Strengthening Health Systems and Their Links with Communities Through a Child Survival Project in Peru

The “Sectorization” strategy was developed to link health facilities effectively with communities for improving health, as one aspect of NEXOS, a USAID Child Survival Project implemented by Future Generations in 250 rural communities of Cusco, Peru. Responsibilities are given to health workers and volunteer community health workers (CHW) for implementing activities of health promotion in communities. Each health worker takes responsibility for one or more sectors or communities to train and support CHWs, who are each responsible for 30 families. CHW refer and accompany patients to health centers. Health staff, CHW, and community leaders and members do community diagnoses and develop community work plans. Local government and other institutions provide financing for these plans. Activities for organizing the health center and the community ensure the sustainability of the strategy.

Other strategies used were Community Emergency Evacuation Committees, birth plans, monthly monitoring by CHW of pregnant women and children under two, and a tool kit for health promoters for face-to-face education of mothers and families, with monitoring checklists, referral slips, monthly report forms, and community birth and death forms.

Municipal governments learned to support community vision development and local planning, and to provide funding through participatory budgetting to community projects.

Results from baseline and final KPC household surveys will be presented on improved maternal knowledge of danger signs in pregnancy, delivery, post-partum, in newborns and in children with pneumonia or diarrhea, increased food consumption during pregnancy and lactation, improved hand-washing, and increased exclusive breastfeeding and immunization coverage. This project has implications for global strategies to improve linkages between the health system, local govenment, and communities.