Making Cities Work: Making Cities Work: Reproductive and Reproductive and

Environmental Health in Environmental Health in the Peruvian Andesthe Peruvian Andes

Delicia FerrandoDelicia Ferrando

American Public Health Association132nd Annual Meeting

Washington, D.C.November 7-11, 2004

Background:Peru’s Internal Armed Conflict: Internal Refugees and Deaths,

1980-2000Total Refugees: 460,920

Women 87% Peasants 70%

Total Deaths: 70,000 Men 80% Quechua-speaking 54% Education below

secondary school 70% Peasants 80%

Source:Peru´s Comission of Truth and Reconciliation. Chapter I. 2003

132nd Annual APHA Meeting, 2004

Internal Migration to Huancayo

132nd Annual APHA Meeting, 2004

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50,000 refugees displaced to Huancayo, settling in peri -urban areas surrounding the city.

The average family earns no more than 100 USD a month.

Living conditions rife with environmental and health problems, including overcrowding, lack of drinking water and sewage systems, high fertility rates, high incidence of untreated STIs, and lack of access to MCH services.

Women’s health among displaced communities

132nd Annual APHA Meeting, 2004

No access to reproductive health services

Large family size (7 to 10 members)

High incidence of unwanted pregnancies

High prevalence of clandestine abortions

Domestic violence is common (physical, psychological, sexual)

Living conditions Refugees settled

in an area used as a waste-dumping site.

It was common to throw garbage in the river or burn it in the street.

No access to drinking water or sewage systems.

Use of chemicals in surrounding fields contaminated the soil and water.

132nd Annual APHA Meeting, 2004

The Huancayo Project: Reproductive and Environmental

Health Education

132nd Annual APHA Meeting, 2004

Components:

Information Education and Communication (IEC) Activities

Promotional Activities and BCC

Reproductive and General Health Services

Community Mobilization

Partners The CATALYST Consortium is a global

reproductive health activity initiated in September 2000 by the Office of Population and Reproductive Health at USAID, and comprises 5 organizations: Pathfinder International, the Academy for Educational Development (AED), Center for Development and Population Activities (CEDPA), Meridian Group International, Inc., and PROFAMILIA/Colombia.

COOPERANDES is a Huancayo-based NGO that works with hard-to-reach and marginalized populations.

132nd Annual APHA Meeting, 2004

IEC Activities 26 Informative Sessions

were held, where 1,082 adolescents and 3,243 adults were reached with information on reproductive and environmental health.

4 Adolescent Fairs were organized.

44 workshops were held on RH/FP involving 1,428 attendees

Main messages include:

Personal hygiene, e.g. washing hands before eating and/or after using the bathroom

Basic reproductive health routines, e.g. encouraging annual Pap smears to prevent cervical cancer

Waste disposal, such as use of trash cans to store and transport garbage

Increase knowledge of and access to contraceptive services

132nd Annual APHA Meeting, 2004

IEC activities cont’d

Promotional Activities (BCC)

132nd Annual APHA Meeting, 2004

25 Wall Panels12 Murals11 Radio Broadcasts 14 TV Programs (68 hours)

Reproductive and General Health Services

Health Center La Esperanza:2,285 patients for RH care4,397 patients for general healthcareAchievementsContraceptive prevalence ratesFemale: increased from 15% to 45%Male: increased from 2% to 9%Prenatal care attendance increased from 10% to 16%Delivery care attendance increased from 9% to 31%Unwanted pregnancy decreased from 68%to 45%STI prevalence decreased from 90% to 44%132nd Annual APHA Meeting, 2004

Community Mobilization

132nd Annual APHA Meeting, 2004

26 “Action Fairs” were sponsored featuring mobile clinics at environmental and RH fairs involving over 1,000 attendees.

COOPERANDES employs community leaders and volunteers as community health “agents” to reach marginalized residents and refer them to RH/FP services, as well as inform the organization about emergency health situations.

132nd Annual APHA Meeting, 2004

Environmental Health 24 Environmental Health

fairs involving over 1,300 attendees

8 fairs held for water treatment, general environmental health and

domestic animal de-parasiting

Initiated campaign to reduce toxic car emissions through media

How They Live Now

132nd Annual APHA Meeting, 2004

Families use purified water. Their water canals are clean

and a new sewage system was installed partly financed by the community itself.

Negotiations with the municipality guaranteed turning a waste-dump area into a community park.

COOPERANDES Staff in“La Esperanza” Health Center

Community Health Promoter

La Esperanza contributes to COOPERANDES’ sustainability efforts in the peri-urban communities in Huancayo.

This clinic was initiated through the ALCANCE project funded by USAID 1998-2002

132nd Annual APHA Meeting, 2004

Conclusions Local NGOs can scale up successful projects

through creating links with national organizations and municipalities to improve the reproductive and environmental health of marginalized populations.

Community health agents are key in determining efficacy of mobile clinics, action fairs and outreach strategies.

Community activism and awareness are now appreciated as legitimate negotiating tools.

The project is now self-sustaining and COOPERANDES is scaling up in other peri-urban areas in Peru.

Thank you!!Pathfinder InternationalAlameda La Floresta 285

San BorjaLima, Peru

www.pathfind.orgWith funding from the United

States Department of International Aid