Improving Maternal Health Status in Indigenous Communities of Panama: Community-Based Participatory Research and Interventions Among the Ngäbe-Buglé People of Panama

Abstract

This chapter describes participatory processes among an indigenous group in Panama, the Ngäbe-Buglé people, to develop appropriate health education and promotion interventions and increase the acceptability and positive impact of educational interventions. We illustrate how the application of formative research—focus groups, community visits, and meetings with institutional stakeholders and community key leaders—provides necessary information to develop a health education intervention responding to the Ngäbe-Buglé health-related learning needs, including prenatal care, working with lay midwives, and detection of high-risk pregnancies. Community participants identified the main health priorities—hygiene, nutrition, healthy environments, prenatal care, the role of the lay midwife in the community, and domestic violence. Most of these are relevant to reduce disease burden and mortality rates, mainly pregnancy issues in poor rural settings. Responding to the Ngäbe-Buglé needs, the material included community pictures with local residents and trained 78 health promoters at a centralized location in the Comarca. During the active phase of the project, community health promoters reached over 8000 people at their remote communities, ten times higher than anticipated! Community involvement and participation resulted in community empowerment and adoption of the project. The Ngäbe-Buglé community has continued to implement the intervention, and 6 months after its conclusion, they reported reaching over 11,000 people in their communities. We conclude that inclusion of community members, community participation to develop appropriate educational material, and reinforcement of empowerment is an effective manner to reach indigenous communities with health-related messages, including pregnancy, prenatal care, and the role of the midwife.