very far from where they live) and this is done twice a week when the market is
held at the central park of the municipality. The intake of fruits and vegetables
is low and what mothers provide to their children is corn based food, black
beans and coffee, but this is not proper nourishment”.
Because this is a current problem, in most of the municipalities of Totonicapán, there is an organization that helps the different actors to deal with the
problem. Most of them are bring support to the Health Center because are the
ones who provide medical attention. Mr. Vásquez, from one of these organizations called Asociación Toto12 Integrado –Association Toto Integrated- “considers that the problem with the parents in the rural areas is that they think
their children seem fine, because the children not complain. In general, a child
who is undernourished has attention problems at school and may feel a constant desire to sleep, this is misinterpreted by the parents as laziness, and they
can’t identify the undernourishment problem. If the children do not get the
proper nourishment will not have a proper mental development”.
Local Governments have also taken a stand regarding malnutrition, as Mr.
Vásquez, from the Municipal Planning Office San Bartolo Aguas Calientes,
explains “acute and chronic malnutrition is consequence of the processes that
have not been taken from an institutional approach, like the information in
each community. Spaces are needed for training, promotion and release of information in the communities, especially for mothers, so that they can improve
their role and that they can appropriate the information received and practice it
too”.
The communicators from the municipalities, perceived the problem of
malnutrition as a lack of information. They also think, that people who identify
a problem of nutrition and health, mention the lack of control from the Health
Center, as well as the lack of proper nourishment and the economic factor.
It has been identified that the mothers believe that after two months of
changing the nutrition, mostly by giving fortified drinks, the children will become “chubby” and will be healthy again. Since they don’t realize that a change
like will take more time, they stop giving the vitamins and drinks provided by
the Ministry of Public Health and Social Assistance. The mothers give up easily
and they lose faith in the Health System.
There are different practices that have been identified by personnel from
the institutions. One that is very common but also extremely wrong is to give
other liquids to children before reaching 6 months of age. With that, mothers
and caregivers, interrupt the period of exclusive breastfeeding. This is also
12
Toto: short name given to Totonicapán.
32
done by another common practice, advice given from family members but it
only reflects the lack of access to information.
3.6 Responses from Different Actors
3.6.1 Ministry of Public Health and Social Assistance
The Ministry is divided in different Programs, Areas and Departments; each
has a specific function and addresses important issues related to people’s
health. In terms of Communication and Education, there is a Department of
Promotion and Education in Health. The objective of this Department is to
promote and develop health protection through Health Promotion with community participation and an effective social mobilization. The Department also
tries to give the knowledge to the communities through Information, Education and Communication –IEC- Strategies, as well as the skills needed to make
actions that are determinant for their health. At the same time the Department
is divided in 14 Programs, one of this is focused in Food and Nutritional Security.
Regarding the Program of Food and Nutritional Security, the Department
follows a list of steps, which are also taught to the Staff in charge of the Program. This specific Program also has produced educational material such as the
Nourishment Guides and the Breastfeeding Standards that are distributed in
the Health Districts of the country.
Since 2007 the Department of Promotion and Education in Health has
been following the IEC/CC approach. This approach is linked to the principles of Social Marketing that follows the same steps in different issues. In relation to Food and Nutritional Security and Supplementary Feeding the MSPAS
has been training its staff in IEC/CC throughout the Health Districts in the
country.
As explained by Mendoza13 “IEC has been used as an easy tool for the
Health Areas to elaborate their work plans within the different Programs of the
Ministry. Also to give attention to the Local Health Plans, which include information and education to people through communication about different
behaviors and practices that help to sustain and improve the health but also
prevent diseases”. According to this information, the way IEC/CC has been
used is to reach the health staff that is the one who has direct contact with the
people that the intervention is seeking to help. If the Program from the MinisEmma Mendoza; Program of Promotion and Health Education from MSPAS Guatemala. (Interview via email, September 20, 2011)
13
33
try tries to establish alliances with other initiatives, the actions would reach
more people and the risk of repeating an activity (educational, informational or
other) will be less and people’s attention will not be lost.
IEC/CC efforts have been focused in two aspects: Food and Nutritional
Security, for Promotion of Breastfeeding and Supplementary Feeding and the
second; Promotion and Education in Health. These IEC/CC strategies have
been given to all the Health Districts so that the health staff is aware of the
activities that have been planned in order to be organized later in the communities and also to have a common understanding on the messages that will be
given, first to the health staff and later to people in the municipalities and/or
communities.
As part of the recent responses and in combination with IEC/CC strategies, the Ministry of Public Health and Social Assistance has been giving different complements for the nutrition in the most affected areas. These nutritional complements are: Vitacereal and Chispitas14 (Appendices Box 2). These
complements are sent to the Health Services and then the educators from the
health staff have to show people, mothers and caregivers of children, how to
prepare them. The reason why this is explained is because these complements
have not been used in the right way by the people who actually need them,
mostly because of the lack of information which affects the actions that people
do.
