Dr. Arturo Hinostroza Atahualpa MINISTRY OF HEALTH Strengthening Public Health Capacity in Peru Rapid assessment at the subnational level: Decentralized

Dr. Arturo Hinostroza AtahualpaDr. Arturo Hinostroza AtahualpaMINISTRY OF HEALTH MINISTRY OF HEALTH

Strengthening Public Health Strengthening Public Health

Capacity in PeruCapacity in Peru Rapid assessment at the subnational level: Rapid assessment at the subnational level: Decentralized Health Care in the Regions ofDecentralized Health Care in the Regions of

Arequipa and CajamarcaArequipa and Cajamarca

VII REGIONAL FORUM - STRENGTHENING HEALTH VII REGIONAL FORUM - STRENGTHENING HEALTH SYSTEMS BASED ON PHCSYSTEMS BASED ON PHCQuito, 29-31 October 2007Quito, 29-31 October 2007

Implementation

RAPID ASSESSMENTRAPID ASSESSMENT

Beaglehole and Dal Poz define public health capacities as the Beaglehole and Dal Poz define public health capacities as the components necessary to perform public health actions and achieve components necessary to perform public health actions and achieve public health goals. They depend on the context of a specific country public health goals. They depend on the context of a specific country or region and to particular requirements to adequately meet the or region and to particular requirements to adequately meet the needs of the population. It is comprised of the following dimensions:needs of the population. It is comprised of the following dimensions:

Strengthening public health capacities requires knowing what those Strengthening public health capacities requires knowing what those capacities are, their status and what the gaps are that affect the capacities are, their status and what the gaps are that affect the performance of the Essential Public Health Functions in Peru at both performance of the Essential Public Health Functions in Peru at both the national and regional levels.the national and regional levels.

DIMENSIONS Public health workforce

Public health information systems

Public health technology

Organizational and Institutional capacity for public health

Financial resources for public health


In 2005 in Peru, a Performance Evaluation of the Essential Public In 2005 in Peru, a Performance Evaluation of the Essential Public Health Functions was conducted at the national level and in all Health Functions was conducted at the national level and in all regions.regions.

ESSENTIAL PUBLIC HEALTH FUNCTIONSRESULTS IN 2001 AND 2006

0,62

0,58

0,300,27

0,35

0,27

0,31

0,13

0,19

0,59

0,73

0,67 0,65

0,37

0,30

0,81

0,39

0,59

0,90

0,33

0,62

0,86

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

EPHF 1 EPHF 2 EPHF 3 EPHF 4 EPHF 5 EPHF 6 EPHF 7 EPHF 8 EPHF 9 EPHF 10 EPHF 11

EPHF 2001 EPHF 2006

Average NHA 200663%

Average NHA 200136%

Regional Average 200646%


Rapid Assessment of Public Health Capacity

This Rapid Assessment at the regional level in Peru is an opportunity This Rapid Assessment at the regional level in Peru is an opportunity to determine the status of public health capacity and its dimensions. To to determine the status of public health capacity and its dimensions. To help the Health Authority improve the performance of public health help the Health Authority improve the performance of public health functions and contribute to a sustained improvement in the health functions and contribute to a sustained improvement in the health system’s response capacity, a new vision of public health that is not system’s response capacity, a new vision of public health that is not reactive but proactive and prospective is required. reactive but proactive and prospective is required.

Peru is in the process of decentralizing the health sector, with regions Peru is in the process of decentralizing the health sector, with regions that perform both the steering and service delivery functions. The that perform both the steering and service delivery functions. The Regions of Cajamarca and Arequipa have implemented decentralization Regions of Cajamarca and Arequipa have implemented decentralization at the regional level. At the local level, Primary Health Care at the regional level. At the local level, Primary Health Care management functions have been transferred from the regional to the management functions have been transferred from the regional to the local level, specifically the provincial and/or district levels.local level, specifically the provincial and/or district levels.


