Local health administration with the community in Peru; CLAS is the opportunity for empowerment

Local Health Administration Communities (CLAS) in Peru are private non-profit civil associations that enter into agreements with government and receive public funds to administer primary health care (PHC) services applying private sector law for purchasing and contracting. CLAS is an example of a government strategy that effectively addresses social determinants of health (SDH), referring to social, cultural, and economic barriers at local levels that keep people from obtaining services. Bottom-up approaches such as empowerment strategies and community participation have become important paradigms in public health and development efforts to address these local barriers and are becoming part of the discourse on SDH. Citizen participation is essential as a path to empowerment, and evidence is now available showing that empowerment strategies do have a positive effect on health outcomes and in reducing inequalities in health. Initially through a Supreme Decree, and now a national law on CLAS, the Peruvian government provides the opportunity structure for more flexible and transparent financial management with social participation that gives citizens direct control in the management of primary health services, in planning and as facilitator of community development, and in promotion of healthy behaviors and lifestyles of individuals in the community, thereby building agency and empowerment. Evidence shows effectiveness, efficiency, equity, and coverage of CLAS that operate in 32% of the Ministry of Health PHC system as compared to non-CLAS PHC services. “Peruxs CLAS program...is one of the world's best demonstrations of …the Alma Ata model of community-based primary health care.” (H. Mahler, 2001).