USAID|Peru Quality Healthcare Program Strengthens the Healthcare System in Peru

The program focused on using standardized tools and methodologies for service provision, strengthening Regional Health Directorates (DIRESA) and micro-network leadership, and solidifying partnerships with local governments, civil society organizations, universities, community organizations, and patient associations. The Ministry of Health in Peru determined that their health objectives of reducing chronic infant malnutrition, infant mortality, and maternal mortality; infectious disease control; and chronic, degenerative disease control could be achieved through three strategies: universal health insurance coverage, decentralization of healthcare services, and strengthening primary healthcare. The Quality Healthcare Program's main objective was to help the Ministry of Health and DIRESA develop locally appropriate solutions to improve maternal and child health, family planning and reproductive health, tuberculosis control and prevention, sexually transmitted infections (STI), the human immunodeficiency virus (HIV), auto-immune deficiency syndrome (AIDS), and intra-hospital infections (IHI). The program implemented the Performance Improvement Methodology Based on Best Practices (PIM), a local management tool that healthcare teams use to identify performance gaps based on established, evidence-based standards. PIM allowed the program to support quality improvement in diverse technical areas, including tuberculosis treatment and control, STIs, HIV/AIDS, and IHI; maternal, newborn, and infant services; and family planning and reproductive health. The program covered the full range of service levels in Peru, from primary care in rural micro-networks to recognized healthcare centers, secondary and regional hospitals, and national hospitals and institutes. The Quality Healthcare Program invested resources in micro-networks, networks, and DIRESA to build the technical capacity of personnel to identify common needs across healthcare facilities and to implement management processes to address those needs. This required ongoing dialogue and negotiation to ensure that program assistance responded to needs. At the regional level, the micro-network and health center teams began to implement the changes necessary to improve quality, resulting in improved health outcomes and a new way of generating and disseminating change from the ground up and in harmony with Peru's healthcare decentralization principles and strategies. The program also strengthened the capacity of micro-networks, networks, and DIRESA to improve supply logistics for family planning through analysis of information provided by the Integrated System of Medicines and Medical Supplies (SISMED), reducing the number of stock-outs. In Loreto, the program supported updating electronic mapping of the sex trade and social meeting points for men who have sex with men and sex workers, increasing the number of clinical services consultations for men who have sex with men and sex workers and improving treatment efficiency and effectiveness. The Quality Healthcare Program also supported the hiring of healthcare personnel, improving infrastructure, and purchasing equipment for training activities in the provincial municipality of Canas and the district municipality of Yanaoca. Another outstanding example of the strategy for strengthening micro-network team capacity was seen in the Llulluycucha micro-network in San Martin, which successfully implemented PIM with the program's support, resulting in improved health outcomes, including maintaining zero maternal mortality since 2010 and improving other indicators such as births attended by trained personnel, pre-natal check-ups, infant immunization coverage, reducing adolescent pregnancy, and reducing infant diarrhea. The program also supported the construction of a maloka, a type of room traditional for communities in the region, to improve bio-safety conditions for tuberculosis treatment in Ucayali's San Francisco micro-network. The network identified sub-standard bio-safety conditions due to inadequate ventilation in the treatment area and implemented an action plan to address the issue.