The strategies of IEC from the Programs of the MSPAS have also included training workshops for mothers and caregivers on how to prepare the nutritional complements. This activity was a necessity because the mothers complained that the children didn’t like the complements. One of the reasons was
because they kept changing the way they prepare them to try and “fool” the
children into taking it. The language was also a problem, mothers didn’t fully
understand what was being said and then prepared the complements as they
could remember. Because the staff in some Health Services does not speak the
Mayan language then people don’t understand and are feel ashamed to keep
asking questions. They do not feel comfortable enough to ask the same question over and over. However, they have been requesting for health staff who
can speak to them in their mother tongue. It has been a slow process, but in
some Health Centers there is at least one person who will be able to speak to
them in their language.
Vitacereal: is a kind of pap that should be given and prepared correctly in order to
work well.
Chispitas: are the micronutrients and vitamins in powder that are needed for these
special cases.
14
34
3.6.2 Government
The Government has addressed the issue with different strategies. After the
Food and Nutritional Crisis of 2002, policies and programs have been created
and approved by the Government; even an entity which is fully dedicated to
this issue, Food and Nutritional Security. The help from the Government has
been problematic because when a new President takes over, then the progresses that have been made can’t continue because the actions have to undergo
through some changes. The current Government (2011) is the third one that
has continued to deal with the problem of Malnutrition but is also the third
change in the strategies.
Because the problem of malnutrition became more serious, then actions
were needed by different sectors. During the Government period of 2004 2008, several actions were taken in order to address the problem. The Policy of
Food and Nutritional Security, the creation of the Secretariat for Food and
Nutritional Security and, the National Program for Reduction of Chronic Malnutrition were created. As from the Secretariat of Social Work of the President’s Wife, a program called Creciendo Bien –Growing Well- was also approved, this was an effort which directly worked with the affected
communities, with indigenous women from the rural areas and the poorest
municipalities of Guatemala. The reach of the Program and the approach was
showing positive results until 2007, later in 2008 the Program had a change in
the name Creciendo Mejor –Growing Better- and also changes were done in
the way it worked. Even though it still remained with the objective to train
women with an approach of Food and Nutritional Security, the results until
now have not been as positive. This illustrates that when a change in Government is done, the positive actions can continue or can disappear, in this case
the Program was affected, hence the people who were getting a benefit too.
The current Government (2011) also initiated a purely paternalistic social
program in order to help the poorest families in the country. The Social Cohesion Program which gives Q200.00 (€20.00 aprox.) to each family (who meets
the criteria) to be used in the household rather than having to send of their
children to work. It has a reach of 307 municipalities out of 333 and helps
890,38415 families. There is also the Bolsa Solidaria16 –Solidarity Bag- which has
the basics to complement a balanced nutrition, especially for the women who
are pregnant or breastfeeding. The commitment of the family is that the parents have to attend the meetings were staff from the Social Cohesion Program
gives them talks about community development.
The Secretariat for Food and Nutritional Security –SESAN-, has been increasing its work and has been strengthening its offices in the different areas of
15
16
Information from www.mifamiliaprogresa.gob.gt October, 2011
Information from www.bolsasolidaria.org October, 2011
35
the country. As explained by a Nutrition Monitor from SESAN of Totonicapán, this Secretariat is the one in charge to propitiate spaces of interinstitutional coordination to work Food and Nutritional Security, in its most
strategic function. It does not have direct intervention with families, but sometimes it is done in coordination with organizations that are obliged to do it.
SESAN from the community and municipal levels has to present the work
plans. This were done in a participatory way and in this process people from
the communities, as well as from institutions (and in some cases from City
Hall), are the ones that had been involved. The operationalization of the plans
was responsibility of the institutions, with people’s support. SESAN then had a
monitoring role of the plans. Recently (2010) this changed and the plans were
being done from the Central level and then sent to the departmental office,
which means that the plans had to be adjusted at the municipal level. The participatory method is no longer viable, and the focus has been more on campaigning, the State has changed and now is also using Information, Education
and Communication –IEC-, seeking to change behaviors.
3.6.3 Local NGO in coordination with International Cooperation
and other actors
For years UNICEF Guatemala has been making use of national campaigns to
address issues that affect children’s life. The use of mass media has always been
a regular strategy and they have also made use of Social Marketing, specifically
when asking famous people to make a radio spot, which then is sent to the national and local radio stations. The same is done with the TV spots and sometime is the same message but the format is the one that changes.
As from 2009, UNICEF Guatemala took a different turn and has been
funding a local NGO to address the problem of malnutrition in two areas of
the country (for this research one has been explained). The approach of this
local NGO comes from Communication for Development and has been constant in its work and projects. At the beginning UNICEF Guatemala, through
the Department of Communication (the one funding the project) was hesitating of the outcomes of project form this approach. Two years later, the project
is still working in both areas of the country.
The Project 36 Cero Malnutrition seeks to strengthen people’s communicational skills, more specifically in the ones that are considered key partners -in
the Project- in the eight municipalities of the Department of Tototnicapán. All
of this is done so that they can assume the task of improving the information
and communication in issues related to health and nutrition. This can help in
the preparation of the mothers and caregivers (direct partners) to face the economic crisis, so that they can be less vulnerable in the topic of children’s health
and nutrition.
36
The fundaments of this Project are based in Communication for Development, strengthening key actors’ skills, in order to be able to improve the
quality of life of their families as well as the rest of the families in their communities. The objectives and/or goals are focused in the strengthening of
skills, communication structures, access to information, and also exchange and
generate communicational spaces for parents, caregivers and pregnant women,
with institutions that can contribute to improve their attitudes and practices
between them.
The NGO has limited the topics to be address, because are the ones that
can be improved and/or are linked through communication actions. Before the
developing of the activities and the elaboration of the communicational plans
(per municipality) a Communicational Audit was made in order to have a clear
scenario of how much do people know in terms of children’s health and nutrition.
There is also an emphasis on working and linking the activities with other
local actors that can be; institutions, government offices, City Halls, church,
education, people from the communities who want to take part in the whole
process. SESAN from Totonicapán has been a key institution in order for this
Project to have access and reach people in the communities. Since the beginning of the Project a contact was established with the eight City Halls as well as
the Health Centers. SESAN through its Nutritional Monitors (one per two
municipalities) has been part of the Project and has helped to give information
of the current situation. An explanation is given on how the NGO links the
participation from other local actors through the Municipal Team of Communication (Figure 3.2).
Figure 3.2: Linking Local Actors
MTeam of Communication /Commission of Communication
City Hall
Health
Education
Civil Organizations
and Associations
Churches
SESAN
COCODES
Source: Adaptation from CECODE Guatemala
37
These experiences from different actors showed that actions are being
done in order to decrease the high rates of malnutrition and that the institutions are trying to contribute from their area of expertise. Although all of these
can seem positive, the lack of inter-institutional coordination affects the outcomes of “X” or “Y” project, regardless the approach. These examples also
show that communication cannot change a situation by itself, communication
and its strategies planned from different approaches are a way towards an improvement, but a key component that should be present is that the integration
of efforts can lead to achieve better results. This will be discussed in the next
chapter.
Looking at the experiences in one particular area and from the approaches
used, it is important to acknowledge that participation and the integration of
local actor is a key component of the development projects. If communication
is promoted and respected by each actor involved in the process, then strategies/actions will have a higher chance to be successful.
38
Chapter 4: Malnutrition and Communication
4.1 From Social Marketing, going through IEC/CC reaching
Communication for Development: the road to improve intersector integration and participation
The experiences presented in Chapter 3 have illustrated that there is a need for
coordination amongst the actors involved. Each experience should establish
which or who could represent the best alliance (for the project) and then work
together. At some point the activities from an approach are done at the same
time from others and, therefore activities may overlap. To avoid repetition of
efforts, communication is needed between the institutions, organizations and
all the ones being part of the same effort.
The approaches (reviewed) seek to change a behavior of people in a locality. One of the differences is the way these changes are achieved. As understood from the literature, one is more participatory than the others and, contributes to the integration and visibility of the local actors who are working
towards the same goal.
4.2 Integration of local actors in a territory
From the experiences presented and from the approaches to communication
reviewed, the reality in the case of Totonicapán, Guatemala has showed that
not all the approaches lead to successful integration of the actors. It is recognized in Communication for Development that all the actors, taken as agents
of change and as partners, should be involved in the planning of the activities
of their territory. In Social Marketing and IEC/CC, the participation is not
mentioned and the people are taken as passive agents since they are audiences
or target groups.
The indicators from each approach, presented in Table 2.3, can help identified the ones that can or cannot contribute to achieve the inter-sector integration that is needed for a project to be successful.
The inter-sector integration is assured from Communication for Development because the actors, taken as partners, assume an active role and also
assume responsibilities for one or more of the actions that are in the Plan of
Communication, which also assures the contribution of the rest of the actors
since they all had a say. The production and distribution of materials are; produced with cultural pertinence and distributed through an established group
(Commission of Communication), try to reach as many people as possible and
not to be left in certain offices. Monitoring and Evaluation is also done in a
39
participatory way and it values the changes and learning that people feel they
have accomplished.
In the experience of Totonicapán, in the eight municipalities the Municipal
Commission of Nutritional Security, approved by the Mayor integrated a
Commission of Communication which is the one in charge to plan, organize
and be the responsible of the communication aspect of the Nutritional Security
in the locality. These Commissions communicate with the Commissions of the
other municipalities to have an integrated view of what is being done and to
contribute with each other.
In the case of Social Marketing and IEC/CC participation is not an option
because the messages sent as well as the materials, are produced at the Central
Level. This means that the MSPAS and SESAN in the national offices based in
the Capital City of the country are producing the messages, and materials as
well as the Plans of Communication. Later, these Plans are sent to the regional
offices and the ones who received them face the challenge to make them fit in
the territory, or not to follow them as intended. Totonicapán, nowadays, is receiving the support from the Communication for Development approach. Offices have to undertake their Plans as sent but now have the chance to be part
of the Municipal Commission of Nutritional Security, which is useful for these
actors who represent the Ministry and SESAN.
SESAN has changed from making the plans participatory and, now the
plans that come from Central Level are being implemented. The information
provided by the Representative of SESAN for Totonicapán17, explained that
the plans were done from the municipalities and communities, since there are
the Commissions of Food and Nutritional Security, but there were not specific
guidelines from SESAN. The Departmental office of SESAN only had the
Strategic Plan of Food and Nutritional Security (at a national level) as a reference. This Plan had its own objectives, guidelines and general actions. Following this National Plan, the ones made from the municipalities and communities
didn’t follow the framework established and because of that SESAN at a Central Level made the decision of making the plans for all.
Another reason for this change was that the plans from the localities were
not in line with the Central Level because were made from the conception and
views from people in the communities. The Strategic Plan of Food and Nutritional Security didn’t include these views, and as stated by the Representative
of SESAN for Totonicapán, this Plan should have had a participatory group to
include the different views but it wasn’t like this and so the result was a Plan
created only by people from the Capital City. Because of this the local plans
weren’t in line the ones suggested by Central Level. Therefore, the Department
Mr. Chom, SESAN’s representative for the Department of Totonicapán (Interview
via email, October 13, 2011)
17
40
Council of Food and Nutritional Security (CODESAN) from Totonicapán
suggested an initiative to create spaces at the municipal and department level to
have people’s participation (that was neglected before). The initiative was presented to the Observatory of Food and Nutritional Security which was working in Totonicapán in 2011.
Another important reason, as explained by Mr. Chom, is that SESAN was
being pushed to satisfy the fiscal goals appointed by the Ministry of Finance in
order to receive the disbursement. Amongst these goals were the elaboration
of the plans at all levels, and because some of the SESAN offices in different
municipalities didn’t manage to have them on time, a change was done. This
was also a reflection of the lack of organization form SESAN in these municipalities, which in the long run affected the whole process. The decision made
by SESAN Central Level was to create the plans and then have them distributed in to the department offices and then each office will have to adapt them in
order to achieve the fiscal goals and some of the Food and Nutritional Security
goals of each place.
4.3 Local Voices
4.3.1 Focus Group
Municipality: Momostenango
Group: Mothers from the community that have been attending the activities from
CECODE/UNICEF
Changes in the eating and food preparation habits.
The women who were answered said that they have changed their eating
habits. They said that before (Project 36) they didn’t vary the food, especially
what they used in the food. What was mostly used were: black beans, herbs
and eggs. Now they say they combine other kinds of food because they know
that the food they give to their families should be balanced and should have
vegetables, herbs, rice or any other carbohydrates and at least once a week
chicken, meat or Protemás18.
They also said that the activities have been useful to learn how to prepare
the food, so that their children will not get bored having the same thing, because they have mentioned that before the children refuse to eat what they
prepared. Even though nowadays the food that they give them is made with
the same basic ingredients, the preparation is different and that has been good
Protemás, is a substitute for meat made out of soy protein and it is accessible to
people’s budget.
18
41
for the children. So now, the children eat the food, they have said they like it
too and the mothers know that it helps the nourishment of them.
The mothers also entered a “Cooking Contest”. This Contest was of preparation of nutritious dishes, and it was among 8 groups form the communities
of Momostenango. Each woman had to explain what she had prepared and
why it was a nutritious dish. In the explanation, they also talked about the importance of having the four groups of food: vitamins and minerals, carbohydrates, proteins and fats. They prepared a dish that had these four food groups
and presented them at the park, before the public that gathered there.
This shows that they have appropriated the information that they have received and that they have learned something useful for them. Something to
highlight is the group from Pabaquit from the Community Santa Ana, that a
few months ago learned to incorporate fish into the diet with vegetables and
rice (seafood in general terms is not part of the diet of indigenous families
from Momostenango). But now, they participated preparing a variant of this
dish with fish fillet and explained that it is important to include it in the diet, at
least twice a month. They explained to people that fish is good because it helps
children to learn, since it contains phosphorus. This can also show that there
has been a change in their diet from the food preparation workshops and from
playing the Nutritional Lottery. They have been the ones who have taken the
initiative to investigate on their own the properties of the food that they are
using now to prepare the food, and this was also part of the information that
they gave in the contest; to the public and the jury.
What they also recognize is that now there has been an increasing rejection for “junk food”. They now know and tell other people that it does not
have any benefit and that is bad for children’s growth. They have also started
to prepare natural juices, rather than keep on buying sodas. An example of this
change was also presented in the Contest because one of the mothers prepared
beetroot and orange juice, and explained the nutritional properties of the drink.
They recommended other mothers to give natural juices because are better
than sodas.
This chapter has presented an analysis of the different approaches that
have been used in one same area in order to address a specific social issue that
has been affecting the poorest people in the rural areas. Although there are the
examples of how the personal attention benefits better the families and people
who need the attention, the other ways of sending messages and information
have been useful to create an awareness amongst the people in the communities, but mostly the people that are creating these messages.
42
4.3.2 Most Significant Change in Totonicapán19
Since participation has been a relevant issue throughout this research it is important to have a section dedicated to the local actors’ voices. The women and
men that have been involved in the process are the ones who can tell better
their stories and also tell what they have found “significant”. Some stories have
been selected to be included in this section, and more can be found in the Appendices Most Significant Change in Totonicapán.
Parents
Story 1: “Thanks to a friendship, I have improved myself”
Sonia Maribel Tuch de Lucas
Municipality: San Cristóbal Totonicapán
Mother of three children; her experience in attending the trainings happened through María Sapón, who motivated her to attend. Sonia’s husband is
jealous and he doesn’t allow her to go out often, but the need to receive
VITACEREAL for her son, made her go to the Health Center. Sonia then began to go with María, and motivated by the Health Center’s Project, of making
raffia baskets, she decided to get involved to the point that she became the
leader in her community. She also got involved in the group called “Friends of
the Nutrition”, a training that is offered downtown. She mentions that the
MSC is to have become leader of her community’s group and to be part of the
COLOSAN. “Now I can give my opinion, and it is heard because I have been
trained in the topic. I also know how to properly feed my family and I am
teaching my daughters too. We have been able to negotiate a proper latrine and
they (daughters) always try to separate the garbage in order to have the house
cleaner.” This family has also been planting their home garden and they are
harvesting radishes for their consumption. For this process they received the
support of the City Hall, Health Center, Peace Corps, the Project and SESAN.
Story 2: “Accepting challenges”
Isarel Yat Zárate,
Municipality: Santa María Chiquimula
Israel is a very active person; however the topics of the trainings have never been his priority. When the first educational session of the COMUSAN
started, he approached it out of curiosity and also because he had been asked
to attend. Now he recognizes that “has raised awareness” and the MSC that he
considers is that now he wants to actively work for the wellbeing, not only of
Information provided by CECODE Guatemala/ El Cambio Más Significativo de
Totonicapán
19
43
his family, but also for his community. A proof of that is that he has accepted
to be part of the Board of Parents in issues of health and nutrition, organized
by the Health Center and the Project.
Local Actors
Story 1: Joining efforts for the same purpose
María Gutiérrez,
City Hall’s OMM
Municipality: San Bartolo Aguas Calientes
The MSC has been the support given by the Commission of Food and
Nutritional Security, Communication and Health in the activities towards a better nutrition of the population. Previously, in 2009 the COMUSAN existed and
with the beginning of the Project the work was done with its members to analyze the communicational situation regarding children’s health and nutrition in
the municipality. As a result a Municipal Team of Communication was created,
which also elaborated a Communicational Plan. In 2010, as a decision of the
COMUDE, the integration of the Municipal Team of Communication into
COMUSAN was approved, being set as the Commission of Food and Nutritional Security, Communication and Health. At the same time, the current
plans were integrated into one. From that moment onwards, the Commission
began to execute the planned communicational activities in a coordinated way.
In this situation the ones involved were: Health Center, the Project,
PRORURAL, MIFAPRO and SESAN. This change was possible by joint efforts from the different institutions for the same purpose. The relevance of
this change is that if the institutions work in coordination with each other, the
planned activities will be successful because the efforts are towards the same
purpose and each institution brings its experience from its specialization. The
recommendation was to continue with the processes and strengthen some activities in the communities.
Story 2: Communicational Empowerment
Giovanni León,
CTA/MINEDUC
Municipality: Santa María Chiquimula
Giovanni León has been part of the Municipal Team of Communication
from Santa María Chiquimula since 2009 and through the sensitization about
the problem of chronic malnutrition and food insecurity; he has gotten involved to the extent that he considers to have empowered the topic. For this
educator, the MSC has been the empowerment, since he indicates that each
time that there are new projects or programs, the organizations aren’t always
willing to support their drive. He recognizes that the use of Communication
44
for Development in improving families’ situation with chronic malnutrition is
very important, considering that it is a space where people can analyze the
problem that they face, also comment and take actions on it. Additionally, C4D
encourages subjects to decide in changing attitudes and a behavior for themselves. This change is also significant because of its organization, the people
who are part of the Municipal Team of Communication have also understood
the importance of communication and this will improve as long as the technical assistance and the presence in the municipality is strengthened.
From the testimonies presented in this section, the local actors are the
ones who talked from experience. These actors have been part of other projects and interventions, but were in the role of “recipients” of the information
brought by experts of Social Marketing and IEC/CC. In their words, the appreciation can be read regarding the opportunity for participation. They have
come to realize that small changes can make big differences, but most important is that they were the ones who made the decision to change. The information, the spaces for participation and dialogue were provided but in the
end they are the ones who make the ultimate decision and through it the life of
their families improves.
45
Chapter 5: Conclusions
To understand the real process of communication can lead practitioners of it
and the ones from mass media to focus their efforts in the right direction. It
can’t be said that there is a right and a wrong way, is just that different processes have to be named differently and not to be assumed that all can fit in the
same “basket”. In the case of Social Marketing, the approach is to deal with
target audiences in order to change a behavior, but what these strategies really
accomplish is to raise awareness of an issue. This is not wrong, but it can’t be
called communication since it does not involve people’s views, experiences and
knowledge. Communication for Development on the other hand, does not aim
for publicity, but its focus is to empower people through different processes
that include upgrading their existing capacities.