– Interviews and Interviews and observationsobservations

– Structured GuideStructured Guide

METHODOLOGYMETHODOLOGY• The dimensions or elements of The dimensions or elements of

public health capacity are evaluated public health capacity are evaluated by the Regional Health Bureaus. by the Regional Health Bureaus.

• Using a structured guide, interviews Using a structured guide, interviews are conducted with key officials are conducted with key officials and personnel of the Regional and personnel of the Regional Health Bureau responsible for the Health Bureau responsible for the execution of the main activities in execution of the main activities in health—for example, the Director health—for example, the Director General; the Director of Health General; the Director of Health Services; the Director of Human Services; the Director of Human Resources; and the Director of Resources; and the Director of Administration. Administration.


Structured GuideStructured GuideA Structured Guide has been prepared that allows for a rapid assessment A Structured Guide has been prepared that allows for a rapid assessment of the status of public health capacities. In order to assess the of the status of public health capacities. In order to assess the dimensions of public health capacity, the dimensions are first dimensions of public health capacity, the dimensions are first disaggregated into their basic characteristics or features. Then they are disaggregated into their basic characteristics or features. Then they are disaggregated by attributes related to these basic characteristics. disaggregated by attributes related to these basic characteristics.

Next, these attributes are scored according to their availability on a scale Next, these attributes are scored according to their availability on a scale of 0, 1, and 2. The highest value is 2, which indicates the presence of the of 0, 1, and 2. The highest value is 2, which indicates the presence of the particular operational attribute. These scores are then totaled to arrive at particular operational attribute. These scores are then totaled to arrive at a score for that dimension of public health capacity. a score for that dimension of public health capacity.

0= has no information or does not meet criteria1= there is partial information or it cannot be sustained by evidence2= has the information


Structured GuideStructured Guide ELEMENTS Basic Characteristics

1. Availability of Public Health jobs 2. Distribution of Public Health workers 3. Qualifications of the Public Health Workforce 4. Workers in charge of key public health processes

1

Public Health Workforce

5. Mechanisms for upgrading public health personnel 1. Scope of Regional Health Information System 2 Sectoral Integration of the Regional Health Information System 3. Transparency of the Sectoral Health Information System 4. Qualifications of the expert support for the information system 5. Qualifications of the tech support for the information system

2

Public Health Information

Systems

6. Mechanisms for strengthening the sectoral health information system 1. Availability of Public Health technology 2. Evaluation of available public health technology 3. Safety of principle public health technologies 4. Qualification of expert and tech support for public health technology

3

Public HealthTechnologies

5. Mechanisms for strengthening public health technology 1. Public Health Authority

2. Codification of Laws and Regulations on Public Health 3. Regional Public Health Policy and Planning 4. Decentralization of Health Care Management 5. Health Services Management

4

Organizational and Institutional Public Health Capacities

6. Mechanisms for strengthening organizational and institutional capacities in public health 1. Investment in financing 2. Progressive Public Health spending 3. Multi-year scheduling of financing and investment in public health 4. Transparency and social control over public health spending

5

Public Health Financial Resources

5. Mechanisms for strengthening financing and investment in public health


Structured GuideStructured Guide

Operational attributes have been defined as the standard for each Operational attributes have been defined as the standard for each capacity. Then, capacities are evaluated for specific dimensions, and this capacity. Then, capacities are evaluated for specific dimensions, and this reveals any gaps in public health capacity for those dimensions. reveals any gaps in public health capacity for those dimensions.

Capacity Standards Capacity Standards

EXECUTION OF PUBLIC HEALTH CAPACITIES (482) Reflecting proper execution of the individual components of public health capacity

ELEMENTS MAX. VALUE

Public Health Workforce 104 Public Health Information System 86

Public Health Technology 74

Organizational and Institutional Capacities in Public Health 160 Financial Resources for Public Health 58

TOTAL 482

Comparative AnalysisComparative Analysis

Quick Evaluation in the RegionsQuick Evaluation in the Regions

Cajamarca Arequipa

Res

ult

s O

bta

ined

Res

ult

s O

bta

ined

37.50% 37.50%

10.00%

56.06%

0.00%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%


87.50% 87.50%

70.00%

63.64%

33.33%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%


Public Health Workforce for both regions Cajamarca y Arequipa. Year 2007

Public Health Workforce CAJAMARCA AREQUIPA Availability of public health jobs. 37.50% 87.50% Distribution of public health personnel 37.50% 87.50% Qualifications of the public health workforce 10.00% 70.00% Personnel skilled in public health processes 56.06% 63.64% Mechanisms for strengthening public health personnel 0.00% 33.33% REGIONAL AVERAGE 42.31% 64.42%



Cajamarca Arequipa

Res

ult

s O

bta

ined

Res

ult

s O

bta

ined

72.22%

33.33%

83.33%

65.38%

50.00%

0.00%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Public Health Information System

83.33%

45.83%

100.00%

73.08%

33.33%

0.00%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Public Health Information System

Public Health Information Systems for the Regions of Cajamarca and Arequipa . Year 2007

CHARACTERISTICS CAJAMARCA AREQUIPA 1 Scope of Regional Health Information Systems 72.22% 83.33% 2 Sectoral Integration of the Regional Health Information System 33.33% 45.83% 3 Transparency of the Sectoral Health Information System 83.33% 100.00% 4 Qualifications of Expert Support for the Information System 65.38% 73.08% 5 Qualifications for Tech Support for the Information System 50.00% 33.33% 6 Mechanisms for Strengthening the Sectoral Public Health Information System 0.00% 0.00% REGIONAL AVERAGE 57.50% 66.25%



Cajamarca Arequipa

Res

ult

s O

bta

ined

Res

ult

s O

bta

ined

16.67%11.54%

30.00%

7.14%0.00%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Public Health Technology

83.33%

42.31%

20.00%

42.86%

0.00%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Public Health Technology

Public Health Technology in the Regions of Cajamarca and Arequipa

CHARACTERISTICS CAJAMARCA AREQUIPA 1 Availability of Public Health Technologies 16.67% 83.33% 2 Evaluation of Available Public Health Technologies 11.54% 42.31% 3 Safety of Principle Public Health Technologies 30.00% 20.00% 4 Qualifications of Expert and Tech Support for Public Health Technology 7.14% 42.86% 5 Mechanisms for strengthening the Public Health Technological Management System 0.00% 0.00%

REGIONAL AVERAGE 13.51% 45.95%



Cajamarca Arequipa

Res

ult

s O

bta

ined

Res

ult

s O

bta

ined

50.00%

75.00%

11.54%

63.51%

86.67%

0.00%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%


91.67%

100.00%

65.38%

89.19%

96.67%

16.67%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%


Organizational and Institutional Public HealthCapacity in the Regions of Cajamarca and Arequipa. Year 2007

CHARACTERISTICS CAJAMARCA AREQUIPA 1 Public Health Authority 50.00% 91.67% 2 Codification of Laws and Regulations in Public Health 75.00% 100.00% 3 Regional Public Health Policy and Planning 11.54% 65.38% 4 Decentralized Health Care Management 63.51% 89.19% 5 Health Services Management 86.67% 96.67%

6 Mechanisms for strengthening organizational and institutional capacities in public health 0.00% 16.67%




Cajamarca Arequipa

Res

ult

s O

bta

ined

Res

ult

s O

bta

ined

50.00%45.83%

66.67%

30.00%

0.00%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Financing and Investment in Public Health

58.33% 58.33%66.67%

60.00%

0.00%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Financing and Investment in Public Health

Financial Resources for Public Health Regions of Cajamarca and Arequipa. Year 2007

