INTRODUCTION

The Millennium Development Goals (MDGs) have generated the most successful movement against poverty, with the commitment that world leaders assumed in 2000 to “spare no effort to liberate our fellow men, women, and children. from the abject and dehumanizing conditions of extreme poverty, facing the roots of the causes, starting from integrating the economic, social, and environmental dimensions of sustainable development; Of the 8 objectives, the 7th refers to Ensuring environmental sustainability since 1990, of the 2.6 billion people who gained access to improved drinking water sources, 1.9 billion did so through piped drinking water until its own home.¹

Of the 17 Sustainable Development Goals (SDGs), 6 refers to Clean water and sanitation to guarantee the availability of water and its sustainable management and sanitation for all. At the Sustainable Development Summit held in September 2015, UN Member States approved the 2030 Agenda for Sustainable Development, to end poverty, fight inequality and injustice, and tackle climate change².

The Montevideo Consensus on Population and Development (2014) is signed with the objective of examining its progress in Latin America and the Caribbean in the last 20 years and identifying the fundamental measures to reinforce its implementation, placing emphasis on emerging regional issues in population and development, and on human well-being and dignity, as well as its sustainability³.

In Peru, the coverage of water supply and sanitation services has increased significantly according to the population and housing censuses; However, various social, economic, and cultural factors do not allow its implementation, affecting public health.

At the same time, assume the country commitment, to respond to the great challenges to face inequities, water, and sewage services are still precarious, few households have a toilet, in rural areas a large percentage continues to eliminate their excreta in latrines, manholes or open-air, a situation that affects public health.

The Regional Sanitation Plan, Cusco 2018-2021, a management instrument within the framework of the National Basic Sanitation Policy, looking forward to 2030⁴, establishes the regional sanitation objectives, to achieve the millennium development goals and the Sustainable development.

The achievement of these objectives depends on many factors: public policies, greater budget for the efficiency, equity, and sustainability of the provision of these basic services, the concerted participation of organizations, environmental management systems to generate a culture in public health, and participatory communication strategies.

Paucartambo, is located 110 kilometers from Cusco, at an altitude of 3005 meters above sea level, made up of 20 population centers, 38 peasant communities, an urban population is 9,352 and the rural population is 41,055, surface area 6,295.01 km2, density (Inhab./Km 2) 8, population centers 74 to 2018⁵.

As of 2012, it presented a Human Development Index (HDI) of 0.1798 with the participation of key leaders such as the municipality, the Health Center, the University of Cusco, and civil society, projects have been developed to improve the quality of life of the population⁵.

In 2007, there were 3,011 homes that had a toilet, a public drainage network inside the home; public drainage network outside the home, but inside the building 5,073, septic tank, septic tank or biodigester 4,650 blind or cesspool or pit latrine 9,186, river, canal, canal or similar 633, does not have 22,941 out of a total of 45,494 homes⁶.

For the year 2017, regarding the hygienic service that the home has: public drainage network within the home 6,561, public drainage network outside the home, but within the building 7,999 Septic tank, septic tank or biodigester 5,147, latrine 3,984, blind or black well 7,448, river, ditch, canal or similar 1,647, open field or outdoors 8,759, out of a total of 41,983⁶. Observing a considerable increase regarding the implementation of the drainage network inside the house, as well as outside it, with a considerable decrease in the use of cesspool or cesspool and latrine; However, the increased use of canal or similar, open field or outdoors for the elimination of excreta is striking.

It is precisely to sensitize the population and generate different practices that communication programs were implemented, but they had no positive impact, because the communication strategies were not participatory, or they did not use means compatible with the social and cultural matrix of these communities.

By not causing changes in the knowledge, attitudes, and practices of the population, health problems were generated; Thus, in 2012 and 2013, 32.3% of girls and boys under five years of age suffered from anemia, due to malnutrition exacerbated by hygiene conditions, being more critical in rural areas, the data gives an account of the prevalence of anemia in these two years⁷; Of the 9361 children under 5 years of age evaluated in the Paucartambo Micro Network, 38.5% had chronic malnutrition.

The implementation of communication strategies is imperative, to define axes and tones that are more conducive to each sociocultural matrix, considering their communicative rationality around the problem. The communication strategy is a conversational device that lays the foundations for desirable social interaction within the framework of a project⁸. Strategies define what and tactics define how.

Health culture is the broad manifestation that transcends the interest placed in people, it is assumed as the scale of values that sustains the practice of those who inhabit⁹building the cognitive, affective level and of the practices implies many conditions such as language and speech to formulate messages and ensure proper use of basic services.

In argumentative speech different aspects are distinguished, in this sense I have tried for my part to make explicit the general communicative presuppositions of argumentation, understanding them as determinations of an ideal speaking situation¹⁰.

METHODS

RESULTS

DISCUSSION

The data from the 2017 census of the INEI, although they show a considerable increase with respect to the availability of a Drainage Services Network, however, there is a considerable increase in those who dispose of excreta in river channels, or in the open field, communication strategies to promote culture in health, as well as the conservation of basic sanitation services, did not use participatory forms, monitoring activities were lacking and surveillance.

Similar research results specify that internal communication is key to the formation of a new culture in health and that therefore the internal communication approach must essentially include health promotion in order to promote actions in this regard¹¹.

The knowledge of health personnel is inherent in their academic training and linear philosophy, which gave rise to the second category: technical dimension, where the discourses were oriented towards the conception of health, dependent on technical intervention¹².

Effective communication is one based on the needs of the leaders, has a flexible plan, with few practical and standardized messages. Regarding the sustainability of the initiatives related to the improvement of water and sanitation conditions, their effectiveness strongly depends on changes in behavior on the part of the population, as in the case of handwashing. Hand hygiene reduces the frequency of gastrointestinal diseases¹³.

It is also pointed out that a healthy city must be conceived as a “force-idea” to stimulate health in development, emphasizing the development of processes and not only that of results; betting on the gradual changes in lifestyles, on the awareness of the community regarding its rights, duties and responsibilities and on the exercise of creative participation¹⁴.

To build healthy and sustainable cities, it is important to implement basic services. Sanitation prevents disease and promotes human dignity and well-being, which is in perfect agreement with the WHO definition of health, expressed in its constitution, as “A state of complete physical, mental and social well-being, and not simply the absence of illness or disease ”.¹⁵

CONCLUSION