Promoting Equity in Maternal Health Through Citizen Monitoring of Reproductive Health Services in Andean Peru

BACKGROUND: This study investigates an innovative strategy called citizen monitoring as a model to promote health equity and strengthen the maternal health of indigenous women in Andean Peru.  Citizen monitoring is a form of participation whereby civil society actors independently monitor the activities of state officials.  In this study rural indigenous women monitor the delivery of reproductive health services at local public health facilities, to improve access and quality of care.   

RATIONALE: While Peru has a rapidly growing economy, deep health disparities persist, particularly affecting rural indigenous populations. For example, the Maternal Mortality Ratio in the capital Lima is 52 per 100,000 live births, compared to 302 in the predominantly indigenous Andean region of Puno.  Indigenous women have long been marginalized from state public health services through patterns of systemic discrimination and cultural insensitivity. 

METHODS: This is a qualitative case study set in a region of Puno, Peru populated primarily by Quechua indigenous communities.  Fifty-two interviews were conducted in 2010-2011 with local indigenous monitors and key informants from Puno and Lima. 

RESULTS: Citizen monitoring was successful in addressing certain barriers faced by indigenous women related to access and quality of reproductive health care, including illegal fees and patient mistreatment.  Integral to these outcomes were: a) the use of international human rights discourse; and b) strategic alliances between monitors, the NGO CARE Peru, and lawyers from the National Human Rights Office.  However, other problems identified by the monitors were difficult to resolve (e.g. those related to lack of supplies, insufficient number of health workers) due to the political and economic relationships that structure the country’s public health system.

IMPACT: This study provides insight into new strategies to help achieve and sustain the MDGs related to maternal health, through active forms of public participation and local governance of reproductive health services.