Leadership, Management and Sustainability (LMS) Program - Healthy Families and Communities in Peru

With the assistance of the BPH program facilitators, Saposoa has developed plans that will greatly increase the community’s access to basic health services. Photo by Michael Paydos, 2008.

Rural Municipalities Produce Business Plans for Local Development

Sapasoa, Peru. In June 2007, the Business Planning for Health (BPH) program was brought to Peru to contribute to the sustainability and involvement of municipalities in their development. Teams from eight municipalities participated in the program with support from two experienced BPH facilitators and six staff from the Health Communities and Municipalities (HCM) Project who were trained to facilitate the program to enable future programs without outside assistance.

Dr. Edgar Medina, director of the HCM project noted that “as part of the new decentralized health system, all regions and municipalities have budgets for health promotion and development. Yet in 2007, on average the municipalities only spent about 40 percent of that money.” The BPH provides municipal governments the tools needed to develop business plans aimed at improving the health and well being of its citizens.

The HCM Project works to improve maternal, child, and peri-natal health in the communities that have signed coca-eradication agreements in Peru. These areas have been traditionally abandoned both by the government and private investment. At its core, health promotion consists of providing people with the means to better control their own health. To achieve this, the program works on improving “health determinants” (latrines, housing conditions, children’s parks, etc.) within the participating communities. Promoting multi-sectoral interventions and active participation of the community is a key element in establishing sustainable, improved health conditions. The HCM project exemplifies the importance of support at every level.

SAPOSOA The city of Saposoa, founded more than 130 years ago, is made up of 52 rural communities, many of which are more than four hours from the nearest health post. With the help of an information system installed by HCM, communities underserved in their health needs were identified. They developed a business plan for a project to establish “Tópicos”—first aid stations run by trained health promoters—to 32 communities. This plan included a budget of about US$35,000, of which communities have already committed or promised $11,000 and the municipal government has dedicated an additional $2,000. The remaining funds will be solicited from the private sector and other budgets.

“The BPH hasn’t just been a one-off project,” explains the Provincial Mayor, Mr. Fernando Grandez Veintemilla. “It has given us a system for developing future priority projects based on the needs of the urban and rural communities.” Mr. Veintemilla is also the president of the association of mayors in San Martin region, and has spoken to other mayors about the BPH as a valuable tool for municipality-led development.

Aguaytía has developed a business plan aimed at expanding the Healthy Communities and Municipalities project. Pictured above are the stoves donated by a local energy company and given as prizes to families who show the greatest success in the program. Photo by Michael Paydos, 2008.

AGUAYTÍA Aguaytía, the capital city of the Padre Abad Province, is the main economic corridor connecting the Amazon to the Andean and coastal communities of Peru. Agriculture, natural resources, and a growing tourism industry are the lifeblood of this city of 16,000. Representatives from the mayor’s office, the local health system, and the communities came together to participate in the BPH with the goal of improving the population’s health and quality of life. Many of the activities and interventions were closely aligned to the HCM Project, including the promotion of improved nutrition and living standards, access to safe water, and the practice of healthy lifestyles (including maternal health visits, vaccinations, and family planning). Additionally, the project aimed to strengthen the cultural identity of the population and promote agricultural diversification. While the HCM project served barely a third of the communities in the municipality, the BPH project was designed to reach all 85 organized communities that comprise Aguaytía. The project plan and budget called for approximately US$900,000 over the duration of three years, 36% funded from municipal budgets, 42% from the regional budget, and the remainder to be sought from external sources.

“Municipalities need empowerment for raising money for health needs,” explains Lucy Lopez of USAID. “They are good when it comes to roads and material projects, but things like safe water, improving housing, and general health development have been challenging. There needs to be a shift from solely material projects to the development of the people. The BPH is breaking grounds in placing more attention on health projects.” The HCM Project has been working to strengthen the ties between rural communities and the municipalities they are a part of, including a more participatory budgeting process. The BPH has given municipalities a tool for developing and setting budgets for new projects that can benefit all communities.