Cerrejon Standard of Living Ingles

8/14/2019 Cerrejon Standard of Living Ingles

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Standard of living and health:An Assessment of Cerrejn Area of Influence

Responsible Mining


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Standard of living and health : an assessment of Cerrejn area of inu-ence / edited by Fernando Ruiz, Mauricio Ferro. -- 1st. ed. -- Bogot :Ponticia Universidad Javeriana : Ecoe Ediciones, 2013 384 p.

Includes glossary and bibliographyISBN 978-958-648-989-8

1. Standard of living Research - La Guajira 2. Primary HealthCare Research - La Guajira 3. El Cerrejn - Medical and Health Af-

fairs Research 4. La Guajira - Socioeconomic Conditions - ResearchI. Ruiz, Fernando, ed. II. Ferro, Mauricio, ed.

CDD: 307.7660986117 ed. 20 CO-BoBN a840319

Biblioteca Nacional de Colombia - Cataloguing in publication data

First edition: Bogot, May 2013

ISBN 978-958-648-989-8

Instituto Cendex - Universidad JaverianaE-mail: [email protected]

Editorial coordination: Ins Mara AndradeDesktop Publishing:Astrid PrietoCover: Wilson Marulanda

Printing: Imagen EditorialE-mail: [email protected]

Printed and made in Colombia - All rights reserved


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Jeannette Liliana AmayaMauricio A. Crdenas

Mauricio FerroRolando Enrique PealozaAnglica A. QuirogaFernando Ruiz

Christine LaurineSusan CowlesMauricio Ferro

Authors

Translated by


Fernando RuizMauricio Ferro

Editors


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LEN TEICHERCEO

LUIS GERMN MENESESChief Operations Officer (COO)

JULIN BERNARDO GONZLEZVice President, Sustainability and Public Affairs

JOS LINKExpansion Project Manager

Responsible Mining


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JOAQUN EMILIO SNCHEZ GARCA S.JPresident

VICENTE DURN CASAS S.JProvost

JAIRO CIFUENTES MADRIDRegistrar

FERNANDO RUIZ GMEZDirector, Cendex

MARA ALEXANDRA MATALLANA GMEZTechnical Director, Cendex

ROLANDO ENRIQUE PEALOZA QUINTERODirector, Health Economics and Policies Group,Cendex


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CHAPTER I.AREA OF INFLUENCE

MAURICIO A. CRDENASMAURICIO FERRO

CHAPTER II.METHODS AND PROCEDURESJEANNETTE LILIANA AMAYAMAURICIO A. CRDENASMAURICIO FERRO

CHAPTER III.STANDARD OF LIVINGMAURICIO FERROMAURICIO A. CRDENASJEANNETTE LILIANA AMAYA

CHAPTER IV.HEALTH CONDITIONSJEANNETTE LILIANA AMAYAFERNANDO RUIZ

CHAPTER V.AVAILABLE PROVISION AND QUALITY OF SERVICESROLANDO ENRIQUE PEALOZAANGLICA MARA QUIROGA

CHAPTER VI.OPPORTUNITIES FOR CHILDRENMAURICIO A. CRDENAS

MAURICIO FERRO

CHAPTER VII.CONCLUSIONS AND GENERAL RECOMMENDATIONSFERNANDO RUIZ

Authors


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Participants in the Study:

CENDEX - PONTIFICIA UNIVERSIDAD JAVERIANA

FERNANDO RUIZ Project Director, Associate Professor ROLANDO ENRIQUE PEALOZA Associate Professor

JEANNETTE LILIANA AMAYA Assistant Professor

ANGLICA MARA QUIROGA Instructor Professor

PAOLA ANDREA ORTIZ Project Consultant

JAIL TAO ORTIZ Project Consultant

CERREJN

MAURICIO FERRO President, Tecnocerrejn

MAURICIO A. CRDENAS Coordinator, Research and InformationCentre


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Participants in the field operationHealth Conditions Survey

COORDINATORRubn Cotes

SUPERVISORS

Albert Gabriel BiscovicheAlexis Jos Campuzano

Alma Rosa Barrosngel Simn Ojeda

Anis Judit CampuzanoBetzy Mara Parodi

Ciro Segundo MontielEdith Marina Amaya

Elaines Marina ReynosoEledis Esther Pintorica Patricia Romero

Erick Fadel UlloqueFrancklin Elberto Gmez

Jairo Wilfrido PintoJos Alfredo MolinaJuan Gabriel BarrosKelis Jhoana Pinto

Lidiana Cindi CastroLisneth Katerine GuzmnLuz Mary OrtizManuel Gregorio BrangoManuela Antonia CuelloMara Cristina FigueroaMara Francisca BarrosNelson Moreno

Nelvis Leonor Yepessmel Francisco CampuzanoPatricia Yalena BritoSandra Milena CervantesYacelis Rafaela ZrateYajaira Estella CuelloYeris Karina PucheYuselys Mara Arr

lex GonzlezAlonso De Jess Mrquez

Einer Soto PotesIsrael Bermdez

scar Enrique CamachoJuan Carlos AguilarJulio Orozco SelwingWilfredo Mosquera

INTERVIEWERS


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HCTOR MALDONADO GMEZ

Director, DANE

EDUARDO EFRAN FREIRE DELGADO

Director DIMPE

ALBA LUCA CADENA SARMIENTO

Adviser, DIMPE

MIYERLANDI FAJARDO

Social Issues Coordinator

IRMA INS PARRA RAMREZ

Sampling Coordinator

LEONEL CASTILLO

Sampling Specialist

LUIS DGAR SNCHEZ

DIMPE Systems Coordinator

Participating DANE OfficialsStandard of living Survey

RAFAEL ANTONIO SEGURA

Cartographer

LUZ DEYANIRA MATEUS

Marketing

RUTH E. ORJUELA

Logistics Coordinator

LILIANA I. VILA

Logistics

GABRIEL TAFUR

Thematic Specialist

ANA CECILIA OLAYA

Thematic Specialist

CARLOS A. TRONCOSO

Thematic Specialist


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CONTENTS

ACKNOWLEDGMENTS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29FOREWORD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31INTRODUCTION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

CHAPTER IArea of influence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

DEFINITION OF THE AREA OF INFLUENCE. . . . . . . . . . . 41

CHAPTER IIMethods and procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

METHODS AND PROCEDURES. . . . . . . . . . . . . . . . . . . . 47

Statistical Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 The Surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Study Population and Sample Size. . . . . . . . . . . . . . . . . . . . 54 Bias Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Calculating Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

CHAPTER IIIStandard of living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

HOUSEHOLDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Type of dwelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Housing tenure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Predominant material of floors and walls . . . . . . . . . . . . . . . 62 Rooms in the household . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Access to public services . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Sanitation services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Cooking fuel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Goods and services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Socio-economic stratification and Sisben . . . . . . . . . . . . . . 71


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18STANDARD OF LIVING AND HEALTH:

An Assessment of Cerrejn Area of Influence

PEOPLE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Population by area and ethnicity . . . . . . . . . . . . . . . . . . . . . 73

Population by age and gender . . . . . . . . . . . . . . . . . . . . . . 76 Marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Kinship among household members . . . . . . . . . . . . . . . . . . 79 Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Occupation of the labour force . . . . . . . . . . . . . . . . . . . . . . 93 Main activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Occupational Position . . . . . . . . . . . . . . . . . . . . . . . . . 94

Empowerment of women . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Autonomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Decisions on expenses . . . . . . . . . . . . . . . . . . . . . . . . 100 Decisions regarding children and sharing in their care 101

Wayu clans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Subjective perception of poverty . . . . . . . . . . . . . . . . . . . . . 104

CHAPTER IVHealth conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

HEALTH AND SOCIAL SECURITY . . . . . . . . . . . . . . . . . . 109 Insurance Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Out-of-Pocket Payment for Out-patient Consultations

and Hospitalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Average Expenditure on Out-patient

Consultations and Hospitalization . . . . . . . . . . . . . . . . . . . . 114

PERCEPTION OF HEALTH AND SERVICE USE . . . . . . . . . 121

FOOD CONDITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Food Habits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Economic Availability and Compensation Mechanisms. . . . . 132 Frequency of Food Inequity Factors . . . . . . . . . . . . . . . . . . . 133

