Sexual and reproductive health care development and participation in Peru : the role of CLAS

This study aims to analyse policy and political processes at multiple levels, and examine the consequences for Sexual and Reproductive Health (SRH) care development arising from the engagement of a participatory movement in Peru. I used Associations of Local Community of Health Administration (CLAS) as a core organisation for Peru’s major participatory model at local level. With policy makers, NGOs, health workers and (potential) service users, I explored factors that facilitated/prevented women’s participation in decision-making mechanisms and health practices. I employed a case study and multi-disciplinary approach at national, regional and local levels, focused upon women from multiple aspects in Andean Peru. I studied rural, periurban CLAS and non-CLAS models to compare across the case studies. I conducted semi-structured in-depth interviews with 116 respondents, unstructured observation, and documentary analysis in 2004. My analytical frameworks focused upon: ‘policy content’, ‘context’, ‘actors’, ‘process’, ‘patterns of participation’, and ‘outcomes and impacts’. Political, economic, legal and technical were identified which reflected the stagnant state of the development of SRH and CLAS policies. The central policy focuses on a narrow sense of SRH care, and neglects Reproductive Tract Infections (RTIs). Central government’s weak political leadership and stewardship to CLAS policies reflected that personal leadership (e.g. regional health directors) can define the destiny of regional CLAS development. Facilitating factors were led by NGOs and mixed factors were led by donors. CLAS appeared to create favourable conditions/environment for women’s participation in the community. Local respondents in the CLAS system understood the importance of participation to solve local problems compared to their non-CLAS system counterparts. Nevertheless, women in CLAS model had no influence on changes of SRH agenda, despite difficulties in the acquisition of contraceptives and effective RTIs medicines. The following actors must be incorporated into the decision-making and evaluation/feedback mechanisms in CLAS model to achieve more gender, age-gentle, and ethnically-sensitive Local Health Programmes and strengthen a rights- and trust-based approach: women’s Grassroots organisations, Defence Committees of Women’s Rights, Community Health Agents, Committees of Communal Development or Health (CODECOS)/(COSACOS), and traditional health providers. Alternative relationships (e.g. rapprochement) between CLAS and government authorities must be sought.EThOS - Electronic Theses Online ServiceProfessor Geoffrey MeadsUniversity of Warwick (UoW)GBUnited Kingdo