Peru: Making people’s voices heard in health care provision

Eugenia Itme, 53, was trained by CARE to be a citizen monitor of the health post outside Ayaviri, Peru. She ensures quality care and helps resolve disputes.

Peru has the second highest maternal mortality rate in South America. On average, for every 100,000 women who give birth, 185 die in labour.

This rate is even higher in rural areas of the country, where health care can be difficult to access.

CARE's Participatory Voices project works to improve the health of poor and marginalised people in some of Peru's most deprived regions. It does so by encouraging people’s involvement in community organisations, providing technical assistance to design policies that benefit those living in poverty and by training citizens from traditionally marginalised groups to monitor heath services.

The women who monitor health services are known as 'Vigilantes'. Although they do not have medical training, they have been trained and accredited through the Participatory Voices project to monitor the quality of attention provided to patients by health services and how patients feel about the services provided.

For example, Vigilante, Primitiva Coharity Condori, has identified many cases in which healthcare providers made women feel uncomfortable, and this has led to greater understanding of the barriers to healthcare and dialogue between service users and providers.

Significant, sustainable change can only happen if the poor have much greater involvement in shaping health policies, practices and programmes, and in ensuring that what is agreed actually happens. - Dr. Ariel Frisancho, National Coordinator for Right to Health in Peru

The work of the Vigilantes has also led to the development of a set of national neo natal guidelines for health workers. Aida Flores Durrand became a Vigilante after giving birth in a hospital where she received poor service from the healthcare providers.

When I was going into labour, I thought I was lucky to be in the hospital. I was wrong, no one helped me and I was left to bleed in my bed. My husband could not enter my room and no one could speak to me in Quechua. I don’t want other women to go through what I did, and that is why I volunteer and do this job. - Aida Flores Durrand, Vigilante

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News and stories are provided by CARE staff working to support our emergency responses and long-term development programmes.