RESUMEN
Adaptive management and ecohealth frameworks were developed for malaria elimination in Amerindian riparian communities of Venezuela. These frameworks were developed as a strategy to capture, organize, and communicate connections among key factors related to local malaria complex systems. Important causal relationships between social, economic, and environmental stressors which are determinant of malaria were identified at different levels and assumptions that guide interventions are offered, based on available scientific knowledge and input from stakeholders. Drawing on our experience of action research committed to the health of Amerindian populations and conservation of areas with biodiversity value, the authors provide lessons to strengthen the practice of an ecohealth approach. First, conservation targets were considered as a way to achieve sustainable human well-being rather than as a consequence of well-being. Second, the effectiveness and sustainability of technical solutions generally proposed for malaria control depend largely on individual knowledge, attitudes, and practices. Hence, it is necessary to look at the real opportunities of choices that Amerindian people have for attaining a life without malaria, and therefore pay attention to local capabilities, needs, and freedom to choose. The ecohealth approach can benefit from the capability approach, and we explain why.
Asunto(s)
Enfermedades Endémicas/prevención & control , Ambiente , Indígenas Sudamericanos , Malaria/etnología , Malaria/prevención & control , Cultura , Economía , Ecosistema , Conocimientos, Actitudes y Práctica en Salud , Investigación sobre Servicios de Salud , Humanos , Malaria/transmisión , Determinantes Sociales de la Salud , VenezuelaRESUMEN
La malaria está resurgiendo en Venezuela, especialmente al sur del país a pesar de los esfuerzos de prevención y control. En el estado Bolívar representó el 71,2 % de los 42.067 casos de malaria diagnosticados en el país para el año 2007, con una incidencia parasitaria anual de 19,3 casos por cada 1.000 habitantes. Las comunidades indígenas en zonas remotas del estado Bolívar (cuenca del río Caura), consideran que la malaria representa uno de los problemas más importantes de salud pública y perciben la enfermedad como últimamente incontrolable, que genera costos socioeconómicos e impacta sus esfuerzos de desarrollo y conservación de sus hábitats tradicionales. En el 2005 se inicia el Proyecto Wesoichay dirigido a formular un modelo de gestión pública para controlar la malaria en la cuenca del Caura y, fortalecer las capacidades del gobierno y comunidades para instrumentarlo. Este trabajo presenta los resultados parciales de dicho proyecto. Los principales hallazgos evidencian vacíos de información pertinentes para la planificación y evaluación de la malaria; capacidad limitada de atención sanitaria y de investigación; aumento de las oportunidades de contacto hombre-vector promovido por la transformación de los ecosistemas alrededor de las comunidades y patrones de movilización de la población, dentro y fuera de su territorio tradicional y, baja participación comunitaria para identificar y adecuar respuestas a la prevención y el combate de la malaria.
Malaria is reemerging in Venezuela, especially in the south of the country despite prevention and control efforts. In 2007, the State of Bolívar represented 71.2% of the 29,940 cases of malaria diagnosed in the country, with an Annual Parasitic Index of 19.3 cases per 1,000 inhabitants. For indigenous communities that inhabit remote areas in the State of Bolívar (Caura river basin), malaria represents one of the most important problems of public health and they perceive the illness as ultimately uncontrollable, generating socioeconomic costs and affecting their development and conservation efforts of their traditional habitat. The Wesoichay Project started in 2005 to formulate a public management model for the control the malaria in the Caura river basin and to strengthen the capacity of the government and local communities to implement it. The main findings show information gaps pertinent for the planning and evaluation of malaria; limited health provision and research capacity; increase in human-vector contact opportunities due to the transformation of ecosystems around communities and population migration patterns inside and out of their traditional territory, and; low community participation to identify and adapt answers for malaria prevention and control.