PERCEIVED MORBIDITY . . . . . . . . . . . . . . . . . . . . . . . . . 135 Oral Health Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Dental Appointment Attendance Factors . . . . . . . . . . . . 135 Location of Consultation . . . . . . . . . . . . . . . . . . . . . . . 137

Care for Young People . . . . . . . . . . . . . . . . . . . . . . . . . 139 Oral hygiene habits . . . . . . . . . . . . . . . . . . . . . . . . . . . 140


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19 CONTENTS

Specific problems of children under the age of six . . . . . . . 145 Chronic Conditions among people between

the ages of 6 and 69 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 High Blood Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Diabetes Mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Back and Neck Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Road Traffic Accident Injuries . . . . . . . . . . . . . . . . . . . 153 Aggression and Violence . . . . . . . . . . . . . . . . . . . . . . . 154 Respiratory Problems . . . . . . . . . . . . . . . . . . . . . . . . . 163

Associated Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Alcohol Consumption. . . . . . . . . . . . . . . . . . . . . . . . . . 169

Cigarette smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Physical Activity during Free Time . . . . . . . . . . . . . . . . 173 Nutritional Conditions . . . . . . . . . . . . . . . . . . . . . . . . . 177 Psychoactive Substance Use . . . . . . . . . . . . . . . . . . . . 179

CHAPTER VAvailable provision and quality of services . . . . . . . . . . . . . . . . . 181

HEALTHCARE PROVIDER INSTITUTIONS . . . . . . . . . . . . 183 HEALTHCARE PROVIDER INSTITUTIONS . . . . . . . . . . . . . . . 183 Provision of Healthcare Services by the Public Network 186 Provision of Healthcare Services by Private IPS . . . . . 189 Analysis of services provided by the IPS public network 192 Patient Referral Network. . . . . . . . . . . . . . . . . . . . . . . . 196

Survey at Four IPS in La Guajira . . . . . . . . . . . . . . . . . . . . 199 San Rafael Hospital in Albania . . . . . . . . . . . . . . . . . . . 200 Nuestra Seora del Pilar Hospital in Barrancas . . . . . . . 201

Nuestra Seora del Carmen Hospital in Hatonuevo . . . . 204 Nuestra Seora del Perpetuo Socorro Hospital in Uribia 205

USER PERCEPTION OF HEALTH SERVICES . . . . . . . . . . 207 Survey Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 Users Perception of Quality Conditions . . . . . . . . . . . . . . . . 227 Clear Information on Medical Condition and Treatment. . . . . 230 Request for Authorization to Carry out a Procedure . . . . . . . 232 Perception of Time between Arrival at the IPS and Service 233 Perception of Service Quality according to Priority Condition 234


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Antenatal Checkups and Care during Delivery . . . . . . . . 234 Pap Smear. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236

Family Planning and Birth Control . . . . . . . . . . . . . . . . . 237 Growth and Development of Children under 10 . . . . . . . 237 Acute Diarrhoeal Disease - ADD . . . . . . . . . . . . . . . . . . 238 Acute Respiratory Infection - ARI . . . . . . . . . . . . . . . . . 239 Out-Patient dental care consultations . . . . . . . . . . . . . . 240 Road traffic accidents . . . . . . . . . . . . . . . . . . . . . . . . . 241 Back or Neck Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 High Blood Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . 241 Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242

Application of vaccines . . . . . . . . . . . . . . . . . . . . . . . . 242

CHAPTER VI

Opportunities for children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245

POVERTY INDICATOR . . . . . . . . . . . . . . . . . . . . . . . . . . 247 UBN as poverty indicator in La Guajira . . . . . . . . . . . . 247

Basic Opportunity Coverage - The p Component . . . . 258 Inequality Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262 The HOI for the Area of Influence . . . . . . . . . . . . . . . . 270

CHAPTER VIIConclusions and general recommendations . . . . . . . . . . . . . . . . 277

GLOSSARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281

APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285

BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373


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List of tables

Table 1. Hamlets attached to the municipalities within the area of influence 43

Table 2. Percentage of households accordingto the material of the walls and floors by area . . . . . . . . . . . . . . . . 63

Table 3. Rural situation of water supply and quality by community . . . . . . . 67

Table 4. Population distribution by area of residence . . . . . . . . . . . . . . . . . 73

Table 5. Population distribution according to ethnicity . . . . . . . . . . . . . . . . 74

Table 6. Description of the composition of households according to ethnicity 74

Table 7. Population distribution according to age range, by area. . . . . . . . . 76

Table 8. Comparison of the school attendance rate betweenLa Guajira and Colombia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Table 9. Distribution of schools according to ICFES test

performance categories (2000 - 2007). . . . . . . . . . . . . . . . . . . . . 92

Table 10. Average amount paid at the last appointmentaccording to type, system and area . . . . . . . . . . . . . . . . . . . . . . . 115

Table 11. Average amount paid for the last hospitalizationaccording to type, system and area . . . . . . . . . . . . . . . . . . . . . . . 119

Table 12. Main reason for not seeking consultations in thepopulation between the ages of 6 and 69 by system . . . . . . . . . . . 125

Table 13. Distribution of households according to the numberof meals normally eaten per day by area. . . . . . . . . . . . . . . . . . . . 130

Table 14. Prevalence of allergies and malnutrition among childrenunder the age of 6, by gender and area. . . . . . . . . . . . . . . . . . . . . 145

Table 15. Prevalence of chronic conditions in the populationbetween ages 6 and 69 by area . . . . . . . . . . . . . . . . . . . . . . . . . . 146

Table 16. Treatment sought for back and/or neckpain in the last week by gender and area. . . . . . . . . . . . . . . . . . . . 153

Table 17. Distribution of the population between the ages of 18 and 69according to injuries caused by traffic accidents

in the past year by gender age range, and area . . . . . . . . . . . . . . . 154


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Table 18. Distribution of the population between the ages of 18 and 69

according to the type of aggression experienced in the

last year, by gender and area . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161Table 19. Distribution of the population according to exercise or physical

activity during their free time, by gender, age range and area . . . . 176

Table 20. Prevalence of marijuana and cocaine use throughout thelives of people 18 to 69 years old by gender and area . . . . . . . . . . 179

Table 21. Prevalence of sedative and solvent or inhalant use throughout

the lives of people 18 to 69 years old by gender and area . . . . . . . 180

Table 22. Network of E.S.E in La Guajira and population of their area of influence 186

Table 23. Installed capacity of first level hospitals in La Guajira . . . . . . . . . . 188

Table 24. Installed capacity of second level institutions in La Guajira . . . . . . 189

Table 25. Participation of healthcare services by municipality and type of entity 190

Table 26. Provision of specialized consultation by the private network . . . . . 191

Table 27. Equivalent production in relative valueunits in the public hospitals of La Guajira . . . . . . . . . . . . . . . . . . . 192

Table 28. Production of medical consultations in public

hospitals in La Guajira by level of care . . . . . . . . . . . . . . . . . . . . . 194Table 29. Dental care in first level institutions in La Guajira . . . . . . . . . . . . . . 194

Table 30. Discharges from public hospitals in La Guajira . . . . . . . . . . . . . . . 195

Table 31. Surgeries in public hospitals in La Guajira. . . . . . . . . . . . . . . . . . . 195

Table 32. Referring and receiving hospital with municipal location . . . . . . . . 197

Table 33. Human resources contracted by the week by the San Rafael Hospital 201

Table 34. Human resources contracted by the week atthe Nuestra Seora del Pilar Hospital . . . . . . . . . . . . . . . . . . . . . . 202

Table 35. Availability of appointments at the Nuestra Seora del Pilar Hospital 203

Table 36. Human resources contracted by the weekat the Nuestra Seora del Carmen Hospital . . . . . . . . . . . . . . . . . . 204

Table 37. Human resources contracted by the week at theNuestra Seora del Perpetuo Socorro Hospital . . . . . . . . . . . . . . . 206

Table 38. Structure of the survey of out-patient consultation,

hospitalization and accident and emergency service modules . . . . 208

Table 39. Volume of consultation, hospitalization and accident and

emergency services by municipality . . . . . . . . . . . . . . . . . . . . . . . 209


