CODIMUSAS NOW: ALTERNATIVE HEALTH FOR PERUVIAN PEOPLE

CODIMUSAS NOW: ALTERNATIVE HEALTH FOR PERUVIAN PEOPLE

Ana Fernandez, Women DOTS Plus Health Promoters of Trujillo

Jose Otiniano, Association of People Living with HIV, La Libertad

Jorge Aguilar, Lutheran Church representative for Northern Peru

Pedro Quiñones, Human Rights and Health Institute

Global Coalition of Tuberculosis Activists (GCTA) of The Americas, Peruvian committee

DOCUMENT ON THE EVALUATION OF ACTIVISTS  ON THE INSTALATION OF CODIMUSA Huanchaco, Trujillo. March 2015.

TO BE PRESENTED TO THE MUNICIPALITY OF TRUJILLO, AND THE REGIONAL GOVERNMENT OF LA LIBERTAD, for discussion  of the Regional Strategic Health Plan – COREMUSA La Libertad

I. Presentation

Each and everyone of us  look for a good job to "live well", but as well we could live better.

Educational institutions are full but are supplied; and people  are not left in the worst "illiteracy", but live well.

Health institutions often do not supply services; an end  all we know.

Then you might consider doing something we can do with both education and health; and there is a bit to specific diseases: TB and HIV / AIDS.

II.- The tuberculosis (TB)

TB is a preventable and curable infectious disease transmitted through the air. Patients whose lungs harboring tubercle bacilli can infect others when they cough.

III HIV / AIDS

Elementary  is knowing what HIV is: Human Immunodeficiency Virus. Acquired Immunodeficiency Syndrome (AIDS) is the final stage of HIV infection.

IV TB statístics

1.Three million deaths per year.

2. Four or five million new cases occur each year

3. Ten million patients expectorating bacilli infection spread around TB.

4. One third of the world population (2 billion people) is infected with TB bacilli.

5. The victims come from countries where most are neither diagnosed nor treated properly.

V. Some statistics of HIV / AIDS

1. There are about 35 million people with HIV

2. There are 2.5 million children living with HIV

3. In Peru there are about 80,000 HIV patients and  also reported 30,000 with AIDS.

V I PERUVIAN GOVERNMENT VI ALTERNATIVES.

As a government alternative, the Peruvian government in 2004, articulated a space with no little struggle: State institutions , Affected  persons and Civil Society representatives, to fight together against HIV / AIDS and  TB.

This space  articulated is Multisectoral National Coordinator of Health - CONAMUSA.

VII REGIONAL ALTERNATIVES

The Regional Government of La Libertad, taking the national initiative of the Peruvian State to the constitution of CONAMUSA dared to organize  the Regional  Multisectoral Coordinator of  Health - COREMUSA-LL.

This regional approach has enabled health for cases of TB and HIV can approach a bit, but still a long.

However, internationally, for Latin America and particularly for Peru, corruption as the main obstacle is recognized, and in that sense in THE ECONOMIST - Bello writes that in regional and local elections in Peru on October 5, 2014 is a testimony of cynicism about politicians Peruvians, especially local.

Of the 25 outgoing, 22 regional presidents are being investigated for embezzlement. Three are in jail awaiting trial; the fourth is a fugitive. Widespread corruption in sub-national governments is partly a result of the erroneous way in which Peru has decentralized power. From the time of the Spanish viceroys who ruled half of South America from Lima, Peru has been excessively centralized.

Decentralization followed a trend in new and restored democracies in Latin America. But in practice, argues Alberto Vergara, political scientist, says that  far from solving the country's problems, decentralization has worsened because national leaders washed their hands out of the problem .

VIII.- ALTERNATIVE IN PERSPECTIVE

Health is a matter of care and staff trained and professionalized, but prevention can help a lot and for that education is key; and  the national and regional are far from the situation .

In this perspective we dream that a particular social articulation will be for better health and can be a space close to all.

So envisioned t the constitution of the Multisectoral District Health Coordinator "CODIMUSA" in each corner Peruvian district  could become the social space of health prevention.

Even these spaces could get together and  seek comprehensive health, ie not only look TB and HIV / AIDS; but all cases are sufficient and necessary for the welfare of all.

It is critical to understand that the constitution of CODIMUSAs is strictly a matter of political will of governments and health institutions.

IX.- PHILOSOPHY OF CONSTITUTION OF CODIMUSAs

Andrea Cornwall and John Gaventa in Closing the Gap, Participation and Accountability observe that worldwide, a growing crisis of legitimacy  characterizes the relationship between citizens and the institutions that affect their lives. In both North and South, people speak of disillusionment with the government, based on concerns about corruption, lack of response to the needs of the poor and the absence of a sense of connection with elected officials and bureaucrats (Commonwealth Foundation1999).

As we re-examine the traditional forms of political representation, the mechanisms of direct democracy are becoming more and more recourse for citizens to play an active role in decisions that affect their lives. In this context, questions of how citizens - especially the poor - express their voice and how institutions  respond and ensure accountability have become paramount.

In our country it highly works the idiosyncrasy of " Law & fashion”:

1. If we "start", a rule setting CODIMUSAs we have secured 50% chance, because that's how we function if innate.

2. And if we spread the CODIMUSAs for help in curing health, and in those  spaces we work to prevent future diseases, we have 49% more likely.

3. The 1% missing is what I call: Will someone will,  that's mysticism. Assure you that we will find men and women with Mystics, and with  minimal information they will run these districts joint spaces .

X. STRATEGIES OF CONSTITUTION OF CODIMUSAs

1. Find men and women interested in the health of your locality. This is auto call.

"Important to prepare a fit and healthy ruling class, education has had in Peru ... the fundamental defect in its incongruncia the needs of the evolution of the national economy and its neglect of the existence of the indigenous factor. Ie the same flaw found in almost all the political process of the republic ".

Process for Public Instruction 7 Testing Interpretation of the Peruvian Reality.

Jose Carlos Mariategui. Editorial AMAUTA.1925.

2. Touch the gates of the bone, either State, Business, affected or civil society to take the first step: "Sell the idea" CODIMUSA.

In health systems there are problems such as inadequate and overly centralized administrative systems, excessive concentration of resources in physical infrastructure, high-cost technologies and isolated measures to address specific risks and inadequate coordination between levels of care, with related institutions and other sectors whose activities affect health conditions.

To strengthen health systems have identified several aspects. In health systems, all the elements and actions should facilitate particiapacion entire social community in decisions and actions of health.

Development and Strengthening of Local Health Systems. 1989. September 1990. November 1990. WHO / PAHO.

3. Disseminate the articulation  via social networks to explain the  need CODIMUSA.

We must ask ourselves:

What stage of organization is the Community  in ?

As organizations change their strategies, eventually modify their structures.

- In the first phase of rapid growth an informal structure is presented, with little specialization (everyone throws his hands in order to do what is needed)

- In the second phase, the organization will professionalized as presented the need for systems and specialists,

- When these organizations hold functions, communication problems occur. The goals of the various  functions that no specific cause is responsible for the needs of a particular product or client.

The problem can be tackled including persons responsible for coordinating the activities of each work (project leaders).

BOWMAN, C. Strategy for the Action. Journal of Management Psicology. Vol.14, N7-8. University Press, USA.

A comprehensive integration, which presupposes be fruitful, including health services, institutions in other sectors and the population is possible. Avoid physical and socio-cultural insurmountable distances.

4. Achieve the  engagement of  the respective authority, whether Town or health centers, to take the first step and involve other actors in the creation of this space.

If the complexity of the problem is beyond the capacity of health services does the contest of the population and their organizations, so com or institutions in other sectors is considered needed?

What would do if there are inconsistencies between health staff and community leaders  and sectoral institutions, on the contributions of each group to consultation process ?

Does the delivered information to the public In particular, are important guides for reflection to review the evolution and mistakes, as well as progress ?

Do community agents are community leaders or individual members involved in some kind of work in the Health services?

Are the Health Committees comprised of a set of grassroots organizations that fight for social demands, civic and human rights?

Have there been any operational research that have been discussed with the organizations and activities whose results are translated eb health and development

5. Adding more CODIMUSA CODIMUSA effect that's the basis of COREMUSA.

As Whitty et al (1) note, there is scope for greater public participation to influence decision-making and service delivery in the health sector. In several countries, the last 20 years have seen an explosion in public participation in the governance of health systems, governance of health research and health promotion.

In a recent article, Evans tracked the evolution of public and patient involvement in research in the UK through an analysis of policy documents (2). Mockford like et al. (3), he found public participation and the patient was deeply embedded in the structures of funding  research, but concluded that involvement  ran ahead of the creation of an evidence base for participation.

More recently, researchers have tried to build the evidence base and establish what might be the optimal approaches for formalized participation (4) .Whitty and colleagues provides an interesting comparison between two approaches: discrete choice experiments and citizen juries .

The authors go on to argue that the combination of quantitative (discrete choice experiments) with the more qualitative (citizen juries) can "maximize the value of public participation in decision-making processes of health policy." Within research and health services, delivery for particpación, have made efforts to engage "genuine", as provided in (5) working however Arnstein said.