Editorial

Social protection of health from the Metropolitan Network of Citizen Participation in Ecuador

0000-0002-6677-7379Carlos Xavier Espinosa Cordero¹  , 0000-0003-3114-4624Teresa Rodríguez Rodríguez^{1  *}  , 0000-0001-9012-1698Pamela Rojas Reyes¹  , 0000-0002-8276-7357Carlos Alberto Amaya López¹ 

¹Fundación Metropolitana, Quito, Ecuador.

Health problems are becoming furtherly pressing in the world, with a marked significance in poor, disabled and historically excluded populations, conditions that exacerbate access to health resources and treatment opportunities.

Several health determinants establish alliances to make the health sector a visible context by chronic diseases, addictions, sexually transmitted diseases, emerging and re-emerging diseases, many of them resulting from climate change.

Consequently, there is an escalation in physical and mental disabilities, premature deaths and a detriment to people's life quality due to reducible gaps which are increasing so their influence in the indicators for population groups is moving into a non-favorable direction. ^1,2

These imbalances have been contained in the goals of the 2030 Agenda for Sustainable Development, declared in September 2015, it advocates the need for collaborative partnerships in order to address the most important social, economic, environmental and governmental challenges of current times. It also seeks to recognize the human rights of all people and achieve gender equality and the empowerment of all women and girls, vulnerable people: children, youth, people with disabilities, the elderly, indigenous peoples, refugees and internally displaced persons and migrants, among others. ⁽³

Internationally, Ecuador is committed to the implementation of the 2030 Agenda and the fulfillment of the Sustainable Development Goals (SDGs); this roadmap will only be effective if all branches of the state, levels of government, civil society and society as whole join efforts together on behalf of the people´s involvement, in the environments, without exclusions. ⁴

In coherence with these projections, the Metropolitan Network of Citizen Participation (RMPC), managed by the Metropolitan Foundation and in close relation with the Metropolitan University of Quito in Ecuador ⁵ (created in 2017) follows to these guidelines, including the need to strengthen from the university scenarios through the association of students and professors of these centers with society, as one of the three constituent aspects of the academic training of third-level professionals. The linkage with society is considered as the human and social interaction that aims at the conscious transformation of the collective environment from the university that influences in the transformation of society through student participation from the professional competencies in which they are being trained. It includes community service, provision of specialized services, consultancies, continuing education, network management, cooperation and development, dissemination and distribution of knowledge; those can allow the democratization of knowledge and the development of social innovation and tends to continuous improvement. It is involved with public processes and attends to the territorial social needs, addressed from the perspectives of different disciplines taught at the university. ⁵

Priority attention to de facto vulnerable and circumstantial human groups is recognized in the Constitution of Ecuador; ⁶ emphasis is placed on attention to the elderly, children and adolescents, pregnant women, migrants and immigrants and people in mobility, people with disabilities, people with catastrophic diseases, people with addictions and people deprived of their liberty. Although public policies aim at special and differentiated attention to these groups, there are still gaps in terms of regulations and actions to address the associated social and economic problems.

One of the objectives contained in the RMPC is aimed at improving the regulatory framework, research-action methodologies, in order to design actions tailored to the needs of groups with special needs, to systematize experiences and innovative actions involving the academia and centers that generate and transfer knowledge, without bearing in mind the inclusive nature and social projection of citizen participation thus to contribute to the welfare and improvement of Ecuadorians life quality.

To reach this objective, the RMPC project has proposed a wide range of activities in partnership with the Metropolitan University, aimed at community spaces and detention centers to improve the welfare and life quality of vulnerable populations, at the same time seeks to bring the academy closer to the knowledge society.

These social interventions are based on the precepts of the Pan American Health Organization (PAHO) which social participation in the development of health is conceived as a necessity, thought of as "the action of social actors with the capacity, ability and opportunity to identify problems, needs, define priorities and formulate and negotiate their proposals in the perspective of health development". ⁷

This type of participation comprises collective actions through which the population faces the challenges of reality, identifies and analyzes its problems, formulates and negotiates proposals and satisfies health needs, in a voluntary, democratic and concerted manner.

Social participation cannot be violated when attempting to transform the health concepts, to solve problems in this field that are in fact crossed by countless biological, psychological and social determinants, reasons that justify not focusing the transforming action on actions only conceived in health spaces. They must transcend to social, governmental, private and public instances, in coherence to common objectives in the effort to provide citizens with tools and resources to ensure good living.

