Recorded presentation

Midori M. De Habich, PHRplus-Peru, Antequera 777 Piso 8 San Isidro, Lima, Peru, 422 5544, mdehabich@phrplus.org.pe

Context and objectives: In 2002 the Government of Peru passed important laws on decentralization and 26 Regional Presidents were elected in early 2003. During this year, the Regional Governments have defined their organizational structure and the previously existing Regional Health Directorates, which were directly accountable to the Ministry of Health (MoH), will now be organizationally dependent on the Social Development Divisions of the Regional Governments. Additionally, a new law of Municipalities has also been passed, assigning competencies and functions in health to the provincial and district level municipalities. In this new and yet unclear institutional setting, the health sector will start its decentralization process in 2004. These new laws specify shared competencies and functions between the three tiers of government: National, regional and local. In order to clarify the responsibilities of each government level, a Peruvian Health Decentralization Framework was developed and applied.

Method: The Peruvian Health Decentralization Framework was designed linking 5 health reform knobs to 11 main health functions and 80 attributes. On this basis a consensus building process was conducted with: a) 50 experts on health functions; b) 100 key stakeholders from the National, Regional, Provincial and District levels, as well as from Citizen Organizations. This process laid the groundwork for decentralization of the health sector and provided information to establish: 1) accreditation criteria for the transference of competencies and functions to sub-national levels of government; 2) measurement of capability gaps and capacity building plans; and 3) definition of monitoring and evaluation indicators of the decentralization process

Learning Objectives: