Peru is a middle-income country with an infant mortality rate of 33 per 1000. It is divided into 24 political divisions (departments) and 34 health districts (DISAs). The map shows the 24 departments, identified according to ranges of infant mortality rates (red: 60 or more, orange: 40-59, yellow: 20-39, green: less than 20). Over one-half of the registered infant deaths occur in the neonatal period (the first seven days of life). Other common causes of death among children under five include acute respiratory infections (18.8%), and diarrhoea (5.6%). One in four children are stunted, with low height for age, and 0.9% of under- five children are wasted, with low weight for age.
Peru is a leading country in the Americas in terms of IMCI implementation, and professionals from several other countries received IMCI training in Peru. Primary responsibility for implementing IMCI in Peru stays within the Ministry of Health (MOH). The main partners include the Pan American Health Organization (PAHO), UNICEF, USAID, Red Cross, and various NGOs (Plan International, Care, Prisma, Adraofasa, Caritas, Hope Project, Depas, Kallpa).
Peru was among the first countries in the world to implement IMCI on a national scale, starting in late 1996. IMCI was introduced in two pilot health districts or DISAs (Pasco and Ucayali) and was rapidly expanded to the whole country. Two separate training courses were developed: one for clinical workers, mostly doctors and nurses, with a duration of seven days, and another for community health workers, lasting five days. By 2000, about 10% of all doctors and nurses had been trained in IMCI. Community IMCI training increased rapidly since 1999 onwards and by 2003 more than 7,200 community health workers had been trained.
Challenges for IMCI implementation in Peru include:
- There is the need to institutionalize IMCI at national and district level, with adequate planning, budgeting, supervision, and a continuous monitoring information system
- The is an urgent need for introduction of new, effective teaching and learning methods of training to ensure good knowledge of IMCI and rapid IMCI skills development among first level health care provides
- Training in clinical and community IMCI should be implemented in the same geographical areas and should happen in the poorest regions
- The problem of staff rotation must be faced to ensure sustainability.
ICATT was introduced in Peru during a planning and orientation meeting between the global ICATT team and representatives of the MOH, WHO country office, as well as the representatives of the National Child Health Institute in Lima (for more details see News page).
Currently the National Institute of Child Health and particularly the Director of IMCI training centre Dr. Dante Figueroa are curently preparing the Spanish version of ICATT and introduce the necessary technical changes in the training materials to reflect specifics of Peru.
Spanish version of ICATT was made in 2008. In 2009 the Peruvian team prepared country adaptation of IMCI ICATT-based materails and started to use it for in-service and pre-service training of medical professionals.