Evaluacion Peru

VCP Final Evaluation Report
Final Evaluation of the (pilot) Project named:
Participatory Community Surveillance 2010)
VCP (before
Monitoring Based on the Community MBC) (2007
Report Prepared by: Federico Arnillas Irma del guila Mara Isabel Merino
Final Evaluation Report
VCP Final Evaluation Report ReportInforme Final de
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Presentation This document is the Evaluation Report of the project Participatory Community Surveillance-VCP that has an implementation period from Fiscal 2007 to Fiscal Year 2010. The document has 4 sections. The first one is the introduction to the project and to its evaluation. It is basically oriented to provide a project synthesis for a non-involved reader with regard to the background and reasons that gave way for the project to be formulated and implemented. The pilot character of the project as well as the intervention area is highlighted. Together with that area are the objectives of the project and of the evaluation, stressing the pilot character of the project and the VCP validation. With regard to the development of the evaluation activity, rapid information will be provided about the field work and the tools that were used. The second section refers to the national context elements that are relevant for the project analysis. The review is oriented to those changes made in the Peruvian political institutional framework associated to the development of participatory democracy and representative democracy styles in a context for the recovery of democracy and the constitutional state that took place in Peru after the political crisis of year 2000. The constitutional expression of this process is the reform of the decentralization process of the Constitution of year 1993 that opens a process for the election of regional and local authorities and introducing at the same time a coordinated planning and the participatory budget; as well as requirements with regard to transparency, accountability, and of course, citizens surveillance. Part of this process is also to create instances such as the Consensus Table to Fight Against Poverty, the National Agreement and the state policies, etc. and the counter-reform of year 2007 and from
there what goes on in a parallel way with the increase of public resources for the regions and the municipalities.
The third section explains the experience of WV Peru with regard to VCP. The aim is to offer a narrative reconstruction of what have been done and what is being done in the project, based on the reviewed documents and on statements made by individuals or groups during the during the evaluation. The evaluation team have worked as writers of the history of someone else ; a history that is lived by the evaluators , based on the own gathered histories that are put in order according to the relevant time that deals with the international background of the project, the start of the project in Peru, the cases that were selected in the ADPs, and highlighting the service around which the case is being centered, the condition in which the service is provided/or the access to it, defined according to the qualitative terms, the identified problems and the stakeholders involved. Finally, the fourth section deals with the outcomes according to a general common guideline based on the VCP proper methodology in order to have a general balance of the experience and the relevant recommendations. In this presentation the Evaluation Team wants to express their thanks for the opportunity and the trust that was provided as well as for the support received from all the persons with whom we met during the whole process, and also those with whom we did not have direct contact but they made possible this activity.
Federico Arnillas Irma del guila Mara Isabel Merino
TABLE OF CONTENTS
Presentation Table of Contents 1. Introduction 2. T h e Context of the Intervention 3. Reconstructing the experience of WV Peru in VCP 3.1. Background 3.2. The start of the project implementation and the VCP Methodology 3.3. The studied cases 3.3.1. The health service in the populated center of Musho, Yungay Ancash. 3.3.2. The health center in Nuevo Milenio, VMT Lima 3.3.3. The Health Post of Accoscca and the Hospital of Huanta Ayacucho 3.3.4. Three experiences in the ADP Urin Qosqo: a) The health center of Santa Rosa San Sebastin Cusco. b) The school Vctor Ral Haya de la Torre in San Sebastin Cusco c) The educational institution 50015 of the farmers community of Punacanha San Sebastin Cusco 4. Conclusions and recommendations

GLOSSARY WVP HH.SS FY AFADIPH ANC CEM COPARE COPALE CRED CS LF DEMUNA DIRES DNI SE E.I. LACRO MCLCP CHAs AO NO ARO CP ADP PEN POA PS RENIEC SIS SPE UERSAN UGEL PCS World Vision Peru. Human Settlement Fiscal Year Association of Displaced Families inserted in the Province of Huanta Association of National Centers Woman Emergency Center Regional Participatory Council for Education Local Participatory Council for Education Health and development control of healthy children Health Center Log Frame Municipal Advocacy Office for children and adolescents Regional Directorate for Health National Identity Document Social Empowerment Educational Institution Regional Office for Latin America and The Caribbean Consensus Table to Fight Against Poverty Children and Adolescents Area Office National Office Auxiliary Registry Office Citizens Participation Area Development Program. National Strategic Program Annual Operational Plan Health Post National Registry for Identification and Civil Status Integrated Health Insurance Public Education Service Health Implementation Unit Ayacucho Norte Local Unit for Educational Management Participatory Community Surveillance.
1.- Introduction
PROJECT GENERAL SUMMARY Project name Monitoring Based on the Community / Participatory Community Surveillance Project Number 182312 Comunitaria Participativa Project location Site: Lima. Implementation: Lima, Cusco, Ancash and Ayacucho. Period covered by the evaluation 01 October 2007 t o 30 September report 2010 Project start year October 01, 2007 Project completion year September 30, 2010 400 leaders 6000 children Project duration October 2007 September 2010 Project budget TOTAL BUDGET: US $ 290. 148 FY 08 US$ 91, 291 FY 09 US$ 106. 495 FY 10 US$ 92. 362 Funding source WV Australia sssssssourcesourcesourcefinanc August 2011 Date when the report was iamiento prepared reporte The project under evaluation is part of an international initiative that is oriented to validate, and if required to promote the adoption of an approach and a methodology for the monitoring of public service based on community stakeholders that may contribute to their improvement. Thus, from the prospective of its promoters as well as of those that participated in its implementation, the project is relevant or can be qualified in a legitimate way as experimental or pilot, that is to say an experience in which all the parties were interested in seeing and validating its applicability. This consideration or character was taken into account for the design of the methodology applied for the evaluation and guide on how to provide the outcomes of the evaluation. Target population
Project objectives
As has been summarized in the Log frame of the VCP Project (a version modified in 2008) the specific project objectives, targets and outcomes are:
Summary of Objectives Objetivos To contribute to the change of structural reforms to improve the quality of public services in favor of children and adolescents at local, regional and national level.. To promote the participation of the poor communities and local government in community surveillance processes. Indicators % of Reforms approved at local, regional and national level. Verification means Report n regulating changes Publication of changes Public sector reports for health, education and justice. Assumptions The Peruvian Government continues promoting citizens Surveillance. The Consensus Table to fight against poverty of the 11 priority actions for children in Peru. The government continues promoting the law for decentralization and citizens participation.
Project Target 01
Outcome 01.01
% of local governments involved in the improvement plans for health, education and protection.. % of communities that incide in changes to improve service quality in the local centers.
Public services improvement plans. Analysis of Database reports. Reports of the local public sectors.
Outcome 01.02
To strengthen World % of ADPs that facilitate Vision Peru the Development processes capabilities from those in the communities. of service provider to facilitator of development processes in the local, regional and national area. The project is implemented through Systems, Management and institutional learning improved for an effective intervention. The project outcomes met by at least 90% through the DME system.. The budget implementation of the project has been met by at least 95%i and according to the administrative system of the institution. % of Project staff that have developed new capabilities according to the required profiles..
Minutes of the meetings with communities, local government and public sectors.
Openness of government instances to coordinate with private organizations..
Outcome 01.07
Monitoring and Evaluation Reports Annual Financial Report Internal Audit Report Performance evaluations of WVP staff.
The management reengineering processes from the Partnership do not affect the projects operations. The natural disasters do not affect the programming of operational plans. Local offer available of uADPting courses for learning development.
% of learnings capitalized Report of the studies, as an output of experience. documents and evaluations made.
VCP Final Evaluation Report ReportReportInforme Final de
Implementation areas
a) Nuevo Milenio Location: Seventh sector, south of the district of Villa Mara del Triunfo, area of 70.57 km2. Urban marginal area. Includes 17 human settlements located in the hillsides and the hills; unpaved road access. Population: 20.796 (WV survey). Migrant population, HHSS w i t h zone organization,
small trading.
WV ADP Area: Nuevo Milenio b) Huanta Location: District Huanta-peri urban area Altitude 2628 m.a.s.l. Population: 41,000 (2005). Peri urban area, quechua speaking people that understand Spanish. HHSS. Agriculture and livestock activity, small trading, with social organization. WV ADP Area: Huanta c) Mancos Location: District of Yungay, Province of Yungay. Altitude, 2463 m.a.s.l, surface area 276.68 km2 Population: 20,075 inhab it ant s . R u ra l a rea , Qu ech ua speaking people, t h a t un d e rs t a n d Sp a n i s h . Villages organized by zones. Farmers and small trading. WV ADP Area: Mancos d) Urin Qosqo Location: District of San Sebastin Population: 70,797 persons, of whom 68 thousand live in the ur ban ar ea. 15,000 people speak Quechua. A l m o s t 25% o f t h e p e o p l e l i v e a t h o m e w i t h a t l e a s t o n e NBI. 69.4% do not have social insurance WV ADP Area :Urin Qosqo
Project development
During the first year most of the work was oriented to the appropriation of the methodology and to develop the initial capabilities to be applied, therefore most actions were focused on the evaluation of the last two years of the project implementation, a period of time in which the project is reconsidered and the actions are continued with the VCP approach.
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External Evaluation
According to the TORs and to the methodological proposal the external evaluation objectives were: To explore the developed actions and the outcomes obtained through the project implementation and how these experiences contribute with e l e m e n t s to make general t h e applicability of the approach and the methodology Citizens Voice and Action. To determine the applicability of the methodology Citizens Voice and Action to promote community surveillance practices. To analyze the link of the Participatory Community Surveillance project with the lines of action of the ADPs. To identify the Sustainability at community and institutional level and the
Citizens Voice and Action approach and methodology.
Given the pilot character of the project and being this oriented mainly to apply the approach and methodology contained in the Guide Citizens Voice and Action, two were the main tools used for the evaluation design, and the second one was adopted, as mentioned in the TOR as the base to report about the experience: The project framework The Guide Monitoring Based on the Community or its modified version Citizens Voice and Action It must be mentioned that since the evaluation TOR the importance of the Log frame (LF) as a base tool for that process was relative, and the document was considered to be only a general reference framework.1. According to information provided by World Vision Peru officers, the LF was modified in a very significant way by midyear 2008, that was a year when changes were made in the approach and in the methodology, including a change in the project name to: Citizens Voice and Action and for the implementation the name adopted was community participatory surveillance (CPS). While the report is addressed to the directors of World Vision Peru, the writers consider the possibility that the report might be shared with other readers that are less familiar with the work carried out by World Vision, or with the Peruvian process.
Footnote N 2 of the TORs of this evaluation indicates:: due to the fact that there have

been changes in the project implementation process, the LF is a reference framework but it does not represent all the evaluation dimension..
2. The initial name was Monitoring Based on the Community (MBC)..
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2. The Context of the Intervention

In this section the attention will be focused on some of the politicalinstitutional changes that took place in Peru during the first decade of the XXIst. Century that precede and frame the decision for the development of the project as well as the process for the project design and implementation.
a) The crisis as a turning point

The central axis of the changes is associated to the political crisis that took place in Peru in year 2000. A crisis that was related to the re-election proposal made by the then President of the Republic during the nineties, and that was attacked with citizens movements in various areas of Peru, demanding for democracy, decentralization, as well as against a process of significant increase of monetary poverty rates. As it is known, the process for the solution of this crisis was developed in the second semester of year 2000, after the discovery of significant corruption actions that had been made by important officers of the government. A political agreement with participation of the various groups of Congressmen and civil society institutions representing the unions, enterprises, human rights associations and the churches, as well as OAS and the international cooperation, were basic for an orderly process with a change of directors in the Congress board and the installation of a Transition Government with Valentin Paniagua as President.
b) A more integrated approach

This context of crisis and the facts that contributed to its solution helped to define a very important agenda for the decade that matches with the issues of the project Citizens voice and action. The emerging paradigms were gathered in words such as: democracy, participation, decentralization, consensus, transparency and surveillance. Added to that were the concepts of strategic planning, participatory budget, and convocations made in favor of a more integrated development that linked in its conceptualization the economic dimensions with the social and environmental ones and of course the proper political and institutional issues. Also the new authorities paid attention to the fight against poverty seen from the rights approach and therefore against the manipulation of th e social
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organizations, and inclusive spaces and processes were opened such as the Consensus Table, the National Council for Work, the national consultation for education, the initiative against corruption, the Commission for Truth, among others.
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Likewise, the first regulations were addressed to affirm transparency in public management, as it was recognized that the lack of transparency was one of the factors that favored the increased corruption. It is worth to point out that during the years of the 80s a n d 90s some citizens participation experiences had began to appear in various local spaces oriented to participatory approaches that developed and validated various management tools (participatory planning, co-management of projects, programs and services, etc.).
c) The institutional changes of the first years

Regulatory changes
Besides the above mentioned regulations implemented by the government of President Paniagua, the election process of year 2001 took place and Peru Posible was the winner. Among the plans announced by the new administration was included the definition of the government policies through a political and social commitment and the implementation of institutional changes that included the withdrawal of the issue of the President re-election, the issue of decentralization, as well as to review the Charter of year 93 as pointed out by some politicians in those days. Worth mentioning among the relevant changes made during that period is the reform of the Constitution that gave way to the decentralization process that includes as a significant issue the regional governments based on departments and elected by the people, with a consensus planning and participatory budget at regional and local level. Together with that was the approval of the Bases Law that makes official the first participatory budget process at regional level carried out in year 2002 with the Table and the CTAR, for fiscal year 2003, that was followed with the organic laws for regional governments and its modification, and the election of regional authorities and shortly after that with the changes made to the organic law for municipalities. Also during those years the Framework Law for Participatory Budget was approved, the right for the Surveillance of public expenses was affirmed, as well as its use and further issues that rule these guidelines, among others. It is important to highlight that the early years of this decade are full of regulations that extend the right to participation and information to citizens in all the management areas. Thus, for instance, the ANC in a publication of October 2004 lists more than one hundred regulations of various legal hierarchies that recognize and/or regulate the right to participation, to transparency and to
VCP Final Evaluation Report ReportReportInforme Final de information, issued between year 2001 and the date of the publication 3.
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The general processes
participation
spaces
and/or
Among the participation spaces that were opened and that are valid until this date, can be mentioned: the Consensus Table to Fight against Poverty, the Regional Coordination
ANC. Legal framework about participation and citizen transparency. Legal information summarized and selected. Castillo, Luis. October 2004. Lima Per.
Councils and the Local Coordination Councils at province and district level. And, of course the Forum of the National Agreements, that grouped the national political organizations in the congress, the national representatives of various civil society institutions and even of the national government. Among the participation processes are the processes for coordinated planning and above all the participatory budget. There are initiatives to promote sectoral participation and /or consultation spaces defined by population segments (Young people, women, adult men and women, children and adolescents) or thematic issues: climatic change, rural development, most of them of just a consultant character. In the sectoral area it is worth mentioning those related to the education sector among them the COPARES, COPALES.
The transparency tools

With regard to the transparency tools are the various regulations oriented to affirm the responsibility of the public operators to provide information to the citizens. In this regard, one of the most complete measure was the portal for economic transparency of MEF and the friendly consultation, through which the citizens can have access to information about the expenses with a high level of detail and timeliness. Besides the M E F are the regulations by which the institutions must provide more information to the community , which at the same time has favored the technological changes that reduce the costs for the access to information.
d) Increased role of the sub national governments for the provision of
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services
Chart 1 TOTAL EXPENSES MADE AND BY GOVERNMENT LEVEL, 2007-2010 Millions of current soles
AO 2007 2008 2009 2010 Source: Friendly SIAF, MEF. Prepared by us GOBIERNO NACIONAL 39,740 45,561 49,114 54,369 GOBIERNO REGIONAL 11,601 12,916 14,913 16,221 GOBIERNO LOCAL 6,868 13,179 15,873 17,816 TOTAL 58,209 71,657 79,901 88,405
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As can be seen from the above chart, the financial resources of the national government have gone up from 3 9 t h o u s a n d 740 millions to more than 54 thousand millions; in the same period of time the resources of the regional governments, that started their work in January 2003 have increased from 11, 6 thousand millions to 16,2 thousand millions and those of the local governments have also increased from almost 7 millions to almost 18 thousand millions.
e) The Surveillance experiences and the observatories

