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Peru
>> Regional Overview >> Peru Overview Activity Data Sheet
PROGRAM: Peru
TITLE AND NUMBER: Improved Health, Including Family Planning, of High-Risk Populations, 527-003
PLANNED FY 2001 OBLIGATION AND ACCOUNT: $14,468,000 (DA)*, $8,132,000 (CSD)**
PROPOSED FY 2002 OBLIGATION AND ACCOUNT: $15,900,000 (DA), $9,500,000 (CSD)
STATUS: Continuing
INITIAL OBLIGATION:FY 1995 ESTIMATED COMPLETION DATE: FY 2003Summary: USAID's health activities contribute to the agency goal of "world population stabilized and human health protected", as well as to the Mission Performance Plan (MPP) health and population goals, by helping build informed demand for health services and creating sustainable, high quality services. The activities also seek to promote healthy lifestyles and encourage behaviors that lead to reduced maternal and child mortality and morbidity. Health activities contribute to the Summit of the Americas Plan of Action by promoting equitable access to basic health services and strengthening the role of women.
USAID is working to accomplish the following results: 1) People take appropriate preventive actions (e.g., immunization) to prevent disease and have access to information on family planning services, which can reduce undesired pregnancies; 2) People take appropriate promotive actions (e.g., good breastfeeding and weaning practices) that contribute to good nutrition; 3) People take appropriate curative actions (e.g., oral re-hydration therapy and referral of high-risk pregnancies); and 4) Sustainable institutions and operations are in place to continue activities when donor investments end. The ultimate customers are infants and young children, women of reproductive age, and people at risk of HIV/AIDS, other infectious diseases, and malnutrition in Peru's rural and peri-urban highland and jungle areas. USAID is increasingly focusing on youth and indigenous populations.
Key Results: USAID assistance contributed to the development and institutional strengthening of 89 "model health centers" certified by the Ministry of Health (MOH) in priority regions of the country. The number of people in priority zones trained in key primary health interventions rose from 24,012 in 1999 to 28,563 in 2000, exceeding the target of 23,700 by almost 5,000 trainees. The number of condoms distributed or purchased through USAID-supported public and private sector channels increased from 38.9 million in 1997 to nearly 44.4 million in 2000 for contraceptive purposes and HIV/AIDS prevention. Seven USAID-supported non-governmental organizations (NGOs) achieved important results in institutional strengthening and capacity building in order to increase demand utilization of health and family planning services in over 1,000 remote, poor communities.
USAID's maternal and child health (Project 2000) activity had a significant effect on behaviors, attitudes, and health outcomes in the areas in which it operated. A USAID-commissioned study found that knowledge of alarm signs for childbirth was higher in Project 2000 sites than in control sites, and 79.2% of women interviewed expressed their intention to deliver their babies in MOH health facilities, versus only 62.7% from control areas. Most importantly, the maternal mortality ratio decreased 25% in Project 2000 areas, in contrast to a 1.9% increase in other areas of Peru.
Performance and Prospects: USAID's support for building sustainable institutions produced important results for both public and private sector health providers. Project 2000 continued improving the management and quality of care in 12 departments. Moreover, nearly 60% of the 2,452 health facilities located in Project 2000 target areas have initiated quality improvement programs, largely as a result of in-service training offered by Project 2000 training centers. A new budgeting and programming system, based on service delivery costs, has been installed in all 34 regional health directorates in Peru, and quality training has been implemented to ensure its efficient utilization. The Government of Peru (GOP) continued to take on more responsibility for the purchase of contraceptives, and it is hoped that contraception provision activities will continue to move toward greater sustainability.
The Expanded Program on Immunization (EPI) continued its gradual but troubling decline in immunization coverage of children under one year of age. (EPI, which promotes delivery of vaccines to children worldwide, targets six major childhood diseases: polio, measles, tuberculosis, diphtheria, pertussis, and tetanus.) Measles coverage fell from 92.5% in 1999 to 92.0% in 2000; and coverage of diphtheria/pertussis/tetanus fell from 98.9% in 1999 to 97.1% in 2000. These declines were largely due to management problems. USAID's infectious disease activity implemented a surveillance and control system for hospital infections, studied the prevalence of infections, and trained over 1,000 health workers in 60 hospitals. USAID-sponsored research evaluated the efficacy of anti-malarial drugs and the emergence of insecticide resistance, and validated a rapid malaria test for use by health promoters.
