“CLAS is the closest thing to the concepts of Alma Ata that I have seen.” –Dr. Haldan Mahler, Director General of the World Health Organization, during his visit to Peru in 2006.
Community co-management and citizen participation has proven to be effective and efficient for local financial administration and human resources management in primary health care services.
The experience in Peru of primary health care co-managed by organized communities in Local Communities for Health Administration (CLAS) is based on Law No 29124 of 2007. This management model has shown better results in terms of quality. There is also better coverage and equity of access for the poorest populations. These results are better than primary care services that are not under this model. The organized community ensures that the expenditure of public funds is timely, efficient, and transparent. CLAS members help to generate additional resources from the local government for their health facility. They also solicit contributions from other public and private sources. These are clear manifestations of the importance of co-management.
It is strange that Congressman Guido Bellido has presented a bill proposing to repeal the Law 29124. The main pretext is that CLAS pay ‘paltry salaries…from the beginning’.
Let’s analyze this. First, CLAS have offered higher salaries than primary care services without CLAS. This happened in the first decade of co-management starting in 1994, thanks to the private labor regime (Law No 728). This labor regime is flexible and contributed to the enthusiastic acceptance of the co-management model and its massive and rapid expansion in the country. Thus, the program scaled-up quickly to incorporate 32% of primary care services by 2002. Then, due to cuts in national budgets and lack of orientation of the program to regional authorities, insufficient funds were programmed for primary care services that use the co-management model. As of March 2022, economic resources are no longer sent directly to CLAS for local management. Instead, the resources remain in the Health Network Management Units, which manage economic resources neither efficiently nor in a timely manner. Thus, the budget executing units of Health Networks are responsible for these economic resources: they decide the salary levels of primary care personnel, not the CLAS.
The country does not need to do away with CLAS. Instead, it should strengthen the co-management model. This is necessary to provide quality services to the vulnerable population that depends on the public primary health care system. We demand the withdrawal of Congressman Bellido’s bill, and instead to move forward with a Bill that introduces improvements to Law 29124.
Laura C. Altobelli 