Lessons from Peru to reduce under-5 mortality: understanding program implementation and context

Area of Science:

• Global Health
• Implementation Science
• Public Health Policy

Background:

• Health policymakers require data on successful intervention implementation to reduce under-5 mortality (U5M).
• The Exemplars in U5M Study identified countries with significant U5M reductions.
• This case study in Peru employed implementation research to analyze factors behind successful evidence-based interventions (EBIs).

Purpose of the Study:

• To explore contextual factors and strategies contributing to the successful implementation of key EBIs in Peru.
• To understand the drivers of reduced under-5 mortality (U5M) between 2000-2015.

Main Methods:

• Utilized a hybrid implementation research framework and mixed-methods approach.
• Conducted a desk review of EBIs and U5M literature in Peru.
• Performed in-depth interviews with key informants on implementation strategies and contextual factors.
• Evaluated three key EBIs: antenatal care visits (ANC), facility-based deliveries, and infant vaccination.

Main Results:

• Between 2000-2015, ANC visits increased from 69% to 96.9%, facility deliveries from 56% to 91%, and infant vaccination reached 90%.
• Key informants cited economic growth, financial reforms, and national commitment to poverty reduction and maternal/child health as crucial contextual factors.
• Successful implementation strategies included data utilization, culturally sensitive adaptation, and a focus on equity and anti-poverty initiatives with multi-sectoral participation.

Conclusions:

• Several EBIs contributed to Peru's successful U5M reduction between 2000-2015.
• A sustained focus on equity increased coverage of essential EBIs, leading to reduced U5M.
• Understanding Peru's implementation strategies can inform replication of this public health success in similar countries.