Promoting Good Health in Peru: Communities Creating Change

[Dr. Edgar Medina, HCM Project Director]Dr. Edgar Medina, HCM Project DirectorThe Healthy Communities & Municipalities (HCM) project in Peru aims to improve maternal and child health in areas lacking government and private sector investment. With funding from USAID, MSH's Leadership, Management and Sustainability program (LMS) has supported HCM since 2006, applying leadership and management principles to promote healthy lifestyles and behaviors, and to empower the Peruvian people through community and civic participation.  The project has expanded from 515 communities in 2006 to 1,764 today.

MSH interviewed Dr. Edgar Medina, the project's director, on the importance of community empowerment, its inherent challenges, and what the project is doing to help communities make their efforts both successful and sustainable.

Tell us about the communities where the HCM program works. What are the biggest health and development challenges the people there are facing?

The communities are located within zones with poor accessibility, and due to drug trafficking and other illicit activities, basic health services are inadequate and insufficient. We are trying to help local residents improve their lifestyles and their health practices, especially in the areas of maternal, child and reproductive health. The idea is to work with the people so the changes come from them, rather than being imposed from the top down.  

How do you work with the communities?

The project empowers both families and communities to improve their health practices, and to do so with the active participation of their community leaders and their local government. One way this happens is through very simple tools that we have provided that enable families to evaluate themselves, plan for any improvements, and take action.   

For both the families and the local community development committees, we have taken concepts that are academically complex and broken them down so that everybody – including those with limited education – can understand.

What are examples of these tools and how do they work?

We have a toolkit that has a component for the family, a component for the community, and one for the municipality. At the family level, we have simple paper "tools" – for example, a written guide on how to create a healthy family; a "vision poster" that enables the family to record their vision of what good health will look like for their family; an assessment poster that helps them analyze their health behaviors; and a safe water and family hygiene poster, that details the specific steps for ensuring portable, safe water. 

At the community level, the toolkit provides monitoring tools to assess and document maternal and child health practices, two community self-assessment tools to evaluate local health practices, and a facilitator's guide on how to promote safe water consumption and other tools. The data we collect for this is input into our HCM designed community-based health information system SISMUNI, which helps community leaders, health facility personnel, and local officials plan and budget according to the health needs of the specific communities. The project staff also use this information to gauge the self-assessed progress of communities toward achieving improved health status.

What feedback have the families and communities given you about this process?

The families we work with consistently mention that never before has anyone helped them to plan, to help them draw their vision and then to attain that vision. One of the greatest successes is that the program has introduced leadership at the community level, so that local residents realize that they can initiate change themselves – they don't have to wait for the state government to help.

The people we work with have taken the basics of health promotion and combined them with leadership, and the program has exploded at the community level. It is at the intersection of these things that we see empowerment.

What recognition has the program received from the Peruvian government?

In the beginning, the municipal and regional governments identified the methodology of the HCM project as extremely effective in achieving change and improving the health of communities. In 2007, Peru began to implement the National Strategy to Fight Poverty and Child Malnutrition (CRECER) and subsequently, the regional governments within the project area, such as Ayacucho, approved the incorporation of the HCM strategy as the operational methodology for reaching families and communities in their region.

Recently, the HCM project has received recognition by the Ministry of Health through the offices of the General Director of Health Promotion, the National Center for Feeding and Nutrition (CENAN), and Interministerial Committee on Social Affairs (CIAS). Currently we are working with these institutions to transfer and adapt the HCM tools so that they may be implemented at the national level.

The program has also attracted interest from the private sector, hasn't it?

Yes, and this has helped us scale-up the program. Last year, Barrick Mining and USAID established an agreement which is helping us expand the program, and is now funding the work in 69 communities in two regions, La Libertad, and Ancash. This year we have also had interest from another Peruvian business, Cementos Lima, which is interested in introducing the project into an urban area. This kind of support ultimately will make the project more sustainable.

Dr. Medina, a staff member of Management Sciences for Health since 2006, has been working  on public health in Peru for 15 years. His professional passion is the development of methodologies, systems and instruments that can be used at the community level to benefit those with little access to quality health services.