142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Re-engineering health systems for local co-management of community-based primary health care and sustainable reduction in chronic malnutrition

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 1:18 PM - 1:30 PM

Laura C. Altobelli, DrPH, MPH , Peru Country Director, Future Generations, Lima, Peru
José Cabrejos-Pita, MD, MPH , Huanuco Project Manager, Future Generations, Huánuco, Peru
Health policy in Peru emphasizes maternal, newborn, and infant health (MNCH) with a special focus on reducing growth stunting in under-fives.  Despite an emerging economy, extreme inequity results in 38% child stunting in the lowest income quintile versus 2% in the highest quintile.  Systems for primary health care (PHC) are based on a medical model; health promotion policies are under-funded and lack effective operational models.  A sustainable integrated community-based MNCH system was built with innovations over a period of ten years to create a functional operational model that strengthens government PHC organization, management and technical capacity to link with communities and community health workers (CHW) for improved access, equity and quality of MNCH services and increased health impact.  

Added to this model, a new participatory teaching methodology for female CHW within a Modular Training Program for MNCH managed by PHC staff and a new cadre of local government-supported worker who links health services with CHW, was tested using a cluster-randomized controlled trial.   Twenty-four health facilities, with 180 communities, were matched and randomized as intervention or control.  DHS-type survey interviews of mothers of under two´s, with anthropometry, were conducted with 600 households in each round at baseline, midterm, and final.

 Differences in intervention and control groups were significant on many survey variables comparing baseline and midterm: intervention clusters had significantly improved maternal behaviors (on exclusive breastfeeding, hygiene, treatment of child illness) and reduced stunting (34% to 27%) at midterm. Final results in mid-2014 will be presented.

Learning Areas:

Administer health education strategies, interventions and programs
Administration, management, leadership
Communication and informatics
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Identify key factors that contribute to strengthening sustainable health systems for primary health care linked to community-based maternal-neonatal-child health financing and interventions.

Keyword(s): Health Systems Transformation, Community Health Workers and Promoters

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked in international MCH programs for over 35 years. I am project director and responsible for project design for the content to be presented.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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