After Brazil, Mexico, Colombia, and Argentina, Peru is the fifth most populous country in Latin America. It is a multicultural, multilingual, and multiethnic country, with populations of 100,000 or more in 21 cities. Over the years, rural migration has increased the urban population from 35.4% of the total population in 1940 to an estimated 74.6% as of 2005. Over half of Peruvians live in poverty (all data from US State Dept).
While the Peruvian government has attempted to
improve the overall healthcare system in Peru, challenges surround the issue of
maternal and child health in the country. In 2008, the Peruvian government announced that improving maternal and infant health would be one
of its priorities for social policy. The government also proposed that it would
work to reduce maternal mortality to 120 in every 100,000 births by 2015. In
comparison to wealthy nations where the maternal morality is only 9 in every
100,000 births, the maternal mortality in Peru is excessive considering the
government advocates for the use of public health care.
Statistics (from the 2010 Human Development Index)
Despite government promises, many pregnant women in Peru still lack quality healthcare. Often, this lack of quality healthcare falls along rich/poor, rural/urban lines. In fact, recent World Health Organization data show a vast difference in the health of rural women versus the health of urban women. Only 42.9% of rural women have a skilled birth attendant, compared to 89.1% of urban women. Furthermore, women in the poorest Peruvian women have 4 times less access to skilled care than the richest Peruvian women, demonstrating a steep wealth divide. These major tensions between rural and urban, rich and poor must be taken into consideration when implementing any health development project in Peru. See the recent WHO data below:
Some addition statistics on the rural/urban, rich/poor divide in Peru (from 2009 Amnesty Report):
Clinics with clean health facilities and doctors have opened around the country, but cost of care still remains an issue. With the high rate of poverty, affordable care is an issue. International organizations, like USAID, have worked to tighten the gaps, by redistributing aid, which make healthcare unaffordable to Peru’s poor.
In comparison to other South American countries, Peru has extremely low mobile penetration. In Peru itself, mobile use ranges from 102% in Lima to only 8% in poor areas of the country. Some statistics show that 94% of the population is covered, although these statistics are likely to be flawed.
Three companies dominate the mobile market in Peru. Telefonica and America Movil are the leading service providers, covering approximately 65% of the market. The third leader is Nextel who mainly provides service to companies. The telecommunications market in Peru, like those in most other parts of the world, focuses on growth in the country, specifically in Lima and rural area. The Peruvian government made plans to increase competition and expand mobile coverage, however, the aim is intended purely for market purposes and it seems unlikely that the increase will also increase coverage to the poor.
Given that there are
several pilot mobile technology and maternal health projects already in existence
in Peru, the potential for implementation and funding is strong. WaWaNet, which
address maternal morbidity and mortality in the Callao Region, shows the most
promise in using mobile technology to improve access to maternal healthcare,
the quality of care, and provide it to low-income women. We thus propose that instead of attempting to create a new mobile phone and maternal health platform in Peru, we work with WaWaNet's existing infrastructure, knowledge, and connections. The recommendations below are therefore geared towards WaWaNet and the expansion of their programs. For more information on WaWaNet, check out their great blog.
In collaboration with the Inter-American Development Bank, Mobile Citizen Program, Universidad Peruana Cayetano Heredia, the Health Region of Callao, Callao Regional Government and AED-Satellife, the WawaNet project aims to:
WawaNet launched its pilot project in Callao, which is made up of six districts: Callao (Cercado) Bellavista, La Perla, La Punta, Carmen Reynoso League and the Ventanilla. Callao Region is the second most populated urban city of Peru, with an estimated 876,877 people. Callao has 53 health facilities that are managed by the State. According to the one of the project leaders, Dr. Walter Curioso, WawaNet seeks to develop a solution to the problems of maternal mortality in Peru, emphasizing that an improvement in the health of mothers and infants would also contribute to Peru’s attainment of the Millennium Development Goals.
WaWaNet just launched in August 2010, the impact has yet to be measured.
However, WaWaNet targets a specific and small population of pregnant women in a
region that is close to Lima, the capital city, making resources easier to
obtain than for rural populations. If the WaWaNet project is successful in the
Callao region, it should expand to reach not only rural populations, but the
indigenous populations. The indigenous Quechua population has the least access to care and experiences language
barriers with health workers. Once the impact and success of WawaNet is
measured, WaWaNet should use its relationship with the IDP and Mobile Citizen
program to fill the following gaps and obstacles:
Step 1: Access WaWaNet’s impact
and lessons learned. Examine areas outside of Callao with low-income pregnant
women and nearby indigenous populations. Access mobile penetration in rural
Step 2: Relationship-building
*Steps 2 and 3 should be simultaneous
Step 3: Obtain Resources and Funding for:
Step 4: Implementation + Community-building, education, advocacy, and policy
Once the funding is
secured, it is important to not only implement a solid program, but also to
raise awareness about the program and what it can offer to low-income pregnant
women. There may be capacity constraints, but the implementation of an advocacy
campaign that focuses its attention on maternal healthcare and the resources
available would be crucial for the Peruvian government to make better strides
in providing access to quality healthcare to pregnant women. With enough
funding and capacity, a local organization could implement the campaign.