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23 CONTENTS

Table 40. Out-patient consultation accordingto type of affiliation declared and gender. . . . . . . . . . . . . . . . . . . . 211

Table 41. Treatment by accident and emergency services accordingto type of affiliation declared and gender. . . . . . . . . . . . . . . . . . . . 212

Table 42. Care with hospitalization according to typeof affiliation declared and gender . . . . . . . . . . . . . . . . . . . . . . . . . 212

Table 43. Care through out-patient consultationaccording to Sisben level and gender . . . . . . . . . . . . . . . . . . . . . . 213

Table 44. Educational level of users of out-patient consultations by gender 214

Table 45. Educational level of users of emergency services by gender . . . . 214

Table 46. Educational level of hospitalization users by gender . . . . . . . . . . . 215

Table 47. Civil status of out-patient consultation users by gender . . . . . . . . . 216

Table 48. Civil status of hospitalization and emergency service users by gender 217

Table 49. Reason for out-patient consultation by gender . . . . . . . . . . . . . . . 217

Table 50. Type of care received by out-patient consultation users by gender 218

Table 51. Reason for out-patient consultation, scheduled or priority . . . . . . . 219

Table 52. Reason for emergency care, by gender. . . . . . . . . . . . . . . . . . . . . 220

Table 53. Reason for hospitalization by gender . . . . . . . . . . . . . . . . . . . . . . 221Table 54. Hospitalization and accident and emergency service events by gender 222

Table 55. Primary payer of users bills for out-patientconsultation by type of affiliation . . . . . . . . . . . . . . . . . . . . . . . . . 222

Table 56. Users who incur out-of-pocket expenses for out-patientconsultations, by declared type ofaffiliation . . . . . . . . . . . . . . . . . . 223

Table 57. Primary payer of accident and emergencyservice users bill, by type of affiliation . . . . . . . . . . . . . . . . . . . . . 224

Table 58. Primary payer of users hospitalization bills by type of affiliation . . 226

Table 59. Users who incur out-of-pocket expenses in respect of payment for

hospitalization and emergency treatment by declared type of affiliation 227

Table 60. Choice of institution for out-patient consultationaccording to declared type of affiliation. . . . . . . . . . . . . . . . . . . . . 228

Table 61. Choice of institution for hospitalization and emergency care

according to declared type ofaffiliation . . . . . . . . . . . . . . . . . . . . . 228

Table 62. Choice of preferred medical professional by out-patientconsultation users, according to type of affiliation declared . . . . . . 229


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Table 63. Choice of preferred medical professional by hospitalization and

accident and emergency service users according to declared

type of affiliation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229Table 64. Out-patient consultation patients access to clear information

on medical conditions according to declared type of affiliation . . . 230

Table 65. Hospitalization and accident and emergency service patients

access to clear information on medical conditions according

to declared type of affiliation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230

Table 66. Out-patient consultation users access to clear information

on treatment according to type of affiliation declared. . . . . . . . . . . 231Table 67. Hospitalization and accident and emergency service users

access to clear information on treatment according to declared

type of affiliation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232

Table 68. Out-patient consultation users (%) who authorized a procedure

according to type of affiliation declared. . . . . . . . . . . . . . . . . . . . . 232

Table 69. Hospitalization and accident and emergency service

users (%) who authorized a procedure, according todeclared type of affiliation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233

Table 70. UBN by municipality in 1973, 1985, 1993, 2005 and 2010, by area 253

Table 71. Timely Completion of Sixth Grade in 1997, 2003 and 2009 . . . . . . 259

Table 72. Affiliation to the General Health System in 2008 and 2009 . . . . . . 260

Table 73. Coverage for Basic Living Conditions for 1997, 2003 and 2009 . . 261

Table 74. Econometric estimates according to the Probit Model . . . . . . . . . . 263

Table 75. Econometric Estimates according to the Logistic Model . . . . . . . . 267

Table 76. Inequality of Opportunities (Index D) in Education . . . . . . . . . . . . . 268

Table 77. Inequality of Opportunities (Index D) in Health and Housing . . . . . . 269

Table 78. HOI for Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271

Table 79. HOI for Health and Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272

Table 80. HOI and simulated years for coverage and equity . . . . . . . . . . . . . 274

Table 81. Opportunity Index for Education and Housing . . . . . . . . . . . . . . . . 275

Table 82. Human Opportunity Index Summary . . . . . . . . . . . . . . . . . . . . . . . 275


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25 CONTENTS

List of graphs

Graph 1. Percentage of households according to type of dwelling, by area. . . 61Graph 2. Percentage of households according to housing tenure by area . . . . 62Graph 3. Percentage of households according to number

of rooms and number of bedrooms by area . . . . . . . . . . . . . . . . . . . 64Graph 4. Percentage of households according to access to public services,

by area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65Graph 5. Percentage of households according to source

of water supply for cooking by area. . . . . . . . . . . . . . . . . . . . . . . . . 66Graph 6. Percentage of households according to type of

sanitation service by area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69Graph 7. Percentage of households according to type of fuel

used for cooking by area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70Graph 8. Percentage of households according to goods

and services owned, by area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Graph 9. Percentage of households according to socio-economicstrata and Sisben classification by area . . . . . . . . . . . . . . . . . . . . . . 72

Graph 10. Population pyramid in the area of influence . . . . . . . . . . . . . . . . . . . 77Graph 11. Population distribution according to marital status by area . . . . . . . . 78Graph 12. Population distribution according to relationship by gender and area 79Graph 13. Gross coverage rate by level of education

in La Guajira (2005 - 2007). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82Graph 14. Average years of education according to age groups by area . . . . . . 83Graph 15. Population distribution according to level of education by area. . . . . 84

Graph 16. Net and gross school attendance rate accordingto level of education by ar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Graph 17. Comparison of the annual fail rate betweenLa Guajira and Colombia (2000 - 2006) . . . . . . . . . . . . . . . . . . . . . 87

Graph 18. Annual municipal and national repetition rates (2000 - 2007) . . . . . . 88Graph 19. Population distribution according to literacy, by area and region. . . . 89Graph 20. Saber Tests Statistics (Grade 9 language results)

in La Guajira and Colombia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

Graph 21. Saber Tests Statistics (Grade 9 mathematics results)in La Guajira and Colombia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91


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Graph 22. Distribution of the population aged 12 to 69according to main activity, by gender and area . . . . . . . . . . . . . . . . 93

Graph 23. Distribution of the population aged 12 to 65according to occupational position by area . . . . . . . . . . . . . . . . . . . 95Graph 24. Autonomy of women (12 - 69 years of age) with a

partner to go out alone by area . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97Graph 25. Autonomy of women (12 - 69 years of age)

with a partner to go out with their children by area . . . . . . . . . . . . . 98Graph 26. Autonomy of women (12 - 69 years of age)

with a partner to pay everyday expenses by area . . . . . . . . . . . . . . 99Graph 27. Participation of women (12 - 69 years)

with a partner in decisions regarding household expenses by area . . 101Graph 28. Shared responsibility of the parents in the care of children during

the first year of life according to gender . . . . . . . . . . . . . . . . . . . . . . 102Graph 29. Distribution of the Wayu population by clan . . . . . . . . . . . . . . . . . . 103Graph 30. Percentage of households according to the opinion

of the head or spouse with regard to their condition of poverty by area 104Graph 31. Percentage of households according to opinion regarding

current standard of living compared to five years ago by area . . . . . 105

Graph 32. Population distribution according to affiliation by gender and area . . 110Graph 33. Distribution of the population by area between the agesof 6 and 69 according to out-of-pocket payments fordifferent costs associated with their latest appointment . . . . . . . . . . 112

Graph 34. Distribution of the population by area between the agesof 6 and 69 according to out-of-pocket paymentsfor different costs associated with the latest hospitalization . . . . . . 113

Graph 35. Distribution of the population (6-69 years old) according to theirperception of their health by system and area . . . . . . . . . . . . . . . . . 122

Graph 36. Consultation prevalence in the past 30 days in the populationbetween the ages of 6 and 69 by system and area. . . . . . . . . . . . . . 124

Graph 37. Average number of days per week eachfood is consumed in the household by area. . . . . . . . . . . . . . . . . . . 127

