Peru's Municipal Public Health Information System
Lima, Peru. When people discuss the development of rural communities, talk often centers around bringing in more resources, construction of schools and health facilities, and training people to do essential jobs. But when resources are scarce and the task at hand daunting, how can the right resources and activities be applied to the right areas?
Nestled among the fertile hills of the San Martin Region in northern Peru lies the municipality of Saposoa, a town of approximately 5,000 people. Saposoa is made up of 52 communities; the furthest is more than a 12-hour walk from the town center, where the only full health center exists. The Provincial Mayor, Mr. Fernando Grandez Veintemilla, is leading a development process for the agriculture-based municipality. The mayor, along with the Office of Local Development, has been working with the Healthy Communities and Municipalities (HCM) project of Management Sciences for Health (MSH). “Local development should be managed by local teams,” he explains. “With our communities spread out so far, we need reliable information for making decisions that impact the lives of our citizens.”
The Healthy Communities and Municipalities Project
The HCM project designed, implemented, and is now offering support to the Sistema de Información Comunal (Community Information System, or SISMUNI), a municipal public health information system. The HCM model enables communities to perform a needs assessment—documenting demographic and economic information and identifying the community’s priorities for becoming a healthy community. In July 2006, communities began monitoring their own maternal and child health indicators such as the number of adolescent pregnancies and number of children consuming clean water. This information is being inputted into SISMUNI so that local government officials can easily access it, run reports, and use the data for policy development and decision making.
Members of the JVC (Juntas Vecinales Comunales, or “community committees”) present data they’ve collected for their community. This data is sent to the municipality where it is entered into SISMUNI. Photo by Michael Paydos.
HCM staff installed the system and trained municipalities in properly entering health and community data into it, which will increase the available data and improve monitoring of local health statistics. More than 150 communities in 60 districts are currently using the system. Within the context of decentralization of health services, this system will be a valuable tool for local authorities, providing a better picture of the state of health at the municipal level, aiding in policy decisions and the creation of community development plans, as well as facilitating participatory budgeting with the community development teams. USAID/Peru has extended the funding for HCM to September 2009.
Rosita, the manager at the Office of Local Development (ODL) in Saposoa, reported that the office and municipality relies heavily on SISMUNI. “We’re using SISMUNI to create diagnostic and development plans for all the communities. Before, gathering this information would have been impossible. SISMUNI let’s us quickly view the statistics of the community and the progress it’s made on its plans. We can make informed and proper interventions.”
SISMUNI helps municipalities make informed choices about where resources should be assigned. “We’d have communities making requests for assistance,” an ODL staff person noted, “such as building a new school. However, thinking they’d get help faster they might say they have more children of school age than they really do. Now, with SISMUNI and more accurate birth certificate records, we can track population figures more accurately and get the appropriate resources where they are most needed.”
SISMUNI enables municipalities to create data-based development plans for their communities, without the need to rely on assistance from the central level of the government. “Another asset has been with our business plans,” the mayor explained. “The system enabled us to bring up data showing the improvements in the communities participating in various programs. We are using that data to support our requests for additional funding in order to reach the rest of our communities.”
SISMUNI has become an invaluable tool for monitoring the results of the HCM Project in its 557 communities. “One of the unique aspects of SISMUNI is that it brings health data from the bottom up,” explains Dr. Edgar Medina, Director of HCM. It initiates the communication flow from the communities up to the regions, something new in the health system.”
“We used the system to look at each community,” explained the Mayor of Tres Unidos, another municipality working with the HCM project. “In it, we could see which communities were without health posts, and see how long it took for each community to get to the nearest health facility. We used that information to determine where the most pressing need for health posts was.” As a result, the municipality was able to maximize the value of its investment while staying within its annual budget.
Twenty-three local governments are currently using the SISMUNI monitoring and planning methodology. Data collected in 2007 indicate that, for example, the percentage of women of reproductive age who know family planning methods increased over a 6-month period from 78% to 86% (from 24% to 31% for adolescents), and the percentage of pregnant women who are adolescents decreased from 26% to 24%. The percentage of women who had their last delivery at home decreased from 31% to 23% during the same period. Photo by Michael Paydos.
“One of the unique aspects of SISMUNI is that it brings health data from the bottom up. It initiates the communication flow from the communities up to the regions, something new in the health system."
—Dr. Edgar Medina, Director of HCM