The 130th Annual Meeting of APHA

Abstract #42969

Laura C. Altobelli, DrPH, MPH, DS Consult (Associated Consultants for Health Development), Av. El Polo 740, C-140, Santiago de Surco, Lima 33, Peru, 511-434-2791, laltobelli@infoweb.com.pe

Since 1994, Peru is expanding a model strategy for government primary health services (called the Shared Administration Program) that has direct citizen involvement in financial management and social control of services, now covering 25% of all primary level facilities. Local Health Administration Committees (CLAS) are composed of six elected community members plus the facility medical chief, who form a legally registered private non-profit association that receives and administers transferences of public resources. Data show that CLAS positively impact equity and quality of services. Community involvement in health is being clearly delineated in Peru by this program, and the model is helping to define larger reform issues. Functions of the community have been in financial management (payment of personnel, goods, and services utilizing public resources, tariff setting and exonerations, decisions on use of discretionary funds), personnel hiring and firing, and social control over health personnel attendance, promptness, and provider-client relationships. CLAS have improved the transparency in use of public health resources, and represent decentralization of decision-making for government services. Reimbursements under the new Integrated Insurance Program for the poor work best under the public-private transfer model of CLAS. Requiring reform are the top-down planning and fragmented budgeting under traditional vertical health programs that conflict with local health planning and monitoring under CLAS. Also being defined are CLAS roles in: (1) health promotion and behavioral change in the home; (2) assessment of client satisfaction; and (3) intersectoral coordination in the community for integrated development. Lessons learned are discussed.

Learning Objectives: At the end of the session, the participant in this session will be able to

• Identify the community roles in a legalized framework for community management of primary health services in Peru through Local Health Administration Committees (CLAS);
• Assess differences in equity and quality of primary health services comparing CLAS with non-CLAS facilities.
• List the key public sector support issues contributing to CLAS success.
• Describe the Map of Decision Space on CLAS vis-a-vis decentralized decision-making.

Keywords: Community Involvement, Health Care Reform

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.