Improving Maternal Health Status in Indigenous Communities of Panama: Community-Based Participatory Research and Interventions Among the Ngäbe-Buglé People of Panama

  • Arlene CalvoEmail author
  • Arturo Rebollón
Part of the Global Maternal and Child Health book series (GMCH)


This chapter describes participatory processes among an indigenous group in Panama, the Ngäbe-Buglé people, to develop appropriate health education and promotion interventions and increase the acceptability and positive impact of educational interventions. We illustrate how the application of formative research—focus groups, community visits, and meetings with institutional stakeholders and community key leaders—provides necessary information to develop a health education intervention responding to the Ngäbe-Buglé health-related learning needs, including prenatal care, working with lay midwives, and detection of high-risk pregnancies. Community participants identified the main health priorities—hygiene, nutrition, healthy environments, prenatal care, the role of the lay midwife in the community, and domestic violence. Most of these are relevant to reduce disease burden and mortality rates, mainly pregnancy issues in poor rural settings. Responding to the Ngäbe-Buglé needs, the material included community pictures with local residents and trained 78 health promoters at a centralized location in the Comarca. During the active phase of the project, community health promoters reached over 8000 people at their remote communities, ten times higher than anticipated! Community involvement and participation resulted in community empowerment and adoption of the project. The Ngäbe-Buglé community has continued to implement the intervention, and 6 months after its conclusion, they reported reaching over 11,000 people in their communities. We conclude that inclusion of community members, community participation to develop appropriate educational material, and reinforcement of empowerment is an effective manner to reach indigenous communities with health-related messages, including pregnancy, prenatal care, and the role of the midwife.


Maternal morbidity Maternal mortality Indigenous women Maternal health Prevention Community participation Pregnancy Central America Prenatal care Panama Comarca Health training Health promoters Midwife Education Pregnancy education Ngäbe-Buglé Guaymí 


  1. Bryan, V., Brye, W., Hudson, K., Dubose, L., Hansberry, S., & Arrieta, M. (2014). Investigating health disparities through community-based participatory research: Lessons learned from a process evaluation. Social Work in Public Health, 29(4), 318–334. CrossRefPubMedPubMedCentralGoogle Scholar
  2. Calvo, A. E., Hess-Holtz, M., Rebollón Guardado, A., Alguero, L., & Vega, S. (2014). Participatory processes applied to developing culturally appropriate educational material among the Ngäbe-Buglé women of Panama for domestic violence prevention. Journal of Cognitive Psychotherapy: An International Quarterly, 28(3), 238–248.CrossRefGoogle Scholar
  3. Caniza, M. A., Maron, G., Moore, E. J., Quintana, Y., & Liu, T. (2007). Effective hand hygiene education with the use of flipcharts in a hospital in El Salvador. Journal of Hospital Infection, 65(1), 58–64. CrossRefPubMedGoogle Scholar
  4. Chi, D. L., Ko, A., & Kim, J. Y. (2014). Bilingual flipcharts help improve oral health-related knowledge and self-efficacy of Korean-American caregivers of preschoolers. Journal of Public Health Dentistry, 74(4), 261–265. CrossRefPubMedGoogle Scholar
  5. Conant, J., & Fadem, P. (2008). A community guide to environmental health. Berkeley: Hesperian.Google Scholar
  6. Contraloria Nacional de la República. (2000). Censo Nacional. Panama: Contraloria Nacional de la República.Google Scholar
  7. Crawford, S., & Garrard, J. (2013). A combined impact-process evaluation of a program promoting active transport to school: Understanding the factors that shaped program effectiveness. Journal of Environmental and Public Health, 2013, 816961. Retrieved from Scholar
  8. Index Mundi. (2016). Panama total fertility rate. Retrieved from
  9. Kaur, B., Roberton, D. M., & Glasgow, N. J. (2013). Evidence-based medical workforce planning and education: the MSOD project. Medical Journal of Australia, 198(10), 518–519.CrossRefPubMedGoogle Scholar
  10. Keyonzo, N., Nyachae, P., Kagwe, P., Kilonzo, M., Mumba, F., Owino, K., et al. (2015). From project to program: Tupange’s experience with scaling up family planning interventions in urban Kenya. Reproductive Health Matters, 23(45), 103–113. CrossRefPubMedGoogle Scholar
  11. Klein, S., Miller, S., & Thomson, F. (2013). Un libro para parteras. Atención del embarazo, el parto y la salud de la mujer. Berkeley: Hesperian.Google Scholar
  12. Lefebvre, R. C., & Rochlin, L. (1997). Social marketing. In K. Glanz (Ed.), Health behavior and health education. San Francisco: Josey-Bass Inc. Publishers.Google Scholar
  13. McKay, C. C., Chang, A. B., Versteegh, L. A., & McCallum, G. B. (2015). Culturally appropriate flipcharts improve the knowledge of common respiratory conditions among Northern Territory Indigenous families. Health Promotion Journal of Australia, 26(2), 150–153. CrossRefPubMedGoogle Scholar
  14. Ministerio de Economía y Finanzas. (2003). Economía, Nivel de Vida (D. d. P. Sociales, Trans.). Panama: Dirección de Políticas Sociales. Ministerio de Economía y Finanzas.Google Scholar
  15. Mintjes, J., Boldewijn, W., Aerts, G., & Sparnaay, M. (2001). Train the trainers course on infection control and hospital hygiene in Bangladesh. Tropical Doctor, 31(1), 36–37.CrossRefPubMedGoogle Scholar
  16. Murphy, M. A., Neequaye, S., Kreckler, S., & Hands, L. J. (2008). Should we train the trainers? Results of a randomized trial. Journal of the American College of Surgery, 207(2), 185–190. CrossRefGoogle Scholar
  17. Pearce, J., Mann, M. K., Jones, C., van Buschbach, S., Olff, M., & Bisson, J. I. (2012). The most effective way of delivering a train-the-trainers program: a systematic review. The Journal of Continuing Education in the Health Professions, 32(3), 215–226.CrossRefPubMedGoogle Scholar
  18. Rawat, R., Nguyen, P. H., Ali, D., Saha, K., Alayon, S., Kim, S. S., et al. (2013). Learning how programs achieve their impact: embedding theory-driven process evaluation and other program learning mechanisms in alive & thrive. Food and Nutrition Bulletin, 34(3 Suppl), S212–S225.CrossRefPubMedGoogle Scholar
  19. Reed, H., Langley, J., Stanton, A., Heron, N., Clarke, Z., Judge, S., et al. (2014). Head-Up; An interdisciplinary, participatory and co-design process informing the development of a novel head and neck support for people living with progressive neck muscle weakness. Journal of Medical Engineering & Technology, 39(7), 404–410. CrossRefGoogle Scholar
  20. Revere, D., Dixon, B. E., Hills, R., Williams, J. L., & Grannis, S. J. (2014). Leveraging health information exchange to improve population health reporting processes: lessons in using a collaborative-participatory design process. EGEMS (Washington DC), 2(3), 1082. CrossRefGoogle Scholar
  21. Rosenstock, A., Mukandi, B., Zwi, A. B., & Hill, P. S. (2013). Closing the gaps: competing estimates of indigenous Australian life expectancy in the scientific literature. Australian and New Zealand Journal of Public Health, 37(4), 356–364. CrossRefPubMedPubMedCentralGoogle Scholar
  22. Sarli, L. (2016). The need to train trainers. Acta Biomédica, 87(Suppl 2), 5–6.PubMedGoogle Scholar
  23. Waqa, G., Moodie, M., Schultz, J., & Swinburn, B. (2013). Process evaluation of a community-based intervention program: Healthy Youth Healthy Communities, an adolescent obesity prevention project in Fiji. Global Health Promotion, 20(4), 23–34. CrossRefPubMedGoogle Scholar
  24. Werner, D., & Bower, B. (2010). Aprendiendo a promover la salud. Berkeley: Hesperian.Google Scholar
  25. Werner, D., Thurman, C., & Maxwell, J. (2010). Where there is no doctor. A villa health care handbook. Berkeley, CA: The Hesperian Foundation.Google Scholar
  26. Wright, M. T., Killian, H., Block, M., von Unger, H., Brandes, S., Ziesemer, M., et al. (2015). Participatory quality development: Engaging Community members in all phases of project planning and implementation. Bundesverband der Ärzte des Öffentlichen Gesundheitsdienstes (Germany), 77(Suppl 1), S141–S142.,347,268 CrossRefGoogle Scholar
  27. Zhao, Y., Wright, J., Begg, S., & Guthridge, S. (2013). Decomposing indigenous life expectancy gap by risk factors: a life table analysis. Population Health Metrics, 11(1), 1. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Community and Family Health, Global Health, Panama Program at the City of KnowledgeUniversity of South FloridaTampaUSA
  2. 2.Department of Global HealthUniversity of South FloridaTampaUSA

Personalised recommendations