Alejandra launched her life’s work out of her deep concern about the healthcare in the poorest communities in Argentina. In 2010, the actions she was carrying out within distinct communities became formalized by establishing Surcos, a citizen organization (CO) comprised of professionals from a variety of disciplines. Currently twelve people work in the organization, which also maintains an advisory board of specialists and leaders in the field of health. Alejandra has managed to secure a wide portfolio of private sector and foundation support to slowly influence how the municipal and provincial public health authorities deal with their constituents.
Surcos intervenes with each community in a different way based on the social phenomena and needs there, but then ties each tactic with its overall vision and other strategies implemented with other communities to achieve a comprehensive, nationwide paradigm change. Alejandra starts by identifying and mapping the most relevant aspects and institutions that have a direct and indirect impact on the community’s healthcare. She does this with the clear input of the members, engaging in lengthy dialogue to pinpoint the actual stimuli. While the main causes of the healthcare problems can range from those more conventionally perceived as medical (such as alcoholism) to other, less directly medical ones (such as intergenerational conflict), Surcos keeps at the core an emphasis on how these phenomena produce an undesirable healthcare outcome. This keeps the frame of reference within the scope of health while at the same time creating a multidisciplinary dimension, overcoming the individualistic and biological focus of traditional public health. After reflection, Surcos works together with the community to prepare an action plan that enables civic participation, making every person a protagonist and changemaker in protecting and preserving their wellness.
Surcos also mobilizes the infrastructure of local healthcare agencies and grassroots organizations and COs to promote new ways of cross-sector and cross-institutional cooperation, through practices designed by the citizens and institutions themselves. To ensure long-term sustainability of the plan, Surcos helps the agencies and COs recognize and overcome obstacles to institutionalize the changes that take place, through public policy reform or building congruence of public and private sector actors. For instance, Surcos may help draft and sign agreements among distinct municipal authorities, community representatives and advocates, and interagency networks. The local media too serves a fundamental role in this construction of a new “health citizenship.” After participating in the initial stakeholder convening, they spread the new holistic projects and programs to help their formal institutionalization. What distinguishes the Surcos approach is how it takes advantage of processes that are never less than 3 years old, allowing it to weave together networks and promote sustainable social change, activating and stepping on existing capabilities and systems.
For example, in 2009 the Perez Companc Foundation invited Surcos to work with a population in the northeastern province of Misiones that had suffered damage sustained after a tornado struck the area. The first responders and emergency aid pulled out six months after the incident, but the community still suffered from the tremendous damage wrought, and Perez Companc and Surcos started their intervention. Their first diagnostic showed a clear misalignment of priorities and poor engagement between the different levels of the healthcare system in Misiones, whose local clinics and outposts were located far away from the isolated communities, which had little means of transportation and adequate roadways to reach them. Surcos helped the community form a cross-sector health working group made up of municipal health clinics, the hospital, leaders from the M’bya Garaní indigenous group (the first time that members of a tribe participated in this way with the health department), educational institutions, environmental agencies, and other community and national stakeholders. Surcos carefully trained 22 representatives of local organizations in the vision of community healthcare and helped them to map out the principal health problems affecting the region and established new initiatives to address and monitor them. Surcos also trained 30 local healthcare promoters and 10 doctors in prevalent issues of healthcare. Most importantly, they demonstrated throughout the intervention the principle of community healthcare, placing health as a key topic in the media and public frame of mind, thereby making public policy change more feasible and raising a demand for quality healthcare among the population.
As part of the project, the network in Misiones and Surcos are developing an online platform to register vital statistics about the population, align priorities and carry out the health program by the local government. If this plan succeeds, Alejandra expects to employ this new online system in other areas. This experience also emblemizes the flexibility of the Surcos model: Alejandra sees that many of the concrete outcomes—strategies and tools—are replicable in other communities with the appropriate contextualization.
Another example of Surcos’s adaptive and flexible methodology is its project in Pilar, in Buenos Aires province. With Surcos the community identified that domestic violence and social conflict among younger and older generations was in fact a source of many problems with health-related consequences. With this in mind, community leaders in Pilar followed a principle of community health and formed a stakeholder working group in conflict prevention. They trained teachers and city leaders in conflict identification and resolution, and they also built the capacity of the local police force to improve their practices in receiving and responding to such cases. They also involved other local organizational specialists. Together, the working group built a space to supervise allegations of violence in the local precinct departments. With older people, the team established a weekly series of activities to help them in memory recovery and improved communication and integration with young people. Then the working group established two semimonthly segments on the local radio to discuss public issues such as respectful birthing, nursing, child-rearing, infant and child development, nutrition, prevention of child abuse, pediatric respiratory infections, and healthy aging. Representatives of the community health centers, healthcare professionals and members of the social center took part in these segments. After these radio shows proved a success in spreading the concept and importance of holistic community health, the community health network in Escobar, also in Buenos Aires province, modeled a similar initiative with a half-hour segment every two weeks on television. During this broadcast they still promote new activities in healthcare and testimonials.
Surcos performs a detailed evaluation to monitor its advances and improvement in community healthcare awareness. In 2012, Alejandra partnered with the prestigious medical university Center for Medical Education and Clinical Research that enabled residents in family medicine, whom Surcos was preparing in the field of community health, to take part in field-based experiences. Alejandra expects that this productive relationship will be vital as she prepares the next generation of doctors in holistic, community health, thereby beginning to dismantle the rigid public health system with disciples in the community of multidisciplinary treatment and prevention. She recently published a lengthy and fully comprehensive textbook Community Health Promotion: A Dialogue Between Theory and Experience that documents in very concrete steps, exercises and modules the different experiences that Surcos has had with community health incidence. This textbook, in the form of a practical manual, will also help in spreading the methodology to other medical institutions and practitioners. Alejandra foresees that the institutionalization of the projects in the field plus the educational component encompassed by the textbook and medical school strategy will both act as multiplier effects that will catch the enthusiasm of other communities demanding a multidiscipline approach to wellness.