Making Cities Work: Reproductive and Environmental Health in the Peruvian Andes

1. Making Cities Work: Reproductive and Environmental Health in the Peruvian Andes Delicia Ferrando American Public Health Association 132nd Annual Meeting Washington, D.C. November 7-11, 2004

2. Background:Peru’s Internal Armed Conflict: Internal Refugees and Deaths, 1980-2000 Total 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

3. LIMA • JUNIN HUANCAYO Internal Migration to Huancayo • 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. OCEANO PACÍFICO 132nd Annual APHA Meeting, 2004

4. Women’s health among displaced communities • 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) 132nd Annual APHA Meeting, 2004

5. 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

6. The Huancayo Project: Reproductive and Environmental Health Education Components: • Information Education and Communication (IEC) Activities • Promotional Activities and BCC • Reproductive and General Health Services • Community Mobilization 132nd Annual APHA Meeting, 2004

7. Partners • TheCATALYST 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

8. 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

9. IEC activities cont’d 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

10. Promotional Activities (BCC) 25 Wall Panels 12 Murals 11 Radio Broadcasts 14 TV Programs (68 hours) 132nd Annual APHA Meeting, 2004

11. Reproductive and General Health Services Health Center La Esperanza: 2,285 patients for RH care 4,397 patients for general healthcare Achievements Contraceptive prevalence rates Female: 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

12. Community Mobilization • 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

13. 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 132nd Annual APHA Meeting, 2004

14. How They Live Now • 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. 132nd Annual APHA Meeting, 2004

15. 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

16. 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.

17. Thank you!! Pathfinder International Alameda La Floresta 285 San Borja Lima, Peru www.pathfind.org With funding from the United States Department of International Aid