Graph 38. verage number of times per day each food isconsumed in the household by area . . . . . . . . . . . . . . . . . . . . . . . . 129

Graph 39. Distribution of households according to foodconsumption throughout the day . . . . . . . . . . . . . . . . . . . . . . . . . . . 131

Graph 40. Distribution of households according to compensationmechanisms used to reduce food consumption by area . . . . . . . . . . 132


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27 CONTENTS

Graph 41. Distribution of households according to the frequency ofcompensation mechanisms used to reduce food consumption . . . . 134

Graph 42. Distribution of the population between 6 and 69 accordingto reasons for not attending dental appointments by area. . . . . . . . . 136Graph 43. Distribution of the population seen for dental

appointments by location of service and area . . . . . . . . . . . . . . . . . 137Graph 44. Oral health habits in the population under the age of 10 by area . . . . 139Graph 45. Adult population distribution according to oral

health habits, by affiliation system and area. . . . . . . . . . . . . . . . . . . 141Graph 46. Distribution of the population by knowledge

about the causes of cavities by area . . . . . . . . . . . . . . . . . . . . . . . . 142

Graph 47. Distribution of the population by knowledgeabout the causes of gum bleeding or swelling by area . . . . . . . . . . . 143

Grfico 48. Distribucin de la poblacin segn conocimientode la frecuencia en el cambio de cepillo de dientes . . . . . . . . . . . . . 144

Graph 49. Prevalence of high blood pressure and related controlsamong people between the ages of 18 and 69 by gender and area . . 149

Graph 50. Prevalence of diabetes and related controls amongpeople between the ages of 18 and 69 by gender and area . . . . . . . 151

Graph 51. Prevalence of back or neck pain among peoplebetween the ages of 18 and 69 by gender and area . . . . . . . . . . . . . 152

Graph 52. Distribution of the population between the agesof 18 and 69 according to their perception aboutaggression among children by gender and area . . . . . . . . . . . . . . . . 155

Graph 53. Distribution of the population between the ages of 18 and 69 accordingto their perception about the need to use physical aggression by area 157

Graph 54. Distribution of the population between the ages of 18 and 69according to their perception about physical aggression in

family settings by area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158Graph 55. Distribution of the population between the ages of 18 and 69

according to factors associated with physical aggression by area . . 159Graph 56. Distribution of the population between the ages of 18

and 69 according to their history of physical aggression in thehousehold by gender and area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160

Graph 57. Distribution of cases of aggression according to the relationshipbetween the victim and the aggressor by area . . . . . . . . . . . . . . . . . 162

Graph 58. Prevalence of coughing in the population betweenthe ages of 18 and 69 by gender and area . . . . . . . . . . . . . . . . . . . . 164


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Graph 59. Prevalence of phlegm in the population betweenthe ages of 18 and 69 by gender and area. . . . . . . . . . . . . . . . . . . . 166

Graph 60. Prevalence of wheezing in the populationbetween the ages of 18 and 69 by gender and area . . . . . . . . . . . . . 167Graph 61. Prevalence of dyspnoea in the population

between the ages of 18 and 69 by area . . . . . . . . . . . . . . . . . . . . . . 168Graph 62. Distribution of the population between the ages of 12

and 69 according to their risk for alcoholism by gender,age range and area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170

Graph 63. Prevalence of current smokers and former smokers bygender and age range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172

Graph 64. Distribution of the population by pattern of light orvigorous exercise by age range and area . . . . . . . . . . . . . . . . . . . . . 174

Graph 65. Distribution of the population according topattern of overall exercise by age range and area. . . . . . . . . . . . . . . 175

Graph 66. Distribution of the population according to BMI byage range and area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178

Graph 67. Distribution of services by municipality in La Guajira . . . . . . . . . . . . 183Graph 68. Distribution of healthcare services according to entity

type by municipality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184Graph 69. Distribution of beds by entity in La Guajira . . . . . . . . . . . . . . . . . . . . 185Graph 70. Installed capacity in intermediate and intensive care

units and rooms in La Guajira by type of entity . . . . . . . . . . . . . . . . 185Graph 71. Referral and counter-referral map of the public

network in La Guajira . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196Graph 72. Human Opportunity Index Summary . . . . . . . . . . . . . . . . . . . . . . . . 273 Taken from the World Banks 2008 study -shows an example

of the probability gaps for calculating the D-index. . . . . . . . . . . . . . . 367


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ACKNOWLEDGMENTS We are most grateful to the communities of LaGuajira for their generosity in sharing their perceptions,

their problems and the resources they have at their disposalto deal with life, to ensure their wellbeing, and to satisfytheir families health needs.

We would like to acknowledge the families of those ofus who strive every day to gain a deeper insight into our

communities and gradually come to understand the vibrantdiversity of our country and its problems, seeking somehowto contribute to their solution.


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FOREWORD We are pleased to present to the communities studied, to La GuajiraDepartment and to the National Community, as well as to both the nationaland the international stakeholders, an initial study of the health and Standardof living baseline of the area of direct influence of Cerrejn coal mine in LaGuajira Department (Colombia) in 2009.

Thisarea of direct influence includes the main towns of Albania, Barrancas,Hato Nuevo, Uribia, two kilometres on either side of the railway used totransport coal to Puerto Bolvar, the hamlets (rancheras) adjacent to the portitself, the rural areas and the communities bordering on the different pits ofthe mine. This territory generates royalties (FCFI, 2009) and the paymentof other taxes levied on the mining activities directly involved in mining thethermal coal produced and exported by Cerrejn to the municipalities. Witha view to future expansion projects, it also includes the bank of the RiverRanchera from the mine to its estuary in Riohacha.

The purpose of this joint effort, carried out under agreements between DANE(Colombian National Department of Statistics) and Cerrejn, on the onehand, was to gather data through the Standard of Living Survey (SLMS)1,and between CENDEX, Pontificia Universidad Javeriana and Cerrejn forthe Health Conditions Survey (HCS)2, on the other, is to provide researchersand analysts with databases containing valid, reliable information allowingrigorous, in depth studies of health and welfare indicators in order to design,follow up and evaluate public policies for Cerrejn area of direct influencein order to ensure sustainable development in the short, medium and

1 http://190.25.231.249/aplicativos/sen/NADA/ddibrowser/?section=overview&id=262 In 2007, Cendex, Centro de Proyectos para el Desarrollo (Development Projects Centre) of

Universidad Javeriana conducted a National Health Survey under a contract with the Ministry of

Social Protection and Colciencias (Colombian Administrative Department of Science, Technologyand Innovation), based on the PAHO/WHO methodology for Health Situation Analysis surveys. See:Epidemiological Bulletin/PAHO (1999) and Rodriguez, et. al (2009)


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long terms. As mentioned below, this forms an integral part of CerrejonsCorporate Social Responsibility endeavours.

In August 2007, Cerrejn and its shareholders Anglo American plc, BHPBilliton and Xstrata Coal, commissioned an independent panel headed byJohn Harker, President of Cape Breton University in Canada, to review themanagement of its corporate social responsibility programmes and practicesand the companys relations with the neighbouring communities3of the mine.

The World Business Council for Sustainable Development (WBCSD, 2000)

defines Corporate Social Responsibility (CSR) as companies commitmentto the Standard of living of their employees and their families, the localcommunity and society in general, to supporting sustainable economicdevelopment and to contributing to achieving this goal.

As the panel has rightly said: In the area of Social Responsibility, Cerrejnalways endeavours to achieve the very best results, rather than limiting itselfto the legal limits or minimum standards set for the industry. Cerrejn not

only complies with the strictest international standards, but also strives toinclude the best practices existing worldwide and to keep at the forefront inunderstanding and implementing Social Responsibility policies that cover itsentire complex multi-dimensionality.

On the one hand, it works to contribute to sustainable economic development,to improve the Standard of living in the area of influence and to achieve areduction in the poverty of the region, while at the same time contributing

proactively to strengthening social inclusion, human cohesion and socialcapital, particularly in all aspects concerning the issues of gender equalityand the participation of aboriginal ethnic groups. On the other hand, itdefends Human Rights and environmental protection through responsiblemanagement of the risk of pollution and the possible degradation of thehabitat of the regions flora and fauna.

