Table 13.

Scaling-up community empowerment in dengue control: the Cuban experience

A major challenge remains in scaling-up, financing, and institutionalizing community empowerment approaches to VBDs. In Cuba, dengue outbreaks helped facilitate the national Aedes control programme to include community empowerment as a major component of its national strategy. The existing programme involved a top-down structure, with over 30 000 field workers charged with entomological surveillance, larval source reduction, adult mosquito control, passive community education, and enforcement of household fines. Changes included a focus on bi-directional and experience-based learning, capacity building and shared leadership, with communities involved in decision-making and a greater focus on local-level organization. This included modifying existing guidelines and plans to incorporate participatory planning, behavioral research, training community leaders and community working groups and fostering intersectoral collaboration. An in-depth analysis over 5-years revealed a slow process of adoption of this new strategy, based on perceived matches between the needs of the national programme and how the empowerment approach could improve performance. The structure, practices, and organizational culture of the national control programme changed little. Important elements of the original empowerment strategy were left out. Major reasons included insufficient dissemination of the approach to government decision-makers, misinterpretation of empowerment principles, and a resistance to organizational change at the management level. This highlights the importance of properly conveying the benefits of an empowerment approach to decision-makers, and the need for better information exchange between those who develop participatory intervention designs, and national vector control staff. From Pérez et al. [147]