In a parallel way to the opening of spaces and channels for participation is the development of experiences of the citizens to know what the government is doing, to see its performance, to surveil its activities and to generate mechanisms for citizens control or community surveillance. These tools are not original from Peru and in fact they are previous to the crisis of year 2000. As for instance for the meeting of CONADES III4 that was held in Lima in 1998, a brochure What it is and how to make citizens control in which its editors indicate that the brochure explains various issues of a new citizens issue known as citizens control, social surveillance, or what in English is known as social watch. The brochure invited to surveil that the commitments signed by the countries the Copenhagen summit and in that regard the brochure reproduces pages 24 and 25 the agreements of that Summit where the attention placed on targets for poverty reduction, malnutrition, child mortality and in in is to
reduce illiteracy as well as access to universal education of good quality, as well as to surveil the fulfillment of these commitments at the highest possible level The same agreements deal with the need for joint actions between public operators and citizens organizations.5 In that framework or based on that experience, during the first decade of the XXI Century there have been surveillance initiatives with regard to public services, the public expenditure, the planning and budget processes and among the last ones specifically the participatory budgets. There are also surveillance actions with regard to the work of the extractive companies, the forestry activities, or better said the deforestation processes, etc. And, not in few cases, the same international organizations are the ones that in partnership with the civil society or with government agencies promote or assume these surveillance processes.
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CONADES is the acronym that identifies the National Conference on Social Development, a space of encounter and link for NGOs and groups of the Peruvian civil society that was established in 1996 and that has continued working since that date until now. 5 Diakonia, CEDEP, What citizens control is and how to do it.. Information brochure prepared for the III National Conference on Social Development, CONADES III / Lima, August 1998 Specially pages 24 to 26
VCP Final Evaluation Report ReportReportInforme Final de their way they deal with citizens surveillance of the government action.
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More recently the observatories for public policies have appeared that also according to
f) A counter action
While the above mentioned elements have been oriented to increase the participation channels and the mechanisms for access to it, as well as to establish the obligation of accountability in a periodic way t o t h e c o m mu n i t y a b ou t t h e g o ve rn me n t a c t i vi t i e s . What have been taking place simultaneously are various actions that have limited the participation and made difficult the access to information. A first signal of alert was given in year 2003 during the process for the approval of the Organic Law for Regional Governments, a resolution that was approved by the Congress, but did not include the mechanism for the Regional Coordination Councils (RCCs), and later on it was observed by the Government of Alejandro Toledo. After that the Regional Governments Law was modified and the Councils were included as part of its structure. Another important regulation issued during the first five years of this decade was the approval of the Framework Law for Participatory Budget that deals with the issue of participation in the participatory budget and the right to surveil the agreements made in that process. It is in the second backwards took place outstands the change cuts down the already five years of the decade that the most significant steps with regard to participation and surveillance. In this line made to the Framework Law for Participatory Budget that existing rights.
Another example of those final years of the decade was what happened with the right to consultation of the indigenous people ruled by the Agreement 169 of the International Labor Organization signed by Peru, but its regulation is still pending. One of the effects of the restrictions that have been included in the participation mechanisms/processes is that they are not more efficient. Therefore, while in the initial phase of the social and political processes that took place in Peru during the first decade of the XXIst. Century the people had in those centers an institutional place where they could process their demands, and now they have started to feel that those mechanisms are not any more efficient and the trend is to go to spaces that are more open to reinvindication and to an increased confrontation.
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Rebuilding the experience of WV Peru in VCP 3.1. Background
a) International development of the methodology

The origin of the VAC methodology are the CBPM methodologies (Community Based Performance Monitoring) that were developed by the World Bank in Gambia as part of the efforts made to improve the government policies and the initiatives for sustainable development 6. The CBPM inherits elements from the Community Points Card (CPC) developed by the NGO CARE in Malawi but including basic contributions of the methodology of the Action Process and Strategic Planning developed in Sierra Leona, in particular with regard to the use of focus groups and more detailed voting dynamics. In Gambia, the CBPM is used as a tool to gather the perceptions and evaluations of the rural communities with regard to the quality of the public services for education, health and agriculture in a Strategy for Poverty Reduction. The advantage of the CBPM i s the implementation of the dynamics with focus groups that includes, as part of the process, the practice of accountability by the operators and the organization of negotiation spaces for an improved public service. This dialogue and the generation of consensus are considered to be, real capital assets seen from an approach of community empowerment a n d o f political incidence. As mentioned, the CBPM h a d significant achievements in particular from a governance perspective in government interventions. The CBPM was assumed by World Vision as an initiative of the office of WV Australia as an institutional commitment that promotes an approach of Citizenships Rights and Exercise. In May 2005 t h e methodology was introduced in Uganda, with training sessions for trainers and facilitators. And, from September 14-23 in Fortaleza, Brazil, with participation of staff from three offices of WV in Latin America, Peru, Ecuador and Nicaragua and one of Asia, Timor Oriental. It is introduced as the CBPM methodology and the training workshop is carried out, and a methodological guide is prepared.

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Community Based Performance Monitoring (CBPM): Empowering and Giving Voice to Local Communities.
http://www.engagingcommunities2005.org/abstracts/S96-forster-r.html 7 Most known for the name in English, Community Scorecard Process.
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Currently, WV is implementing the CBPM methodology in Albania, Zambia, Kenia, Uganda, India and Armenia, as well as in Brazil and Per8.
b) World Vision Peru decides to introduce the CBPM and multiple initiatives are developed (2006-2007)
The methodology, known further on as Community Monitoring of Performance (MCD, for the acronym in Spanish) would be used for the community monitoring of public services. WV Peru assumes, as part of its institutional mission, the role of facilitator of a transformational development, based on the fact that WV Per expressed its interest and commitment to promote an improved quality of life in the communities of its ADPs and, in that process, to promote the empowerment of its members and the improvement of the governance indicators. The National Office assumes that the commitment to work the practices of the citizens surveillance intervention exists and have sense in a political incidence
approach.9 That work was carried out initially by the Area for the Promotion of Justice, coordinated by Marlene Arroyo, and it is in this Area that the VCP Project is registered. In year 2009 the institutional changes gave way to have this area changed by that of Social Empowerment , coordinated by Marlene Arroyo, an from there on the project will depend of this new area. In March 2006, the National Office decided to organize the Training Workshop for Trainers10 held in two moments: March 20-23 in Lima, with participation of 17 persons from the Area Offices and ADP of Huaraz, Trujillo, Ayacucho, Cusco and Lima nd two participants from WV Ecuador. In the workshop the participants are informed about the principles and tools relevant to the methodology. From March 24 to April 01 a training workshop was organized f o r t r a i n e r s i n Cusco. I t w a s a d d r e s s e d t o 10 ADP coordinators and 9 facilitators of the region of Cusco and one participant of the AO of Cusco. The field exercises ( use of the monitoring tools) were held in two locations, one in the urban area (Pachactec) and the other in rural area (Lamay).
See: Report Inter Learning Workshop on Participatory Community Surveillance Per-Brasil. Lima, 2326 July, 2009; Report of inter learning workshop CVA in UK October 2010. 9 The critics of the CBPM methodology ( The Real World of Community Empowerment in International Development. htpp://arts.monash.edu.au/psi/news-and-events/apsa/refereed.../davis.doc) argue that without an assertive approach of incidence it has limited reach. The methodology in pure condition would maintain an intervention approach that privileges the use of
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management tools and is supported in an assumption, that cannot always be verified: the determining role that citizens demand would have for improved public services (Community
Based Performance Monitoring (CBPM): Empowering and Giving Voice to Local Communities. http://www.engagingcommunities2005.org/abstracts/S96-forster-r.html). This tool faces a
social reality that includes structural issue that require for its transformation a design and intervention with more political extension. 10 I Report of the Workshop for Community Monitoring of the Performance. Training Workshop for Trainers., 20 March-1 April, 2006.
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As in the former cases, in the event held in Per the training method was in cascade: First a training workshop for trainers, with a more theoretical emphasis ; after that those that were trained give training to a group of facilitators that implement after that a monitoring process to a public service using the CPBM methodology: the school Pachactec and the medical post in Lamay, in Cusco. With them all the process planned by the methodology was implemented: t he in it i a l m eet i ng , t he f ocu s g rou p and th e f in a l m eet i ng w it h th e pl an f or t he im pro veme nt o f th e se r vic es . A l l th i s pr oc es s to ok p lac e in tw o w ee ks: the first one in Lima and the second one in Cusco. In the initial phase the participants were 23 persons from various places, two from the province, three from each region, two or three from the regional offices that were four at that time ( absent were Huancavelica, Ancash, and La 11 Libertad). In the phase of Cusco t h e p a r t i c i p a n t s w e r e r e p r e s e n t a t i v e s f r o m t h e 1 0 A D P s o f Cusco: we selected Cusco because there we cover 50% of the organization. Both in the Workshop in Brazil (set. 2005) a s i n t h e o n e Peru (mar. 2006), t h e d i s c u s s i o n w a s o n t h e m e t h o d o l o g y a n d t h e t e r m i n o l o g y t h a t w a s u s e d . According to the interviews, in Brazil, there was an important discussion about the issue that it was a closed methodology; in Per, the discussion was about the terminology , because with regard to the word Monitoring t h a t w a s t h e l a b e l o f t h e m e t h o d o l o g y , t h e r e w a s c o n f u s i o n w i t h the one used by WV for the follow up made to children: we understood what accountability was, but we had problems with the monitoring issue . 12t It was for that reason that WV Per decides to have it as VCP participatory community surveillance. One of the main conclusions in both events was that the methodology should be contextualized for each country, and that implied both an issue of terminology management as well of concepts and processes with regard to the national policies for public services. The other problem with regard to the manuals is that the Peruvian team did not consider relevant to use two manuals: one with the methodology and the other oriented to the facilitator that was the one that would apply the methodology; t h i s w a s e v a l u a t e d a s a n i s s u e t h a t g a v e w a y t o repetition and confusion. It was for that reason that WV-Per decided to prepare just one manual. Therefore, to deal with the issue of improving and adapting the manual submitted by Australia and translated for the Workshop of Brazil, from 7 to 9 June 2006 another workshop is held in Cusco that was oriented specifically
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to work again on this Manual in order for it to be better adapted to the Peruvian reality. The participants in this workshop were 8 facilitators, and there was a 60% progress in the review and adaptation of the Manual.
In November 2006, with the participation the three ADPs working in the area, a workshop is organized for the training of facilitators, that was led by Edith Villarreal.
11 Interview to NO officers 12
Interview to NO officers
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She had a project Strengthening of Local Democracy (SLD) that was a special project that had resources and was related to the issue of the strengthening of democracy that in those days was proper for that, and had a parallel development.13 Between January and March 2007 an opinion poll was carried out i n 7 ADPs about what was understood with regard to social Surveillance and if they would like to be trained on that issue, and what elements they would like to be included in a guide. Between April and June 2007 t h e VCP methodology i s u s e d i n Chaca a n d i n Araguay en Ayacucho, one of the facilitators that had come for the training implemented the methodology in her ADP. Between May and August 2 0 0 7 an external consultant was hired to develop a training program to create awareness about Citizens Surveillance with methodological and technical tools to be developed in urban and rural areas in those regions of World Vision Peru intervention.14 As part of this process a pedagogical proposal and some materials were designed. On August 10, a Workshop was organized to review and to discuss the proposal of the NO with the participation of Cusco, Ayacucho, Huaraz a n d L i ma: where we prepared some modules and documents as inputs but we were not able to have them edited in an adequate version and it was not applied directly in 15 a community, but they were inputs that were useful. Simultaneously, between June 2006 and August 2007 the NO of WV-Per requested funding from WV-Australia for a project where the methodology would be implemented. There were problems to have the project adapted to the format and requirements of Australia. Finally the project Monitoring Based on the C o m m u n i t y (MBC) N 182312 to be implemented in fiscal years 2008, 2009 a n d 2010 (September 2007 t o September 2010), and its baseline was developed between November 2007 and February 2008. It must be mentioned that since the start of the project conception, the NO and the coordinators responsible for the project proposed it as an initiative that should be incorporated to the PEN strategy. Thus, in the planning for FY 2008 (August 2007) t h e p r o p o s e d n at io n a l g ui d e li n e i s t o i n c o r po r a t e t h e V C P i n t h e g ui d e f o r n at i o n al S t r at e g i e s o f PEN and POP in the framework of LEAP, with the aim that 95% of the ADPs include the surveillance as a social mobilization strategy to improve the conditions of children and
VCP Final Evaluation Report ReportReportInforme Final de adolescents. .
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13 Interview to NO officers 14
See Training Program on VCP for agents for community changes of WVP, June 2007 15 Interview to NO officers
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c) Some important milestones during the development of the project (FY2008 to FY 2010)
The project was started with Edith Villarreal as coordinator, but after the first year the project had faced internal problems and a limited progress in project achievement, thus assumed by Marita Roa. In March 2008, a Training Workshop on the CBPM methodology was organized in the United Kingdom, and Marlene Arroyo attended that event, taking with her the Peruvian experience with regard o the implementation of that methodology. Among the important contributions made by Peru is the need to introduce a previous phase to create awareness and a further phase for incidence. Discussions were held also with regard to the need to adapt and to contextualize the methodology in each location. In November 2008 a 2nd. VCP National Workshop was held with the participation of all the project facilitators. In this activity a balance was made of the progress that had been achieved, as well as an evaluation and adjustment of the intervention strategy, and space was allocated for training and discussion of key issues about citizenship and surveillance. In June 2009, an Inter-learning Workshop between Brazil and Peru about the VCP experience was held in Lima, Peru. In October 2009, a VCP Third National Workshop was held and it was oriented to evaluate the work carried out in the pilot cases, to identify the adjustments and innovations made to the methodology and to work with regard to the profile of the facilitators working in VCP, as well as that for the regional facilitators. In October 2010, a 4th. National Workshop was held and there a global balance of the project was made. 16
29
16 It must be mentioned that this external evaluation did not have the documents of the IV workshop.
30
3.2.
The VCP methodology in Peru
a) About the name of the methodology

In the review made of the documents several names and acronyms were identified with regard to the methodology, and they are summarized in the following chart: Chart 2 Principal names given to the methodology as found in the various documents that were reviewed.
CBPM Community-Based Performance Monitoring Name in English for the methodology developed by the WB, known also as Comprehensive Community Score Card
Monitoring Carried out by the Community MCD MRC MCD VCP CVA Community Monitoring of Performance Monitoring of Community Output Monitoring Based on the Community Participatory Community Surveillance Citizens voice and action for the acronym in English
Translation for CBPM used in the reports of the initial events in Brazil (Set 2005) and in Per (March 2006) Another translation used for CBPM Another translation used for Official name of the project Name used in Peru for the methodology Currently name used in the Partnership CBPM
b) The Approach: Citizens Voice and Action

These lines include one of the definitions of the approach:17 In the framework of the guidelines of the ministry for Development and for Promotion of Justice, WV Peru is empowerment of the community bases for the well-being adolescents with the aim to change the unjust structure poor people in various levels, from local to national level.
17
Transformational focused on the of children and that affects the
TORs oif the Consultancy , p.6
VCP Final Evaluation Report Reportorme Final de Evaluacin
22
From Citizens Voice and Action, that is the framework on which the Surveillance project is being developed, the aim is to increase the dialogue between the citizens and the Government starting with surveillance to the quality of the local public services and the strengthening of the community capabilities to have dialogue and influence on the service operators and their local authorities to implement and/or maintain the proposed improvements. The approach is based on the recognition by the society of the rights of each child, since the moment that the child is conceived, to have access to those conditions that are needed for their total development by the society. In this general approach it is affirmed that the government is responsible to ensure these conditions through equitable public policies oriented to reduce inequalities and social exclusion for children; and this refers not only to those policies that are oriented directly to ensure the access of children to basic services, but also to those policies that promote citizens participation in the decision making processes and their responsibility with regard to continued improvement of the care services and programs. For this, the children must be in the center of the public policy, and both the government and the civil society m ust recognize and ensure that the childrens rights are respec ted and enforced. In Peru, the population under 18 years old represents 40% of the total population, and for them to be able to develop their life some features in the countrys context must be emphasized . According to what is mentioned in the manual Citizens Voice and Action,18 The aim of Citizens Voice and Action is to increase the dialogue between the common people and the public service organizations. Its objective is also to improve the responsibility of the government administrative and political sectors (at national and local level) in order to provide better public services. The objective of this approach is the empowerment of the communities in order for them to have influence on the quality, efficiency and responsibility of the public services. The manual promotes that those citizens that are educated, empowered and mobilized may evaluate the performance of the public services that are working in their communities. They are motivated to compare the actual services with the service standards that their government has promised to provide. The citizens, together with the service providers, the government
23
and the local partners must identify the type of actions to be taken in order to improve the public services.
18
Citizens Voice and Action:
Orientation Guides, Prepared by
Keren Winterford, January 2009, p.
24
This approach is based on the perspective that the individuals and the community are citizens of nation-states. Every citizen has the right to communicate and to establish a relationship with the government. An active citizenship and the commitment with the government help those in the government to work in an effective way and to provide quality services. From this approach, the five basic elements to be considered in every action are: 19 Information More access and use of government information with regard to the election and action of citizens. More opportunities to share information and to generate knowledge in the community about the performance and the reform of the public services. Voice Increased opportunities for the citizens to be actively committed and to have influence on decisions that affect their life, and to demand answers from those that have power. Dialogue Increased dialogue, talking and listening with the perspective to have a shared relationship for comprehension and strengthening and to create comprehensive and cooperating partnerships, in particular with those that have power.
Responsibility Increased responsibility and response capability of those that have power and of those responsible for the service, in order that they may be able to meet their obligations and responsibilities with regard to the citizens. (It must be mentioned that in some documents the term used for this element is Accountability) Organization This fifth element does not appear in the Manual of Citizens Voice and Action that we are mentioning here, however it is considered in other documents prepared by World Vision Peru and it was included by the Peru Office as a basic condition for the intervention and promotion of local empowerment processes. The idea is to strengthen the social base organizations as an intermediate and representative instance that
25
can inform about the common problems and bring the voice of the most vulnerable ones.
19
Idem.
26
c) The VCP tools

The VCP methodology was made specific in a proposal mad for training tools and sequence of activities, that from now on will be referred as VCP tools. These tools are organized in three great phases: Creating conditions Developing capabilities Incidence from the community In the following lines a brief description will be made of the package of the VCP tools, having as source the training materials prepared in the project framework. Phase1: Creating conditions This stage considered the development training sessions with the people and leaders, the service operators and authorities (and if relevant with children and adolescents) with the aim to make them aware about the issues of rights, democracy, and surveillance and to develop a strategy for basic formation on these issues. Seven are the issues considered to be included in the sessions with these stakeholders: Session 1. Development and transformational development Session 2: Children and adolescents rights Session 3: Democracy Session 4: Citizenship Session 5: Citizens participation Session 6: Citizens surveillance Session 7: Community surveillance 3 fascicles were prepared as support material for the facilitators (June 2008) Fascicle 1: Creating Conditions for Participatory Community Surveillance.
F a c i l i t a t o r s G u i d e . Steps to create awareness about the community surveillance process.
This introduces in a general way each one of the steps that the facilitator must follow during the stage to create awareness: from the analysis of the context of the intervention, the programming of activities, how to prepare each session, to the evaluation of the project stage ; the learning objectives; the communication aids designed for the project, and finally some thoughts with regard to the lessons learned and the perspective of community Surveillance for the evaluation of the stage.
VCP Final Evaluation Report ReportInforme Final de Fascicle 2 :
27
Building a favorable attitude for Participatory Community Surveillance and understanding its meaning and implications. Methodological guide. Workshop to create awareness about the participatory community surveillance process, for community agents for change of WVI Per.
This fascicle presents in detail the methodological designs of each one of the workshops or training sessions to be carried out with each one of the public objectives. Understanding the meaning and implicancies of Participatory Community Surveillance . T h e m a t i c F as c i c l e s In this fascicle are the thematic contents to be presented in the each one of the workshops described in Fascicle 2, in a format and language oriented to the workshop participants. Fascicle 3: The communication material prepared to support the convocation made for the people to participate in this formation process consists of: of a recorded model for radio program and a model of basic contents in order that in each ADP a triptych may be prepared adapted to its own context. Phase2: Development of capabilities This phase that is the central part of the methodology includes the various activities proposed by WV-Australia and adapted by WV-Per, organized in three steps: organization, service evaluation and improvement plan. In these lines we include the description of the process presented in the Participatory Community Surveillance Manual, that is a simplified version of the Citizens Voice and Action Manual oriented to the facilitators, that was published in May 2009. This phase has three parts that in the guide are mentioned as steps. The next diagram presents the three steps and the stage of each step.

Diagram 1 Steps of the second phase of the VCP methodology
28
a) Step1: Organization This step considers the following activities:
Remarks with regard to some of these activities: The process that was carried out in the former phase (Creating conditions) must have at the end a group of people and leaders that are motivated to participate in a community surveillance experience. A work group (WG) will be formed with those interested to participate in the experience, and the group will assume the commitment to carry on the surveillance process and they must be the main stakeholders of the process with the facilitators support and advise. Once the WG is organized, it will start a second process to create awareness in the community [1.2] (the first process is carried out by the facilitator as part of the initial
29
process) with meetings, coordination, interviews to the people, service operators and authorities, to create their interest on improved services and have them involved in surveillance activity. One of the important tasks of the process is that the WG (with the support of the facilitator) prepares a diagnose and an information chart of one or more specific issue (resources) of the service to be surveiled [2.1]. In this regard the capability of the members of the WG for the management of information is very important ( the search for sources, analytical capability, interviews with experts) and to be capable to have indicators to follow up the quality of the public services.
The information chart will be complemented with indicators that will permit to follow up the improvements made [ 2.2]. The methodology considers two types of indicators: a) the standard indicators: defined by the WG based on the information that has been gathered and the visits made to the service, and that are used at national or international level, the WG must select them previous to the community workshop; b) group indicator: this is defined in the community meeting [3.1], by the group of persons attending the Workshop, and it must respond to the expectations of the population. The preparatory phase of the Workshop must be monitored by the facilitator in order for the WG to be the directors. b) S t e p 2: Evaluation of the service
The space that has been foreseen for its Development is the Community Workshop in which the expectation is the participation of the community leaders, the service operators, and the authorities. The sequence of the activities is:

-
30
Presentation of the Information Chart and the indicator selected by the WG To evaluate the service and identify the indicators For each indicator, evaluate the satisfaction with the service (Little faces) Evaluation Chart Analysis of each indicator (problems, remarks and possible improvements Prepare the proposals chart Prepare the Chart with the Summary of Outcomes
- Focus groups (FG): activities to be carried out in each one of them:
- Plenary meeting: Each WG submits its Summary Chart of Outcomes to the Plenary meeting. The tools designed for this step are three:
31
c) S t e p 3: Improvement Plan The space to begin with this step could be the second part of the Community Workshop that was started in the former Step or a further Session. The planned activities are:
Plenary session: The Summary Charts submitted by each Focus Group are analyzed in a joint way and with an agreement of opinion the main improvements to be implemented in the service are selected. With the selected improvements the chart Plan for Improvements is filled out.
The document with the minutes of the session is signed by the persons that participated in the meeting.
32
After the Workshop:

- Prepare the Report (by the WG) with all the information gathered about the service: the information chart, the charts with the Summary of Outcomes prepared by the WG and the Plan for Improvements. Dissemination of the Report Deliver copy of the report to the leaders, authorities and service operators. Organize group meetings to submit the Report and to reinforce the commitments made.
For this second phase Development of Capabilities, the national coordinator with the project facilitators prepared the following material:: The manual Participatory Community Surveillance, a simplified version of the manual Citizens Voice and Action, i s oriented to the facilitators w o r k g r o u p s a n d
VCP facilitators. It develops step by step the use of the methodology for t h e s u r v e i l l a n c e o f s e r v i c e q u a l i t y . (May 2009)
Handbook Informing about Surveillance of Public Policies t h a t
has 4 t h e m a t i c f a s c i c l e s and e ach o ne deve l ops t he de fi n it io n of of pub l ic p o li cy , the Sur ve i l la nce ob j ect iv e and the S urve i l la nc e gr ou ps (October 2009): 1: Surveillance of the public policies for health. 2: Surveillance of the public policies for education 3: Surveillance of public policies for protection: The Municipal office for advocacy of children and adolescents rights. 4: Surveillance of the public policies for local management: participatory budget.
Phase 3: Incidence This phase is less structured than the ones mentioned above. In the document Public Incidence, prepared by the end of year 2009 to guide the work of the project in its third year of implementation, the following steps are
VCP Final Evaluation Report Reportuation pointed out:
31
And the following activities are detailed for each one:
For this Phase two support materials are prepared: - Public Incidence (December 2010) - Module Having Incidence from the community in local public policies. This material was not edited. d) Discussion and adjustments made to the methodology during the project development. The 3rd.National Workshop of the Project (OCTOBER 2009) had as one of its main issue to evaluate the VCP process and methodology. Here is a selection of the main thoughts made with regard to the methodology :
34
Diagram 2
Feedback of the First Phase: Creating conditions

1. Adjustments made to the sequence of the steps :
2.
The outcomes: What outcomes should be achieved in this stage? I Identified service. Partners that are aware Plan for the Development of capabilities Document for the analysis of the public policy to be surveiled.
3. The learnings: which were the learnings obtained? To create awareness is very important and should be included for the surveiled person. To work with emphasis on the framework of the right to promote participation. To have information about public policies management. To know the sector that will be surveiled. To have clear the complementation of internal and external processes for the implementation of the VCP. Prepare graphs of the community actions for the achievement of outcomes. 4. Development of capabilities: what issues must be included in the Education for surveillance in public policies Formation in public policies. S olution of conflicts Public Management for health, education and protection
Source: Memory of the 3rd VCP National Workshop: Outcomes and Sustainability, Lima, 26 to 30 October 2009.
This new scheme was an outcome of the think about actions made by the team project and it reports in a better way about the process carried out in the experiences and it expresses the complexity of the process to be carried out. An important issue to be mentioned is that this stage is conceived (both in the
VCP Final Evaluation Report Reportuation initial version as in this modified version) as a previous and differentiated process of
31
VCP Final Evaluation Report Evaluacin
33
formation and training of the members of the WG. But this is not ratified in the field experiences because they are combined with the formation activities of the WG. Feedback of the Second Stage Development of Capabilities
1. INNOVATIONS:
Construction of the information chart: o f l a w w i t h t h e s p e c i a l i s t : i n f a c t only with the community Focus of the intervention (communities). Training for the work group on management issues and access to information. Previous meetings with service operators. 2. CRITICAL ISSUES: What are the things that were not done, that have Rural area: the methodology could not be transferred to the work group. A limited knowledge about the surveiled sector. No information was available about rights. A weak participation of children and adolescents. For the evaluation of the service, no focus groups were available for all the experiences with operators or with authorities. Lack of previous and permanent training to the ADP teams. Limited information about the outcomes. 3. STRATEGIES: What actions must be carried out permanently to ensure the outcomes in
What things that were not included in the manuals, and we have put into practice, and that has improved or facilitated the process?
affected the achievement of outcomes?
this stage?
Create awareness in a permanent way among the service providers and have them involved in preparing information (variables and priority indicators) Linkage with multisectoral and civil society networks and of civil society on the issue of rights. Linkage with local spaces for decision-making (UGEL, DISAs) Direct commitment of the community leaders. Linkage of the improvement plan to plans of the ADP Projects, with organization facilitator, with facilitator for surveillance services. Parallel work with adolescents for their involvement. Management of strategies for the search, analysis and compilation of information.
Summary of the Memory of the 3rd.National VCP Workshop: Outcomes and Sustainability. Lima, 26 to 30 October 2009.
34
3.3.
The studied cases
3.3.1. The health service in the populated center of Musho, Yungay Ancash
a) Features of the area The province of Yungay is located at 2,463 m.a.s.l. at 56 Km. north of the city of Huaraz20. It has moderate weather with an average temperature between 20 to 25 centigrade degrees, it has 8 districts: Yungay, Cascapara, Mancos, Matacoto, Quillo, Ranrahirca, Shupluy, Yanama a n d i t s c apital is Y ung ay . T he p opu l at io n i s appr ox im ate l y 59,963 inhabitants21. Its economy is based mainly on the agricultural and livestock activity. The area of the ADP Mancos covers the districts of Yungay, Mancos a n d Ranrahirca. I n t h e d i s t r i c t o f Mancos is located 57.1 % of the total intervention area of the ADP Mancos22, in 6 Populated Centers: (Huaypn, Huashcao, Utupampa, Yanamito, Mancos and Tingua), h a s 37 communities or annexes and a total population of 11,073 inhabitants. In the district of Yungay is located 37.5 % of the intervention area of the ADP Mancos and it is distributed in 7 Populated Centers, (Pampac, Aura, Cochahuain, Aira, Huashao, Tumpa and Musho) and 14 communities or annexes, a population of 3,497 inhabitants that represent a total of 877 families with 457 children under 6 years old. In the district of Ranrahirca is located 01 Populatd Center that represents 7.1 per cent of the intervention area of the ADP Mancos (Cajapampa) and it has only 2 communities (Barrio Soledad de Cajapampa and Cajapampa) that has 473 inhabitants with 105 families and 40 children under 6 years old. The three districts have similar poverty rates according to the Population and Housing Census 2007.23.
20
Design document of Program Mancos, FY 11 to FY 15.

21 22
35
Minsa, Office of Statistics and Information. Design of the Program Mancos Phase 2, FY 11 to FY 15 23 Design of the Program Mancos Phase 2, FY 11 to FY 15. Source ADP Mancos 2010.
36
Porcentajes Distrito Poblacin 2007 Poblacin Rural Poblacin sin agua Poblacin sin desage /letrina 19 10 19 Poblacin sin electricidad 32 22 20 Mujeres Analfabetas 30 32 28 Tasa desnutricin Nios 6-9 aos 39 43 38
Nios 0-12 aos 27 25 27
IDH
Yungay Mancos Ranrahirca
20.075 7.180 2.818
58 70 67
20 9 22
0,5193 0,5214 0,5046
b) A D P Mancos According to the Program Profile, the Phase I of the ADP Mancos started in year 2007 and its estimated life is 15 years. The program coordination was assumed by Nilda Gonzlez. Currently, the ADP develops the Project of ESSponsorship and the Health and Nutrition Project. The budget for the ADP for the current management of the Project for the Fiscal Year (FY) 2011 is US$ 450,000.00. Its target population is: District Yungay District Ranrahirca District Mancos PEN Infants PEN Children PEN Adolescents : : : : : : 1,183 CHAs 103CHAs 1,268A CHAs CH sCH AsCHAN 755 CHs NAs 1,424 CHs 306 A
The intervention area of the ADP Mancos covers, as mentioned before, the distr icts of Yungay, Mancos and Ranrahirca, in the province of Yungay. It includes 14 Populated Centers, 53 Communities or Annexes, with a total of 15,043 inhabitants relevant to 3,812 families, that have a total of 1,132 children under 6 years old among sponsored and non sponsored ones. 24 c) The Health Post of Musho The ADP Mancos decided to surveil the health post of Musho that is a cnter of Level 1.1 and it provides assistance and promotion services.

24
37
Design of the Program Mancos Phase 2, ADP Mancos, FY 2011- 2015
38
The health post belongs to the network Huaylas Norte, micro n e t w o r k Mancos a n d i t d e p e n d s o f t h e D ISA of Ancash25. The director is the obstetrician Nancy Delgado. The coverage of the health post includes the communities of Piscuy, Pariantana, Huamba Musho, Apagrande and of Musho center, with an estimated number of 2400 beneficiaries. On December 2008 three persons had been assigned, one obstetrician, a nurse and a nurse trainee. d) A D P Mancos and the VCP Project The NO considered including the ADP Mancos in its pilot experience taking into account the success of WV projects in those locations, in particular the Health and Nutrition Project. Besides, the relationship that had been established with the community leaders and the sustainable health work with members of the Peace Corps, the staff of the Health Post and the health community agents. In the evaluation of WV these were favorable conditions for the development of the pilot project VCP.
Our health experience in Musho had been a very good one. We had worked together with the Peace Corp, the health post The health agents were more active. The health staff responded well.27. Training of the staff and the organization
Training on community Surveillance methodology was provided to the ADP staff in Mancos. Involved in these trainings were the VCP Facilitator Csar Flores and the Facilitator for Organization, Flor Silvestre. In year 2008 the ADP organized two workshops, with participation of the Coordinator of the pilot project VCP. The VCP facilitators and organization staff participated also in the Workshop for Inter Learning of VCP Peru-Brazil, held in Lima from 23 to 26 June, 2009, in which the contributions for improved work were gathered and reviewed for the VCP processes in those countries. In year 2008 the ADP Mancos prepared a diagnose, and later on a Baseline. In addition proposes were made for material to create awareness addressed to the coordinator of the project in the NO, in Lima: triptychs Promoting Participatory Community Surveillance with Children and Adolescents and radio spots. It was decided to produce these spots in Spanish (120) and in quechua (207). The pilot project VCP in the ADP Mancos w a s m a n a g e d d u r i n g i t s life by two facilitators: Csar Flores, who started and accompanied the process until 2009 and Lucia Fernandez who carried out the organization and evaluation of the service.
VCP Final Evaluation Report Evaluacin Csar Flores CODECOS.

25
26
39
accompanied
her
at
the
time
of
the
constitution
of
the
Minsa, Office of Statistics and Information technology. Information Card of the Surveillance Unit ADP Mancos, 22 /12/ 2008. Data of INEI 2008. 27 Interview with members of the AO/ADP, 14 July 2011.
40
During the field visit of this evaluation consultancy, Lucia Fernandez was working in another institution outside from the city of Huaraz, It was not possible to have an interview with her.
Enabling (generating conditions for) citizens participation

