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

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.