CHARACTERISTICS CAJAMARCA AREQUIPA

1 Investment in Financing 50.00% 58.33%

2 Progressive Public Health Spending 45.83% 58.33%

3 Transparency and Social Control over Public Health Spending 66.67% 66.67%

4 Multi-year Scheduling of Financing and Investment in Public Health 30.00% 60.00%

5 Mechanisms for Strengthening Financing and Investment in Public Health 0.00% 0.00%


Comparative Analysis Comparative Analysis Public Health CapacitiesPublic Health Capacities


Cajamarca Arequipa

Res

ult

s O

bta

ined

Res

ult

s O

bta

ined

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

Total Observed

Public Health Capacities

PUBLIC HEALTH WORKFORCE

PUBLIC HEALTHINFORMATION

SYSTEM PUBLIC HEALTHTECHNOLOGY

ORGANIZATIONALAND

INSTITUTIONALCAPACITIES IN

PUBLIC HEALTH

FINANCIAL RESOURCES FORPUBLIC HEALTH

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

Total Observed




SYSTEM

PUBLIC HEALTHTECHNOLOGY

ORGANIZATIONALAND

INSTITUTIONALCAPACITIES IN

PUBLIC HEALTH FINANCIAL RESOURCES FORPUBLIC HEALTH

Execution of Public Health Capacity at the Regional LevelIn the Regions of Arequipa and Cajamarca. Year 2007

Cajamarca Arequipa

ELEMENTS

Public Health Workforce 0.4231 0.6442 Public Health Information System 0.5349 0.6163 Public Health Technology 0.1351 0.4595 Organizational and Institutional Capacity in Public Health 0.5688 0.8500 Financial Resources for Public Health 0.4138 0.5345 TOTAL 0.4461 0.6660

Public Health Capacity Index


Comparative Analysis Comparative Analysis Public Health CapacitiesPublic Health Capacities

Results of the Quick EvaluationResults of the Quick Evaluation

Cajamarca Arequipa

Res

ult

s O

bta

ined

Res

ult

s O

bta

ined

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

Total Observed


PUBLIC HEALTHWORKFORCE


SYSTEMPUBLIC HEALTHTECHNOLOGY

ORGANIZATIONALAND

INSTITUTIONALCAPACITY IN

PUBLIC HEALTH FINANCIAL RESOURCES FORPUBLIC HEALTH

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

Total Observed




SYSTEM


ORGANIZATIONALAND


PUBLIC HEALTH


Execution of Public Health Capacities at the Regional Levelin the Regions of Arequipa and Cajamarca. Year 2007

Cajamarca Arequipa

ELEMENTS

Public Health Workforce 0.4231 0.6442 Public Health Information System 0.5349 0.6163 Public Health Technology 0.1351 0.4595 Organizational and Institutional Capacities in Public Health 0.5688 0.8500 Financial Resources for Public Health 0.4138 0.5345 TOTAL 0.4461 0.6660


Public HealthCapacity Index

Regional Analysis Regional Analysis Cajamarca RegionCajamarca Region

Results of the Quick EvaluationResults of the Quick EvaluationR

esu

lts

Ob

tain

edR

esu

lts

Ob

tain

ed



SYTEM

PUBLIC HEALTHTECNOLOGY

ORGANIZATIONALAND


PUBLIC HEALTH

FINANCIAL RESOURCES FOR PUBLIC HEALTH

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

Total Observed


Public Health Capacity Index Cajamarca Region. Year 2007

ELEMENTS Total Observed

Total Expected

Public Health Workforce 44 104 0.4231 Public Health Information System 46 86 0.5349 Public Health Technology 10 74 0.1351 Organizational and Institutional Capacities in Public Health 91 160 0.5688 Financial Resources for Public Health 24 58 0.4138 TOTAL 215 482 0.4461


Comparative Analysis of Cajamarca’s Comparative Analysis of Cajamarca’s Public Health Capacities and Essential Public Health Capacities and Essential

Public Health FunctionsPublic Health Functions




SYSTEM


ORGANIZATIONALAND


PUBLIC HEALTH

FINANCIAL RESOURCES FOR PUBLIC HEALTH

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

Total Observed

Public Health CapacityEVALUATION OF THE EXECUTION OF ESSENTIAL PUBLIC HEALTH FUNCTIONS

CAJAMARCA REGION - 2005

0.56

0.39

0.160.21

0.46

0.17

0.29

0.20

0.43

0.67

0.36

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

EP

HF

1

EP

HF

2

EP

HF

3

EP

HF

4

EP

HF

5

EP

HF

6

EP

HF

7

EP

HF

8

EP

HF

9

EP

HF

10

EP

HF

11

EPHF 2006 Standard( 0.50 ) Regional Result ( 0.35 )

Regional Capacities Regional Capacities Arequipa RegionArequipa Region

Results of the Quick EvaluationResults of the Quick EvaluationR

esu

lts

Ob

tain

edR

esu

lts

Ob

tain

ed



SYSTEM PUBLIC HEALTH

TECNOLOGY

ORGANIZATIONAL AND


PUBLIC HEALTH FINANCIAL RESOURCES

FOR PUBLIC HEALTH

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

Total Observed

Public Health Capacity

PUBLIC HEALTH CAPACITY INDEX FOR THE AREQUIPA REGION

ELEMENTS

Public Health Workforce 67 104 0.6442 Public Health Information System 53 86 0.6163 Public Health Technology 34 74 0.4595 Organizational and Institutional Capacities in Public Health 136 160 0.8500 Financial Resources for Public Health 31 58 0.5345 TOTAL 321 482 0.6660

PUBLIC HEALTHCAPACITY INDEX

TotalObserved

Total Expected

Comparative Analysis of Arequipa’s Comparative Analysis of Arequipa’s Public Health Capacities and Essential Public Health Capacities and Essential

Public Health FunctionsPublic Health Functions




SYSTEM


ORGANIZATIONALAND


PUBLIC HEALTH


0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

Total Observed

Public Health CapacityEVALUATION OF EXECUTION OF ESSENTIAL PUBLIC HEALTH FUNCTIONS

AREQUIPA REGION - 2005

0.81

0.380.42

0.20

0.26

0.460.48

0.74 0.74

0.55

0.72

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

EP

HF

1

EP

HF

2

EP

HF

3

EP

HF

4

EP

HF

5

EP

HF

6

EP

HF

7

EP

HF

8

EP

HF

9

EP

HF

10

EP

HF

11

EPHF 2006 Standard( 0. 50 ) Regional Result ( 0.52 )

This study provides the opportunity to measure the different degrees of This study provides the opportunity to measure the different degrees of development in public health capacity. This study found that the instrument development in public health capacity. This study found that the instrument used allowed the establishment of a baseline for public health capacity and its used allowed the establishment of a baseline for public health capacity and its five elements. It is a tool that can identify and bridge gaps in capabilities. In five elements. It is a tool that can identify and bridge gaps in capabilities. In most cases, these gaps can be corrected by improving the decentralized most cases, these gaps can be corrected by improving the decentralized management of health services. management of health services.

Through a precise definition of the main attributes of these elements, we have Through a precise definition of the main attributes of these elements, we have been able to construct an index to measure public health capacity, which we been able to construct an index to measure public health capacity, which we have called the have called the Public Health Capacity Index.Public Health Capacity Index. This index makes it possible for This index makes it possible for us to rapidly assess the level and degree of development in public health us to rapidly assess the level and degree of development in public health organizations. organizations.

The comparative analysis has, in turn, revealed the differences in health The comparative analysis has, in turn, revealed the differences in health

management among various organizations, which has made it possible to management among various organizations, which has made it possible to establish a path to follow and a series of management plans that will contribute establish a path to follow and a series of management plans that will contribute to the development of public health organizations.to the development of public health organizations.

Conclusions drawn from the Rapid AssessmentConclusions drawn from the Rapid AssessmentAT THE METHODOLOGICAL LEVELAT THE METHODOLOGICAL LEVEL

The Arequipa Region shows better public health capacity and also reveals a higher level of development than the Cajamarca Region. This is evident in the better organization and cohesion of Arequipa’s regional health authority, as opposed to Cajamarca’s, which is limited by the recent change of authorities at the Regional Health Bureau.

The Cajamarca Region has low levels of development in the availability and distribution of public health personnel, which bears no relation to the real needs of the health management organizations or public health needs in the region. This low level of development is correlated with the poor qualifications of the personnel working in public health in the case of Cajamarca; conversely, Arequipa has one of the highest levels, expressed through the presence of plans and programs that guide the public health training processes.

This situation improves when we consider the personnel responsible for the principal public

health processes and activities, and those charged with the important responsibility of ensuring the capacity to respond to regional public health problems. However, this is part of a reactive approach, and it is not focused on strengthening the public health workforce in this region. It should be noted that the Regional Health Management Office for Arequipa bases several of its interventions on the improvements in the 2005 EPHF. Furthermore, it is internally a single structure with the health networks, as opposed to Cajamarca which continues to be fragmented into four subregional bureaus with different policies, plans and programs, and has kept only the regulatory unit.

Conclusions drawn from the Rapid AssessmentConclusions drawn from the Rapid AssessmentPUBLIC HEALTHPUBLIC HEALTH WORKFORCEWORKFORCE

Both Regional Healthcare Bureaus have a medium level of development, although this is an institutional and not a sectoral characteristic. The information system has a broad base and several information subsystems, which allows for greater availability of information, as it is collected from a haphazard system that is internally and sectorally fragmented. These subsystems are not integrated at all, which means that only part of the information related to goals and health outcomes is ever collected. A similar situation with respect to high performance was found in the transparency of the information system. No mechanisms have been found that help strengthen this capacity.

It should be pointed out that the Arequipa Regional Healthcare Bureau, called the Regional Health Management Office, bases several of its interventions on improvements in the 2005 EPHF.

However, if we consider the issue from the standpoint of available resources,

we find that the Cajamarca Region is the more inefficient in allocating the financial resources it receives under the Mining Rule, and it does not invest enough in IT systems hardware through public investment.

Conclusions drawn from the Rapid AssessmentConclusions drawn from the Rapid AssessmentPUBLIC HEALTHPUBLIC HEALTH INFORMATION SYSTEMSINFORMATION SYSTEMS

Capacity in the two regions remains low: the Arequipa Region is at a medium-low level, and Cajamarca, at a very low level. This can be explained in part by the perception in Cajamarca that technology means only material or tangible technologies, resulting in the neglect of technologies based on models, methods, and forms of health intervention. This reveals an instrumental perception, that is, use of technology without considering whether it meets a need or its ability to improve the level of health care in the region. Both regions make no effort with regard to mechanisms intended to strengthen a technology system for public health management.

The Arequipa Region has the more integrated approach to technology, which demonstrates a marked superiority, despite the fact that the occurrence of adverse events or technology failures is higher in Arequipa.

This seems to be a problem of perspective, approach, and prioritization of technology, that

comes from the Ministry of Health’s central offices and is expressed in poor performance in cost-effectiveness evaluations of the principal technologies, since this type of analysis is not done except in exceptional situations with respect to drugs and raw materials and quality control of public health laboratories.

Conclusions drawn from the Rapid AssessmentConclusions drawn from the Rapid AssessmentPUBLIC HEALTH TECHNOLOGIESPUBLIC HEALTH TECHNOLOGIES

The capacity of the Arequipa Region is greater than that of Cajamarca, although in this case Cajamarca’s level is still high. The differences are based on governance and the degree of cohesion in the regional authority. In Cajamarca, we find clear differences between the Regional Government and the Regional Bureau. For the moment, these differences have been resolved through the intervention of the regional courts, which have replaced the former director of the Regional Health Bureau.