Initially, the ADP Mancos assumed that the pilot experience was going to be implemented in eight locations of the Program intervention area. According to the information that has been gathered information activities were carried out in the various communities. The work started with a bombing in the c o m muni tie s w ith t he p rop os al 28 disseminating the message and, in this regard creating expectations with regard to the ADP intervention, that later on they could not attend. For the second year the time and human resources were evaluated and the intervention area was assigned restricted only to the community of Musho and annexes. According to testimonies gathered in the area and in the National Office, this adjustment made in the intervention scale, gave way to some tensions from the perspective of the local stakeholders. The weak community organization in Musho makes difficult to organize a Work Group (WG). In year 2009 s t a r t s t h e w o r k w i t h t h e c o m m u n i t y agents involving also the local authorities (peace judge, the M a y o r o f M u s h o ) . Early in year 2010, the facilitator Luca Fernndez, t o g e t h e r w i t h Csar Flores and the Peace Corp volunteer, promoted and accompanied the organization of the CODECO (Community Development Committees) in each one of the villages but in the central area of Musho. The CODECO assumes the WG role, with the help of World Vision and of the health staff of Musho. Since the beginning, the WG was set up under a subordination scheme with regard to the health staff. The CODECO depends of the health post, and its main role is that of community support staff for the sector initiatives. Furthermore: its members maintain an ambivalent relationship with the Director of the health post: they are very critical about the management style, but at the same time they accept the decisions made b y t h e d i r e c t o r . 29. This is relevant to a traditional model and practice about the concept of community participation and the relationship with the public sector, in this case, with the health sector. This relationship is also valid for the WG affirming a critical attitude associated to the incorporation of a rights and accountability approach, that is associated with the VCP, but with difficulty for the development of the proposal. The WG members had training sessions with regard to surveillance and information
41
with regard to the regulation and guidance about public policies at the initiative of World Vision and the health post. Since the start the idea is to carry out joint actions.
28
Interview with members of the AO and ADP Mancos, 14 July,2011. 29 In a case referred by members of CODECO, they and the health post agreed to organize a chicken party to collect funds top ay part of the salaries owed to the porter of the health post. The director decided to manage the funds collected by the community without a support committee for accountability . The members of CODEC in the narrative workshop expressed misgiving for this one-sided decision, but no initiative was taken to request formally the constitution of the committee.
42
Musho has a particular issue if we want to intervene we must coordinate with the health post, we could not have meetings without them30.
In general, these trainings were provided in the same health post.
Community participation
In Musho, World Vision and the staff in the health post agreed since the start not use the term Surveillance in the process nor in the actions carried out by WG/CODECO as they had verified once more that the term Surveillance gave way to inconvenience among the officers due to confusion with the term control. The ADP decides to make a di agnose of the service , something like a SWOT31, with participation of the staff of the health post and of CODECOS, to explore where was the concern of the people for Surveillance. For that, external staff was hired, because we did not want to participate in that32 as the aim is to avoid a conflict with the director of the health post. The outcome was the (ill) treatment of the staff33. T h e d i a g n o s e i n t r o d u c e s t h e was the treatment, the medicines, their benefits34.
misgiving of the health post director and undermines the dialogue w i t h W V . They put [ the population) from where, at what time they wanted to be cared, how
The woman director ordered her staff to stop the cooperation with WV and all that had been done by us was left behind35. The director gave instructions to the staff not to
circulate the document internally until it was discussed with the Coordinator of ADP Mancos. It must be pointed out that this moment coincides with the change of facilitator, Csar Flores, and the position was assumed by Luca Fernndez. When the director of the health post is replaced temporarily by a new chief (obstetrician), temporary bridges are extended with WV. W i t h t h e n e w D i r e c t o r t h e r e w a s n o t m a n y p r o b l e m s 36. This fact highlights the importance of the commitment of the institutional leaders with the development and final outcomes of the process. The meetings with the CODECOS are recorded since the start days of year 2010. The training and the service evaluation phase took place until the month of August. The training included how to make a diagnose, what is the incidence and other issue related to the process.
30 31
Interview with members of the AO and ADP Mancos, 14 July 2011 dem 32 dem 33 dem 34 Interview with the health service operator, 13 July 2011. 35 dem 36 dem
43
The information meetings of the health service were held with the staff of the health post. In those meetings the staff discusses issues related with the situation of the staff, the infrastructure and the service. To prepare the matrix for the Information Chart an identification is made of the service resources and of the issues/features of the intervention, among them: Equipment Care hours Care provided by the staff (treatment by the staff) Care in emergency cases Registration in SIS Number of staff to provide care Care time schedule Security Medicines This includes the continued claims made by the people with regard to an extended schedule for care hours (as of 7 oclock in the morning) and better treatment by the health staff (good and respectful treatment), among others. The standard form for the process was used (duties and actions chart). As an outstanding detail is the difficulty faced to identify the regulation references and the guidance for sector policies that support the demands. The meetings for the evaluation of the health service will use the focus group dynamics with participation of health staff, community leaders, authorities and children. The persons responsible for the group facilitation were the members of the work group and the Peace Corp volunteer.37 To prepare the Chart with the Outcomes of the Evaluation of the Health Post there are only two indicators: the Care time schedule and the Number of Health staff38. In the same day of the Evaluation Session a Plan for Improvements was prepared (August 20). The participants from the five villages were: authorities and leaders, children, family mothers and fathers, and a focus group of men and women neighbors of the health post. 39. Of the team of the ADP Mancos, Alicia Falcn, assistant of the Health Project, Yenny Cachachn of the DESECO project, Luca Fernndez VCP facilitator and Marita Roa of the NO of WV. Kaitlyn Stanhope of the Peace Corp, and Lic. Jhonson Figueroa from the health post.
37
Interview with the Peace Corp volunteer,
Musho, 12 July
2011.

38
44
Chart of Outcomes of the Evaluation of the Health Post of the Populated Center of Musho, 20 August 2010 39 Improvement plan for the Health Center in the Populated Center of Musho, 20 August, 2010
45
The following priority activities were identified in the matrix: Request for medical staff To manage together with the health staff the schedule for care hours and shifts Odonthological campaign in the IEPP Mrtir Olaya de Musho To request the support of community people with technical training in health To request and incide with the local government of Yungay for an improved sanitation system for Apa Grande. It is interesting to point out that also here are not included indicators with regard to the treatment of the service staff to the users that is the reason for the insisting claims made by the population. The Improvement Plan identified the persons responsible for the actions, the resources needed to carry out the actions and the time or term for the implementation. During the narrative workshop, the WG members recognized period of midyear 2010 in which training and citizens participation meetings were the evaluation of service and to prepare an Improvement Plan, but distinguish the specific time. They cannot remember the contents meeting, the purpose and date (month) of each one of the meetings. time by held for they not of each
With regard to the health staff, they participated in the phase of the VCP evaluation of the service. One service operator mentions that the staff meetings with CODECO were programmed once a month (but he cannot remember the agenda for each meeting or distinguish the VCP phases). The start of this phase of the VCP process was favored, according to the opinion of the operator, with the temporary license of the director of the health center. e made turns with the other staff to attend the meetingswith the obstetrician 40 man that replaced the obstetrician Nancy) . The meetings to prepare the Information Chart, the Chart with the Evaluation Outcomes (smiles scale) and the Improvement Plan were held in the months from June-August 2010. The project was superposed, we had to run. The stages had
41 This delay refers also to the impact of the initial rhythm of not been respected . the project and the conditions that have been mentioned: weak organization and opposition by the service staff, but also in a more favorable environment, the possibility to carry out actions in a less spaced time.
46
40 41
Interview with the health service operator, 13 July 2011 Interview with members of the AO and the ADP Mancos, 14 July 2011
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Improving the services and having influence in the policy

Improvements made in the health service
The health staff changed the hours for care to the public from 7 am t o 2 p m . T h i s was more convenient for the patients in particular for those that had to be derived to the health center in Yungay. However, this time schedule was not going to be valid for a long time. About the treatment provided by the staff to the patients, the members of the WG and of the ADP/AO coincide in pointing out that the ill-treatment still persists. They have identified that the director of the health center is not willing to make changes in this regard. It must be mentioned that in one of the meetings of CODECO the issue of a change of director was discussed, but the objective was not achieved and the problem is still outstanding. On the other hand, it must be mentioned that the WG knows about their rights with regard to the Integrated Health Service and the registration process. The representatives of CODECO and the authorities (Mayor and Peace judge) made a request to the Regional Directorate for Health for the assignment of a medical doctor to work in the health center of Musho, that had been for es een initially f or one month ( September) and extended until D ec em ber, according to w hat had been programmed in the Im pr ov ement Plan. In this point it is difficult to distinguish in the perception of the various stakeholders of the process, the achievements made with regard to the VCP process and the Improvement Plan and those obtained by the initiative of the local authorities and CODECO. That is not something negative or less important. It is the VCP process/methodology that permits to identify these problems and determines the development of these actions, and that is something positive and what gives way to this ambiguity about whom is the one that makes it possible is the fact that CODECO that functions as WG gives way to the ambiguity, but at the same time it can be valued as something positive. In general, with regard to the perception of changes, the members of WG/CODECO point out that the concrete outcomes have been very discreet. However, they consider in a positive way that the fact of having been able to identify those problems in the meetings of the process of VCP/coordination with
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CODECO, and helped with the methodological tools included in the Guide (the use of the most remembered ones are the smiles scale and the rights chart). The CODECOs found in the meetings of the VCP process a space in which the health rights are affirmed and critical opinions are expressed with regard to the service. Even more, they value the fact that they have been able to open spaces where their voices are being listened and they have lost fear to express their opinions in public. They are aware of the fact that they are creating opinion about issues related to public policies, regulations and others that they did not know before.
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3.3.2. Nuevo Milenio, Villa Mara del Triunfo, Lima

a) Features of the Area Nuevo Milenio is located in the urban southern area of the district of Villa Mara del Triunfo (VMT). I t s borders are: in the North with sector 6 (Villa Poeta Jos Glvez Barrenechea), in the South with the district of Pachacamac, in the East with the HH.SS. Jos Glvez of VMT, and in the West with the district of Villa El Salvador VES. The area is known as one of the greatest risk areas with difficult accessibility as it is located in the foothills where the access by car is complicated and humidity is sometimes at a 100% level. 42 According to the Baseline report for the ADP (2008)43, by mid-year 2008 the population in Nuevo Milenio would be 22,534 persons ( 5.96% of the total population of Villa Mara del Triunfo) distributed in 19 human settlements. According to this report, the population in this sector is among the youngest and the poorest ones in the district of Villa Maria del Triunfo; the basic services are limited and the houses have been built with good and incipient concrete, and are smaller than those in other sectors of the district (between 90 and 129 m2). According to the Census of year 2005 in the district of VMT 33% of the people are poor, 14.8% are very poor, and 34.1% are extremely poor. For year 2004, in Nuevo Milenio the Economically Active Population (EAP) is of 46.0% of the population of 15 years old or more. This means that 54% o f t h e population at work age is unemployed; but 16.9% of this population studies and 37.1% does not study or work and it is that young people group that is more susceptible to be oriented to delinquency and to be organized in gangs. According to the same source, the distribution of the EAP includes workers (33.5%); workers in services that includes a large percentage of domestic workers (18%); small traders (10.6%); peddlers (8.2%); and farmers only 0.8% With regard to health, the same source indicates that among children less than 5 years old 5 2 . 8 % have anemia and 5.3% chronic malnutrition, without taking into account the large number of children in risk condition. Also, 30% of the children under 1 year old does not have a full vaccination scheme and in the jurisdiction of the WG Micro Network there have been 8804 cases of acute respiratory infections (ARIs) and 884 cases of diarrheic diseases among children under 4 years old.
42
Design Plan of the Area Development Program (ADP) Nuevo Milenio (2008 2012). Lima, August 2007, p.9.

43 44
50
Baseline of PENs and POP ADP Nuevo Milenio. Lima, November 2008. Design Plan of the Area Development Program (ADP) Nuevo Milenio (2008 2012). Lima, August 2007, p.15.
VCP Final Evaluation Report Evaluacin b) The ADP Nuevo Milenio
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According to the national intervention strategies of World Vision International in the Lima Region, these area was selected to implement an ADP because there was a highly concentrated population with a large population of children that did not receive care (2973 children from 0 to 9 years old), and in that location no sustainable impact projects or programs had been developed. There are also alarming average rates of anemia and malnutrition, insufficient sanitation conditions because of the rapid and disorder ly growth of the neighboring districts (Villa El Salvador and Lurn).45 In August 2005, ( when Fiscal Year 2006 starts) the National Office of Peru and the Support Office of Australia approved the creation of the ADP and the process for the recognition of the intervention area was started in FY 2006. According to the LEAP guidelines in September 2006 the Diagnose document is ready; by the end of 2007 the Design Plan for the period 2008-2012 is ready; and in November 2008 the baseline is set up. The ADP starts for its first five years of life with four Projects: Sponsorship, Health and Nutrition PEN 1, economic development, and also the SAAM. Until year 2008 the ADP coordinator was Edwin Quispe Fuster, and afterwards the Coordinator was Juan Valverde, who was on that position during the evaluation. c) The service to be Surveiled: the Health Post Nuevo Progreso The health post Nuevo Progreso, of category I-2,46 is located in Sector I known as P ueblo Joven Nuevo Progreso, that is one of the human settlements of Nuevo Milenio seventh sector of the district of Villa Mara del Triunfo. This health post is part of the Micro Network for Health Jos Glvez - Nueva Esperanza (Health Directorate II Lima Sur of MINSA) and it is one of the few health centers that provide care to the people in this sector. Besides this center, there is also the parish health center Santa Ana and a private polyclinic. From the review of the documents relevant to the ADP Nuevo Milenio as well as the interviews the deduction is that since the creation of the ADP Nuevo Milenio ( by the end of year 2007), this health post is a strategic partner for the ADP, in particular with regard to the Development of its Health and Nutrition Project. d) The ADP and community surveillance of health In the strategies foreseen by the ADP for the achievement of Output 02.02.01 reference is made that there is a c o m m u n i t y s u r v e i l l a n c e s y s t e m . While this
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45
Design Plan of the Area Development Program (ADP)Nuevo Milenio(2008 2012). Lima, August 2007, p.9. 46 Health post with a medical doctor (http://www.minsa.gob.pe/oei/servicios/DetalleEstab.asp?id=0000006145)
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s y s t e m h a s a n a m e that is very similar to that of Participatory Community Surveillance, it refers to the methodology of the follow up that is made to each child with regard to some health and nutrition indicators , with the participation of a group of volunteers for the gathering of information: an information that feeds the POP system. This similarity in the names has given way to some confusion in the work teams ; in order to make a difference between them they are known now as internal surveillance or Surveillance of health with regard to the one that is oriented to monitor the condition of the children and the information feeds the POP system; and external surveillance or community surveillance is the one that is oriented to surveil the quality of the public services. e) The ADP Nuevo Milenio and the VCP Project The NO selected the ADP Nuevo Milenio as one of the places to implement the pilot project because it was a new ADP where it would be easier to include a new intervention strategy in the community. The ADPs Nuevo Milenio (Lima)
and Mancos (Ancash) a r e n e w b u t f a v o r a b l e i s s u e s a r e p e r c e i v e d for citizens participation because of the relationship with the local government; but it is necessary to strengthen the o r g a n i z a t i o n c a p a b i l i t y o f i t s c o m m u n i t i e s . 47
In a parallel way and during the same period of time in which the documents are being prepared to start with the ADP Nuevo Milenio, the National office of World Vision Peru prepared the documents to start with the VCP Project, for both projects December 2007 is the date for the final version of the Design Plan. It must be highlighted that in the Design Plan of the ADP Nuevo Milenio no reference is made with regard to the VCP Project. By the end of year 2008, the health post Nuevo Progreso was selected for the pilot project and by the end of year 2007, F l o r Curo Lpez, sociologist, was hired as project coordinator in that area. The project faced difficulties during the first year and had to be reoriented, and from November 2008 until August 2010, Yessenia Mara Lorenzo, political scientist was hired as coordinator. Among its roles was to ensure that the pilot experience would be implemented according to the project guidelines and also that the experience would be shared and that there would be training and transfer of the VCP methodology to the facilitators of all the ADPs in Lima. It must be noted that the development of Surveillance experience in the health post Nuevo Progreso gave way that early in year 2010 a experience of VCP in initial education had to be started in the PRONEI. The facilitator for the initial education project and the Director of the PRONEI were very interested in this work. A WG was organized with CENEI and APAFA, but it was a weak one; a Workshop and an Improvement Plan was prepared, but with out a follow up
VCP Final Evaluation Report process.

47 48
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Diagnose report and design of the VCP project, January 2008 Tracking table of the VCP project, first semester 2009.
VCP Final Evaluation Report Informe Final de Evaluacin
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f)
Surveillance to the health service in Nuevo Milenio, VMT Lima49
The project in Nuevo Milenio had two stages : the first one, that is relevant to the first year, with Flor Curo Lpez as facilitator; and a second one from the end of year 2008 until the end of the period with Yessenia Lorenzo as Facilitator. According to the report of the 2nd. National Workshop of the VCO Project (November 2008), the Situation of the organization in Nuevo Milenio s h o w ed s v e r a l w e a kn e s se s t h a t m a de d i f f i cu l t t h e p r o j ec t pr o g re s s :
there are leaders that do not have representative bases (political leaders). Inadequate leadership practice, it is not a shared leadership. there are not organized groups, lack of new leaders. the situation must be investigated, must be followed up.
In the first phase the work was oriented to create awareness, and thematic workshops were organized, but there were only few participants..
Staff training and organization

Yessenia Lorenzo was the Project Facilitator as of November 2008 and one of its first activities was to participate in the 2nd.National Workshop of the VCP Project Developing Capabilities, and event that was oriented to evaluate the first year of the project intervention and to define the intervention strategy for the second stage. Two other organization facilitators of the ADP Nuevo Milenio: Carlos Ortiz Angulo and Blinder Fidel, participated also in this workshop. According to the Facilitator, besides this Workshop, Marlene Arroyo and Marita Roa had an important role in the training about VCP methodology.
Implementing (generating conditions for) citizens participation

Given the fact that during the first year of the project Little progress had been made wityh regard to the phase to create awareness, the work by the end of year 2008 and the start of year 2009 was oriented to make contacts, motivate and convoke, as awareness should been created initially in order to have a group of persons with whom to organize the Work Group. Between December 2008 and March 2009 the phase to create awareness was implemented in Nuevo Milenio. Upon completion of this phase a group of community leaders would have been organized and at the same time the service
VCP Final Evaluation Report ReportInforme Final de operators and authorities may have been involved.
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46
Narrative prepared based on the interviews and documents received.
45
A ccording to the interview, At the beginning I did not know from where to start, it was not an organized population, therefore, it was decided to work together with the facilitator for organization of the POP project, and with him a contact was made with some leaders in order to be able to get closer to the population. To
motivate and create awareness about the issue, a partnership was established with Py Organization, and attended the meetings organized by them, where the video was shown.
Among the difficulties were some conflicts and splits among the leaders of the human settlements that were in the motivation process, because of the way in which they perceived the participation of WV-Peru in the area, in particular with regard to accountability.
Together with the among the leaders about the work accountability about it.
problem of accountability were the conflicts with regard to WV: some of them were critical performed by WV because there was not the sponsorship funds, and the others approved
By the end of March a group of approximately 50 persons had been convoked to start the training and motivation process to prepare the diagnose of the service,
supported to some extent by the community volunteers that are related through the POP project.
The WG was formed with leaders and authorities of the HHSS, health promoters and 2 adolescents. All the members of the WG were elected by their community in the meetings that the facilitator organized in each HHSS to introduce and to create awareness about the CP. The WG members that participate in the workshop convoked for this evaluation (further on Evaluation Workshop), remember this time as the convoking period, In which the facilitator visits settlement by settlement, to invite the people to participate in the VCP process. Likewise, in the Evaluation Workshop they remember that the process started a large group of persons, but Little by Little they were leaving, and at the only 12 members remained that were the ones that were working during whole process. The adolescent girl member of the WG remembers in a specific way and with great satisfaction the fact of having been elected by community to carry out this work. with end the very her
April and July 2009: Now that the WG has been organized there will be training meetings on issues relevant to rights, citizenship, surveillance as well as on rights and standards of quality of the health service, and activities to create awareness among the leaders , operators and authorities about the importance of
46
community surveillance and of an improved quality of services. In this period the training activities programmed for the First Phase will be carried out as well as those of the first step of the Second Phase of the methodology (the evaluation workshop where the time line identifies both activities in this period of time ). The objective of this stage was that the WG will prepare the Information Chart of the service, select the standards of the indicators, be trained in the methodology, prepare the Community Workshop and make the convocation to the population.
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In the process relevant to the analysis of the service, the WG identified the following resources or issues to be evaluated: nurse, medical doctor, social worker, selected staff, care hours, infrastructure; it identified also some sources that establish the standards for the service quality and it identified the things that were lacking.50 And the WG selected the standard indicators to be submitted in the Workshop. The participants convoked for the Workshop were: leaders, local people, family
mothers, adolescents, doctors,
service
operators, councilmen
of Villa
Maria, medical
Community participation first VCP

The first Community Workshop was organized in July 2009; the methodology was used in this workshop under the directio n of the WG with the facilitators support. Among the participants in the workshop was Dr. Pinto, the medical doctor responsible for the He alth Post, who was very interested in the process; the WG members keep very good memories of his participation and his interest in the community surveillance process. According to the information recorded in the Evaluation Workshop, the WG submitted the evaluation chart of the service and the standard indicators worked by them: : good care and entrance working hours; as an outcome of the focus groups work and the plenary session the infrastructure indicator was added.. On this set up health board basis, the participants in the process prepared the Improvements Plan and the commitments. Among the agreed improvements were: to extend the post, t o p u t a m a i l b o x f o r s u g g e s t i o n s a n d a n i n f o r m a t i o n with the time schedule and others. Dr. Pinto assumed the
commitment to install the post box for suggestions, because some family mothers were standing in line since 4.00 in the morning and received care by mid-day, I was there the whole day. This problem was discussed with Dr. Pinto, in order to have it improved. Improvements Plan
After the Workshop, the facilitator and the WG will carry out various activities and meetings to disseminate the Improvements Plan among the health network, the service operators, the community and the local authorities. The Improvements Plan will be modified and adjusted during these meetings, looking for new commitments that will be recorded in Commitment Minutes. And after a period of time, these
VCP Final Evaluation Report ReportInforme Final de commitments will also be followed up : follow up and pressure will be made to the
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agents in order for them to meet their commitments. Meetings will be held in the Health Post with the WG, the leaders, councilmen, and zone representatives.
The facilitator promotes also that the WG must inform in their location what they have done and also disseminate the information visiting other institutions located outside
50
Information Chart First
VCP.
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the south cone. Therefore they visited the Health Forum 51 (in Jess Mara), to inform about what they were doing and get their commitment for an improvement plan. a group went to the Health Forum , we requested a space in their time
schedule to explain what we have done and also to make them know about us.
The actions carried out in the community were known as community sessions, through which the WG were able to inform about the work carried out and the surveillance outcomes, as well as to have more leaders committed with the work. According to the statements made by WG members that participated in the narrative reconstruction workshop, this process strengthened their leadership, recognition and representation in their community. A testimony in this regard is the one given by a young member of the WG who said that she met
a leader that was coming back from the health post where he had received medical care, and he recognized her as member of the surveillance committee, and he asked to carry out once more this process.
organization, in September 2009, ofthe Seminar about Public Management. An important issue that was mentioned several times in the Evaluation Workshop was the Improvement Plan that was submitted to the Municipal authorities (early in year 2010) and was submitted by the WG: During the Workshop that was held in the Municipality, Yessenia disappeared, she left us alone and I had to make the presentation of the whole Improvement Plan and of all the agreements.
During this time, in a parallel and complementary way, the facilitator promoted the
The Improvement Plan was presented In the municipality (requesting also) their support and also (to complement) the commitments made with other stakeholders, we suggested that they could help those persons to participate in the surveillance activities and also for the health post to change their attitude with regard to the care provided to the people. And they (the officers) be also committed to this. And it was there that a small improvement plan was made, with them. It is important to mention that in this activity for the presentation of the Improvement Plan was also the medical doctor and the Councilman for Health. Given the fact that early in year 2010, the medical doctor of the Health Post was changed, and the new doctor was Dr. Lizeth Pizarro, it was necessary to submit to her the agreements made in order to have her committed in the process. A meeting was held in the health post, with all the staff that work in the health post, to tell them about the Improvements Plan that had been approved and to continue with it , but that was not well accepted by the doctor that is the
VCP Final Evaluation Report ReportInforme Final de director:
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51
The Forum of the Civil Society for Health (ForoSalud), i s a s p a c e t h a t i s l i n k e d t o the civil society in the area of health and it convokes many organizations n a t i o n w i d e . http://www.forosalud.org.pe/.
VCP Final Evaluation Report ReportInforme Final de a n n o y e d a l s o , ..the doctor did not give importance to us
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: the doctor said, w h y y o u d o n o t l e t m e k n o w s h e w a s
We were there not to judge her but to give her what had been agreed, Dr. Yessenia had copy of everything that had been worked. The medical doctors did not like our work: they felt uncomfortable, [MIM: w h y ?] They said, why the people has to tell you the problems, they must tell them to us ; they were against that, and the people did not want to tell them the problems, the ill treatment], may be to avoid future reprisals We had a meeting in the Health post with all the workers, and we talked with her, but she tried to skip the subject. She said that we had not sent her the papers, that we had not informed her, that the patients do not say here what we reported as having said by them with regard to ill treatment. This will give way to have a second VCP process that will evaluate the progress level of the First Improvement Plan and will prepare a new one.
Community participation second VCP

April 2010 a new training plan was prepared about participation, citizenship, and health; the WG and the leaders were convoked, and with them the organization of a 2nd. Workshop on Surveillance was prepared. The children and adolescents were also convoked to participate.
On
In this workshop (August 21) only the population and leaders will be the participants. On this occasion the diagnose will be focused on the quality of service provided by SIS. The selected indicators were: a) Care and Good Treatment by the staff of the Health Post to the persons that have the SIS insurance, b) Waiting time for the SIS insured patient, and c) as a group indicator, the number of workers in the health post. Three focus groups were organized: family mothers, leaders and a group of children that receive care in the health center, and children and adolescents; the out come was a great deal of unsatisfaction with regard to all the indicators. After the Workshop, there was a new dissemination process of the outcomes and to promote the commitment of various agents to participate in an Improvement Plan. On September 21, 2010, a second Workshop was organized to work on the Improvement Plan. In this event, almost at the end of the project,
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the participants were: representatives from 13 of the 19 Human Settlements located in the area, representatives from social organizations; the Advocacy Group of Nuevo Milenio, women organization of Nuevo Milenio, the Glass of Milk committees, the NGO Health Forum, councilmen from the Municipality, and the Representative of the Micro Network for Health of Jos Glvez. The outcome was that a new Improvement Plan was prepared, and the follow up was to be made by members of the Work Group and of the ADP in order to provide continuity to this experience.
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3.3.3. The case of the Health Service of Huanta

a) Features of the area and of the living conditions of the people According to the census of INEI for year 2007, the total population of the province of Huanta was of 93,000 inhabitants, of whom 40,000 lived in the district of Huanta, and of them 26,000 lived in the urban and peri-urban areas, while the rest of the people lived in the rural populated centers of the district. In year 2007, the rate for total monetary poverty at province level was 69% and in the district of Huanta, according to the same source, it was 71%, and the rate for extreme poverty was 38%. In the case of poverty due to Unmet Basic Needs (UBN), one of every two persons lived in households with at least one UBN, and the most significant needs were the poor condition of the household, the overcrowding and the lack of basic services and all these factors affect in particular the children and the elderly people. The information in the census of year 2007, shows that most of the EAP was self-employed or was working in micro enterprises (76%) without a health insurance or access to social security. With regard to the total population, 53.8% did not have health insurance and an additional 34.3% had access only to SIS, and that was a restriction to the access to the health services. b) The ADP Huanta WV has been working in the area for a long time. The ADP Huanta started its work in year 1996 accompanying the insertion processes of the displaced families victims of the political violence and since year 1997 it has worked under an institutional organization and work pattern that is different to the ones implemented in other areas. In this case the institution has a strong and privileged relationship with the Association of Displaced Families Inserted in the Province of Huanta (AFADIPH for the acronym in Spanish) ) that is expressed in a cooperation agreement through which both institutions have built an institutional platform for all the actions related to the projects that are implemented in that area. 52. The following graph shows the type of organization that has been adopted by both institutions for the general development of the ADP activities. It must be pointed out that while at the start the strategy of WV for the work to be carried
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out in the area was a particular one, gradually the work has been carried out oriented to improve the quality of life for children and adolescents, promoting the access to education and health services and the participation in local processes such as the participatory budget.
52
Document of the Redesign of the Program ADP Huanta 01587 FY 2008-FY 2012 Intermediate phase.
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The graph shows that there is an instance integrated by representatives from both institutions that are responsible for the program coordination and for the relevant projects. Please note that the VCP project is not placed clearly, according to the feature of the complementary project. According to the information gathered during the interviews there are some potential pressures between both institutions, and in most cases in the community sectors AFADIPH is considered as a NGO rather than as a social organization.
Graph 1 Relationship AFADIPH of World Vision and
Source: Redesign Document of the Area Development (FY2008 FY2012) Intermediate Phase. Lima, September 2006, p.27
Program
Huanta
According to the information that has been reviewed, in year 2006 the ADP H u a n t a w o rk e d w i t h 1 2 c o mm u n i t i e s o r h um a n se t t l em e n t s , a n d in y e a r 2 0 0 9 , t h e sp e c i f i c w o r k a r ea o f t h e A DP had been extended to 17 human settlements53.

53
56
Arteaga Romero, Irene. IDTs Comparative Report 2006 2009. V i s i o n Huanta- Ayacucho Per. October, 2009.
ADP Huanta. W o r l d
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Chart 3 Communities of the intervention area of the ADP Huanta, 2007.

HH.SS &/or SUBURBS URBAN MARGINAL POPULATION OF AFADIPH 2007 Population Total NUEVA JERUSALEN HOSPITAL BAJA ALAMEDA BAJA CASTROPAMPA TRES ESTRELLAS CEDROPATA ACCOSCCA VISTA ALEGRE PERASCUCHO CHANCARAY DURAZNOPATA ALLPAPILAR PUEBLO LIBRE AHUIMPUQUIO LOS SAUCES HUANTACHACA COLLPA TOTAL 1054 852 225 346 435 249 589 320 260 351 656 938 168 295 180 252 180 7350 Number of Families 263 213 48 86 106 55 145 60 74 73 160 235 38 72 30 62 30 1750 SPONSORED CHILDREN ADP HUANTA-2007 0a5 years 119 125 08 34 51 27 69 32 48 49 81 137 31 52 13 35 14 925 6 a 11 years 198 191 36 45 84 42 116 47 58 55 109 204 40 51 17 26 23 1342 Adoles cents 142 119 55 59 64 36 76 34 37 28 56 83 4 1 6 0 0 800 Total 459 435 99 138 199 105 261 113 143 132 246 424 75 104 36 61 37 3,067
DISTRICT HUANTA
Source: List of Families of AFADIPH 2007 and Sponsored children of the ADP Huanta 2007
c) The Project activities
Organization of the ADP and first training activities

In the case of the ADP Huanta the project activities were started together with the general start of the project, but with regard to this evaluation the view will be focused basically on the activities carried out in fiscal years 2009 a n d 2010. The reason for that is that the interviews that were made and the gathered information report about a change in the project facilitation that in some way does not allow an adequate approach to what took place during the first year of the project. Despite that fact the men and women participants consider year 2008 to be important for them with regard to issues or outcomes, as well as for the development of training activities that gave them the opportunity to:
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know their rights and duties.
VCP Final Evaluation Report Informe Final de Evaluacin to begin to see the needs of the population to know how to make requests to the public institutions
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These activities are mentioned also in close connection with the process of the participatory budget made this year and the participation of the communities in that process, in which requests were made to the municipalities for the health post, and the participatory budget was obtained. The issue to know rights and duties appears in statements gathered from the users as well as from the service providers, as something that has been maintained and for which both users and service providers express a positive valuation. The approach of both dimensions (rights and responsibilities) in the training actions contributes to reinforce or to offer a more integrated view about the services and the relationship with the citizens with regard to the service operation. From the side of the users of the services their statements associate strongly the knowledge of their rights with that of a process opened to the authorities with regard to the conditions required to have access to the services. On the other hand, the service operators mention that it is a positive fact that the people are aware about their responsibilities and not only about their rights. With the joint treatment of rights and responsibilities and in spaces or processes in which the users and service providers participate in a simultaneous way there are more opportunities for an improved level of dialogue.
HUANTA: MAIN ACTIVITIES IN THE FIRST YEAR Planning in the ADP Ayacucho Py. VCP (the methodology was used, the VCP was applied) Training of the Py staff, VCP Presentation of the VCP in the community, training of the WG (based on the experience of surveillance of health and creates awareness among the community, the authorities and the service providers) Prepare the WG GT (VCP), meetings with the service providers, standard indicators, Coordination with the UGEL and the Municipality, change of attitude of the service operators, and processing of the system.. Mobilizations of the community, organization of the meetings, general indicators, prepare the work plan. Election of health Source: Memory of the Second National Workshop of the Py VCP from page. 17 10 to 14 Nov. 2008,
The issue of paper work in the public institutions is not a secondary issue, on the contrary, it is part of the work and intervention of the leader that affirms him in that position. In that regard to know what work is to be done, how to do the work and to be sure about what is to be performed implies a type of personal development that is recognized and required, and finally the consolidation of a non confronting leadership capability.
VCP Final Evaluation Report 55 Reportnforme Final de Evaluacin Another relevant factor to reinforce the recognition of the paper work in one side and of the non-confronting leadership in the other side is that the management effort is expressed finally in a success because they were able to win the participatory budget (in year 2008). The information that has been gathered indicates that in this first stage of the project operation the activities carried out were oriented to all the communities linked to the ADP. However, between the end of the first year and the start of the second year there was a change in this situation when with the support of the National Office the project goes from the stage to create awareness to that of the organization of the surveillance process and it is decided to promote a new work scheme.
Organization of the WG and the election of health as the service to be surveilled

The design of the two work groups, the first one associated to Accoscca a n d t h e s e c o n d o n e t o Nueva Jerusaln was the start of a new work stage in the process for the implementation of the VCP methodology.
MAIN TASKS OF THE WORK GROUP FOR THE IMPLEMENTATION OF THE VCP To inform the Community To get the resources for the community meeting: facilities, chairs, materials, etc. To convoke participants To prepare and submit the Information Chart To define the Focus Groups To facilitate h community meeting for evaluation of the service To prepare the Improvement Plan To manage the improvements
Source: World Vision. Implementation of the VCP in the ADP Huanta. Implementation of the VCP In the community of Accoscca. Accoscca, March 22 , 2009
As mentioned in the testimonies and in the documents of World Vision: Pas an
output of the created awareness, both communities: Accoscca and Nueva Jerusaln decide to participate in a Surveillance process to the health service, with concern about the service provided by SIS, the program that more difficulties, and because as a right it covers most of the people.54
54
IMPLEMENTATION OF THE 2009.
Taken from World Vision. IMPLEMENTAION OF THE VCP IN THE ADP HUANTA .
VCP IN THE COMMUNITY OF
ACCOSCCA. Accoscca, March 22,
56
The members of the work groups were elected in a community meeting where they were informed about community surveillance and the responsibilities of the work group. The event was carried out with the participation of authorities and community representatives. The most important of the activities to be organized by the Work Group during this period of the process was the organization of an event with participation of representatives from the various community groups as well as representatives of the services in order to make an evaluation of the services and to prepare the improvements plans. According to the testimonies that were gathered and the reviewed documents, additional activities were carried out with the work group to strengthen their capabilities and be able to coordinate and carry out their activities, in particular the evaluation of the services and to prepare the improvements plan. Something to be highlighted is that together with the men and women participating in the WG, World Vision reviews the VCP methodology and tools, in order for the WG members to have a better level of knowledge and appropriation of these issues.
The persons that are convoked:

