Recorded presentation

Laura C. Altobelli, DrPH, MPH, Future Generations, Av. Andres Reyes 165 - E, San Isidro, Lima 18, Peru, 511-442-5235, laura@future.org, Ana Sovero-Utrilla, MS, MPH, Consultant, Calle 2-174, Urb. Carabayllo, Lima, Peru, and Ricardo Diaz-Romero, MD, MHA, Futuras Generaciones Peru, Av. Andres Reyes 165 - E, San Isidro, Lima 18, Peru.

The Peru Ministry of Health has for 10 years increasingly implemented a system for financing and administering primary health care (PHC) co-managed by elected community members called CLAS Associations. The Shared Administration Program and CLAS now cover 35 percent of all PHC facilities in Peru. CLAS are legally registered as private non-profit civil associations, and function within a strict regulatory system receiving transfers of public funds for administration of PHC services. Among many advantages of this system, human resource management is improved. Also, local decisions on discretionary income generally lead to re-investment in the health facility and improved quality of services. Previous studies show benefits of the CLAS system on population coverage, equity, and access to medicines. To determine the cost-efficiency of CLAS-administered PHC services over those administered traditionally, we conducted a study of all CLAS and non-CLAS in three provincial departments of Peru. Data were collected from regional health offices on income from all sources (transfers, reimbursements, and fees-for-services), number of curative and preventive services provided, and total population in the jurisdiction of each facility. More health service activities were provided per inhabitant by CLAS versus non-CLAS in both urban and rural areas. Urban CLAS had significantly lower income per service provided versus urban non-CLAS, showing better cost-efficiency. Income was significantly less in all rural facilities as compared with urban. However, rural CLAS had higher income than non-CLAS, explained by greater success of CLAS in affiliating rural populations in the Integrated Health Insurance Program.

Learning Objectives:

• 1. Describe the Shared Administration Program in Peru and identify its benefits to quality and equity of primary health care services.
• 2. Identify study results on the improved cost-efficiency of primary health care services from decentralization of health financing to the community level.
• 3. Describe the mechanisms through which community-controlled financing of primary health care improves cost-efficiency of primary health care services.

Keywords: Health Care Reform, Developing Countries

Related Web page: www.future.org

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation