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Going to Scale
Officials often think that promoting community participation is a slow process, but the CLAS movement in Peruvian villages demonstrates that the process can scale up quickly.
In 1994, the first community co-managed government primary health centers began as a pilot program in five government facilities in the Ayacucho subregion and nine in the
Ica
subregion. Huge national demand quickly overwhelmed initial planning, and about 250 more formed in the next six months. Four years later, there were 548 CLAS out of the 5,060 government health facilities, with over 150 organized CLAS waiting to be recognized. By mid-2001 the number of CLAS centers had grown to over 1,200. Today in the year 2004, over 2000 of 6700 health clinics are managed by CLAS Associations, representing 35% of all government primary care services. Demand continues for rapid expansion as this community-based approach becomes known nationwide.
A recent study conducted by Future Generations Peru using government records showed that CLAS-administered health facilities achieve significantly greater coverage of mothers and children under the new government-funded Integrated Health Insurance program which is oriented to the poorest population groups. The greater coverage of insurance beneficiaries by CLAS provides them with greater reimbursement income than non-CLAS health facilities. The study showed that this money is spent, as decided by the CLAS Association, on hiring more personnel and other investments that improve the supply and quality of health services provided, which in turn leads to greater demand for services and more self-generated fees-for-service income in CLAS as compared to non-CLAS.
Future Generations Peru is offering a systematic way to coordinate through the CLAS financing and co-management model the varied strategies of the Ministry of Health for health reform, including quality assurance, health promotion and prevention, and decentralized financing through health insurance reimbursements. Using the SEED-SCALE methodology, Future Generations Peru is working with community and government partners to design and test this new model of community-based health and development. Regional training centers known as Model CLAS are being established to serve as centers of excellence to then train and support other CLAS Associations and their co-managed health facilities and communities. These centers create a process for evolving solutions systematically and finding sensitive and practical responses to local needs. These centers also integrate health services with the broader community needs of food security, sanitation, education, housing and environmental protection.
The first Model CLAS has been established in Las Moras, a poor peri-urban settlement in the temperate highland town of
Huánuco
in the
Huallaga
Valley
of east-central
Peru
. For more information on this program, see the <Project Sites> section. A rural Model CLAS is being planned for the Department of Huánuco, and two more Model CLAS are being planned to support CLAS in a coastal region and in the upper Amazon region of
Peru
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Contact Information
PERU
Av. Primavera 2049
Santiago de Surco, Lima 33, PERU
Tel. +511-436-9619, 436,9623
Email: > peru@future.org
Future Generations
HC 73 Box 100
North Mountain
Franklin, WV 26807 USA
Telephone (304) 358-2000 / Fax (304) 358-3008
Email: > info@future.org
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