Main questions to prepare the list of the persons to be invited or convoked to the participation process:
a) Who are the direct beneficiaries of the service? b) Who are the service providers? c) Which are the community organizations that are related to this service?
To carry out the WG activity, besides the analysis made of the service, that we will see further on, an identification was made of the stakeholders and sectors that are committed with the operation with regard to various issues. As an outcome of that it was possible to identify the sectors to be convoked that included representatives of the family parents organizations, representatives of the children and adolescents, community authorities and representatives of the local government and the health sector working in the region, in this case both the staff that provide the services as well as administrative staff of the executive unit.
A look to the community eyes
service
through
the
Once the work group had been organized, and according to the methodological
VCP Final Evaluation Report Reportnforme Final de Evaluacin
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proposal, a view or balance of the service was started from the perspective of the service users. The key step for this view was the description of the service, comparing the features that the service must have with the ones that the service really have. For this, the main tool used was the information chart or matrix with a scheme of the Situation of law and fact of the service. To arrive to a conclusion the service providers were invited and their opinion was considered for the definition of the best standard of the service (the must be or right). It is with regard to this regulation level or desire of service to build the effective level of the service or the existing factual situation that is pointed out based on the comparison gap to be faced. This can be seen in the reports, as for instance when the following statement is made: The Information Chart was worked with support of the person responsible
of the Insurance Unit of the Support Hospital Huanta, to in f orm th e comm un it y ab out t he ir r ig ht s acc or ding to th e Ho sp it a l lev e l and a lso t o t he c ompo ne nt of insu r ed pers on s t o w h ich t hey be lon g: th e d ocu m ents , leg is la t ion a nd r egu lat io ns re levan t t o SIS w ere re v iewe d . . 55
These documents that include the view of the work group were the inputs for the meetings with participants from the various community organizations, that became discussion groups or focus groups to gather the opinions and proposals of the local population. It is important to highlight that in this process WV work is to accompany and facilitate the dialogue between the community and the service operators. In the case of Huanta the analysis of the health service went further from the Hospital case because it covered other issues related to the service, such as the problem of access that affects the issue of rights. The key indicator was the quality of the care provided by the service and the experience of having faced or not ill-treatment in the access process. Added to this were other indicators that were relevant in the analysis or opinion of the men and women that participated in the focus groups. Thus, in the chain of factors that limit the access to the service, or from which quality is derived, the participants in the process mentioned: the issue relevant to SIS, and in this regard that of the National Identity Document (DNI) required for access to the service.
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Other critical issues relevant to the service were: - the waiting time for access to service the ill-treatment practices or behaviors when dealing with the people. - some community groups mentioned the issue of the availability of medicines in the health centers..
55
THE VCP IN THE COMMUNITY OF ACCOSCCA. Accoscca, March 22, 2009.
World Vision. IMPLEMENTATION OF THE VCP IN THE ADP HUANTA .
IMPLEMENTATION OF
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As in the other cases, besides the qualitative appraisal, the methodology uses the smiles scale to reflect in a quantitative way the valuation made by each group member with regard to the level of satisfaction or unsatisfaction with the service operation and to build on that basis a quantitative representation of the group perception about the service. In this regard the level of difficulty of the adult participants with regard to making the estimate was verification rather than Learning56., Finally, the estimate of the outcomes was made by the members of the work group with the support of an adolescent, the coordinator and the facilitator. Finally, with regard to the outcomes of the work and how they were used, it is worthwhile to mention the following: The information obtained was used as an input to define the priority issue, and the main proposals, at least at a level of critical priority issue.
based on that and on an analysis of the options to be able to prepare the Plan for the Improvement of the Services and certainly as a support for the definition of
The outcomes of the process gave way to prepare the relevant report, to disseminate the outcomes and to sign a commitment document with regard to the follow up of the situation and the fulfillment of the commitments that had been made.-
Besides plan
the
Improvements
A proper balance of the process in Accoscca must deal w ith at least thr ee pr oc esses that w ere related w ith the above mentioned process as they w ill help to give a more integrated view of w hat took place ther e. W e refer to: the transformation of the community premises that for some time was the Community uro is now the Health Post of the HHSS of Accoscca - The DNI campaign for registration in the SIS and in the universal insurance The acquisition of the building site for the health post to meet the commitment made with regard to the Participatory Budget in 2008 that as will be seen later, was effective only in year 2010. The Health Post of Accoscca As the first case we have the situation of the community premises of Accoscca, which according to the testimonies that have been gathered was abandoned for a long time, and it has been transformed gradually into
VCP Final Evaluation Report Informe Final de Evaluacin what it is now: a center for
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60
World Vision. Implementation of the VCP in the ADP Huanta implementation of the VCP in the community of ACCOSCCA. Accoscca, March 22, 2009
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several services for the community among which are the health services that provide care to children and pregnant women as an external platform for community and preventive health services to which have been added recently educational services to work with family parents of small children. In the new center, the people receive medical care and control for CRED and
they do not need to go to the hospital where they had to wait standing in long lines for a long time .
The transformation of the community premises into an effective health post, was posible among other factors because of i) the priority a ssigned in this work to the issue of integrated care for children , ii) the work carried out by the WG with the accompaniment of the VCP facilitator.
The habilitation of the premises for the establishment of a health service, had some support from World Vision and at the same time the support of the Hospital of Huanta, that provided the relevant staff, and of the community that worked to prepare the space. Initially the community worked for the installation of the water and electricity services, and they paid for those services during the first months, during the evaluation we were informed that it is the Hospital that is paying now for those services. The population highlights this effort and this achievement that they clearly identify it as their work and effort, they mention that in the inaugural event the godfather was the former regional president, the regional government did not contribute at all to do this, but as mentioned before, the regional government assumes the financing of the staff and of the medicines used in the health center. The campaign for the DNI and the improved paper work for the registration in SIS. The lack of documents or errors in the documents is part of the facts that restrict the proper access to all the rights in general and in particular to the right to health. The importance to have an identity document has been increased as an outcome of the political decision to have a single registry for the beneficiaries of social programs based on the use of the C U I -DNI as a standard identification. In a parallel way, among the segments of people that require to a larger extent the health services and where the problem of the lack of documents is even worst, have been and are still: the elderly people and the children, the rural people, women and the population affected by political violence processes. All these sectors are highly significant for the area and they are the people with first priority for the health services. In the past there were information or promotion campaigns but with a low
VCP Final Evaluation Report Informe Final de Evaluacin outcome both with regard to the community exclusive institution for the delivery of the committed by the initiatives promoted by Advocacy of the People, and even less by
62
and to RENIEC that is the document, but it did not feel MIND ES, the Office for the a NGO.
63
During the evaluation period an important campaign was carried out with regard to this right and for the delivery of the CUI-DNI; the campaign was carried out by the WG of Accoscca and the Hospital of Huanta and other instances were involved also in the issue relevant to the reactivation of the Multisectoral Table for Health. This initiative is relevant to a need that identified and seen from the low side i n
o r d er t o ha v e a c c es s t o s e r vi c es s u c h as h e al t h , an a need seen from the upper side with regard to an improved quality of the public services and the social programs, together with
the allocation of resources to RENIEC for this activity. Besides the access to the identity document and to reduce the existing gap, the process included other initiatives as for instance the installation of a Branch Registry Office for RENIEC in the Support Hospital of Huanta (ORA) , a registry center for all the children born in that health center, which facilitates the availability of the document and also the registry for the public health service ( Universal insurance) for those families that are qualified and registered in that insurance system. With the installation of ORA, that is considered as positive by all the parties concerned, it is expected that for all the children born in that center there will no mistakes in their birth certificate, as usually happens in the registry offices of the municipalities, and they will be at the same time registered in the universal insurance system. The women and men that participate in the WG feel that this campaign and the installation of ORA is an achievement of their effort because this issue was developed after the installation of an inter institutional table under the leadership of the WG, and with the participation of several institutions: CEM, Office for the Advocacy of People, Province Municipality (Legal Advisor, Demuna and the Mayor), Health Network, Support Hospital of Huanta (Director, Promoter and Insurance Office), Executive Unit for Health Ayacucho Norte (UERSAN) (President and Board of Afadiph), Family Mothers O r g a n i z a t i o n , RENIEC (Administrator o f t h e O f f i c e o f Huanta and Ayacucho). The building site for the health post. With regard to this case we mentioned that one of the initial achievements of this community was to include in the process of the participatory budget in 2008 the project for a health center for Accoscca and the surrounding suburbs. This initiative was considered as an achievement by the community but later on it was a frustration because in year 2009 the municipality left aside the proposal.
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The Situation changed early in year 2010 when there was a river overflow (18 January 2010) and the area of Accsocca as well as the surrounding ones were strongly affected with it. The emergency situation brought the community to be the center of attention and the conditions were opened to promote preferential care for the people living in the affected areas, including, among the solution to the identified problems, the project for a health center in Accoscca. But, the option to invest in the community premises where up to this date the service is in operation, was left aside because it was located close to the water course and faced a future risk. In these conditions and when it was apparent that the opportunity was going to be lost again with regard to the implementation of the agreement of the Participatory Budget of year 2008 to finance the premises for a health center, the WG with the support of the community and of WV requested to the municipal authorities the acquisition of the building site for the health center, appealing in
this case to the Plan for Municipal Incentives considered in the Budget Law for year 57 2010. , .
On the time of this evaluation, and with a new administration in the local government, the Municipality has acquired the building site as requested by the community for the construction of the new health center. As recognized by the various parties involved, the challenge is now to convince the new municipal authorities to start the paper work and the approval of the technical file for the implementation of the construction work. During the evaluation process some of the persons that were interviewed pointed out the need to incide with the new authorities to finance the work to prepare the technical file and after that the construction of the new building. In this regard, Dr. Rosauro Gamboa, one of the persons interviewed who was in the past chief of quality of the hospital of Huanta, and now he is regional advisor, expressed his interest and said that he was committed to support the project for the construction of the new health center. In these three cases, that are closely related to each other: i) the habilitation of the health post of Accoscca that up to this date is working with the staff assigned by the Hospital and by staff from the education sector, ii) the campaign for the DNI nd the establishment of ORA service in the Hospital of Huanta, and iii) the actions for the acquisition of the building site as part of a more integrated strategy to provide the area with an improved health service in the community of Accoscca, - the WG and the WV team have participated in the implementation of the VCP project and have been involved in this work.

57
65
The plan for an Improved Municipal Management for Health, is based legally on the Budget Law for year 2010 and on the Supreme Decree N 003-2010-EF, and the aim is to have an improved allocation of public funds to improve these services, in particular those related to fight against chronic malnutrition.
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3.3.4. T h e c ase s o f t h e ADP Urin Qosqo

a) Features of the area The ADP Urin Qosqo is located in the district of San Sebastin, i n t h e e a s t c e n t e r o f t h e p r o v i n c e o f Cusco. The district cover an area of 89.44 km2., and is located at an altitude of 3,248 m. i n t h e valley of the rivers Huatanay and Cachimayo (a very urban area), known for the disorder due to a rapid population growth up to 4,451 m. in the Huaynapicol hill , in the Northeast area of the district. The population is of 74,712 i n h a b i t a n t s 58, m a i n l y i n th e ur b an a r ea (96.7%), w i t h a p o p u l a t i o n d e n s i t y o f 835.3 Inhab. /km2. The Poverty Map shows that 6% of the people do not have access to water, 7% do not have electricity and y 18% suffer of chronic malnutrition. Also, the illiteracy rate is 6% among women and an average of 9% of families do not have sewage services or latrine.59. b) ADP Urin Qosqo According to the Profile of the Program Urin Qosqo, the Phase 1 of the ADP was started in year 2008 and its estimated life is 15 years. The project coordinator is Yesenia Espinoza. Currently the ADP develops the Health and Nutrition Project, the Education Project and the Economic Development Project. The budget allocated for this Phase I is of US 2045, 36860. The direct beneficiaries of the Program are 5,237 persons, t h a t i n c l u d e t h e sponsored children and families: Adult men: 1,325 Adult women: 1,312 Children and adolescents: 2,600 The indirect beneficiaries of the Program are 10,339 persons or 2,585 families: Adults: 6,696 Children and adolescents: 3,463 The ADP intervention area includes 18 communities, a m o n g u r b a n c e n t e r s , APV a n d r u r a l c o m m u n i t i e s : P umamarca, Quillahuata, Huillcarpay, Punacancha, Fedetrac, Suryhuaylla, San Antonio, Tpac Amaru, Tres Cruces, Ununchis, Santa Rosa, Naciones Unidas, San Miguel, Salvadores, Sauces de la Pradera, Marcachayoc, La Quebrada y Patrn de San Sebastin.

58 59
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National Census 2007: XI of Population and VI of Housing, in: http://www.inei.gob.pe/ Source Foncodes 2006, with updated data of census 2007 in: 2009-05, Report IDTs, PEN and POP. 60 Program Design ADP: Urin Qosqo WV Per. Phase 1: FY08-FY12.
VCP Final Evaluation Report Informe Final de Evaluacin c) Surveilled services in the ADP Urin Qosqo
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Health Center Santa located in the extension of Av. de la Cultura s/n, 8 bus stop, in the district of San Sebastin. A place of level 1.3, that is relevant to a health center with final and intermediate services, without internal patients, mainly for prevention and cure services, with a large demand in medicine and mother and child care, The care rate is 80 persons per day, distributed in two shifts, morning and afternoon. 95% of these patients receive care with the Integrated Health Service (SIS). The coverage area of the health center includes the 42 APV of the district of San Sebastian (peri- urban, almost 90% of the total population), the urban area of the district (Naciones Unidas and Santa Rosa) and to 2 farming communities. As stated by the officer responsible for the Promotion of Health in the Health Center Santa , the staff available among officially hired staff, those with temporary contracts, and students, include more than 45 persons that work distributed in two shifts. I.E. Vctor Ral Haya de la Torre is located in the street Tpac Katari S/N, in Tpac Amaru, district of San Sebastin. It is a public school for secondary education (morning shift), that depends administratively of the UGEL Cusco. In year 2010 there were 458 students enrolled and distributed in 12 school rooms relevant to the 5 grades of secondary education. During the pilot VCP experience (2009-2010) the I.E. had 19 teachers, including the school director, Prof. Celinda Saravia (2004 june 2011). I.E. 50015 Punacancha is located in the populated center Puna Cancha, district of San Sebastin. It is a public school for primary education (morning shift) that depends administratively from the UGEL Cusco. In year 201 there were 40 students enrolled in five of the six grades of primary education: from 1st. to 5th.grade, no classes for the 6th.grade. It has two teachers, including the school director. d) ADP Urin Qosqo and the VCP Project The VCP intervention in Urin Qosqo s t a r t e d i n y e a r 2008, proposed by the National Office after an analysis of the favorable conditions for the implementation of the project in the ADP Urin Qosqo61. The ADP accepts in the assumption that the VCP project was going to be incorporated to the POP project and was going to contribute to the Health and Education projects.
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Training of the staff and organization of the ADP Urin Qosqo

Edgar Mendoza, facilitator of the VCP project was trained on the community Surveillance methodology by members of the National Office of WV. The project facilitator organized a training workshop for the team of facilitators of the health, education and POP projects of the ADP Urin Qosqo.
61
Interview to members of the AO,
ADP Urin Qosqo and Pachactec, 21 July, 2011
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These facilitators also provided support to Edgar Mendoza in the various phases of the project: th us the f ac i l ita tor for the ADP of education participated in the process to prepare the Improvement Plan in the school Vctor Ral Haya de la Torre, and the facilitator of the ADP of Sponsorship accompanied in various stages of the implementation of the methodology in the I.E. 50015 in the populated center of Punacancha. The ADP scheduled institutional meeting every Monday to create awareness among the local office staff with regard to the VCP methodology and tools. In year 2008, the diagnose, baseline and meetings to create awareness were organized and between April and August 2008, the ADP organized 23 workshops. Contact was established with the directors boards of the base organizations (APV and rural communities ) and APAFAS, as well as with health and education workers and municipal officers (operational staff working on the issue of citizens participation.) Edgar Mendoza and the other three facilitators of the four ADPs involved in the pilot experiences, contributed to the process to prepare the Surveillance Handbook and a file about policies, in Lima, under the leadership of the NO. These documents were published, except a document about incidence that was worked also by all of them. In addition, at the start of the phase to create awareness, the A D P Urin Qosqo prepared and disseminated by radio two spots about community
surveillance, in Spanish (58) and Quechua
(110).
Habilitating (generating conditions for) citizens participation (ADP Urin Qosqo)

Work Groups: were organized in the three VCP projects of the ADP Urin Qosqo. In the I.E. Vctor Ral Haya de la Torre the WG was organized in April 2009. The members were the school director, Celinda Saravia, who was the leader of the process, school teachers, administrative staff, and members of the CONEI, and o f APAFA and student representatives of the School Room Committee and of the School Municipality. In the I.E. 50015 the WG was formed with the members of the APAFA , the leaders of the rural community of Punacancha and the school teacher Romel Sotomayor, in the second semester of year 2008. In the Health Center Santa Rosa the leaders of the Neighbors Boards
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and health promoters of the APVs of Tres Cruces, Marcachayoc, Naciones Unidas, Ununchis, La Quebrada and San Miguel, were convoked together with the representative of the rural community of Huillcarpay and s taff of the areas for the Promotion of Health and of CR ED , s ince the first quarter of year 2 009 .
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A study has not been made of the cultural and economic profile of the members of thew Work Group, there is only an outline prepared by the ADP facilitator, that mentions the following:62: I.E. 50015: the family parents come from the rural area. They speak Quechua but most of them understand Spanish, in some cases, with a limited knowledge of the language. They work in agricultural and livestock activities. Most of the households do not have water and sewage services; the social infrastructure is a limited one. School Vctor Ral Haya de la Torre: peri-urban population, they speak Spanish as a first or second language. Some of them work in small business and non-qualified technical activities. Health Center Santa Rosa: they speak Spanish and Quechua comprehension of Spanish language; in this case the linguistic features are similar to those of the people living in the rural areas, mentioned before. They work in small business and non-qualified technical activities. The WG leaders that were consulted in the focus groups, express that they have not had previous experience in citizens surveillance activities. They had only some knowledge about surveillance before being members of the WG63. The Work Groups were trained by the facilitator of the ADP Urin Qosqo on the issue of citizenship, democracy, participation and human rights.
Community Participation
In the second semester of year 2008 the VCP experience was started in Punacancha, in the first quarter of year 2009 i n t h e H e a l t h C e n t e r Santa Rosa a n d i n A p r i l 2009 i n t h e s c h o o l Vctor Ral Haya de la Torre. The service operators provided support for the diagnose phase and to prepare the indicators, and in the school Vctor Ral Haya de la Torre a commission formed by school teachers and family parents was convoked to make the diagnose of the institution. The Health Center Santa Rosa submitted its diagnose and health center in a workshop organized in the first quarter of diagnose and the indicators of the health center were proposed the operators. The five indicators selected were: infrastructure, of care to patients, quality of service and care for the staff. indicators of the year 2009. The and submitted by equipment, time
The diagnose of the I.E. 50015 was worked by WV ADP Urin Qosqo with the
VCP Final Evaluation Report Reportnforme Final de Evaluacin work group formed by the family parents.
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62 63
Profile of the members of the Work Groups for Surveillance. Focus Groups with the leaders of the Work Groups of the six pilot VCP experiences.
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In the second workshop the information charts of the three VCP experiences were prepared. The matrix of the information chart include from left to right a column with the title of Resource, two columns that indicate Rights ( what it must be) and Of Fact (what it is) with regard to issues or specific resource of the public service that would be included in the intervention. A final column with remarks and comments. For the I.E. 50015, the matrix prepared on October 17, 2008 does not have information about the regulating framework that supports the citizens claims64. I n t h e I.E. VRHT, t h e i n f o r m a t i o n c h a r t s h o w s a b e t t e r l e v e l o f d e s i g n , a s f o r i n s t a n c e , t h e c olumn Indicator has remarks with regard to the proper or desired level of the resource (for instance, 1 text per student in the subjects of65). Something similar happens with the chart prepared by the WG of the CS Santa Rosa, that in th mentioned column are included previous remarks (for instance, integrated care to th girl and/or boy : a . Cordial reception to the parents; b. review and open a notebook for an integrated health However, in both cases, an specific reference is missing with care to children, etc. regard to the regulation of the sector that supports the demand and the proposal for improvement. These missing issues with regard to the legal framework and the sector policies are another significant weakness in the intervention of the WG, as pointed out by the facilitators of the process s (Edgar Mendoza and Marina Cuela) and by the WG members in various occasions. 66. The work groups established an order of priority of indicators for the surveilled services, that permitted to evaluate and establish a priority and to prepare a final list, as follows: I.E. 50015 Punctual attendance of the school teachers To meet the schedule set up for teaching hours Implementation and equipment for the school center Information of the progress of the school curriculum and children learning School Vctor Ral Haya de la Torre Introduction of audio visual material for teaching Implementation of the laboratory Practice of values in the school Good treatment (teachers attitude) Health Center Santa Rosa The waiting time of the patients Medical care quality

64
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Matrix of Information of the Service A Vigilar (Priority)in: Memory. Implementation of the Methodology of Participatory Community Surveillance. 65 Memory of the Implementation of VCP, Information Chart I.E. VRHT 66e The evidence of this difficulty gave way to prepare a file with four fascicles with details of the standards of quality relevant to health, education, protection and participatory budget. However, this material was available after the first practices of the VCP.
VCP Final Evaluation Report Informe Final de Evaluacin Infrastructure of the health center Equipment for the health center Treatment provided by the staff
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On the other hand, the I.E. VRHT made use of the consensus spaces and the convocation to representatives of the three groups (teachers, students, family parents ) to prepare its Strategic Institutional Plan and have it validated in those instances. The Health Center Santa Rosa worked and gave priority to five intervention thematic issue according to the reality of the district: 1. 2. 3. Nutrition and food, Sanitation and environment, Promotion of health ( schools, centers, healthy municipalities, etc.), 4. Reproductive sexual health, 5. Peace and culture (fight against violence: alcoholism, early pregnancy, drug addiction, interfamily violence, suicides, prostitution, etc.). These information charts were prepared in an environment of dialogue. In the three VCP experiences, the members of the work groups and the operators of the of the Surveiled services were in agreement and approved the proposals in the workshops. Although at the beginning there was some rejection among some of the operators of the Health Center Santa Rosa and the I.E. 50015 and VRHT, that was overcome and no problem is recorded in the process with regard to these stakeholders. The former director of the I.E. VRHT recognizes that at the beginning ,
67 I was also afraid with regard to the participation of the family parents , some school teachers were distrustful with regard to the presence of he family parents in the school, what do they do?, are they going to control us?. But later on, they learned t o work together, and each group assumed its relevant role in the process with mutual respect. The school teachers worked together with the
(APAFA), hand in hand. It must be highlighted that the term surveillance gave way to a little bit of rejection68 in these pilot experiences, and for that reason WV decided to use it in a restricted way, and instead of that use citizens participation for an improved service.
Preparing the Improvement Plan

The methodology required that the process to prepare the Improvement Plan be made according to the dynamics of discussions in focus groups. The WG are
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best known in some cases, but not all the WG are able to be the leaders of the Focus Groups. In the I.E. 50015, a strictly rural area, the ADP facilitators are the ones that assume the facilitation.
67 68
Interview to the former director of the I.E. VRHT, 18 July 2011 Interview to the health service operator, 18 July 2011
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In the I.E. VRHT and the Health Center Santa Rosa, the responsibility is assumed jointly by the ADP facilitat ors and the members of the relevant WGs. This reality would make evident a better level of training for the management of the VCP methodology in the two pilot experiences of urban and peri-urban origin. On 14 July 2009 the Improvement Plan for the I.E- VRHT is prepared and approved by consensus. During this journey the Information Chart, the Information Matrix and the Service Evaluation (Smiles Scale) are submitted based on the priority indicators distributed to the participants in the focus groups. Specific workshops were organized to see the problem of each one of the groups involved: school teachers, students and family parents. It included student delegates by year of study, members of CONEI and of APAFA, school teachers and administrative staff. In the I.E. 50015 the focus groups were three: 1. family fathers; 2 family mothers and 3. school teachers (teacher and teacher/director). In the Health Center Santa Rosa focus groups were organized to work on Service Evaluation (Smiles Scale) on June 10, 2010, with community leaders, health promoters , and care service directors of the health center.
Smiles Scale
The focus groups of the three VCP pilot experiences used the tool known as Smiles Scale to measure the level of satisfaction with regard to the surveilled service. The evaluation using t h e Smiles Scale was accessible and useful to register what we really think, to think about, to listen our opinion. It facilitates our 69 identification with what we feel . The tool permits to give an opinion with a spontaneous game dynamics and without the need for a previous capability of writing abstraction. The difficulty is faced with regard to the processing of the outcomes that require an advanced mathematic capability (thorough knowledge of the four arithmetic operations) a n d that in the last instance reinforce an issue of the WG with regard to the facilitator. That was the case of the I.E. 50015 where the WG was not able to make the estimates operations, and the task had to be carried out by the facilitators. In addition, the facilitator of the VCP processes suggests that the submission of the outcomes be supported not only with numbers, but also with graphs (cakes, cheeses, etc.) that may illustrate better the situation70. This contribution would be specially relevant for the WG of the I.E. 50015 whose members, of rural origin and with uncompleted school education, maintain an oral and tactile
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Improvement Plan proposals

All the proposals of the Improvement Plan were prepared following, in general terms, the matrix suggested in the VCP Handbook that has four columns, as follows:
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Focus Groups: leaders of the Work Groups of the six VCP pilot experiences Focus Groups: facilitators of the six VCP pilot experiences
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1.Activities; 2. Responsible, Who will do it?; 3. Time, When will it be done?; 4. Resources , What do we need? It must be mentioned however, that in the final matrix this last column was not used, but a new column was introduced about follow up: Who will do the follow up for the fulfillment , will WV or the WV facilitator be responsible or co-responsible for all the follow up tasks. The matrixes that have been prepared introduce also an order of priority of activities/proposals to be implemented, which might be useful in a place with limited resources and institutional support. The document of the Improvement Plan for the I.E. 50015 r eceived consensus on November 21, 2008. The Improvement Plan for I.E. VRHT was approved on July 14, 2009, after a discussion and validation process in the focus groups. The process for the consensus and approval of the Improvement Plan for the Health Center Santa Rosa was not completed. At the end of life of the pilot project VCP (September 2010), the Health Center had two proposals for the Improvement Plan: one that was prepared by the service providers and the other by the service beneficiaries. In general terms, it must be highlighted that the demands expressed in the process of the I.E. 50015 and of the Health Center are common to other VCP pilot experiences for similar institutions: in education, punctuality, attendance, and fulfillment of the teaching hours by the teachers; regular report the family parents about the progress made by their children. In health, implement a capacity system (one day before), extend the hours for care in the Health Center, and other mechanisms that may allow to reduce the witing time; improve quality care (that includes good treatment). Other important requests are related to improvements to be made in the infrastructure and equipment of the services. In the case of the I.E. VRHT, the emphasis of the Improvement Plan is placed on the reinforcement of the spaces for the students participation, in the improvement of the pedagogical proposals of the school teachers, in the pedagogical guidance of the student and improved infrastructure and equipment for the school premises.
Improved services and policy influence.

The outcomes of the Improvement Plans were disseminated in public audiences, one in year 2009 and the other in year 2010, and also in meetings with the community boards, with the APAFA members and family parents and with UGEL representatives.
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The members of the AO and of the ADP Urin Qosqo report that the follow-up made by WV to the Improvement Plans had been indirect71. In the case of the project VCP Punacancha, the follow-up is made through the PRONEI. Additionally, in this case and that of the Health Center , they receive back ups in the community assemblies, or internally, in the
71
Interview to members of the AO/ ADP Urin Qosqo, 20 July 2011
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documents of the Operational Plans of projects of the communities involved when actions are proposed that are included in the Improvement Plans of the VCP. But, they insist, it is not intentional for us to see the Improvement Plans. Due to the fact that the I.E. VRHT is an institution for secondary education, it is more difficult to do the follow up because it is not in the usual intervention sphere of the ADP intervention in which the projects, according to the guidelines of the National Strategic Plan 1 W V , give preferential attention to groups of children under 5 or 6 years old. An evaluation meeting relevant to the experience of the Improvement Plan of the I.E. 50015 was held one year after it had been approved (review of the implemented actions and updating of the proposals) that gave way to prepare an Improvement Plan 2010. That was not the case however for the other two VCP pilot experiences. With regard to the above, it must be mentioned that the WG and the work commissions of the three pilot experiences have participated in some of the follow-up activities. In the I.E. VRHT monthly meetings of the commissions are reported from September to December of year 2009, to inform about the progress made with regard to the Improvement Plan, and later on, to share the findings in a workshop to create awareness. These outcomes and inputs have permitted them to prepare an institutional diagnose updated to December 2010. The PEI convoked also the work commissions from August to December 2010. In year 2011, there have been two meetings, in March and May; these actions report about a dynamic that was not finished upon the project completion. It must be mentioned that the actions of the Plan of the I.E. VRHT have been included in the school PEI and that preserves the implementation and follow-up of those actions. The health promoters report also that they have monthly meetings (last Thursday of each month) during year 2010, to discuss the progress made in the implementation of te Improvement Plan that is included in the Institutional Plans such as the Contingency of Children Malnutrition that had the financial support of the Municipal Incentive Plan. In year 2011, the meetings have been spaced gradually, and the person responsible for the promotion of health reports that during the last months no meetings have been held. The elections process and the change in the administration in the municipalities and the regional government have been an earthquake for the VCP process, as that
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means, with regard to some issues, to start again from cero: to reorganize the networks for inter- institutional work, to create awareness among the new officers about the need and usefulness of the surveillance work, the respect for the agreements that have been signed with the administration that is going out, etc. With regard to the main changes that have been made after the implementation of the Improvement Plan and reported by the beneficiaries, it must be mentioned what is highlighted in the document Achievements and Outcomes72:
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Document Achievements and Outcomes, ADP Urin Qosqo
VCP Final Evaluation Report Informe Final de Evaluacin I.E. 50015 More fulfillment with the hours and teaching schedules Establishment of monthly meetings of school teachers with the family parents to inform about the progress made in the learnings Improvements in infrastructure and equipment: o TV , DVD o PC o Childrens park o Painting of the I.E. premises o Bathrooms in construction condition o Acrylic blackboards I.E. VRHT Improvements in infrastructure o Paining of the I.E. premises o Desks for the school teachers o More desks for the students o Improved halls and sidewalks o Remodeling of the benches in the school yard
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The Institutional Educational Plan PEI includes the Improvements Plan with Improved institutional environment, more dialogue, more listening with regard to the problems faced by the teachers.
regard to education quality in order to ensure the relevant fulfillment.
More approach with regard to the problems faced by the students, and listening to their perceptions with regard to the educational quality. Approach towards a democratic management with participation of the various groups of the educational community. Health Center Santa Rosa Modified appointment system (delivery of morning appointments the day before, and in the morning for the afternoon appointments). The health center team is aware about the quality of the service from the users perspective. The facilitator and the WG in the meetings with their relevant focus groups have coincidence in stating that the main points of the Improvement Plan of the I.E. 50015 have been met. However, the WG of the school in Punacancha underlines that if it is true that the computers have arrived t h e y s t i l l c a n n o t b e u s e d 73.
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Beside, the WG insists that the library is still to be implemented as well as the laboratory, and an issue that was not included in the document. Later on, the members of the WG of the I.E. 50015 that attended the narrative workshop (20/07/2011) mentioned the same outcomes.
With regard to the case of the I.E. VRHT, t he facilitator confirmed the outcomes listed in the document Achievements and Outcomes. He added also, that the paperwork had started for the construction of premises for the library (S/.40,000 New Soles), as considered in the Improvement Plan. The ADP facilitator confirmed the outcomes mentioned in the document Achievements and Outcomes for the Health Center. Besides, the members of the WG (users and operators) of the Health Center, at a meeting in the narrative workshop (20/07/2011) mentioned the following significant outcomes of the surveillance process: 1. Extended care hours (morning/afternoon) 2. Better treatment by the operators 3. Construction of two spaces for administration 4. Increased number of professional and technical staff 5. Project for the construction and equipment of the Health Center that has already a technical document, and has been declared feasible by the SNIP. The discrepancies with regard to the report of outcomes in the Improvement Plan for the surveilled services will be related not only with the difference in the time of the relevant reports (document Achievements and Outcomes vs Narrative Workshop) but with the cross-cutting of management and surveillance processes. Thus for the case of the I.E. VRHT and with the Health Center Santa Rosa, the agreements signed by these centers that cover the commitments of the Improvement Plans, and are also part of an strategic institutional vision and commitment that the community surveillance process contributed to reinforce. Thus, in some cases, the members of the WG, (users and operators) do not distinguish clearly the actions provided in the agreements included in the Improvement Plans and those that were part of the PEI (for instance, premises for the library), that, frequently, are actions assumed both in management and surveillance processes. Besides, to meet some of these actions it was necessary to have inter-institutional cooperation agreements: that is the case of the Health
VCP Final Evaluation Report 86 Informe Final de Evaluacin Center Santa Rosa that was supported by the Plan for Municipal Incentive with 3 million new soles for its Contingency Plan in the fight against children malnutrition in which were programmed actions that had been considered in the Improvement Plan of VCP (operators).
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The delivery of the computers and other documents was made to the director of the educational center. What has been acquired is not of the Community; according to the leaders of the WG of the I.E. 50015, this would prevent from requesting the use of the equipments that have been acquired..
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4. Conclusions and recommendations