Malnutrition is one of the different problems that have been affecting the
poorest people in Guatemala. Even though it has been a problem existing for
over the past 30 years, for some reason the strategies have not fully reached the
ones in real need for help. This could be to the fact that the efforts have been
done from an individual perspective, rather than an integrated work from all
the sectors that can help in decreasing the high rates that the country has. Resources could have been used in a more efficient way if the organizations,
Government and other important local actors could reach consensus in the
actions. The relevant input is the one that can be delivered from the different
actors according to their experience and knowledge.
Before Communication for Development, the communication models had
their foundations from the modernization paradigm. In contrast and since the
70s the South has been proposing participatory communicational approaches.
These approaches have given importance to: true participation, a horizontal
dialogue, local actions, local knowledge, the role of facilitators and communication as a process. These are the response to the Northern way of doing communication. This can also be an explanation why Communication for Development is more important in the South than in the North, it started as need for
social responses to social issues.
Participation as mentioned before can be defined depending on the project, and in Communication for Development it tries to get the integration of
local actors and it is considered as “the development goal in and of itself for its
potential to activate local mobilization, consensus building, self-reflexivity, indigenous knowledge, awareness of structural problems, and other practices and
changes leading to self-development” (Inagaki, 2007:13). Participation is the
way to vindicate people’s right to communication which has been neglected or
denied in some cases. Also through participation, the local knowledge recovers
importance and relevance in the actions that will directly affect people in a territory. To be able to reach consensus within the actors is also through partici-
46
pation that, in this study case was through the strengthening and/or creation
of the Commissions of Communication. With this the actors involved in the
project had a place to discuss, plan and decide together the right actions to address the issues that can help to decrease the high rates of malnutrition. Not
directly but through the activities, and like it was said before, creating the
awareness so that people can recognize what is being done and what can be
best for them as well as their families and communities.
When people are taken seriously into account in a project, they tend to
show interest and commitment to the activities. If they see that their ideas and
the local knowledge are represented, they are willing to take responsibility in
some of the activities. People have also shown appreciation for the information received, but mostly because of the fact that they were able to take part
in the planning of the activities that affects them and their communities.
47
Appendices
The following Table shows examples that illustrate the differences between
indigenous and non-indigenous population in terms of access to basic services.
Table 1: Differences in access to services and other health indicators20
Indigenous
Population
Non- Indigenous
Population
Piped water
61%
70%
Sanitation (toilet / latrine)
82%
88%
Percentage of literacy
52.3%
79.6%
Average schooling (in years)
2.5
5
Infant mortality (per each
1,000)
69
52
Immunization (complete
scheme)
61.4
63.3
Chronic malnutrition
(height /age 36-59 months)
69.5
35.7
Maternal mortality (per each
100,000 born alive)
211
70
Service / indicator
Income differences
This inequality manifests itself in access to income as well as consumption
patterns. Income discrimination is given when a person with the same productive capacities as another, but with differences in a personal characteristic nonrelated to income generation, gets a different treatment. On average, indigenous people receive a lower income. The low incomes produce high levels of
poverty which affect in the nutrition and levels of schooling. This provokes
monetary expenses for the ones suffering of poverty, their families, the State
and the country in the following ways: the private expenses that families have
to face due to incidence of diseases that have an additional cost: treatment, and
also the amount of money that these people stop receiving because they can’t
go to work (UNDP, 2005).
20
Diagnose of Racism in Guatemala, 2006
48
Graph 1: Thresholds of poverty, extreme poverty
and average private consumption (2004)
Annual Quetzales per capita
1,5400
5,780
2,560
Extreme Poverty
Poverty
Private Consumption
Source: Adaptation from UNDP, 2005:100
Malnutrition
The Census was done with children from First Grade from the Official Sector
a total of 459,808 children from the ages of 6 years 0 months to 9 years and 11
months.
Box 1: Malnutrition in different aspects
Age: the children with 8 and 9 years showed a prevalence of 51.6% and 60%,
while the ones with 6 and 7 years showed 34.8% and 39.6% of prevalence.
This illustrates that the older the children get, the worse the nutritional damage.
Urban and Rural Areas: the ones from urban areas showed a prevalence of
28.3% and the ones from rural areas 49.7% of prevalence, which presents that
these areas are more affected and the difference is of 21%.
Language: the children who have Spanish as their mother tongue have a
prevalence of 34.6% and the children who have a non-Spanish mother tongue,
most likely a Mayan language the prevalence of 62.5%, almost twice as much.
Source: adaptation from Third National Height Census, 2008
49
Communication
How IEC is understood in the Western and the Vietnamese context.
Table 2: IEC in different contexts
Western
Vietnamese

A general term for communication activities to promote a variety of issues including health, for example, water supply and sanitation and child rights.

An approach based on the need to make
all concerned, become more effective
communicators.

Has a combined meaning that encompasses both communication and ideological orientation.

The term includes complex concepts:
propagation and education, socialization, community organization.

A more controlled process of coordinated action toward a national approach
within guiding ideological principles.
