WASH as part of an integrated community development plan in Nicaragua

[Individual articles from the Winter 2019 issue of Intersections will be posted on this blog each week. The full issue can be found on MCC’s website.]

In 1984, a group of Nicaraguan university students who felt called to emphasize their faith in action founded the organization Acción Médica Cristiana (AMC). This group of doctors and other health professionals started out by sharing their gifts in medicine through mobile medical care in the rural, war-torn areas of Nicaragua. In October 1988, after its humanitarian response to Hurricane Joan, AMC began a more permanent presence in the Caribbean regions of the country. Initially, AMC’s response to health needs was primarily clinical, but as time passed the organization recognized the need for a more holistic community development model, and in 1990 AMC shifted toward community health prevention and promotion. Addressing the basic need for clean water and sanitation was a central part of this shift. AMC leaders and staff observed that, without clean water, medical care was only a short-term solution for communities. In the years that followed, AMC leaders included water, sanitation and hygiene (WASH) interventions in the organization’s strategic plan. AMC uses a holistic approach that integrates WASH projects into its larger community development strategies. An additional principle for AMC is for WASH education and infrastructure to go hand-in-hand. AMC has both enjoyed successes and faced challenges as it incorporates WASH strategies into its health and development outreach.  

Over the past thirty years, AMC has focused mainly on rural communities in the Autonomous Caribbean Regions of Nicaragua. These regions are home to many of the poorest municipalities in the country, where drinking water and sanitation systems are limited. The root causes for malnutrition and dehydration in the regions include waterborne illnesses, making WASH interventions essential. AMC has expanded into other areas of development beyond WASH, but with the ongoing limited availability of drinking water and sanitation infrastructure, AMC has worked to keep WASH in its strategic plan. At the same time, AMC collaborates and advocates closely with local and municipal governments in WASH initiatives as more government regulations are put in place and as access to clean water and sanitation becomes a priority within the public sphere, stressing that the success of WASH initiatives is crucial to the overall success and sustainability of general health outcomes. 

AMC’s philosophy that WASH projects are a basic community development strategy has led the organization to incorporate WASH into various levels of their work. AMC uses a holistic model in which infrastructure, education, peacebuilding and spirituality are intertwined. Currently MCC is partnering with AMC in both WASH and education projects in and around the city of Bluefields in the South Autonomous Caribbean Coast Region. AMC’s focus is to invest at the community level, especially in schools. Support for education without any assistance to address school infrastructure is often received by communities as shallow and insufficient since the schools in this region of Nicaragua have substantial infrastructure needs, including WASH infrastructure, such as wells for schools to access potable water. At the same time, building wells without education has led to contamination and disrepair. From AMC’s perspective, infrastructure and education must go hand in hand. 

AMC works hard to integrate and involve community members from project design through to implementation, monitoring and evaluation. AMC’s experience shows that community participation is fundamental to the success any development project. This involvement ensures ownership by the community. AMC also works together with the community to ensure that whatever system or tool is being offered is appropriate for the location. For example, a community with only sporadic electricity may benefit more from a hand pump on a well than an electric one.  

Community members are also involved in the actual manual labor of the project. Gerardo Gutierrez, AMC Project Director, tells the story of one community where the men were not interested in helping with the project because the water storage system was located up a large hill and they felt the work was too intense. The women, however, felt the need for clean water in the community was great, since they were the ones who walked for kilometers to the river to collect buckets of water for daily chores. The women started taking the plastic pipes one by one up the hill and digging trenches. The men felt ashamed to be outdone by the women and children and decided in the end they should join in as well. The water system was completed and the project has been administered exclusively and successfully by the community for 20 years, demonstrating the community ownership of the project.  

The community is also empowered as it makes decisions about the design, the education process and the community potable water committee that functions after the official projects have ended. With increased community participation, AMC has used input from the community to develop gravity-based water systems, hand-dug and -drilled wells and water treatment systems using filtration, chlorine, ozone or ultraviolet treatment, depending on the context and need. AMC also has ample experience in the construction of different types of latrines based on the geographic and cultural conditions in the area.  

While AMC staff are positive about their efforts, they also face many challenges. They continually work to be culturally sensitive in a region with substantial cultural diversity. They also face challenges to foster community participation when other groups, both nongovernmental and governmental, come in and do projects for free or even pay beneficiaries, while failing to slowly build community ownership for WASH initiatives. A serious concern in the region where AMC operates is climate change that is increasing the already heightened risk for disasters, especially flooding, which contaminates soils and destroys infrastructure. Despite this, AMC has witnessed the improvement of health, education and community organization, all as a result of making WASH part of an integrated community development model. 

MCC has been privileged to work with AMC over the past thirty years. We as an organization have learned from their experiences in community development and specifically WASH projects. AMC’s collaboration with the community has been especially meaningful as it aligns with MCC’s own values as an organization and provides evidence for the benefits of community involvement in projects.  

Rebekah Charles is the MCC Nicaragua representative. Jeannette Kelly is AMC’s project coordinator in Bluefields, while Gerardo Gutierrez is the AMC Project Director. 

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