To date, the RMPC has conceived the implementation of actions related to the citizen rights of historically excluded populations, all aimed at promoting the exercise of their rights that result in personal wellbeing, life quality and health protection.

The main actions are described below:

-Violence against women and girls and women's empowerment: training for women belonging to organizations that pursue respect for their rights and empowerment, training in topics related to health and personal self-care through digital platforms. Free legal clinics have been created for proper guidance in terms of citizen rights and auxiliary to these women victims of violence, which undoubtedly also constitute an important element in social support, agent favoring health and welfare by teaching them to cope with stressful situations, mitigate the effects of emotional distress which inexorably helps to maintain better mental health in the face of these contingencies experienced.

-People with physical and physical-motor disabilities: Actions have been conceived in close coordination with the Chamber of Commerce of Ecuador and the Decentralized Autonomous Governments (GAD), to develop training that will allow them to master a profession according to their limitations to be actively integrated into society.

Coordinated actions have been proposed with organizations that serve children and teenagers with visual impairment for the creation of learning spaces, as well as the creation of a reading club through digital platforms in order to improve their culture, their welfare and a group space where they can share experiences and life experiences. These groups will be led by UMET students in training process.

It is planned to teach sign language to children with hearing disabilities through virtual platforms in coordination with the National Institute of Hearing and Language of Ecuador, as well as the development of educational actions with mothers and primary caregivers of early childhood children with this disability to ensure the proper management and education of these children to enhance their integral development.

Education scholarships have been granted to physically handicapped people to pursue university studies, as a way for their personal growth and fulfillment, as it enriches their spirituality, wellbeing and improves their social condition.

To deepen into the felt needs of people with physical disabilities, it is intended to start research on people with this condition, it will allow the development of practical actions from the University based on the identified needs.

-Persons Deprived of Liberty (PPL): Based on the rights of these people to be treated in a dignified and respectful manner, to have rights to health protection and social reintegration, the RMPC in coordination with the representative authorities of the National Social Rehabilitation System (SNAIS) has proposed actions aimed at the literacy of PPL from primary to university level, to learning jobs coordinated with representative groups of the educational systems also with university students in training.

It goes beyond social justice and moral education, it also aims at fostering the basis for attitudinal and behavioral modifications, strengthening self-valorization structures and improving personal wellbeing.

Some other actions have been conceived for the elderly deprived of liberty (PPL) aimed at detecting neurocognitive alterations and consequently providing guidelines to rehabilitate them; there are also plans to interfere with teenagers and young lawbreakers to promote moral citizenship values that will enable them to behave better when they leave the penitentiary centers.

Schools for Citizen Participation were created to address issues of public interest related to citizen rights and health promotion and prevention. These are conducted by students and professors of the University intended to train and raise awareness in citizens, fostering a spirit of self-protection that translates into a better life quality, so quantity too.

It is proposed the creation of a unit of accompaniment and guidance for people living in the Metropolitan district, attached to the UMET to develop many actions of health promotion and prevention, through the treatment of social and health issues of high prevalence in Ecuador, which can be carried out in groups and individually, and will be conducted by students and professors of the institution.

The actions conceived in the RMPC aim to increase citizen training in health-related topics, promote healthy lifestyles, modify risk factors for chronic diseases, prevent the consumption of harmful substances in adolescents, empower Ecuadorian women by training them in topics of interest for their social performance, and in those who are victims of gender violence, accompany and guide them in the exercise of their rights as citizens, actions that at the same time constitute mechanisms of social support.

By extending the actions to populations deprived of liberty, it contributes to the improvement of the life quality of these people also to the social reinsertion so necessary for their rehabilitation.

No less important are the actions that privilege the treatment of people with physical disabilities and the elderly, which have an implicitly high humanistic and social component, at the same time are reverted in better conditions of physical and psychological health and contribute to family orientation, turning them into change agents and social support of the members with affectedness.

The social participation approach with which the RMPC is projected to promoting the action of social actors in decision making and public health management, in order to influence the social determinants of health with both, equality and equity, incorporating the co-responsibility of citizen power in the achievement of Good Living in health.

In the medium and long term, it is hope to incorporate other universities in Ecuador to the Network and perhaps can take as a reference international experiences ^8,9,10 that have succeeded in intervening so that local populations to be aware of their health and strive to improve it through their own actions, led by professionals and trained university students.

REFERENCIAS BIBLIOGRÁFICAS

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2.  UNICEF. Estado Mundial de la Infancia. Nueva York: UNICE; 2016. [Internet]. [citado 4 de Ago de 2022]. Disponible en: Disponible en: https://www.unicef.org/argentina/informes/estado-mundial-de-la-infancia 2.

3.  Naciones Unidas. La Agenda 2030 y los Objetivos de Desarrollo Sostenible: una oportunidad para América Latina y el Caribe (LC/G.2681-P/Rev.3), Santiago: Cepal; 2018. [Internet]. [citado 4 de Ago de 2022]. Disponible en: Disponible en: https://repositorio.cepal.org/bitstream/handle/11362/40155/24/S1801141_es.pdf 3.

4.  Naciones Unidas en Ecuador. Reporte de Resultados 2021 [Internet]. 06 junio 2022 [citado 4 de Ago de 2022]. Disponible en: Disponible en: https://ecuador.un.org/sites/default/files/2022-06/Reporte%202021%20-%20ONU%20Ecuador_1.pdf 4.

5.  Juanes Giraud BY, Reyes Rojas P, Amaya López C, Cedeño Espinoza E. Red metropolitana de participación ciudadana. La vinculación con la sociedad desde el contexto universitario de la UMET. Revista Universidad y Sociedad [Internet]. agosto de 2021 [citado 4 de Ago de 2022];13(4):512-20. Disponible en: Disponible en: http://scielo.sld.cu/scielo.php?script=sci_abstract&pid=S2218-36202021000400512&lng=es&nrm=iso&tlng=es 5.

6.  República del Ecuador. Constitución de la República del Ecuador. Decreto Legislativo 0. Registro Oficial 449 de 20-oct.-2008 [Internet]. Ecuador; 2021/01/25 [citado 4 de Ago de 2022]. Disponible en: Disponible en: https://www.defensa.gob.ec/wp-content/uploads/downloads/2021/02/Constitucion-de-la-Republica-del-Ecuador_act_ene-2021.pdf 6.

7.  Organización Panamericana de la Salud. La participación social en el desarrollo de la salud. (Desarrollo y fortalecimiento de los sistemas locales de salud en la transformación de los sistemas nacionales de salud, HSD/SILOS) Washington, D.C.: OPS; [Internet]. 1993 [citado 4 de Ago de 2022]; Disponible en: Disponible en: https://iris.paho.org/handle/10665.2/3363 7.

8.  Sanabria Ramos G, Pupo Ávila NL, Pérez Parra S, Ochoa Soto R, Carvajal Rodríguez C, Fernández Nieves Y, et al. Seis décadas de avances y retos para la promoción de la salud en Cuba. Revista Cubana de Salud Pública [Internet]. septiembre de 2018 [citado 4 de Ago de 2022];44(3). Disponible en: Disponible en: http://scielo.sld.cu/scielo.php?script=sci_abstract&pid=S0864-34662018000300003&lng=es&nrm=iso&tlng=es 8.

9.  Núñez Jover J, Alcázar Quiñones A, Proenza Díaz T. Una década de la Red Universitaria de Gestión del Conocimiento y la Innovación para el Desarrollo Local en Cuba. Retos de la Dirección [Internet]. diciembre de 2017 [citado 4 de Ago de 2022];11(2):228-44. Disponible en: Disponible en: http://scielo.sld.cu/scielo.php?script=sci_abstract&pid=S2306-91552017000200015&lng=es&nrm=iso&tlng=es 9.

10.  Cassetti V, Paredes-Carbonell JJ, López Ruiz V, García AM, Salamanca Bautista P. Evidencia sobre la participación comunitaria en salud en el contexto español: reflexiones y propuestas. Informe SESPAS 2018. Gac Sanit [Internet]. 1 de octubre de 2018 [citado 4 de Ago de 2022];32:41-7. Disponible en: Disponible en: http://www.gacetasanitaria.org/es-evidencia-sobre-participacion-comunitaria-salud-articulo-S0213911118301638 10.

Received: September 11, 2022; Accepted: October 06, 2022

^*Autor para la correspondencia. Correo electrónico: [e-mail]

Los autores declaran que no existe conflicto de interés en esta investigación.