The exercise of health authority in the region also rests on the legitimacy and cohesion of the regional government, which means that, although governance has improved, it has not gone hand in hand with the health leadership in either the sector or the network structure itself. In Cajamarca, there is a lower degree of health management capacity, and the strategic planning and health intervention processes are less effective.

The Arequipa Region is trying to strengthen the public health system’s organizational

capacity, especially in the performance of essential public health functions. It has superior performance in all aspects; and particularly stands out in Governance and Policy Planning in public health.

These entities present two levels of organizational development, with the Arequipa

Regional Management Office being the more uniform and advanced of the two. Both performed well in Regulation, Decentralized Health Management, and Services Management; and both performed poorly in the implementation of mechanisms aimed at strengthening organizational capacity.

Conclusions drawn from the Rapid AssessmentConclusions drawn from the Rapid AssessmentORGANIZATIONAL AND INSTITUTIONAL CAPACITYORGANIZATIONAL AND INSTITUTIONAL CAPACITY

The level of development of financial resources for public health is fair, but in the case of Arequipa, we can clearly see better utilization of public resources. In fact, Cajamarca has performed poorly in multi-year programming and public investment, despite having additional resources as a result of the Mining Rule. Neither region has mechanisms in place to increase the availability of workers able to improve cost-effectiveness or to design public investment projects intended not only to improve cost-effectiveness but to boost the other capacities described above.

Information on sectoral entities such as ESSALUD and Sanidad has not been collected, and there is limited coordinated action on the delivery and supply of materials. The Regional Healthcare Management Office for Arequipa has begun to develop planning and specific goals for spending by essential public health function. Even though the two regions promote social control and accountability in healthcare, there are few grassroots organizations.

Conclusions drawn from the Rapid AssessmentConclusions drawn from the Rapid AssessmentTHE LEVEL OF DEVELOPMENT OF FINANCIAL RESOURCESTHE LEVEL OF DEVELOPMENT OF FINANCIAL RESOURCES

The two regions have revealed two different, intermediate levels for the exercise of public health capacities. Arequipa scored medium-high, and Cajamarca was medium-low.

As we can see, the Arequipa Region presents a medium-high level of development for all elements. Arequipa has a higher level of development in organizational and institutional public health capabilities, which are affected by problems of a political nature such as those that occur in the Cajamarca Region. In all aspects, the Regional Health Management Office of Arequipa was superior.

The Arequipa Region has a more highly developed approach to public health, allowing it to analyze its actual situation more clearly, which in turn can lead to better use of its financial resources. This contributes to the fact that the degree of development is more uniform in the case of Arequipa.

Both regions have a similar development structure as far as their information system and

financial resources are concerned; at the same time, there is little development of public health technologies, although Arequipa is still at a different level.

Conclusions drawn from the Rapid AssessmentConclusions drawn from the Rapid Assessment EXERCISE OF PUBLIC HEALTH CAPACITY: PERFORMANCEEXERCISE OF PUBLIC HEALTH CAPACITY: PERFORMANCE

ChallengesChallenges

Institutionalizing public health capacities as a tool for managing the performance of the Regional Health Authority, and for using the gaps as projects for change. This will help strengthen public health capacity to improve the performance of the Regional Health Authority.

Continuing the rapid assessment in order to provide a baseline for the execution of Public Health Capacity in the RHA. Thoroughly analyzing the results for the regions to improve outcomes of this short- and medium-term evaluation.

Providing technical support to consolidate the use of the PASC measurement instrument at the regional level. This will makes the initial experiences available as input for improving the RHA’s performance.

Refocusing cooperation efforts on the development and strengthening of Public Health Capacity, prioritizing regions with lower levels of performance.

Documents

Dr. Arturo Hinostroza Atahualpa MINISTRY OF HEALTH Strengthening Public Health Capacity in Peru Rapid assessment at the subnational level: Decentralized