Source: Laverack and Dap, 2003
Totonicapán, Guatemala
Table 3: Population of Totonicapán
Population Data21
21
22
2011
Ethnic Groups22
2002
TOTAL
476,369
Maya
333,438
MEN
226,873
Garífuna
4
WOMEN
249,496
Xinca
9
Ladino
5,640
INE: http://www.ine.gob.gt/np/poblacion/index.htm, September 2011
INE: http://www.ine.gob.gt/np/poblacion/index.htm, September 2011
50
Table 4: Technical Information of Totonicapán
Territorial Extension
1,061km2
Meters Above Sea Level
2,495
Languages
K´iche´
Climate
cold
Totonicapán one of the 22 departments of Guatemala23, is located in the area
of the Sierra Madre and it’s integrated by eight municipalities: Momostenango,
San Andrés Xecul, San Bartolo Aguas Calientes, San Cristóbal Totonicapán,
San Francisco El Alto, Santa Lucía La Reforma, Santa María Chiquimula and
Totonicapán. It borders with four departments: at North with Huehuetenango,
East with Quiché, South with Sololá and West with Quetzaltenango.
To access Totonicapán, the main road is the Interamericana CA-1 (the
paved road that also connects to other departments); there are other roads that
will lead to it too. Within the eight municipalities there are roads, not in good
conditions and mostly not paved, that connect each other. In the rainy season
this is usually a problem because the access is limited to most vehicles; therefore people face a problem to get to the urban area of the municipality.
Production and Economy in Totonicapán
Within the agricultural, commercial and industrial activity of the population;
the products that highlight are: wheat, maize (which is mostly for the family
consumption), beans, potatoes, oat, barley and others. Great part of the lands
is eroded and some are non-productive, especially in Momostenango. Regarding poultry, there is no organized or technical growth and each family owns a
number of animals that are sold or for family consumption. Milk and its derivatives are for business and few people leave part of it for consumption.
23
Information from Diccionario Geográfico de Guatemala.
51
Malnutrition in Guatemala
Department
Table 5: Prevalence (%) Delayed in Height
Total
Moderate
Severe
San Marcos
55.5
38.4
17.1
Huehuetenango
62.8
41.4
21.4
Quiché
63.9
42.5
21.4
Sololá
65.2
43.8
21.4
44.8
24.6
Totonicapán
69.4
Note: the National Average is 45.6%.
Department
Table 6: Departments with Low Prevalence
Total
Moderate
Severe
Capital City
18.5
16.0
2.5
Escuintla
25.3
20.8
4.5
El Progreso
25.5
20.3
5.2
Jutiapa
28.1
21.7
6.4
Guatemala
28.7
23.3
5.4
In the specific case of Totonicapán, even though it has the highest rate
there is a difference between its eight municipalities.
Municipality
Table 7: Prevalence (%) of Totonicapán
Total
Moderate
Severe
San Cristobal Totonicapán
62.5
44.2
18.2
Totonicapán
65.2
44.1
21.2
San Bartolo Aguas Calientes
66.6
43.9
22.7
San Francisco El Alto
66.9
44.1
22.8
Santa Lucía La Reforma
67.8
45.8
22.0
San Andrés Xecul
68.9
43.3
25.6
Momostenango
74.1
45.9
28.2
Santa María Chiquimula
75.5
45.3
30.3
52
The Ministry of Public Health and Social Assistance has been giving different
complements for the nutrition in the most affected areas.
Box 2: Nutritional Complements
Vitacereal: is a nutritional complement that is given to mothers through the
educators of each Health Service. It should be prepared as compote, but the
mothers have said that the children don’t like it like that and they decide to
change the way it has to be prepared. When it is prepared differently, like a
shake or a regular drink, then it loses its effect.
Chispitas: another kind of nutritional complement that has to be spread over
the food, the food has to be solid or semisolid. It has also been identified that
mothers don’t follow the instructions and have been giving them as a drink. If
it is a liquid it will not have the same effects and may also send a wrong message to children, making them think it is a medicine and hence, reject it.
Source: Mónica Ramos, Nutritionist from MSPAS
The Most Significant Change in Totonicapán, Guatemala
MSC in the Quality of Life (Parents)
Story 1: “That my children have a better life”
The story of Marta María Ixcoy Ajiataz
Municipality: San Bartolo Aguas Calientes
Marta María values the improvement of her knowledge: “The talks and the
demonstrations of how to prepare food are very good, that you (Project) provided. Before I didn’t know or didn’t have the knowledge because I didn’t attend the talks, but now I do, I have knowledge. With the money from
MIFAPRO I buy books, notebooks and I contribute with the school. My experience is that I only attended until the second grade, and for that I tell my children to study so that they won’t be like me. Before the talks, we did things just
for the sake of doing them, without knowing about the benefits: cleaning the
house, family planning, etc. In this change have influenced: The Health Center,
MIFAPRO, and what’s important our willingness to learn.” She values this
change and her participation because: “I don’t want my children to be ignorant, and for that reason they should go to school; so that in the future they
can be a teacher, be a professional. If not, they will be like me, not having the
capacity to read or write and like that one can’t move forward. Also what’s important is that with the economic help or without it, I have to send my children to school and to keep attending the talks that are very important. If I
53
knew how to read and write, I wouldn’t be receiving these talks because I
would know about the topics. So now, that I have realized this, I don’t want
my children to be like me.”
Reasons for the selection
This case is about changes were a connection has been made between
what is known and the practice, one of the challenges established at the beginning of the Project. This person’s participation in the educational activities,
linked to the participation in other programs that benefit her, have helped her
established the connection between knowledge and the activities she has to
make in order to improve the quality of life of her family.
Story 2: “The value of herbs”
The story of María Griselda Vicente
Municipality: Momostenango
Griselda is a member of the group of mothers that is involved in educational
activities organized by the Project in coordination with the Health Center. She
has attended video forums, demonstrations of how to prepare food and recreational activities about prioritized topics; health and children’s nutrition. Griselda’s children are 2 years old and the other is 9 months old, she recognizes to
have learned about the value of food, like the herbs. Now she buys the herbs
and prepares them at home in the way she has learned from the demonstrations and she is confident that these herbs, together with other food is good
for her children to grow better. She learned to prepare proper food for the
children, which she has done at home and they liked it.
Reasons for the selection
This case illustrates the effectiveness of the educational activity focused in
food preparation, since the resources used are available in the community but
at the same time are nutritious. In the preparation this kind of food (herbs) is
combined with other type of food rich in nutrients, also available in the community. María Griselda, like other women, says that what she has learned to
cook, she has prepared it a home and her children liked it. Actually, there are
some women who recognize that now, that they prepare the herbs in a different way; their children are more likely to try them and have liked them too.
54
MSC in the Quality of Life (Local Actors)
Story 1: A speed recovery
The story of Josefina Poroj Morales
Municipality: San Andrés Xecul
Josefina’s daughter is chronically undernourished, and the problem has increased since she also became acute malnourished. With the help of the Health
Center and the dialogue that has been established with her, her daughter has
recovered. For her (Josefina), the MSC is that she has understood the importance of taking care of the family, especially of her children since she has
noticed that otherwise it can lead to serious consequences. Now she has decided to take action to improve her family’s situation, in this change the Health
Center has been involved and recently the Project. For Josefina is a Significant
Change because now she is conscious of the problem and knows that her family’s nutritional situation will improve. She suggests that the organizations
should join and cooperate in a better way, carrying out integral assistance to
families. Since she has always dreamed of having a family garden but due to the
economic limitations it has not been possible. For that she suggests for the organizations to work together to make actions of deep impact.
Reasons for the selection
It is about changes in a direct partner, a mother, who had a girl with
chronic malnutrition, but due to her participation in the activities from the
Health Center and the Municipal Team of Communication of San Andrés
Xecul, promoted by the Project, she understood the magnitude of the problem
and chose to improve her family’s quality of life.
MSC in knowledge and application
Story 2: I made my voice be heard in my language
The story of Santa Pelicó Chanchavac
Municipality: San Bartolo Aguas Calientes
The MSC consist of “being taking into account in the activities organized in
my community to improve my family’s health and to avoid the consumption of
bad food and also avoid sicknesses in my family members. Nowadays we are
changing as parents, so that our children can be better than us, and so that they
won’t suffer like we have in the past. We weren’t allowed to attend school, and
when the schools censuses were done, we were forced to hide in a chest where
55
our parents kept the corn. Until now and with the support of our husbands,
who have also had to understand that as women we also generate an income to
support our home, aside from the fact that we are the ones who also stay at
home to care for our children. Today, by the information received from the
different organizations, we know how to communicate with each other, and
even though is hard to give our opinion, we do it in our way and in our language because we are not ashamed of who we are or where we come from; we
are Mayan women.” The ones involved in this change were: UNICEF /
CECODE, PRORURAL, City Hall, other institutions as well as the Health
Center. This change happened because “we are aware now and we have received orientation in our community.” This change is valuable because “we see
that the children don’t get sick as much and we (mothers) take the advantage
of the advice to improve the health of our children since their birth and
throughout their growing years. I recommend for the organizations to keep
visiting the communities and to keep giving us their support.”
Reasons for the selection
Since the work’s emphasis of fighting nutrition is set to strengthen the
communicational capacity between the actors, this case shows the advance in
recovering the right to communication, especially in the case of women and
with the value added, that is a communication with cultural relevance and in
their mother tongue.
MSC in the participation and coordination of an organization in
COMUSAN or Municipal Team of Communication
MSC in comprehension and appraisal of C4D
Story 3: C4D in the City Hall’s Plan
The story of Benjamín Puac
President of COMUSAN and City Hall’s Councilor
Municipality: San Cristóbal Totonicapán
For Benjamín, the MSC has been to include in the City Hall’s Operational
Plan; for 2011 and onwards, the area of C4D and with it strengthen the institutions. He expresses that the dialogue and participation from the communities
and institutions it is also needed.
Reasons for the selection
56
It is a significant change for the Local Government to assume the commitment of including C4D in the Operational Plan. This represents innovation
in the municipal management, given the fact that C4D isn’t just a tool to approach malnutrition problems, but also has a broader sense of intervention,
that if the City Hall makes use of, can be effective for Local Development.
57
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