3 http://www.cerrejon.com/secciones/CERWEB/HOME/MENUPRINCIPAL/NUESTRACOMUNIDAD/COMITEIND/seccin HTML.jsp


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33 FOREWORD

Good intentions, however, are not enough in themselves. Results have to beobtained and measured and the mechanisms to achieve these goals have to be

explained. Measurements must be independent, objective, valid and reliable,conducted in accordance with the strictest international methodologicalstandards, in order to allow both longitudinal (before and after) and cross-sectional comparison with other regions and areas of Colombia, and alsowith other countries and other mines and/or major projects that impact theirenvironment and its inhabitants.

At this point in time, it is beyond the capacity of any private company

to replace the state. Therefore, a key part of social responsibility lies incontributing to citizen participation in the achievement of civil society goals.This requires results from the state and the political class responsible foradministering government institutions and establishing social and economicpolicies in the region. It helps to strengthen democracy, good governanceand accountability, a fundamental component of transparency in themanagement of the state apparatus at municipal, departmental and nationallevels. This cannot be achieved without fixing objective indicators by which

to measure results.

Both surveys follow the relevant methodologies and are accessible to thescientific community and stakeholders in accordance with DANEs rules onStandard of living data and those of CENDEX on health related data. Wehave included an introduction to the methodology followed, a descriptionof the findings and, by way of an example, an initial analysis of what willbe required of further studies in order to formulate policies to improve the

health and wellbeing of the communities of La Guajira.


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INTRODUCTION This publication presents the results of the Standard of living Survey(SLMS) and the Health Conditions Survey (HCS) in the area of influenceof Cerrejn, an open-pit thermal coal mining project, which includes, as weshall explain in further detail below, the urban areas of the towns of Albania,Barrancas, Hato Nuevo and Uribia, as well as the rural areas of those samemunicipalities, and the railway corridor that connects the mine itself withPuerto Bolvar from which the coal is exported by sea. It also includes therural area of the banks of the Ranchera River from Albania to its estuary inRiohacha.

This publication starts out, in Chapter I, with an explanation of theterritorial demarcation of Cerrejns area of influence. Chapter II specifies themethods and procedures associated with the study: statistical design, surveysconducted, study population and sample size, bias control and calculation ofobserved accuracy. Subsequent chapters contain an explanation of the resultsof the surveys, as indicated below.

Chapter III, Section 1 discusses the Standard of living conditions ofhouseholds and Section 2 those of people per se. These sections contributesome topics of interest obtained from the HCS to the results of the SLMS

with. Chapter IV refers to the health conditions of the population in the areaof influence based on social security conditions, followed by perceptions ofhealth, the use of services and ending with food conditions and the perceivedmorbidity of the population.

The available provision and quality of services are explored in Chapter V,which explains the situation of the Health Care Providers (IPS) and patientsperception of the health services they receive. The former gives a description

of the health services network in the Department, the provision of servicesand the results of the surveys applied to four IPS in La Guajira, while the


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latter focuses on the results obtained from the survey of patients on comingout of a doctors surgery, a hospital or an accident and emergency service.

Chapter VI contains a very pertinent application of the HumanOpportunities Index, which explores the type of opportunities children havein the territory based on a multi-dimensional approach. It also follows themethodology proposed by the World Bank for focusing on equality and thesearch for opportunities for the childrens future, based on their conditionalprobabilities of achieving certain goals given the nature of the environmentin which they are born.

The results of the two surveys are descriptive in nature and are intended toestablish ratios, rates and proportions comparable with similar previouslycollected measurements. On the one hand, the Standard of living indicatorsof Cerrejn area of influence are comparable with those of the total nationalSLMS of 2008 and with the results for the Atlantic Region produced byDANE in 2010.

The health results are also comparable with the 2007 National Health Survey

(Rodrguez, et. al., 2009) with regard to the following three inputs: 1) anepidemiological profile of the population, showing the characteristics of theperceived prevalence and risks of disease, which will make it possible to defineintervention and design priorities for specific programs; 2) an analysis of thetechnical capacity of the IPS, based on which priorities for investment inhuman resources, equipment and consolidation can be established in orderto structure more competitive and efficient service projection units, and 3)a user perception profile of the quality of services, aimed at enabling healthcare institutions to develop quality policies designed to improve services.

The results presented in this publication, as well as the databases, constitutean invaluable ingredient for the creation of inferential studies, to facilitateanalysis of causality or to establish statistically significant interactions. All ofthis warrants the effort that will lead to specific developments and, moreover,by integrating the socio-economic characteristics of the population collectedin the SLMS, it will facilitate a complete description of the population. It is

therefore a positive baseline for evaluating interventions and programs.


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37 INTRODUCTION

For Pontificia Universidad Javeriana, through Cendex, the implementationof the Health Conditions Survey represents a challenge and an invaluable

technical process, as well as an opportunity for the private sector to supporthealth care system development. This is particularly so due to the scope ofthe study, which includes the micro-conditions of a population with highnecessity and vulnerability levels, as in the case of residents in Cerrejn areaof influence.


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CHAPTER IArea of influenceMauricio A. CrdenasMauricio Ferro


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41CHAPTER I

Area of influence

DEFINITION OF THE AREA OF INFLUENCEThe area of influence is not a random geographical demarcation definedby Cerrejn as it pleases, but rather relates directly to the impact causedby its mining operation and associated activities, specified mainly in theenvironmental licence granted by the Colombian Government at thebeginning of the mining project in the late 1970s.

In addition, to define the zone or area of influence with a view to carrying outthe Standard of living survey, the guidelines of the SEAT4tool were followed

in order for the coverage to facilitate a more complete analysis of the socio-economic reality in which Cerrejn operates in La Guajira Department.

The tool SEAT states that an area of influence is a zone in which both directand indirect impacts can be expected to be caused by the operation. Typically,an area of influence is unique to each operation. It is larger than the actualsize of the operation, covers its environmental impacts and problems andalso addresses the health and socio-economic issues within its boundaries.

Taking into account SEAT guidelines Cerrejon area of influence includesthe following:

The area receiving the primary physical impact caused by the miningoperation. This covers the main location of the project and itsassociated infrastructure (including contractors infrastructure), suchas power transmission corridors, pipes, access ways, etc.

The area receiving the secondary physical impact caused by mining

development. This would include impacts caused by chain reactionsand the cumulative effects of the mining operation, as well as anyfuture expansion project.

Associated facilities not financed as part of the mining project, butwhose viability and existence depend exclusively on the mining

4 SEAT (Socio-Economic Assessment Toolbox) is a set of methods to assess both the positive andthe negative social and economic impacts caused by the mining operations of Anglo AmericanPLC. It was designed to help Anglo Americans operations engage more effectively with local

stakeholders and to identify and optimize the management of its social responsibility programs.See: Anglo Americans SEAT Toolbox. http://www.angloamerican.com/aal/development/social/community-engagement/seat/


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operation and whose goods and services are essential for the mineto operate (for example, means of transportation such as roadways

and trains). Primary areas which can provide the operation with manual labour

and in which consumption is created as a direct result of the presenceof the mine. These areas cover the neighbouring populations andcommunities directly affected by the mining activities, but alsopotentially more distant areas which could provide workers or beinfluenced by the creation of consumption.

Surrounding areas which could eventually be impacted by theoperation, both positively and negatively, such as locations with highbiodiversity levels, protected areas, etc

Taking these elements into account, the area to be considered as that of thestudy population was limited to the main towns of Albania, Hatonuevo,Barrancas and Uribia and their respective rural areas (the Aboriginalreservations of the Wayu of Provincial, Trupio Gacho, San Francisco, and

Cuatro de Noviembre). The Wayu communities adjacent to Puerto Bolvarare also included.

In the urban area, the hamlets attached to the municipalities within the areaof influence were also taken into account, as shown in Table 1.

The adjacent corridor (2 km on either side of the railway) is also a part ofthe area of influence throughout the 150 kilometre railway that connects themine with Puerto Bolvar, which carries coal for shipment to clients by sea,

as well as the banks of the Ranchera River from the mine to its estuary inRiohacha. The great majority of this rural population belongs to the Wayuethnic group.

The following map shows the location of Cerrejn area of influence definedfor the study.


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43CHAPTER I

Area of influence

Table 1.Hamlets attached to the municipalities within the area of influence

MUNICIPALITY HAMLET

AlbaniaCuestecitas

Los Remedios

Barrancas

Carretalito

Papayal

San Pedro

Nuevo Oreganal

Patilla

Chancleta

RocheBarrancn

Las Casitas

ManaureAremasahin

La Gloria

Source: DANE Census Mapping

Map 1. Demarcation of the study area of influence

URIBIA

MANAURE

MAICAO

BARRANCAS

FONSECASAN JUAN DEL CESAR

HATO NUEVO

RIOHACHA

ALBANIA

DISTRACCIN

REPUBLIC OF COLOMBIANATIONAL ADMINISTRATIVEDEPARTMENT OF STATISTICS

Department of La Guajira - 44AREA OF IMPACT OF THE CERREJN TAILROAD

N

1:132.008

0 4 .4 50 8. 90 0 1 7. 80 0 2 6. 70 0 3 5. 60 0

METERS

SOURCE NATIONAL GEOSTATISTICAL FRAMEWORK 2007

STANDARD CARTOGRAPHIC SUPORT SYSTEM - DIMPE

ROADS

Railroad

GEOSTATISTICAL FRAMEWORK

Railroad Area of Influence

Ranchera River Area of Influence

CONVENTIONS


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CHAPTER IIMethods andproceduresJeannette Liliana AmayaMauricio A. CrdenasMauricio Ferro


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47CHAPTER II

Methods and procedures

METHODS AND PROCEDURESThis chapter describes the methodology used in the design and applicationof the two surveys, as well as the sample size to ensure that they were bothrepresentative and valid. The content of each of the surveys: Standard ofliving Survey and Health Conditions Survey, the basis on which the estimatesin the following chapters were made and, finally, the procedure to determinethe accuracy or margin of error of the estimates.

Statistical DesignTo calculate the representative sample for the Standard of living Survey(2009) in Cerrejn Area of Influence, DANE used a stratified, multi-stage,probabilistic cluster procedure. The Health Conditions Survey was basedon the same sample and therefore followed the same selection process.

With this design, each sampling unit had a known selection opportunity

greater than zero. This methodology makes it possible to determine thedesired accuracy of the estimates in advance and then to calculate that ofthe results obtained. Two pre-defined domain strata were defined: urban,consisting of the towns and hamlets within the municipalities of the area ofinfluence, and rural, consisting of the sparsely populated areas of the zonedefined as the area of influence. The main advantage of this stratification isan increase in the accuracy of the results.

In the urban stratum, the primary sampling units are the blocks or groupsof blocks that contain at least one size measurement (SM); the secondaryunits are segments or SM. In the rural areas, the primary sampling unitsare communities; the segments or SM are the secondary sampling units. Tobegin, primary units are first randomly selected, and then secondary unitsamong them, also at random, so that the desired sample size was ensured.This procedure is known as multi-stage sampling.

Clusters are the different groups of units formed, which facilitate theprocess of identifying and selecting the sampling units. For this study,


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the municipality is taken in the first instance and the urban area withinit, then the blocks and within them, the segments; in the rural area, the

communities and, within them, the segments, are all taken into account(DANE, 2009).

The Surveys

The Standard of living Surveys were designed to obtain a set of indicators todescribe the target population based on the different dimensions involved in

the wellbeing of households and of the people that are their members.

Measuring poverty, whether from an objective, subjective, structural orcircumstantial perspective, forms an integral part of the goals of this type ofstudy. It allows a more in-depth analysis of wellbeing factors such as health,education, jobs, ownership of goods in the household and access to publicservices. Ultimately, what is required is access to information that showsus and explains the factors that can help to improve wellbeing or to reduce

poverty and, therefore, enable us to carry out an objective, rigorous followup of the variables necessary for the design, implementation and monitoringof public policies, especially those related to achieving the MillenniumDevelopment Goals(FCFI 2010) in a relatively underdeveloped region suchas this one.

The indicators obtained during this study represent a baseline (DANE,2004), because, by comparing them with the results of subsequent studies

that measure the same variables, it is possible to systematically followup and evaluate the policies, programs and projects carried out to assessprogress and achievements. With time, these can be used to improve thedesign and decision-making process for sustainable development andbetter Standard of living.

In the past 20 years, there has been a great deal of methodological progressin both the design and the implementation of population surveys,

especially since the beginning of the decade of the nineties. On theone hand, improvements have been incorporated on the basis of World


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49CHAPTER II


Bank experience in the Measurement of Living Conditions (Grosh M. &Glewwe, P., 1995) aimed at ensuring good data quality and, on the other

hand, the Inter-American Development Banks Technical CooperationProgramme for the Improvement of Surveys and the Measurement ofLiving Conditions in Latin America and the Caribbean (MECOVI).

The SLMS applied in this research is the same as that of the nationalstudy carried out by DANE5 in 2008, but with the above mentionedmethodological improvements. It was a pioneer study, as it was the firstSLMS of small municipalities with a significant scattered rural population

belonging almost entirely the Wayu Aboriginal ethnic group, whoselanguage is Wayunaiki.

DANE had previously conducted six Standard of living surveys (SLMS)6and subsequently, in 2010, conducted an additional survey of the entirecountry by regions. It was a multi-purpose survey with direct informantsand using personal digital assistants, with an average duration of 2.4 hoursper interview in the household. A process to raise awareness before field

collection began was carried out and the number of households used forthe sample was updated prior to the survey.

Questions that had not been representative during the 2008 national surveywere not included in the SLMS in Cerrejn area of influence. These wererelated to the following:

Dwellings affected by floods, landslides and subsidence

Dwellings near airports, refuse dumps, industries, water channel andtransportation routes

5 Cerrejn made the decision to financially and logistically support DANE, Colombias NationalStatistics Department, in carrying out this study so that the data collected would be of the bestpossible quality and available to any national or foreign researcher in accordance with internationalstandards, as well as to government entities. This arrangement also helped protect the privacy ofthose surveyed.

6a. Poverty and Standard of living survey in Santa Fe de Bogot, 1991. City and locality totals.

b. 1993 National Standard of living Survey. National, municipalities, and for four major cities. c. 1997 Standard of living Survey. National, by regions.

d. 2003 Standard of living Survey. National by regions and Bogot by localities. e. 2007 Standard of living Survey. Bogot, by localities. DANE under an agreement with the District. f. 2008 National Standard of living Survey. National, by regions.


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51CHAPTER II


epidemiological sense, so that they can be compared with census data andnational and international household surveys. A household consists of an

individual or a group of people living under the same roof and sharing atleast one meal (eating from the same pot), without this necessarily implyingfamily ties. When a single housing unit is inhabited by various groups ofpeople who cook separately, each group is considered a different household.

The section on household services records the payment and quality thereof.The use of sanitation services is also determined. Questions regarding thetenure of housing units were to learn the occupation of housing, the number

of units possessed, the number of months during which they are occupiedand the reasons for moving from one to another, if any. This section thusenables us to identify critical overcrowding.

The chapter on the characteristics and composition of households has twoobjectives. The first is to identify the people who make up the household, theirrelationship with the head of the household, as well as whether they belongto an aboriginal community - in this case, the Wayu - and their marital

status. The head of the household is a regular resident who is recognizedas such by other members of the group. The second objective is to trackmigration of household members. All household members, who identifiedthemselves as belonging to the Wayu aboriginal group, were asked if theyspoke Wayunaiki as well as the caste or clan to which they belonged inorder to determine the size of the different clans in the area.

The brief chapter on health examines social security coverage, peoples

perception of their own health and some of the household healthcareexpenses (diseases and health management).

The purpose of the questions about caring for children under the age offive is to identify the person or institution responsible for their upbringingand care and to estimate the coverage of public and private establishmentsdedicated to protecting and educating children.

The questions also seek to estimate the household total expenses spent onschool fees during the year, monthly food and other expenditures on looking


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after, caring for and bringing up minors until they begin their basic primaryeducation.

The chapter on education gathers information on the main educational traitsof the population of five years and over, such as illiteracy, school attendance(current grade) and level of education (last grade passed). It also covers theamount of money spent by households on education and identifies where orwith whom pre-school and primary pupils spend their time when they arenot at school.

