The Strategic Participative Health Planning in the Regions from Peru

By Anibal Velasquez


Since the passing of the decentralization legislation in Peru, the regions and local governments are required to promote citizens participation in the definition, debate and negotiation of their development plans and budgets, and to this effect, government has ordered the formation of regional, provincial and local health councils (consulting bodies of the respective governments) with members of civil society, to implement the health plans.

Between 2004 and 2006, 23 regional health plans were prepared, with different participative processes, such as: health personnel meetings, focus groups, group interviews, assemblies and a referendum (WHO, 2005)[1]. Public participation levels were also varied, ranging from those which where public participation was limited or non-existent, to those in which citizens were allowed to define health priorities or validate the viability of strategies and goals.

No evaluation has been made about what occurred in the definition of these plans or in the implementation thereof. Certain regions have published their regional health plans (Huánuco[2], Pasco[3], Junín[4] La Libertad[5], Lambayeque[6], Ucayali[7] and San Martín[8]) and as can be appreciated, there are sharp differences in the methodology used, in the degree of evidence backing the plans, in the level of public participation, in the institution responsible for implementing the actions, in the degree of inter-sectorial and inter-government actions, as well as in the degree of commitment of the highest regional authority in the definition of the plan and in its implementation.

Certain reflections (WHO, 2005)[9] and lessons learnt (Regional Government of Lambayeque, 2005)[10] have been published with regard to the regional planning process. These studies indicate that the participative processes generate enthusiasm and hopes of improvements, especially amongst the poorest participants, promising to serve as a tie with the allocation of resources geared to the neediest people, also finding deficiencies which may be improved in subsequent planning processes.

Accordingly, worth highlighting are the health plans of the La Libertad, Lambayeque, Ucayali and San Martín regions, which are no longer simple statements of good intentions and which were not meant to be management tools and social agreement documents between government and society. These plans defined the priorities, commitments, institutional arrangements, goals, indicators and agreements to monitor compliance. Three processes came into play in these regions: the political, the participative and the technical processes. Decision making to elect priorities and to validate goals and interventions was participative in form. With this object in mind, there were assemblies or caucuses held in Ucayali and San Martín and a referendum in Lambayeque (with 124,000 people voting) and in La Libertad (with 265,000 people voting), to define priorities. Technical people evaluated health needs and the preparation of the food and the vote ballot and then they checked the evidence on the factors and effectiveness of the interventions. Currently, these plans are in the implementation phase, and there is a commitment to implement them, even if the authorities change because of the new elections, as stated in the signed resolutions of regional political parties [11] [12] [13] [14].

Photograph: students voting by the priorities of health of the Strategic Participative Health Plann in Lambayeque, Peru (November 19, 2004)

References

[1] WHO (2005). Brazil and Peru pool views of their people to set health agenda. Bulletin of the World Health Organization; 83(7):485-486
[2] Gobierno Regional de Huanuco. Plan Regional de Salud Concertado 2003-2006, Huanuco (Perú). Available in: http://www.pathfinder-peru.org/site/DocServer/Plan_Regional_Concertado_de_Salud_Huánuco.pdf?docID=381, access September 2, 2007
[3] Dirección Regional de Salud de Pasco. Plan Regional Concertado de Salud de Pasco 2005-2015. Available in: http://www.diresapasco.gob.pe/crs/prcs%20edicion1.pdf, access September 2, 2007
[4] Consejo Regional de Salud de Junín. Plan Regional Concertado de Salud Junín 2005-2012. Available in: http://www.diresajunin.gob.pe/crsj/planconcertado.pdf, access September 2, 2007
[5] Gobierno Regional de La Libertad. Salud: La Voz de La Libertad. Plan Participativo Regional de Salud de La Libertad 2006-2010. Trujillo (Perú). Available in: http://www.praes.org/docs-pdf/publica/2t0.pdf, access September 2, 2007
[6] Gobierno Regional de Lambayeque. Para Vivir Mejor. Plan Participativo Regional de Salud de Lambayeque 2005-2010. Chiclayo (Perú). Available in: http://www.praes.org/docs-pdf/publica/2p1.pdf , access September 2, 2007
[7] Gobierno Regional de Ucayali. Salud para todos los ucayalinos. Plan Participativo Regional de Ucayali. Pucallpa (Perú). Available in: http://www.praes.org/docs-pdf/publica/2p2.pdf , access September 2, 2007
[8] Gobierno Regional de San Martín. Plan Participativo Regional de Salud de San Martín 2007-2011. Available in: http://www.praes.org/docs-pdf/publica/pprsm.pdf, access September 2, 2007
[9] WHO (2005). Brazil and Peru pool views of their people to set health agenda. Bulletin of the World Health Organization; 83(7):485-486
[10] Gobierno Regional de Lambayeque (2005). Consulta Ciudadana en Lambayeque. El Mandato Ciudadano en Salud. Chiclayo (Perú): Gobierno Regional de Lambayeque, Consejo Regional de Salud. Available in: http://www.praes.org/docs-pdf/publica/2o.pdf, access September 2, 2007
[11] Región La Libertad. Acuerdo de Partidos Políticos en Salud de La Libertad, 2006. Available in: http://www.praes.org/docs-pdf/arll.pdf, access September 3, 2007
[12] Región Lambayeque, Acuerdo de Partidos Políticos en Salud de Lambayeque, 2006. Available in: http://www.praes.org/docs-pdf/arll.pdf, September 3, 2007
[13] Región San Martín. Acuerdo de Partidos Políticos en Salud de San Martín, 2006. Available in: http://www.praes.org/docs-pdf/arsm.pdf, access September 3, 2007
[14] Región Ucayali. Acuerdo de Partidos Políticos en Salud de Ucayali, 2006. Available in: http://www.praes.org/docs-pdf/aru.pdf, access September 3, 2007