Breaking the cycles of poverty: Strategies, achievements, and lessons learned in Los Cuatro Santos, Nicaragua, 1990–2014

Abstract

Background: In a post-war frontier area in north-western Nicaragua that was severely hit by Hurricane Mitch in 1998, local stakeholders embarked on and facilitated multi-dimensional development initiatives to break the cycles of poverty. Objective: The aim of this paper is to describe the process of priority-setting, and the strategies, guiding principles, activities, achievements, and lessons learned in these local development efforts from 1990 to 2014 in the Cuatro Santos area, Nicaragua. Methods: Data were derived from project records and a Health and Demographic Surveillance System that was initiated in 2004. The area had 25,893 inhabitants living in 5,966 households in 2014. Results: A participatory process with local stakeholders and community representatives resulted in a long-term strategic plan. Guiding principles were local ownership, political reconciliation, consensus decision-making, social and gender equity, an environmental and public health perspective, and sustainability. Local data were used in workshops with communities to re-prioritise and formulate new goals. The interventions included water and sanitation, house construction, microcredits, environmental protection, school breakfasts, technical training, university scholarships, home gardening, breastfeeding promotion, and maternity waiting homes. During the last decade, the proportion of individuals living in poverty was reduced from 79 to 47%. Primary school enrolment increased from 70 to 98% after the start of the school breakfast program. Under-five mortality was around 50 per 1,000 live births in 1990 and again peaked after Hurricane Mitch and was approaching 20 per 1,000 in 2014. Several of the interventions have been scaled up as national programs. Conclusions: The lessons learned from the Cuatro Santos initiative underline the importance of a bottom-up approach and local ownership of the development process, the value of local data for monitoring and evaluation, and the need for multi-dimensional local interventions to break the cycles of poverty and gain better health and welfare.

Assessing the multiple dimensions of poverty. Data mining approaches to the 2004-14 Health and Demographic Surveillance System in Cuatro Santos, Nicaragua

“…The Health and Demographic Surveillance data have been judged to be of high quality (13, 14) and covered the whole population in the Cuatro Santos area with very few non-participants, thereby providing a reliable basis for analyzes. The temporality of poverty predictors (a predictor happening before poverty) was not fully captured by our design.…”

“…The randomized controlled trials evaluation of multifaceted programs in six countries have comparison villages (22) and a recent publication tried to accomplish comparisons for the Millennium development villages evaluation (23), both reporting positive results for complex interventions aiming for increased welfare in poor areas. The Cuatro Santos case study (13) has no comparison area so we cannot rule out that the general transformation of the Nicaraguan society is a reason for the improvements in welfare seen in the area. The finding in this analysis of multiple dimensions of poverty do however, provide some support that the interventions contributed to poverty reduction.…”

“…Priority interventions were school breakfasts, environmental protection, water and sanitation, preventive healthcare, home gardening, micro credits, technical training, stipends for university education, and telecommunications including access to and training in the use of Internet. Data collection through a Health and Demographic Surveillance System was central for monitoring of trends over time, and research evaluation of various aspects (13,14).…”

“…Local level bottom-up interventions might, however, result in sustainable poverty reduction that might inspire decision makers at the national level. We have documented such a case in northern Nicaragua; the Cuatro Santos experiences of local poverty reduction (13). That case study showed that factors such as local ownership, locally guided multidimensional interventions, and close monitoring and evaluation of the development efforts yielded a substantial poverty reduction of household poverty from 79 to 47 % over a ten year period (2004-14) (13).…”

“…Participation in micro credit programs, the involvement of young individuals in technical training, and home gardening were associated with the transition of households out of poverty (14). The Unsatisfied Basic Needs scoring of households was used to identify geographic areas with higher levels of poverty to target interventions (13). However, poverty indices, such as the Unsatisfied Basic Needs or asset scores, have limitations for a context-specific description of poverty.…”