CARTAS AL EDITOR
Local committees for health administration: what can be improved through health policy
Rodrigo M. Carrillo-Larco
School of Medicine "Alberto Hurtado", Universidad Peruana Cayetano Heredia; Lima, Perú. email@example.com
To the editor: Years ago Iwami et al. reported to the public health community the implementation of the Local Committees for Health Administration (LCHA), within the primary level of the Peruvian health care system.1 These are community-based organizations in which the community and the responsible for allocating budgets make joint decisions based on the health needs, assessed by the community itself.1 It could have been thought that, because it is the organized community who takes care of itself, the resources will be better used, as they meet their exact needs; however, the authors found some limitations: i) poor communication with regional authorities as there were no clear guidelines for this relationship, and ii) lack of training among its administrators.1
I would like to point out some of the guidelines and laws that have been promoted by the government to address the LCHA's limitations, since they were first presented.
The Law 29124 (October, 2007), clearly establishes what duties belong to either the LCHA's government or to the Regional/Local Government. The former should use efficiently the resources (human and material) in order to satisfy the needs targeted at the Local Health Plan (which should have been identified through surveys, meetings and active participation of the community); also, to foster the participation of the community in health promotion activities, among other responsibilities. The Local/Regional Government, on the other hand, should provide the infrastructure and equipment to achieve the aims of the Local Health Plan, supervising the correct use of the financial resources and verifying that the LCHA's government is consistent with the law, among a few more duties.2 Both entities should promote and provide, respectively, the continuing education of the LCHA's administration force, in order to ensure the good quality of its work. These, and other details of the LCHA's responsibilities, goals and plans, are detailed in the Law's guideline (Supreme Decree 017-2008-SA), published in the year 2008.3 In table I, I present the laws and guidelines regarding LCHAs, published after the year 2002.
This letter's objective is neither to state that LCHAs are the best option for the primary level of any health care system, nor to highlight the work of the LCHAs at Peru. The real aim of this communication is to show that even though, at first, some health initiatives might not work as well as expected or plenty of limitation might arise, with adequate health policies and with the government commitment on health issues, plans and new strategies will survive, improve, and impact positively on any community's health. However, continuous assessment, through research4,5 and other methods, must be carried out to ensure the highest standards are achieved.
1. Iwami M, Petchey R. A CLAS act? Community-based organizations, health service decentralization and primary care development in Peru. Local Committees for Health Administration. J Public Health Med. 2002;24(4):246-251.
2. Peruvian Congress; Peru. Law 29124 [Internet Document]. Lima: Peruvian Congress, 2007 [accessed: 5 July 2012]. Available: http://www.congreso.gob.pe/ntley/Imagenes/Leyes/29124.pdf
3. Peruvian Ministry of Health. Guideline of Law 29124 [Internet Document]. Lima: Peruvian Congress, 2008 [accessed: 4 July 2012]. Available: http://bvs.minsa.gob.pe/local/MINSA/1079_MINSA1474.pdf
4. Pardo K, Andia M, Rodriguez A, Pérez W, Moscoso B. Remunerations, benefits and labor incentives perceived by health care workers in Peru: an analysis comparing the Ministry of Health and the Social Insurance, 2009. Rev Peru Med Exp Salud Publica. 2011;28(2):342-351.
5. Bambaren C, Alatrista M. Estimation of the socioeconomic impact of the earthquake of Pisco on the Peruvian health sector. Rev Med Hered. 2009;20(2):177-184.