The family planning activity has continued to recover from the setback caused by the unsuccessful Peruvian government sterilization campaigns of previous years. USAID continued to educate practitioners on the importance of patient counseling and quality reproductive health services, which stress informed decision-making. The total number of couple-years-of-protection, which had dropped from 1.9 million in 1997 to 1.1 million in 1998, rebounded to 1.4 million in 1999. Overall, surgical contraception declined significantly while other forms of contraceptive use, such as DepoProvera and condoms, more than doubled.
USAID's reproductive health activity implemented by ReproSalud, a local NGO, reached a large and growing number of women in poor communities with information and activities of different kinds. By the end of 2000, 241 women's community-based organizations (CBOs), which are responsible for prioritizing reproductive health problems and implementing projects to address those problems, had been started. In addition, ReproSalud has enjoyed great success in increasing male participation in family planning, and workshops for men have proved successful in changing attitudes of participants. The 241 CBOs have established relationships with 1,627 additional neighboring CBOs, increasing the reach of the project to a total of more than 1,321 communities. Direct beneficiaries for ReproSalud's educational activities now number more than 89,000 and will grow to 98,500 in 2002. During 2001, the advocacy component will result in increasingly strong relationships between CBOs and the MOH, increasing demand for MOH services that are responsive to women's needs.
As a result of USAID assistance to the MOH through Project 2000, which focused on the country's poorest regions, health indicators in Project 2000 areas have substantially improved. According to a study done by a USAID monitoring and evaluation team, the maternal mortality rate has declined in Project 2000 areas from 172 deaths per 100,000 live births in 1997 to 129 in 1999, a 25% decrease. In comparison, in non-Project 2000 sites, the rate went up slightly, from 103/100,000 in 1997 to 105/100,000 in 1999. Other USAID activities with Peruvian NGOs are resulting in significant gains in acceptance of family planning and other desirable reproductive health practices in difficult-to-reach areas with historically high rates of maternal mortality and poor health indicators. Max Salud, a private sector initiative to test alternative models of primary health care delivery in the north of Peru, managed over 400,000 client contacts in four years, established and monitored 20 community-based oral re-hydration centers, and trained and supervised over 120 community and youth health promoters and traditional midwives.
Activities in family planning and wider reproductive health, child survival, health reform, infectious diseases, and HIV/AIDS prevention are key to the impressive progress made in the health sector in Peru over the last decade. Positive performance is expected to continue through 2002, though hoped-for improvements in national health status will likely be tempered by the uncertain political and economic climate. Nevertheless, in 2001 and 2002, USAID's activities will be achieving or exceeding planned results in a number of areas. For example, contraceptive prevalence should recover and surpass previous levels by 2002. The national epidemiological surveillance system will have begun national surveillance of sexually transmitted diseases and HIV/AIDS. Twenty-two new or upgraded laboratories will be tracking infectious diseases throughout the country. Improved MOH management capabilities will result in higher quality health services for the 80% of the population who use MOH services.
In FY 2001, Development Assistance (DA) will be used to: promote breastfeeding activities ($289,360); fund female education and empowerment in reproductive health, including family planning, sexuality reproductive tract infections and related themes ($7,234,000); and provide quality family planning services ($6,944,640). FY 2002 DA funds will be used to: promote breastfeeding activities ($275,200); fund female education and empowerment in reproductive health as stated above ($7,880,000); and provide quality family planning services ($7,744,800).
In FY 2001, $2,295,000 of the Child Survival and Disease (CSD) funds (including carryover funds) will support infectious disease prevention, control, and treatment. The remaining $5,837,000 CSD will be directed toward a range of activities that improve health care delivery in Peru. These activities include: improving the services and capacity of the MOH through staff training, improved management and information systems, and reforming health care financing; promoting biomedical and operations research; developing and testing private sector models of primary health care for families as an alternative to public system provision of care; improving quality and access to prenatal and delivery services to optimize maternal health and assure safe pregnancy; expanding integrated management of childhood illnesses, especially to prevent and treat acute respiratory infections and diarrhea disease; and improving the nutritional status of children, including the control and prevention of micro-nutrient and vitamin A deficiencies. Of the FY 2002 CSD funds, $4,250,000 will fund infectious disease prevention, control, and treatment and $5,250,000 will be directed toward the range of activities listed above.
Possible Adjustments to Plans: As most ongoing USAID activities are designed to continue for at least two more years, no immediate restructuring of the existing portfolio is planned. In the near term, however, some adjustments in emphases will guide activity planning and implementation. Greater emphasis will be placed on integration of services, with health, population, and reproductive health services increasingly being consolidated to improve efficiency and coverage. Also, greater emphasis may be placed on identifying and meeting the needs of young disadvantaged Peruvians, especially their need for information on preventive health care. USAID and other donors are anticipating that there may be new opportunities to work in the areas of health sector reform and health care financing with the changes in national government leadership.
Other Donor Programs: USAID completed an analysis of donor assistance (both retrospective and planned) in health, population and nutrition for the years 1994-2005. Of a total projected investment of $6 billion during this period, $4.2 billion will be provided by Peru and $1.8 billion by external donors. USAID is presently the largest donor, providing 40% of total external assistance. Loans from the Inter-American Development Bank and the World Bank currently represent 11% and 9%, respectively. Major new health sector loans from both banks, which were originally scheduled to begin in 2000, have been delayed and are currently under review.
Principal Contractors, Grantees or Agencies: U.S. Cooperating Agencies active in Peru include Pathfinder International, John Snow Inc., Macro International, Johns Hopkins University, CARE, and others. Major local grantees are the MOH, the "Movimiento Manuela Ramos," and a consortium of seven Peruvian NGOs. The Population Council is an international organization.
* This excludes $250,000 NOA swapped for a like amount of FY 2000 carryover funds
** This excludes $200,000 NOA swapped for a like amount of FY 2000 carryover funds
FY 2002 Performance Table
Peru: 527-003
Performance Measures:
Indicator FY97
(Actual)FY98
(Actual)FY99
(Actual)FY00
(Actual)FY00
(Plan)FY01
(Plan)FY02
(Plan)Indicator 1: Immunization coverage of children younger than one, by type of vaccine 97 97.5 93 95 95 95 95 Indicator 2: Number of facilities certified as model health centers in priority zones 7 70 88 88 88 88 88 Indicator 3: Number of condoms distributed or sold through USAID-supported channels in a year 38.9 45.6 46.3 26 27 27 27 Indicator 4: Number of people in priority zones that are trained in key primary health care interventions NA 17,852 24,012 30,912 23,700 7,000* 6,000* Indicator Information:
Indicator Level (S)or(IR) Unit of Measure Source Indicator Description Indicator 1: IR Percent of children under one Ministry of Health records The average of the immunization rates for the six major childhood diseases targeted by the worldwide Expanded Program on Immunization. These are: polio, measles, tuberculosis (BCG), and diphtheria / pertussis / tetanus (DPT). Vaccines, 1999, 2000: Polio, 96%, 95%; DPT, 99%, 97%; Measles, 92%, 92%; BCG, 97%, 95%. Indicator 2: IR Cumulative number at year end Ministry of Health and USAID records Number of health facilities (regional hospitals and health centers) certified as model centers in priority zones. The criteria for certification are: a) use of health information; b) community outreach activities; c) implementation of the permanent education system; d) adequate infrastructure; and e) standardized clinical management. Indicator 3: IR Millions of condoms Ministry of Health and NGO records The number of condoms distributed or sold through the public, non-governmental and commercial sectors. Indicator 4: IR Cumulative number of people USAID reports The number of health workers and promoters trained under USAID's maternal and child health and reproductive health activities. * Starting 2001, targets have been revised to report the number of trainees in each year, not the cumulative number. Numbers decrease because the main strategy is to strengthen health training centers and supervision systems and not to do the training. Additionally, these figures will be revised with the new USAID Strategic Plan 2002-2006. U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999 56,789 DA 47,050 DA 9,739 DA 33,550 CSD 24,789 CSD 8,761 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Fiscal Year 2000 13,350 DA 12,310 DA 6,500 CSD 6,556 CSD 0 ESF 0 ESF 0 SEED 0 SEED 0 FSA 0 FSA 0 DFA 0 DFA Through September 30, 2000 70,139 DA 59,360 DA 10,779 DA 40,050 CSD 31,345 CSD 8,705 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Prior Year Unobligated Funds 250 DA 200 CSD 0 ESF 0 SEED 0 FSA 0 DFA Planned Fiscal Year 2001 NOA 14,218 DA* 7,932 CSD** 0 ESF 0 SEED 0 FSA 0 DFA Total Planned Fiscal Year 2001 14,468 DA 8,132 CSD 0 ESF 0 SEED 0 FSA 0 DFA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 15,900 DA 9,545 DA 110,052 DA 9,500 CSD 6,053 CSD 63,735 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA * This excludes $250,000 NOA swapped for a like amount of FY 2000 carryover funds.
**This excludes $200,000 NOA swapped for a like amount of FY 2000 carryover funds
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Last Updated on: May 29, 2002 |