In this section are the main conclusions and recommendations of the evaluation process that include also as a concern or base question the interest in the VCP as local experience as well as the possibility of an expanded use of it as a tool to develop awareness about rights and to improve the quality of the basic public services, in particular those related to children, and as a support tool for the design and development of strategies for incidence of a supra local scale, in the regional or national area. For this we have considered the interest expressed by the officers members of the national team of WV with regard to the development of strategies for incidence at supra local level (regional/national) as part of its transformational development strategy. The evaluation was defined as a study of a pilot project, that is to say an intervention oriented to validate ( totally or partially) a different way to have influence from the community in the improvement of the operation conditions of a public service related to the guarantee of a right. General appraisal about the work 1. The studied cases show that the VCP can be a very important strategy /tool to contribute to the knowledge and the exercise of rights and based on that be able to have a definition about the relationship of the person as a citizen, and of the community with the government through the public services that are provided. 2. The cases give elements to think in a more integrated way about this relationship between nominal rights and the exercise of citizenship in local contexts of various types. 3. The experiences provide elements for the inclusion of VCP in the local work of World Vision in Peru, and to give support to national processes and strategies for citizens surveillance of social services and policies as well as to support the incidence actions for the improvement of those processes. About the selected cases: 4. The pilot experience was developed in communities heterogeneous realities with regard to: the type of environment, selected for the surveillance, the strengths and weaknesses of organizations. While there is a previous presence of WV, the with very the service the base length of
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the service, the type of work, the level of consolidation and relationship with the service operators and the community also is not equal. From that point of view, the cases that are evaluated include a wide range of situations, something that is positive for the validation of the VCP proposal, because it permits to test the possibilities for adequation and contextualization that can be assumed by the strategy/methodology of VCP in different settings.
The national and international context and its relevancy for the actions 5. The project was managed in a national and international framework with positive elements in favor of the participation and empowerment of the poor people. However, the project was implemented in a political environment that was negative with regard to participation. 6. As has been mentioned in section 2 of this report, the project was started in a national context that was basically positive during the democratic transition that prevailed in Peru after the crisis of year 2000, and the organization and citizens movements, in particular the decentralized movements were very active stakeholders in that process. As an outcome of all that Peru adopted a number of political agreements and legal frameworks were developed to promote citizens participation, the election of regional and municipal authorities by popular vote, and capabilities and functions were transferred to the new authorities on key issues for the daily life as those relevant to health, nutrition and school education. The government was based on consensus planning and participatory budgets at regional and local level , and the mechanisms for transparency and accountability were extended as a reaction with regard to the former regime that was based on the secret and had at the end serious corruption problems. 7. As of year 2001 there was significant economic growth and the public resources were increased in relative terms by an increased tax pressure according to output growth. The monetary poverty was reduced and the public expense was increased at national government level as well as at regional government level. During the early years of the decade the growth was slow but it was accelerated during the last years of the decade. Together with an increased economic growth and increased public resources, was the growth of the citizens expectations with regard to
8.
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their participation in the benefits of the economic growth (reinvindicating demands) and also to avoid payment of the costs relevant to the growth (for example: the environmental conflicts. All that gave way to a gap of expectations
9.
While the initial mechanisms to solve the crisis of year 2000 were oriented to increase the mechanisms and spaces for democracy and participation, by the middle part of the decade several initiatives were implemented that were limiting gradually the participatory mechanisms and their effectiveness. All these facts increased the feeling of frustration and some regions the participatory ideas were abandoned and replaced by more confronting attitudes.
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During the final years of the decade there was an increased citizens indisposition and social conflicts, as well as an abandonment of consensus spaces and processes that were for the benefit of more confronting processes. 10. Another context element but of more international character was the increased recognition in the international community working in cooperation for development, with regard to the importance of some key conditions for action, such as: the participation of the people that will receive the benefit of the actions to be developed, that will be from the design of the work up to evaluation of the outcomes. the importance to consider the rights approach in the decisions to be mad about the actions to be carried out. the definition of targets at impact level, intermediate outcomes and outputs and the use of strategic and operational planning tools that will permit to see and to follow up the management process. these elements modified since the end of the 90s the action of the cooperation, and that included an increased concern with regard to the impact of the intervention. In line with that was highlighted the strategic importance of the public policies and the incidence on them in order to achieve outcomes. 11. These changes in the conception and in the cooperation tools opened the space for various initiatives oriented to listen the voices of the poor. These initiatives were not only in the field of the international and national NGOs, but they were seen also in organizations that were apparently very distant to those voices such as the WB, and not in few cases joint programs were developed to listen and to respond to these voices. This international context favored at that time the development of the project74 at international level such as in Latin America and Peru in particular. About the institutional appropriation of the VCP methodology and approach 12. It is worth mentioning that an issue that appeared early is the one relevant to the need to contextualize the methodology that has been proposed at international level in order to respond to the specific features and challenges presented by Peru and among them the intervention areas. In this work line and according to the information gathered during the evaluation a significant progress has been mad with regard to this process.
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In the case of Per the first significant presence of the WB with an opening to the NGOs and the Civil Society was by the end of the 90, when in partnership with the European Union and in dialogue with the government promoted the organization of the Poverty Forums- Further on to this spaces were integrated the the IDB and AID..
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13. Both the VAC approaches as well as the methodology for the Surveillance of service quality have been included in the national strategy of WV Peru, thus giving way to the national project for social empowerment and the strategy for citizens surveillance. It must be mentioned also that the cross wide made from the VCP to intervention lines such as Children and Adolescents Participation, Protection and Health. 14. Information and statements have been gathered from various WV officers that have assumed all or part of the VCP methodology in promotion actions for the participation and external surveillance by the social organizations that work with the institution. 15. The most important internal objections that were identified during the process are those of the service operators when we talk with them about the Surveillance action that is being promoted. The ADP officers see in this objection of the service operators a problem for the daily work with an institution that they consider to be in a legitimate way their strategic partners. About activities carried out with regard to the VAC guide 16. In all the communities the activities were carried out according to the stages and steps considered in the VAC Methodological Guide, up to preparing the improvements plan. It was verified also the use of the main tool included in the methodology for the various phases of the process to be carried out by the facilitators and the WG, mainly the Smiles Scale and the chart rights and facts. 17. In general, according to what was gathered in the narrative workshops, the members of the participant WG in five of the six experiences recognized the methodology steps (diagnose and information; preparing the proposals; preparing the Improvement Plan) that were developed in their communities, as well as the most important contents, actions and decisions made at every moment. 18. In general, the members of the WG state that they have become involved in the process through different ways and in different levels according to how each VCP experience is seen, and how the VCP dynamics are being applied, in particular with regard to the management of the focus groups. According to this perspective, it can be seen that the men and women participants value in a positive way the experience and they recognize that its has contributed to develop their dialogue, negotiation and management capabilities, as well as the strengthening of
VCP Final Evaluation Report Informe Final de Evaluacin their leaderships.
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It can be seen that with regard to the more rural populations it is more difficult to have an independent management of the methodology (without the facilitators support) as well as to start new initiatives, besides those that have the direct support of World Vision.
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Problems have been seen also among the adult people with regard to the management of basic mathematics, an issue that must be taken into account in the design of the interventions. The presence of young people with a higher level of school education has been most valuable to solve the problems and to improve their self-esteem. 19. In all the communities, including the urban ones, the base organizations maintain some level of dependency with regard to the facilitators during and after the experience. It is too early to think that they may be able to take replication initiatives without the accompaniment of WV. However, the WG state that they are involved directly in the management of the VCP practice, an issue that they value and recognize that has contributed to develop capabilities for the dialogue, negotiation and management, and it has also strengthened their leadership. It can be said also that once is not enough for the appropriation of the methodology, that in this regard it is convenient to repeat the surveillance cycle in order to be able to do the appropriation of the methodology, and on that basis the citizens empowerment. About the training for the WG members and the use of indicators to measure the achievements 20. The training of the WG members is a key component in the process for the empowerment of the population. The use of process indicators is important to report about the development of actions from the point of view of the institutional offer but it is not enough to ensure the achievements nor to report about them. The experiences show that to carry out a process and to develop in it a theoretical and at the same practical experience is something important for both the appropriation of the methodology at initial level as for the improvement of the self-esteem of the man or woman participant as well as to build or reinforce the group relationship. The evidence that has been gathered makes us think however that it is required to repeat the process in order to strengthen the knowledge acquired and to consolidate the recognition by the community and the service operators about the role that has been fulfilled. Regardless to what is mentioned above, it is necessary to recognize that neither the empowerment nor the leadership of the WG are consolidated in the community participation spaces through the replication of the VCP experience. The VCP actions carried out by the ADP and in particular by the VCP facilitator
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should be oriented to achieve targets inside the process. For sure, it would be most valuable to include indicators to measure the achievements, as for instance in the building of leaderships in consensus spaces and capabilities among the WG members in processes for the management of community participation.
In other words, the idea is to have the emphasis of the intervention displaced from the action to the targets allocated with regard to the final achievements; and that must be made taking into account the different times in which they operate; thus the short term includes the training activities and the output indicators (attendance, stay, evaluation of learnings) in the medium and long term are the outcomes and impacts more clearly related to empowerment and to the quality of services from a rights approach. It must be recognized that in this regard there have been initiatives in WV, in the proposal for the social empowerment program that includes indicators of achievement, such as co-management of initiatives in favor of children and adolescents participation in decision- making spaces, participation in networks, and development of incidence activities. Also, those that promote participation and protagonism of children and adolescents.
With regard to incidence 21. With regard to incidence, the VCP process has promoted work addressed to direct operators or to immediately senior instances, oriented to specific improvements in the public service to be surveilled or to relevant public services. 22. The aim of the incidence actions based on the participation of the members of the WG, is to have the commitment of the local government or public service officers, for a more close relationship with the community (for instance: inviting them to inform the service users about their rights and responsibilities with regard to themselves) and to identify with them the relevant problems and responsibilities) and to identify with them the problems as well as the improvements to be made. It has been seen that there is resistance or fear to participate in the identification of these problems as well as to accept proposals for improvements, made by the communities.
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With regard to the outcomes, there are differences according to the experience and the internal and external conditions of each process. In some cases the government and social stakeholders recognized the improvements made in the operation of the projects both with regard to infrastructure and quality service, and in the opening or reinforcement of the participation spaces. In not few cases, the proposed improvements were beyond the capabilities of the staff assigned to the local service including the participation of the immediately higher instance, depending more of the regulating issues of the sector or orientations of the national public policies. These mobilization processes and the creation of consensus inside the VCP processes have permitted to capitalize in a more effective way the opportunities available in the area. The achievements have been more when the proposals of the community were in synergy with the institutional processes/decisions/campaigns that were of an increased scope; as that favored the development of inter institutional partnerships. About the relationship of the VCP team and the ADP 25. The perception in the AO and the ADP is that the pilot experience of the VCP was made outside of the institutional life of the local offices. As they were
complementary projects, the facilitator had to establish a direct and permanent communication line with the national coordinator with regard to the project life. 26. The perception was in some cases of facilitators working in field interventions, in parallel: those of the ADP Program and those of the pilot experience and what that implies in terms of an extended work schedule, and in some limited cases, of interference in the pilot project interventions over the usual ADP activities.
27. A cross-cutting design of community Surveillance, linked to the ADP interventions, within the National Strategic Plan, will surely help to redesign and to redistribute the use of human capital available in each ADP. The objective is to have the whole ADP team working in different areas in community surveillance. According to the documents that have been reviewed, this orientation is in force in the proposal that is valid for the National Strategic Plans, and if it is true that it is associated to actions oriented to social empowerment ( formerly POP) for an adequate impact it will be required that the whole team of each ADP to be involved directly in these actions. 28. The information that has been gathered indicates that the coordination of
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the pilot experience maintained permanent work contact and updated information with the ADP coordinators and project facilitators; i t seems that the information chain was weaker with regard to the coordination of the Area Offices. 29. While the ADPs include projects with social surveillance components, the VCP experience is not considered in documents for the Program Design of the ADPs, and the pilot experience of the VCP was not integrated as a cross-cutting component in the Strategic Plans of the ADPs involved, despite the fact that there have been initiatives and actions on that regard, as in the case of the ADP Nuevo Milenio that included the VCP actions in its redesign process. The planning of the intervention of the surveillance process would gain consistency and sustainability if it is integrated to the Strategic Plans of the ADPs as a transversal component. That certainly implies a change in the work approach and would require a review of the current design of the information transmission chain. 30. The pilot VCP project was designed and implemented in coordination with the NO in Lima. An information chain was set up with the ADP coordinators and the facilitators assigned to the project. The transmission line with the AO had not been fluid enough with regard to the development of the VCP process, and that made difficult the coordination and implementation of the relevant actions. Relationship of the community with the service operators 31. In all the evaluated experiences the starting point shows a widely
asymmetric relationship between the service operators and the community. There is some initial fear of the people with regard to the service operators, that to their condition of public workers and service administrators must add the role of providers in a wider and symbolic sense with regard to community wellbeing. Besides, the experiences show that through the development of the VCP process, in different rhythms, the fear to raise the voice to express opinions is being lost , according to the level of presence and respect that is being obtained in the public sphere developing more reinvindicative attitudes and in some cases going from the protest to the proposal. Despite the positive valuation that the WG members give to the issue of
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accountability in the surveillance process, persists (with different colors in each case) the fact that many people are afraid to request accountability to the operators, there is a perception that the good will of the provider prevails over the exercise of the public position, according to the regulations and procedures. That is why the people is afraid to give way to reprisals Some of this can be seen also among the workers of the ADP that see in the reactions of the officers that are surveilled a resentment and distance that threatens the success of the work for which they are responsible. With this, it must be underlined that the VCP process opens, in all the cases, a dialogue space among citizens (WG) and the Government (officers, service operators and local authorities), identifying mutually their responsibilities according to the law, and even more, its interests. This is an important precedent for the Community stakeholders and, in some cases, it has been a swift in the possibility to stake out a relationship with the Peruvian government different from the traditional one. 32. In the case of the WG of the rural area the asymmetries are even more because added to an increased monetary income inequality and limited access to goods and services is the ethnic and cultural component and an even more deep patriarchal culture. In this regard it has been mentioned the fear to speak in Spanish and to talk in that language with the service operator. This issue deals with structural realities that are difficult to modify in the short term. However, the affirmation of the language capability in the mother tongue is necessary in this process: that The language to be used in the spaces for care in the health services and in those of participation and community management of the public services in general, will be the original language that is used by the beneficiaries.
VCP Final Evaluation Report Informe Final de Evaluacin About the relationship of WV with the service operators in the development of surveillance actions.
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33. The evaluated services are very important for the children and adolescents and for the work of WV to achieve its objectives, thus it is key to ensure a good dynamics for an inter relation with the service operators. In this framework and based on the cases that have been seen, the introduction of VCP modifies the traditional relationship between WV and the service providers. In all the experiences there are testimonies about the alerts and fear of the service operators with regard to the surveillance practices in the community. In a parallel way in some of the cases there are replies or reactions not only positive but pro active with regard to these surveillance initiatives , that are seen by the officers as an opportunity to promote changes and improvements in the services provided. That is clear for instance in the cases of the Hospital of Huanta (quality service), in the case of the IE VRHT (Institutional project) and it can be seen also to a less extent in the Health Center Santa Rosa and in the case of Punacancha. In general, the operators highlight in a positive way to have been invited and that the issues seen were not only rights but also responsibilities of the population. But they are more resistant to see the problems and of course the implementation of the improvements that are related with their work or that of the service staff. It is not the same however with the proposals for the improvement of infrastructure, equipment, the inputs that imply community support for their achievement. 34. There are also several response strategies by WV with regard to these attitudes of the service operators, in order to maintain the relationship with these strategic partners. The main trend that is part of the methodology- is to involve the service operators in part of the process and to adopt measures oriented to reduce the profile of surveillance in order to keep opened the work relations with the service staff. But despite all that, there were cases of distance between the service provider staff and WV staff. 35. As part of the strategic relationship with the services, WV should focus its interaction in an integrated way, include to dialogue with them about the proper mechanisms to strengthen the instances of participation and management of quality services (Surveillance) from a dimension of right and citizenship in government instances and using in the process the
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36. Without impairment of what is mentioned above, WV has a challenge to build locally a new style of relationship between the Government, responsible to ensure rights and to provide services for that purpose, and the community, aware of its rights as well as its tasks with regard to the well-being of children and adolescents. The change requires these two roles as well as a mediation work with both parties, as the one performed by WV in the cases that have been evaluated. 37. The achievement of this challenge requires also changes in the supra local scales to contribute to define the public policies at regional level, and even better at national level. Policies and measures that from the top may interact proactively with the local efforts, and from the bottom t o i m p r o v e t h e s e r v i c e s , a s c a n b e s e e n i n s o m e o f t h e e x p e r i e n c e s t h a t have received attention in this evaluation. 38. WV can perform a strategic role in this process, because of the diversity of contexts in which it works and its partnerships at local, regional, national, and international level. In summary, and going back to the initial questions that gave way to this evaluation that has had essentially a qualitative approach:
Applicability and possibility replication of the VAC:
for
The cases that have been evaluated - that include and represent a diversified set of situations and services- a n d the outcomes of the evaluation permit to point out that the VAC methodology can be applied and replicated in various contexts in order to promote community surveillance practices for education and health services that are essential for the whole population and in particular for children and adolescents. It would be convenient to develop new experiences in other services as the ones that are being started with regard to citizens safety and other municipal ones, that in their implementation and evaluation may provide new contribution for development. As it is usual with all methodological tools, the specific conditions in which the actions are going to be implemented must be considered in order to include the required adjustments oriented to achieve the relevant outcomes. In this are included issues such as the cultural relevancy of the tool, the capabilities that
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are required for the men and women participants for the use of the tools or according to the roles and functions that they may perform in the process, etc.
Community Sustainability
Simultaneously and as relevant to the use of a tool, the skills required to use the tool, are associated to how often that tool is going to be used. In this regard the
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community sustainability requires not only training but also repeated surveillance exercises that may permit for the community members and the service to build a new relationship framework based on the rights approach, including the right to participation as a basic issue of quality of the service. In this dynamics, community empowerment is at the same time outcome and means in the process and it goes in hand with the improvement of the services.
Articulation o f VCP to the action lines of the ADPs sustainability of this initiative.
and
institutional
In the cases that have been studied prevails the treatment of VCP as a complementary project for the work of the ADP. That is adjusted to the contract formality with which the project has been implemented and the institutional practice on this issue. To this date, the VCP is included in the PEN guidelines and will required according to its approach condition as well as tools quality to be incorporated in the future strategies and actions of the ADPs. Without impairment to the above, information and statements have been gathered that show that the VCP proposal is being received and implemented by several ADPs for their institutional work. It must be underlined also that the empowerment approach that supports the VCP proposal is a challenge also for the action of the institution itself with regard to the creation of links with the community, and with the children and adolescents, as well as its relationship with the public service operators.
Model of public management based on the approach of rights and quality of services.
Finally, it is important to underline what has been said in the above lines: a change is required in the local space with regard to the relationship between the government and the society, based on a proactive government for the exercise of its responsibility to ensure rights and to provide the relevant service, and a community that is aware of its rights and makes use of its voice to contribute with its proposals. The local change requires also changes in the supra local scales, that is to say public policies at regional level, and even better at national level, that from the up lines they may interact in a proactive way with the local efforts, from the bottom lines in order to have improved services. W V can and must perform a strategic role in this process for change, providing help to both instances, the government and society, in order for each one of them to perform their relevant role.
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ANNEXES

Evaluacion Peru

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VCP Final Evaluation Report

Final Evaluation of the (pilot) Project named:

Participatory Community Surveillance 2010)

Monitoring Based on the Community MBC) (2007

Final Evaluation Report

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Openness of government instances to coordinate with private organizations..

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Citizens Voice and Action approach and methodology.

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2. The Context of the Intervention

a) The crisis as a turning point

b) A more integrated approach

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c) The institutional changes of the first years

The general processes

The transparency tools

d) Increased role of the sub national governments for the provision of

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e) The Surveillance experiences and the observatories

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Rebuilding the experience of WV Peru in VCP 3.1. Background

a) International development of the methodology

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The VCP methodology in Peru

a) About the name of the methodology

b) The Approach: Citizens Voice and Action

Transformational focused on the of children and that affects the

TORs oif the Consultancy , p.6

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Citizens Voice and Action:

Orientation Guides, Prepared by

Keren Winterford, January 2009, p.

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c) The VCP tools

F a c i l i t a t o r s G u i d e . Steps to create awareness about the community surveillance process.

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a) Step1: Organization This step considers the following activities: