Tanilaya: caring with quality.

The resources allocated to health promotion and prevention are scarce, and this investment can reduce the global morbidity burden by up to 70%; In Latin America, only 20% of the population receives preventive health care annually, which is a significant health gap and it is vital to have health care focused on networks, with resolution capacity and a preventive-promotional approach. When PHC strategies began to be used in Latin America, their efficiency and effectiveness were demonstrated, being that applied in the PNAS (first level of health care) it could solve up to 95% of cases.

The MINSA Peru (2019), mentions as the main national health priorities raising barriers, especially cultural, in access to health services. Some important trends in the country regarding PHC (Primary Health Care) are the following: there is an emphasis on making use of highly complex establishments in the face of manageable health problems in the PNAS (First Level of Health Care), saturating services of high complexity unnecessarily and missing the true objective of the PNAS; Users seek their health problem to be addressed beyond the clinical, to delve into their reality and the way in which they address their health problems individually, this is key to the continuity of care (care, treatment, rehabilitation, etc. .). The Peruvian state does not have a follow-up of these goals and the performance of PHC at the level of regulatory, operational or management framework, as it corresponds to being the governing body through the Regional Governments (Regional Health Management, networks and integrated micro-networks of Health).

Specialists agree that health providers, especially PNAS establishments, must base themselves on aspects of PHC to achieve satisfactory health services for users; the PNAS is the strategy that has shown the best results globally, leaving evidence that investing at this level and in PHC is cost-effective for the health and development of the population; It has been designed to be the first contact between the population and the health system; It is, more than the entrance door, the organizing axis of the health system and the primary source of information systems for case management, the monitoring of strategic and operational processes and the reference and counter-reference system. It is advisable to continue generating evidence on the performance of PHC functions in more than one establishment due to its social relevance to identify opportunities for improvement in care and services provided to the population in the process of better living conditions, individual and community development. Currently, health facilities in the interior of the country do not have an official system, nor appropriate technology, for official monitoring of PHC performance in the Peruvian context.

Given the context described, we see that at the Peruvian level, it is conducive to implement a sustainable digital monitoring system for PHC performance with an instrument culturally adapted to the Peruvian context, with the active participation of the population; having indicators in this regard will be an important tool for monitoring and evaluation that could be extrapolated to the national sphere by the Peruvian state. Having an efficient source of information will contribute to the implementation of efficient strategies that allow better performance of health services, better access and rapprochement between the population and the health system, a more efficient approach to the main problems perceived of health and a better health status of the community.

A digital system will be implemented to monitor the performance of PHC (Primary Health Care) in health establishments, which will allow the generation of indicators with technology such as tablets and all-in-one computers. Existing information will be provided and information will be collected; Likewise, aspects of primary care such as first contact (accessibility and use), longitudinality or continuity (degree of affiliation and interpersonal continuity), community orientation and cultural competence will be addressed.

The implementation of the digital system will have the following stages:

• Digital monitoring system design: the technical design of a digital monitoring system prototype will be carried out and indicators to be followed will be established.
• Cultural and community adaptation of the implementation: focus groups and home visits will be carried out to culturally validate the monitoring system to be used.
• Training of health personnel and community representatives: training of the actors involved in the use of the monitoring system.
• Implementation of the digital monitoring system: the implementation of the digital monitoring system will start
• Sustainable digital monitoring of PHC performance: The first PHC performance report will be prepared based on the PHC digital monitoring database

The PHC performance digital monitoring system is expected to contribute to improved decision-making and the formulation of PHC strategies focused on better access to health services, health status and, therefore, development. social and economic of the population.

The target population are PNAS establishments in the regions of Amazonas, Madre de Dios and Loreto. In the interior of the country, in health establishments in rural areas, there is no monitoring (neither digital nor using another methodology) of the performance of PHC (Primary Health Care); There are no updated and efficient data that allow evaluating the analysis of the health situation and PHC in a sustainable manner, which contributes to decision-making for better performance of health facilities at the local level, taking into account that these have to meet specific standards for licensing.

Having a digital monitoring system for the performance of PHC (Primary Health Care) adapted cross-culturally and sustainable in the Peruvian context will contribute to generating a bridge between the health system and the community, a greater rapprochement; Aspects of primary care such as first contact (accessibility and use), longitudinality or continuity (degree of affiliation and interpersonal continuity), community orientation and cultural competence will be addressed.

It seeks to contribute to a more efficient approach to health, understanding and based on the worldview of the community on health and the main local health problems perceived with an individual, family and community approach; this will generate a more optimal state of health, a fact that will affect the social and economic development of the community.

The implementation will be carried out hand in hand with health establishments in the regions of Amazonas, Madre de Dios and Loreto. For the implementation of the solution, in a first phase, a technical work of cultural and community adaptation/validation of the PHC performance monitoring system will be carried out; Focus groups and home visits will be carried out to culturally validate the monitoring system to be used; this in order to understand their conceptions and worldview about health and the main health problems they perceive. The sustainable inclusion of a representative team of the community will be key for the initial adaptation and the sustainability of the implementation; The constant training and exchange of knowledge among community representatives will be taken as a pillar to make their participation sustainable; work will be done under the concept of individual, family and community and, at the same time, of self-responsibility in health. The project will have the support of PAHO (Subregional Program for South America) and two research centers of the Universidad Peruana Cayetano Heredia (Mama Wawa Maternal and Child Health Research Center and Primary Health Care Research Center).

The application to this challenge is important since it is considered that the PHC (Primary Health Care) approach is essential to improve access to health services and, therefore, the health status of the community, influencing the social and economic development. In the Peruvian context, and specifically in the regional context, there is no constant and efficient monitoring of PHC, monitoring of baselines and specific objectives or goals of health facilities is very weak; there is no database that contributes to improving the performance of the health system from the opinion or perspective of users; likewise, innovations are often implemented without the corresponding validation in community and cultural aspects.

It is expected to set a precedent for the generation of a state policy based on the evaluation and monitoring of the functions or aspects of PHC in Peru, as has been the case in countries such as Argentina, Brazil and Uruguay, the proposal being a input to be extrapolated to the national level in the near future for health establishments with compliance with adequate standards and indicators for their implementation/operation.

Likewise, the aforementioned adaptation process requires a human management and operational team, tools and materials; these, in turn, require the corresponding financing; Health personnel have been working in the community for many years, so they need an external team to refresh the vision of the problem and be a link for an adequate community and cultural adaptation of the health services provided.

Latin American countries such as Uruguay, Argentina and Brazil have adapted to their health systems instruments related to monitoring the performance of PHC (Primary Health Care) with digital and conventional methodology; In Peru, various studies related to PHC performance evaluation are being carried out, but these are mostly concentrated in Lima and/or use versions of instruments adapted cross-culturally in other Latin countries; The solution aims to promote a sustainable digital PHC monitoring system using instruments officially adapted to the Peruvian context and efficiently using existing data (but not converted into performance indicators), where there is no official PHC technical monitoring. . PHC; a new alternative will be brought to health facilities that do not have tools to monitor their performance;

The impact objective for the next 5 years is to improve the performance of primary health care with respect to the baselines located in health facilities.

The specific impact objectives are:

• Increase the level of performance of the first contact function (accessibility and use) in health facilities
• Increase the level of performance of the function of longitudinality or continuity (degree of affiliation and interpersonal continuity) in health facilities
• Increase the level of performance of the community guidance function in health facilities
• Increase the level of performance of the cultural competence function in health facilities

The impact objectives will be measured through the following indicators:

• Performance level of Primary Health Care.
• Level of accessibility to health services.
• Level of use of health services.
• Degree of affiliation to health services.
• Level of interpersonal continuity in health services.
• Level of community-oriented health services
• Level of cultural competence of health service

The logical framework of the project is as follows:

Enlace de Marco Lógico

The central technology of the project will be a digital application for access through cell phones and/or tablets; Artificial intelligence will be included to detect patterns of specific alerts about the health service.

To date, no data has been collected on aspects of primary care; those in charge of collecting related data are the health promoters and healthcare personnel. Health promoters are key representatives of the community, who do so on a voluntary basis, being trained in various health issues. The health personnel has as an incentive the remuneration according to the law, it also includes the professionals who are carrying out their Rural and Marginal Urban Service, who according to their application and the socioeconomic level of the area where they provide the service, can get paid or not.

The goal of the project will be to be inclusive from the formation of the team to its execution, having a wide opening for vulnerable communities/populations, contributing to these groups having access to citizen participation (employment access, access to participation in decision-making, etc. .) equitably and representatively; likewise, to achieve the goals, community participation and the cultural adaptation of the actions within the project will be the base and pillar (a stage of cultural adaptation is included).

The beneficiaries of the implementation will be the population of the Amazonas, Madre de Dios and Loreto regions who are users or from the health services jurisdiction; A sustainable digital monitoring of PHC performance will be implemented, training will be provided to health providers and community representatives. The business model will be a service subsidy, selling products or services to an external market to help finance other social programs. This model is integrated with the non-profit organization; commercial activities and social programs overlap. Products/services for sustainability will be consultancy, advice, academic activities (courses, workshops, seminars and the like). The profits obtained from the activities will be used for the implementation of the program and the sustainability of the human resource (manager and operative), the acquisition of materials and work tools, and the acquisition of relevant assets for the program.

The business model will be a service subsidy, selling products or services to an external market to help finance other social programs. Products/services for sustainability will be consultancy, advice, academic activities (courses, workshops, seminars and the like).

Some examples of financing are:

Hope (Peru) (Grand Challenges Canada;
Mamas del Río (Peru) (financed by the Peru-Colombia Foreign Ministry)