1. SHOULDER TO SHOULDER Building Sustainable Partnerships Between U.S. and Rural, Developing Communities Wayne Waite President, Shoulder to Shoulder, Inc.

6. Her Bedroom

10. AMFI: Levels of Poverty per Municipality (percentages) Municipios Extreme Poverty Relative Poverty Non poverty Total San Marcos 73.4 6.3 20.3 100.0 Concepción 75.6 5.5 18.9 100.0 Colomoncagua 72.4 6.3 21.3 100.0 Camasca 69.9 5.3 24.8 100.0 Magdalena 68.5 7.4 24.1 100.0 Santa Lucía 69.4 5.5 25.1 100.0 Total 72.0 6.0 22.0 100.0 Prueba chi-cuadrado p= .734 Fuente: Encuesta de hogares PNUD-FLACSO

11. INDICATORS: AMFI – ASOCIACION DE LOS MUNICIPIOS FRONTERIZOS DE INTIBUCA July 2008 Variables S. M. de Sierra (%) Concepción (%) Camasca (%) Colomoncagua. (%) Magdalena (%) Santa Lucia (%) S. Antonio (%) Extreme Poverty 73.4 75.6 69.9 72.4 68.5 69.4 ----- Extreme Exclusion 72.6 69.9 54.2 60.0 60.8 63.9 ------ Infant undernourishment (0-5years old) 79.7 69.5 66.5 70.2 63.7 65.2 67.1 Pre-school 35.3 39.5 45.4 39.1 53.8 37.9 65.3 Elementary School 93.6 96.6 94.2 92.7 94.7 89.2 92.9 Jr. High/ Plan Basico 71 48.6 51.1 55.3 52.2 45.5 55.7 Diversified /Colegio 25.3 23.7 33.7 27.7 26.4 18.3 32.3 Childbirths by midwives 27.3 57.1 31 74.3 33.3 48.5 69.4 Water access by Pipe 31.8 78.5 84.2 81.6 70.1 82.3 77.4 Have bathrooms 58.6 87.3 81.5 70.4 60.6 51.3 66.5 Have electricity 29.3 33.5 60.2 54.8 65.3 57.2 74.6 Illiteracy 27.6 20 15.8 18.8 19.1 26.9 16.9

13. Health Planning and Health Spending Tertiary Care Secondary Care Primary Care Household Care Health Care Priorities Health Care Spending

15. Why Partnerships? Health professionals work in many ways to improve health in developing nations… Build health infrastructure (e.g. a hospital) Supplement Specialty Services shortages Short term Medical Missions Community Partnerships 1 2 2 3 4

27. How Shoulder to Shoulder Views the Determinants of Health Determinants of Health Examples Ecology Sanitation Water Quality Food Quality & Quantity Environmental Stability Faith Health Beliefs Mother’s literacy Household income Household care Primary Health Care Risk for diseases Health and Disease In a Community Social Determinants Physical Determinants Cultural Determinants Genetic Determinants Health System Determinants

28. Determinants of Health for the Individual Primary Health Care Household Care Water Quality Literacy- mother Ecology Food Quantity and Quality Sanitation Environmental Stability Household Income Faith and Culture

29. Health outcomes are improved by effecting the determinants of health

31. Expanding the Health Center Network

32. Evaluating access to community health resources

33. INTIBUCA Santa Lucia La Esperanza Concepcion

42. The Process

43. Outdoor “kitchen” at the school

44. Grinding the corn

45. Tortillas

46. Cooking the beans and rice

52. Happy camper (no shoes)

59. STS Clinic in Santa Lucia

60. Shoulder to Shoulder

62. Our web page: www. Shouldertoshoulder.org