Using Information to Improve Health: CARE Perus Experience with a Communitybased Health Surveillance

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Using Information to Improve Health CARE
Perus Experience with aCommunity-based Health
Surveillance and Response System

• Authors Jenny Milla, RN and Luis Tam, MD, DrPH,
  CARE Peru

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PROJECT BASICS

• 1996-2000, USAID/BHR/PVC-funded.
• Pop. 130,000 mostly poor and illiterate
  inhabitants in dispersed, mountainous rural
  communities.
• High maternal and infant mortality.
• MOH services limited coverage and serious
  under-representation of morbidity and mortality.
  
• Community participation negligible.

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PROJECT EFFECTIVENESS(FINAL EVALUATION, 2000)

• Attendance to prenatal care at MOH facilities had
  risen from 38 (1996) to 73 (2000).
• Births occurring at a MOH facility had increased,
  from 100 (1996) to 700 (2000) per year.

• 93 of obstetric emergencies were seen by a MOH
  provider in 2000, as compared with 45 (1996).
• The percent of children with suspected pneumonia
  seen by a qualified provider increased from 32
  (1996) to 60 (2000).

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COMPONENTS OF THE COMMUNITY-BASED SURVEILLANCE
AND RESPONSE SYSTEM (CB-SRS)

• Communal map showed the location of all homes
  and identified the at-risk families (i.e.
  children aged less than 12 months and pregnant
  women). Updated monthly.
• Periodical collection and analysis of health
  information Bimonthly or quarterly community
  meetings with ACS. MOH facilities and their ACS
  held monthly meetings

• Patient referral and counter-referral ACS
  referred community members needing facility-based
  care (e.g. prenatal care, growth monitoring).
• Community-based emergency transport of severely
  ill patients Groups of community members were on
  duty during specific days to assist with the
  emergency transport of these cases.

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LEVEL HOUSEHOLD
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LEVEL COMMUNITY
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LEVEL COMMUNITY-HEALTH FACILITY
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COSTS AND BENEFITS

• COSTS
• External
• a) training of MOH staff and the ACS
• b) design and production of materials and
  instruments and
• c) periodic supervision
• Approximately USD 300,000 over four years
• Local
• Time invested by the ACS, the MOH facility staff,
  and community leaders and groups.

• BENEFITS
• Saved lives and improved health. Participants
  could see improvements via the results presented
  during community meetings and impact in their
  household.
• Improved coverage statistics in participating MOH
  facilities resulting from SIVICS-generated
  referrals and emergency evacuations increased
  facility support of the CB-SRS.

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LESSONS LEARNED

• In order to achieve results, the use of health
  information must be coupled with the potential to
  perform a concrete action, at times immediately

• Existence of personalized relationships, i.e.
  each facility-based provider was responsible for
  the organization of a CB-SRS in a group of
  communities.

SIVICS has two closely dependent components, and
both are essential for success. The technical
component is composed of forms to be filled,
reports, information flows, and action protocols.
Yet there is the equally essential social,
human-based component comprised of a sense of
meaningful participation, personal achievement,
and community and individual ownership and
empowerment.
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POTENTIAL FOR REPLICATION

• CB-SRS is largely applicable where there is
  already a community-based system for provision of
  essential preventive and curative services, which
  is linked to a referral facility.

• Where these essential elements are lacking there
  should be the potential of having them in place
  in a reasonably time.