Rights-Based Citizen Monitoring in Peru: Evidence of Impact from the Field

This paper discusses a human rights-based initiative developed in Puno, Peru, in which indigenous women seek to address problems with access and quality of care by monitoring their government-run health facilities. The evidence of impact presented here is based on a qualitative study of the rights-based monitoring initiative (53 key informant interviews in 2010-2011), corroborated by findings from a review of previous qualitative and quantitative assessments of the initiative. The research findings show that the citizen monitors are able to identify, document, and act on a set of persistent "everyday injustices" experienced by health care users. These can include illegal financial charges, abusive or dismissive treatment, extended wait times, and culturally insensitive care. These results suggest that citizen monitoring can lead to important changes at the health facility level, as well as in the lives of the volunteer monitors. It can also provide key information that can be used to put previously neglected concerns onto local and national health policy agendas. However, as this article explores, the citizen monitoring initiative faces several of its own challenges.