AN INTRODUCTION TO HEALTH ISSUES IN PERU

Peru has been recognized for making strides to curb maternal and infant mortality, and increase life expectancy.  Peru’s economy has been growing at an impressive rate and generous funds have been allocated to improve health care delivery and organize interventions to address urgent issues at a local level.  Peru’s national Ministry of Health recognizes its critical role in increasing access to health care services and addressing the health issues plaguing children which prevent them from becoming productive adults.

The Ministry of Health has outlined a plan of action to address a range of health issues across several target populations, and has partnered with Peace Corps Peru to carry out critical interventions to ensure adequate development of children under three years of age and adolescents aged 12-17.  Nationally, one in five Peruvian children suffer from malnutrition, caused by poor nutrition and loss of nutrients resulting from frequent diarrheal diseases and parasite infections. 

In addition, the Ministry of Health has partnered with Peace Corps Peru to direct programs that ensure adequate preparation of adolescents to become productive members of their communities.  Adolescents are generally lacking in reproductive health education and prevention of unwanted pregnancy, HIV and sexually transmitted infections.  The teen pregnancy rate nationally hovers around 13% (for girls aged 15-19) but is slowly creeping upwards.  Locally, in the Piura region, statistics from 2012 show the rate has shot above 16%, a dramatic increase from 9% in 2000.

Please continue reading below to find more about health issues impacting small children.
Please click here to read more about health issues impacting adolescents.

COMMUNITY DIAGNOSTIC

My first task in my community of El Tallan, Piura was to undertake a community diagnostic to determine the health needs of the target populations.  The diagnostic included a survey of homes with children under 3 years of age, a SWOT analysis with adolescents, and interviews with key community leaders, including representatives from local food banks and mother’s groups.  The results from these efforts were meshed with health statistics reported by the district office of the department of health to create a Community Diagnostic Report, on which I based recommendations for public health improvement interventions. 

I presented the findings from the Community Diagnostic Report in a public forum which was attended by representatives from the local municipal government, academic leaders, health center staff and concerned citizens.  After reviewing the findings, I facilitated a discussion with attendees who prioritized each issue to address with a public health program.  Once we had collectively identified the priorities, I formed a committee of local leaders and we worked tirelessly to design and implement programs that suited the community’s needs and desire for change.

I worked closely with the local health center to identify 300 families in the community with children under three years of age, and we trained 8 volunteer health promoters to administer a household survey.  The survey was based on one developed by Peace Corps Peru, in coordination with Peru’s Ministry of Health.   We reviewed the questions as group and altered them to be culturally appropriate for the community, changing the wording as needed and omitting irrelevant questions.  We retained questions pertaining to sanitation, hygiene, prevention and identification of diarrhea and respiratory illnesses, food preparation, nutrition, as well as early childhood growth and development, as these are areas identified by the local health center as relevant to the community.

We marched from house to house under the blazing 100-plus degree summer sun in February 2013 and managed to complete surveys on 135 families in four main neighborhoods of the district of El Tallan before the enthusiasm of the volunteer health promoters finally surrendered to the heat and demands of their families.

The results of the survey showed that the main issue affecting people of all ages across the entire district is respiratory illness.  Not surprising, given the high percentage of people who cook over an open fire inside their homes, exposing themselves and their families to toxic smoke.  The main issues impacting the health of small children are diarrheal diseases and malnutrition. (Please click here to read the Community Diagnostic report in Spanish).

The health post has already been conducting some minimal outreach in the community to address issues of diarrhea and malnutrition but the level of success was not documented.  Truthfully, there is no way to know to what degree the outreach efforts have impacted the health of the community because no monitoring of activities or evaluation of programs had ever been conducted.  In this part of Peru, it is not customary to set goals or measure progress or evaluate results.  The traditional definition of success is too often that an educational session occurred and people attended.  Period.  There is rarely any coordinated follow-up to determine whether the participants changed behavior as a result of the intervention, and never any before/after assessments to determine the impact of the intervention on prevalence of an illness or condition.

For example, the health center has effectively become a broken record with respect to hosting educational sessions to review the steps to wash hands correctly and encouraging mothers to do so in key moments, such as prior to preparing meals for their children.  The mothers proudly demonstrate the steps accurately and can recite the key moments, but the health workers are often dismayed to discover that the mothers do not practice this at home.  Instead of wondering what they could do differently to help mothers change their habits or inquire about which barriers they may be facing, the health workers assume that the information provided to mothers is sufficient for influencing their behavior. They continue leading the same hand washing educational sessions and are repeatedly frustrated by the lack of positive results.

Please continue reading to find out how we tackled these issues with the Healthy Homes project.