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Community participation in a multisectoral intervention to address health determinants in an inner-city community in central Havana

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Abstract

It is increasingly acknowledged that the process of community involvement is critical to the successful implementation of community-based health interventions. Between 1995 and 1999, a multisectoral intervention called Plan Cayo Hueso was launched in the inner-city community of Cayo Hueso in Havana, Cuba, to address a variety of health determinants. To provide a better understanding of the political structures and processes involved, the Cuban context is described briefly. The interventions included improvements in housing, municipal infrastructure, and social and cultural activities. A qualitative study, consisting of interviews of key informants as well as community members, was conducted to evaluate the community participatory process. Questions from an extensive household survey pre-and postintervention that had been conducted in Cayo Hueso and a comparison community to asses the effectiveness of the intervention also informed the analysis of community participation, as did three community workshops held to choose indicators for evaluating effectiveness and to discuss findings. It was found that formal leaders led the interventions, providing the institutional driving force behind the plan. However, extensive community involvement occurred as the project took advantage of the existing community-based organizations, which played an active role in mobilizing community members and enhanced linkage systems critical to the project's success. Women played fairly traditional, roles in interventions outside their households, but had equivalent roles to men in interventions within their household units. Most impressive about this project was the extent of mobilization to participate and the multidimensional ecosystem approach adopted. Indeed, Plan Cayo Hueso involved a massive mobilization of international, national, and community resources to address the needs of this community. This, as well as the involvement of community residents in the evaluation process, was seen as resulting in improved social interactions and community well-being and enhanced, capacity for future action. While Cuba is unique in many respects, the lessons, learned about enhancing community participation in urban health intervention projects, as well as in their evaluation, are applicable worldwide.

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Authors and Affiliations

  1. Instituto Nacional de Higiene, Epidemiologia y Microbiologia, Havana, Cuba

    Niurys Fernandez &  Mariano Bonet

  2. Centre for Human Settlement, School of Community and Regional Planning, University of British Columbia, Canada

    Ariadna Fernandez

  3. Department of Community Health Sciences, University of Manitoba, Canada

    Robert B. Tate

  4. Liu Centre for the Study of Global Issues and Institute of Health Promotion Research, University of British Columbia, Canada

    Jerry Spiegel

  5. Institute of Health Promotion Research, University of British Columbia, Room 432, 2206 East Mall, LPC Building, V6T 1Z3, Vancouver, BC, Canada

    Annalee Yassi MD, MSc, FRCPC (Professor and Director)

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  1. Annalee Yassi MD, MSc, FRCPC
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  2. Niurys Fernandez
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  3. Ariadna Fernandez
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  4. Mariano Bonet
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  5. Robert B. Tate
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  6. Jerry Spiegel
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Correspondence to Annalee Yassi MD, MSc, FRCPC.

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Yassi, A., Fernandez, N., Fernandez, A. et al. Community participation in a multisectoral intervention to address health determinants in an inner-city community in central Havana. J Urban Health 80, 61–80 (2003). https://doi.org/10.1093/jurban/jtg061

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