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Does Community Empowerment through Shared Management of Primary Health Care have Impact on Health Outcomes in Peru?

Laura Altobelli, DrPH, MPH, Peru Country Program, Future Generations, Av. Prolongacion Primavera 2159-2397, Monterrico, Santiago de Surco, Lima, 33, Peru, 511-442-0095, laura@future.org

The Peru Ministry of Health (MOH) has for 12 years increasingly implemented a decentralized system for financing and administering primary health care (PHC) co-managed by elected community members called CLAS Associations that are legally registered private non-profit civil associations. The Shared Administration Program and CLAS now cover 35 percent of all PHC facilities in Peru. Studies show benefits of CLAS on health service coverage, equity, quality, and cost efficiency. This study was conducted to assess the impact of CLAS on health outcomes, comparing CLAS-administered PHC facilities with those operated under traditional public administration. We utilized data from the national Peru DHS survey. Sampling conglomerates were matched by district-level geographic identification code with the same code assigned to CLAS-administered health facilities, to distinguish CLAS and non-CLAS households in the data set. We found that this matching method worked for rural areas which have smaller districts, but not urban areas. Therefore we used only the rural sample for this analysis. Rural households in CLAS and non-CLAS districts were compared on a series of health outcome variables, including prevalence of child diarrhea and respiratory symptoms, child anthropometry, and institutional birth attendance. Results are not yet available at the time of abstract submission. Policy implications will be significant as the decentralized CLAS system is not fully accepted by all MOH and regional government officials, and this is a presidential election year and new officials will need information for policy decisions on maintaining system reforms, especially those involving empowerment of communities in public services administration.

Learning Objectives:

Keywords: Community Involvement, International Public Health

Related Web page: www.future.org

Presenting author's disclosure statement:

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Reproductive Health: Innovations, Policy, and Access

The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA