The Shared Administration Program in Peru is one of the successful community change experiences that the Future Generations SEED-SCALE methodology is based on. Co-founder Dr. Carl E. Taylor provided orientation to Peru in 1994 at the request of their Minister of Health to design a new program for primary healthcare with community participation. SEED-SCALE was then in the process of development, so the Peru program was designed on the basis of SEED-SCALE principles, while also soon becoming evidence for further development of the methodology.
|Meeting of members of CLAS Las Moras, the original pilot site.
Peru is now one of the few countries with a governmental health program that features legalized, regulated, and institutionalized community participation. A 1994 government decree gave community entities collaborative responsibility and decision-making power over the management of public resources to administer primary healthcare services. Called CLAS Associations (Local Health Administration Committees), these private non-profit entities work under contract with the state, and the medical chief of a primary care facility is executive director as the public sector counterpart. The three-way partnership involves government, health services, and community.
How does social participation reflect SEED-SCALE through CLAS? When local people identify their needs instead of only central planners, it improves equity and efficiency of public spending. The watchdog role of citizens overseeing use of public resources ensures transparency and reduces misuse of funds. Citizens can exert social control when they pressure health providers to come to work on time and treat patients well, and can make decisions on purchases (equipment, maintenance, extra staff) to ensure better quality of care. Social participation makes local health and development programs more sustainable. The CLAS program scaled-up rapidly to cover 32% of all 2,700 primary healthcare facilities nationwide because of word-of-mouth from satisfied communities. Future Generations was instrumental in development of a law on CLAS approved in 2007 by the Peruvian Congress that enhanced the SCALE-Cubed policy environment.
Future Generations has played a key role over the years in conducting CLAS program research and evaluation, preparing papers for dissemination and advocacy, and providing technical support on the CLAS program. Documents on the CLAS program in Peru are available through Future Generations University’s publications library.
Customarily, mothers are taught health lessons which, even if simplified, are paradigmatic and hard to remember. Dr. Laura Altobelli, Professor and Director of Future Generations Peru, is leading research to advance a method that transforms the training of community health workers (CHWs), leading to faster progress in knowledge and behavior change of mothers who learn from older women whom they know and trust. Through systematic recall and sharing memories of personal experiences, this innovative behavior-change method engages and empowers female CHWs to take ownership of their cultural beliefs and practices, and on those build a new collective understanding for future behavior. Community health workers gain self-confidence and can better convince other women to uptake knowledge and behavior that improve health and healthcare use in the key first 1,000 days of life (conception to age two).
Dr. Altobelli’s prior study in Peru provides preliminary evidence of reduction of child stunting when government personnel used this methodology to teach CHWs, who then taught mothers with similar methods. The earlier study showed it to be low-cost, simple-to-learn, and effective. It enhances current best practice of participatory women´s groups and home visits by providing a replicable interactive participatory method grounded in local knowledge. Findings corroborate empirically proven conceptual frameworks on memory and behavior change. Future Generations Peru hopes to continue research on the method to demonstrate effectiveness at scale of this maternal behavior change innovation, with reduction in child stunting and anemia, supported and sustained by primary healthcare services and local government, and incorporated into global policy and programs.
Mothers are the world’s primary healthcare providers, and the home is the world’s primary healthcare facility. Although formal health systems and facilities are necessary, effective work at the household level can both improve the overall health of populations and help the formal health system focus on those conditions that cannot be addressed by families and communities alone
Future Generations Graduate School has focused on strengthening the evidence base for community-based health through its experiences running programs and doing research with students, alumni, faculty, and partners. Central to this is the empowerment and education of mothers so that they have the knowledge and support to become more effective providers of child healthcare services as well as addressing many social determinants of health in their families and communities. Evidence of the impact of such efforts from around the world includes dramatic reductions in infant mortality rates, increased immunization rates, improved nutritional status, and many related social changes such as improved transportation and expansion of the voice of women in community life.
How can we move towards a more equitable and inclusive state of health for the world? There are myriad ways, but further supporting mothers is one of the most powerful. We know that primary healthcare interventions such as hand washing, breastfeeding, oral rehydration therapy, and use of insecticide-treated bed nets (ITNs) that can be implemented in homes and communities tend to be more equitably available to all households in communities, especially the most vulnerable and difficult to reach sub-population groups. We also know that, if families are bypassed by or cannot access healthcare services and knowledge, their health outcomes suffer. These situations are deeply unjust, often avoidable, and can undermine efforts to move the health of the entire global population forward by leaving sub-populations vulnerable to infectious diseases and by putting strain on the formal health system through costly and often avoidable interventions.
A mother’s job is not just during business hours, or just when she feels like it. We honor every mother who contributes to the health of her children, family, and community every single day. Here is a way you can help show that respect and appreciation, too: This Mother’s Day, please consider shopping on smile.amazon.com By using the Future.Edu account. A percentage of what you spend will come back to Future Generations so that we can continue to support mothers throughout the world. Use this link: https://smile.amazon.com/ch/20-4093450. Thank you. Happy Mother’s Day.