The chapter on the workforce has three objectives: to determine whichmembers of the household have jobs, which of them earn an income andwhich would be able to do so, either as a result of being in the job marketor from other types of activities; to examine employees working conditions,such as access to social security, hours worked and income and to classifythose who are out of work or inactive, establishing whether they receivean income from other sources, such as assistance from relatives, friends,institutions, or others.

Household living conditions are approached from a subjective perceptionof poverty, the occurrence of events which cause tension or concern and thehouseholds income capacity to cover its minimum expenses. The survey alsoverifies the goods owned by the household, not only as patrimony, but alsothose that satisfy its needs. Having such goods is an indicator of the comfortsa family or household enjoys, which may be considered a need for theirwellbeing in the modern urban context. The information in this chapter

enables us to analyse violence and the victims of aggressive acts, perceptionof security and also how parents correct their children under the age of 18.

In addition to the Standard of living Survey, the Health Conditions Surveywas applied in order to investigate the peoples demographic and socio-economic conditions and the health conditions of the population withinthe area of influence. This survey used the same sample of households asthose of the SLMS and, therefore, it is equally representative. Surveyors were

equipped with computers in order to capture information electronically.


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Before field work began, a process of raising awareness of the populationwas undertaken and the team responsible for the application, supervision,

verification and revision of the surveys were selected and trained in order toreduce any possible bias associated with the process and to ensure the validityand reliability of the information gathered.

The original design of the NHS (2007) was used to gather information. Thestructure of the survey provided parameters for comparing the situation ofthe population studied, not only with national, but also with regional anddepartmental totals. Two sub-modules were added to the original design of

the survey, both related to regionally important issues: 1) the Food HabitsModule, in which variables in consumption patterns were integrated with thepopulations food safety conditions and, 2) the Respiratory Disease Module,which studied the frequency of respiratory symptoms among different agegroups.

The following three of the four original NHS modules were applied: 1)Households Survey Module, which collected information on the population

between the ages of 0 and 69; 2) User Survey Module, applied in the fourhospitals located within the defined area of influence, and 3) the HealthProvider Institutions (IPS) Module, which analyzed the installed capacity ofhealth services in four IPS of La Guajira Department.

The households survey consisted of four Modules. It began with theapplication of Module 1 regarding the data of the housing unit and thehousehold, whose informant was either the head of household or another

adult member. As part of this Module, a list of all members of the householdwas drawn up, from which the population for the application of the Moduleswas selected.

Module two was applied to young people between the ages of 6 and 17 andto a sub-sample of people from 18 to 69 years of age. Firstly, respondentswere asked about certain population characteristics, such as education, theworkforce and the empowerment of women. Questions were then asked

about health conditions in relation to: perceived morbidity, demand and useof services, chronic conditions, dental care, risk factors for chronic diseases,


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such as cigarette smoking, alcohol consumption and lack of physical activityand knowledge and treatment of certain diseases with a major impact on

public health (high blood pressure, diabetes and back pain are some of these).Questions were also included about food conditions and the respiratoryproblems faced by people over 6 years of age.

Module 3 of the household survey was targeted to all children under theage of 6 for whom their mother, father or a guardian were responsible. Thismodule gathered information on childrens health conditions with relationto perceived morbidity, specific conditions, vaccinations and dental care.

Module 4 was only applied to a sub-group of people between the ages of 18and 69, in which respondents were asked about sensitive topics involvingaggression, psychoactive substance use and sexually transmitted diseases.

Surveys were also applied to each of the four IPS to investigate the dataof the institution, consultations on specific protection and early detection,characteristics of paediatric and adult hospitalization and emergency servicesand surgical and support services. A description of out-patient services was

also defined, as was the functioning of the provision of out-patient andobstetrics consultation services was also verified.

User surveys were applied immediately following the respective service ofhospitalization or out-patient consultation, the latter referring to thosereceived by users of an IPS, including: general or specialized medicalconsultations, dental appointments, pre-natal or growth and developmentcheck-ups, family planning appointments, consultation for diagnostic

or therapeutic examinations or procedures, vaccinations and ambulatorysurgery, among others. This survey included questions about patientsperception of access to, and the quality of the service they received.

Study Population and Sample SizeThe study population comprised the civilian, non-institutional populationliving in Cerrejn area of influence, as defined in Chapter I. The sample

selection framework was based on a previous count of dwellings and householdswith their respective geo-referential information in order to not only identify


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the sample and observation units, but also provide basic information for therespective estimates and for coverage control.

Likewise, health care institutions (IPS) were included in the study population,from which four institutions were selected: San Rafael Hospital, NuestraSeora del Pilar Hospital, Nuestra Seora del Carmen Hospital and NuestraSeora del Perpetuo Socorro Hospital in the municipalities of Albania,Barranca, Hatonuevo and Uribia, respectively. A sample of users was selectedfrom each hospital at the levels of out-patient consultation, hospitalizationand the emergency service in order to ascertain their perception of access to

and the quality of the services.

Observation units thus consisted of housing units, households and thepeople within them for both the SLMS and the HCS household Modules.Likewise, in the HCS, the IPS and their technical personnel are included inthe observation units, as well as the users of hospitalization, emergency andout-patient consultation services.

The sample required for application of the Standard of living Survey was2,496 households, with sampling accuracy or error at 5% for both the urbanand the rural areas, for rates or ratios greater than 10% with a reliability levelof 95%. Frequencies of less than 10% increase the possibility of error andreduce reliability. By expanding these data, based on the 2005 census, thepopulation covered by the survey included 65,659 people: 36,315 rural and29,344 urban, located in 14,146 housing units, of which 7,463 were in ruralareas, and 14,284 households, of which 7,492 were in rural areas. These data

were collected between 1 and 30 September 2009 in urban areas and between3 November and 2 December 2009 in rural areas.

For the Health Conditions Survey - HCS - field work was carried out in Apriland May 2010. Population sub-groups were needed because of the scope ofthe study and according to the Module to be applied as explained below.The sample comprised 2,739 households surveyed in Module 1, with a totalof 11,484 persons. Once all the members of the household were identified

in Module 1, Module 2 was applied to all people between the ages of 6 and17 (3,251 persons) and a population sub-group between 18 and 69 (6,254


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people). Module 3 collected information on all children under the age of 6from informants who were either their mother, father or a guardian (1,692

children). Finally, due to the sensitive nature of the questions, Module 4 wasapplied to a sub-group of 3,003 people between 18 and 69 years old.

The initial conditions for expanding the household sample for the HCSrequired the use of the sample framework established for the SLMS; however,this proved impossible and an adjustment of the SLMS expansion factors wasnecessary in order to avoid biased indicator estimates. The adjustment tookinto consideration refusals to reply due to rejections or displacements and the

replacements that were necessary to cover the pre-established sample. As sub-groups of different age groups were needed depending on the survey Moduleto be administered, another adjustment factor was required in addition to thefinal expansion factor.

At institutional level, four IPS were consulted, as were a total of 322 oftheir service users: 216 out-patient consultations and 106 hospitalizationsor emergencies. The results obtained from these samples were not expanded

to the national total as it was impossible to obtain all the records of servicesprovided from the four hospitals, nor was any complete report found amongnational statistics.

Bias Control

Possible sources of bias were identified: unequal selection probabilities for thefinal observation units (households, persons, IPS and users), the difficulty

of complete coverage of the selected samples, possible imperfections in thesampling framework used to select the samples, possible design errors inthe measurement instruments and occasional deficiencies in selecting andtraining the surveyors in data collection and processing.

Potential problems in instrument design were controlled through testing andvalidation processes. Possible deficiencies in training and data collection andprocessing were reduced to a minimum thanks to a controlled, structured

collection process, strict personnel selection guidelines, theoretical and


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practical training, detailed manuals of functions, procedures, and exhaustivesupervision and quality control plans.

Any bias originating in the different selection probabilities and failureto cover certain selected sampling units was controlled by applying anadjustment factor to the expansion factors calculated for the SLMS inCerrejn area of influence, thereby guaranteeing unbiased estimates of theresearch populations absolute values. Although the IPS and user resultsare presented without expansion, strict sample selection and control of theabove mentioned processes reduced possible biases.

Calculating Accuracy

All estimates of the characteristics of the study population based on probabilitysamples are approximate, which is why it is important to establish their degreeof accuracy or margin of error. The appropriate indicator is the standard orsampling error, calculated as the proportion between the standard error andthe indicator, which measures the variability of sample randomisation. Themathematical formula for calculating standard error is a function of the typeof sample, selection stages and the respective probabilities.

For the design described above, formulae appropriate to a stratified sampling,of unequal clusters, were adapted for two levels of clustering (see, for example,Kish, 1965). The STATA statistical package is basically programmedaccording to the Taylor series method, which was used to calculate standarderrors in this study.

Due to the complexity of the sample designed, calculations of the specificestimates are affected by sampling and non-sampling errors which must becontrolled. Non-sampling errors, which generally arise during the processof collecting and processing data, were minimized by careful survey design,surveyor training and exhaustive supervision during collection in the field,as well as information coding, purging and processing. Sampling errorswere estimated with an algorithm that produces very reasonably accurateapproximations.


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Because the 2009 Standard of living Survey was a complex, multi-stagesampling, special formulae had to be used to take the effects of stratification

and clustering into account. Thus, the sampling errors associated with SLMSestimates were calculated by DANE (National Statistics Department). Thesampling errors for the estimates obtained from the Health ConditionsSurvey were calculated using the survey data procedure (svy command) inSTATA version 10. This procedure applies to complex designs and takes theexpansion factor of each selected sample or sub-group into consideration.

In general, the selection of a cut-off point in the relative standard error or

coefficient of variation, on the basis of which the decision was taken todeclare the estimate of the population value given because of the considerablemagnitude of the associated sampling error, is arbitrary and essentiallydepends on the type of measurement effected and its desired use. Forexample, if one wanted to evaluate the quality of a serial production of high-precision instruments through a sampling study, the acceptable differencesbetween the estimate and the population value must obviously be quitesmall. In other cases, such as samples of households or other observation

units studied through personal interviews on various topics of interest, alevel of accuracy no higher than 15% or 20% of the relative standard error isgenerally accepted (EUSTAT 2005, DANE 2006, INEC 2004).


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Standard of living

CHAPTER III

Mauricio FerroMauricio A. CrdenasJeannette Liliana Amaya


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61CHAPTER III

Standard of living

HOUSEHOLDS

Type of dwelling

The following graphs show each population groups household conditions,identifying important gaps in their access to public services, especially thatof basic sanitation.

Graph 1 shows the information by type of dwelling, the predominant type

in the rural area being aboriginal (the Wayu settlement) at 68.2%. 31.1%of the rural and 82.1% of the urban population live in houses.

Graph 1. Percentage of households according to type of dwelling, by area

Source: DANE Calculation - Standard of living Survey, Cerrejn, 2009

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House Apartment Room in Another Type of Structure Aboriginal ResidenceRented Room


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Housing tenure

With respect to housing tenure (Graph 2), 86.6% of the rural populationhave their own completely paid house. This percentage is explained by thefact of collective ownership on aboriginal reservations, which, in accordancewith Articles 63 and 329 of the Political Constitution ...are inalienable, arenot subject to any statute of limitations nor to seizure. Reservations are aspecial legal, socio-political institution made up of one or more aboriginalcommunities with a collective title and the guarantees of private ownership,they possess their territory and are governed for their management and their

internal life by an autonomous organization protected by the aboriginaljurisdiction and under their own system of laws (Osorio and Salazar, 2006).Among households in the urban area, 53.1% live in their own completelypaid houses and 36.7% are rented or sub-leased (see Table 1, Appendix 1).

Graph 2. Percentage of households according to housing tenure by area

Source:DANE Calculation - Standard of living Survey, Cerrejn, 2009

Predominant material of floors and wallsTable 2 shows that 56.7% of residences are built of blocks, bricks, stone orhardwood, which is low compared to nearly 80% at national level. Thesematerials are followed to a lesser degree by unplastered (18.1%) and plastered

adobe (15.4%), considerably higher than the percentages reported for theentire country, which were 2.1% and 3.0%, respectively. Moreover, while in

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urban areas 85.3% of dwellings have exterior walls in blocks, bricks, stoneor hardwood, in rural areas, this percentage is only 26.4%. There is evident

participation of other important materials, such as plastered adobe (33.7%)or unplastered adobe (23.4%) walls.

92.0% of floors are in cement, gravel, earth or sand. This percentage contrastswith 37.7% at national level, where the predominant flooring materials are(49.0%) tiles, vinyl, panels, bricks or hardwood. In urban houses, 76.4%have cement or gravel floors, while in rural areas this percentage is only32.3%. There are more earth or sand floors (64.9%) in the rural setting.

These results outline a predominant type of basic dwelling that uses fewindustrially processed materials and finishings

Table 2.Percentage of households accordingto the material of the walls and floors by area

PREDOMINANT MATERIAL OF EXTERIOR WALLS URBAN RURAL TOTAL

Block, brick, stone, hardwood 85.3 26.4 56.7

Unplastered adobe 3.4 33.7 18.1

Plastered adobe 7.9 23.4 15.4

Bamboo, cane, straw or other vegetal matter 0.7 11.5 5.9

Untreated wood, board, panel 0.2 3.1 1.6

Prefabricated material 1.4 0.9 1.2

Zinc, fabric, canvas, cardboard, tins, waste, plastic 0.7 0.8 0.7

Compressed earth, adobe 0.4 0.2 0.3

No walls 0.1 N/A 0.0

Predominant material of floors

Cement, gravel 76.4 32.3 55.0

Earth, sand 10.6 64.9 37.0

Tile, vinyl, slabs, brick, hardwood 10.9 1.0 6.1

Untreated wood, board, panel, other vegetal matter 0.8 1.8 1.3

Marble, parquet, lacquered hardwood 1.2 - 0.6

Rug or wall-to-wall carpeting 0.1 - 0.0

Source: Cendex Calculation- Health Conditions Survey- Households, Cerrejn, 2009.


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Rooms in the household

The average number of rooms in the household, excluding the kitchen,bathrooms, garages and those intended for business, is 2.3, which is lowerthan the 3.3 national average. 85.6% of households have between 1 and 3rooms; this percentage is 94.6% in rural areas and 77.0% in urban areas.However, over half the households have one bedroom, which indicatespossible overcrowding, given the average number of persons per householdand the number of available spaces in the dwelling (Graph 3).

Graph 3. Percentage of households according to numberof rooms and number of bedrooms by area

Source:Cendex Calculation- Health Conditions Survey- Households, Cerrejn, 2009

Access to public services

One particularly important aspect for good health is the availability ofdrinking water and sewage and waste water management. Despite the

One room Two rooms Three rooms Four rooms Five or more rooms

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existence of water supply in urban areas, it does not ensure drinking waterquality or uninterrupted supply. Of the households with water supply from a

public, community or hamlet system, 40.9% do not have continuous serviceduring the week. This is more serious in urban areas (47.4%) than in ruralareas (31.5%). At urban level, waste water treatment is not adequate and, atrural level, this is one of the most complex issues to manage

Graph 4 shows access to public services of households in the area of influence.Although electricity is the service with the widest coverage, it does not reachall communities in the rural area. Access to water, which influences childrens

performance at school, reaches barely 38.1% among the rural population,compared to 98.6% in urban areas. Only 21.1% of rural households haveaccess to running water, 11.8% to sewage systems and 13.2% to garbagecollection. A fact which it is important to highlight is that 59.6% of the ruralpopulation reported having no access to any public services (see Table 2 inAppendix 1).

Graph 4. Percentage of households according to access to public services, by area

Source:DANE Calculation - Standard of living Survey, Cerrejn, 2009

Similarly, it is important to analyze how water for human consumption is

supplied, especially in rural areas, where 35.7% is obtained from so-calledjageyes(water holes), in 19.3% of cases it is pumped from wells, in 13.4% is

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taken from rivers or streams and in only 11.4% are there public water supplysystems, the latter being a source of microbiological contamination. In urban

areas, 83.1% of water is supplied by public systems (see Graph 5 and Table3 in Appendix 1)

Graph 5. Percentage of households according to sourceof water supply for cooking by area

Cerrejon Standard of Living Ingles

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