by Carolina González Acero


Peru has an innovative plan to provide monetary incentives to the regions of the country that guarantee health care coverage and nutrition services for children.  

The current situation in Peru indicates that, in spite of great efforts to improve the conditions of the most vulnerable population, there are still significant gaps, especially in the services provided to children. By 2016, policymakers hope to reduce chronic malnutrition from 18.1% to 10%, to reduce anemia from 34% to 10% [link in Spanish], to achieve preschool coverage of 85%, and to increase water and sanitation coverage to 85%.

What’s the plan?
Peru’s Stimulus Fund for the Achievement of Social Outcomes (FED) [link in Spanish] contributes to inter-sectoral and intergovernmental coordination in terms of early childhood development. Through performance-based funding agreements signed between the Ministry of Development and Social Inclusion [link in Spanish], the Ministry of Economy and Finance, and regional governments, management commitments and coverage targets have been established for the delivery of services to children between the ages of 0 and 5.

Coverage targets by age group
There’s a prenatal plan whose aim is for mothers to receive four check-ups during the first trimester of pregnancy, prenatal care, and iron and folic acid supplements. The plan aimed at children during their first two years of life establishes indicators related to obtaining an identity card, a complete health record, pneumococcal and rotavirus vaccines, multimicronutrient supplementation, and family support. There are two additional plans. One meets the needs of children ages 3 to 5, and the other benefits children of all ages, given that it relates to providing access to chlorinated water.

What’s new

An agreement that defines a performance payment based on coverage goals and management commitments is established with each region.

The comprehensive nature and organization of the indicators stands out, along with the inclusion of maternal health targets and the fact that regions have set their own goals.

One aspect that sets FED apart from other pay-for-performance initiatives is that it kick-starts coordination between sectors. Coordination is crucial when dealing with a topic such as early childhood development because it involves health, nutrition and education issues.

What’s most important

As mentioned above, some of the most notable aspects are the comprehensive nature and organization of the indicators, as well as the targets that certain regions have set. While fulfillment of these targets is a great challenge that involves stakeholders at the central, regional and local level, these goals are a reflection of the regions’ commitment to improve the management and coverage of services that have a direct impact on child development.

This is one of the first projects in our region to link pay for performance and child development. The pay-for-performance model has been shown to be effective in various sectors, and it is likely that FED will also achieve a positive impact on the early development of Peru’s poorest children.

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Carolina González Acero works as a consultant for the Division of Social Protection and Health (@BIDSPH) at the IDB in Lima, Perú. Her work focuses on the design and supervision of projects in  health, nutrition, child development ans social protection.

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