FutureGenerations

Roads are vital for overall development and the access afforded by these can be both extremely beneficial as well as hugely damaging. The road network in Peru includes the Inter-Oceanic Highway South [Carratera Interoceania Sur], a route linking the Pacific Ocean in Peru with a highway in Brazil that continues east to the Atlantic. This artery, already completed in Brazil but not totally finished in Peru, brings substantial social and environmental change to many areas.

Excitement is rapidly growing concerning the potential for community-based primary health care (CBPHC) to accelerate progress in reducing the tragedy of millions of children dying world-wide each year from readily preventable or treatable conditions. Consequently, a review of the evidence concerning the effectiveness of community-based approaches is timely.

Why has the $2.3 trillion dollars spent by the West over the past four decades not had more of an impact in promoting health and decreasing poverty?

The economist William Easterly addresses this issue in his provocative new book, The White Man's Burden. His view is that we need to abandon the grandiose plans of the Planners and that we begin to develop new and effective ways for supporting those people he calls Searchers -- those who are working at the grassroots level and who are experimenting and learning by trial and error to solve local problems of poverty and health.

Health sector reforms in Peru, despite nearly a decade of reform efforts, are best described as piecemeal. The reform project itself lacked a comprehensive vision, and the resulting policies often either conflicted with each other, or with the stated overall goals of health sector reform: “a reform with equity, efficiency and quality”. Major health indicators, moreover, show improvement in health status, but these improvements are not substantially different from improvements in non-reform, and even crisis periods of the health sector.