Designing strategies and activities for a health intervention like the one carried out by Con Corazón is a challenge. Our desire is to have a positive impact to improve, maintain, promote or modify the health of the population we serve. The activities include educational programs, medical-dental care, improvement of health conditions and health prevention and promotion campaigns. The impact we want to produce must be subject to periodic evaluation through data collection. The importance of using data to confirm beliefs about which management strategies and practices are working and which are not. “You can’t improve what you don’t measure”, Peter Drucker.

Assessing the impact of health interventions is essential for making future decisions. It is important to compare the observed results with what you would expect if the intervention had not been implemented. A wide range of routinely collected data should be available for the evaluation of health interventions.

One of the main reasons for our Managing Director Saulo Gamarra having taken a course in “Consultancy skills in International Health: Evaluation of health facilities, projects and programs” at the University of Heidelberg in Germany, is precisely to gain knowledge and experience in this type of activity. Many colleagues from different parts of the world, who also took the course, also need to have a new perspective to improve the health projects they manage in their respective countries.

Evaluation of health services

It is a systematic process for evaluating the achievement of a program’s stated objectives. Its adequacy, effectiveness and acceptance by all parties involved are reported.

The costs and resources for the provision of health services have increased over the years. The current international situation has not helped to overcome this challenge. An evaluation provides us with data to understand the effectiveness and efficiency of our health services, including the impact on beneficiaries.

For example, one of the indicators of the good use of resources and therefore the quality of the service is the following: Directly after the opening of our dental clinic in the city of Cusco, the staff demanded the purchase of alcohol gel for regular hand disinfection. This important request was implemented directly. After six months, we noticed that there were no more requests for hand sanitizer. The indicator was that the bottles had been mostly used only 30% of its content. This means that the bad habit of not disinfecting hands was stronger than the real need. The use of alcohol in gel is essential in any health establishment! To solve this problem, training had to be implemented for all the staff of the establishment. After this, the change of habit was noticed and the use was more frequent, consequently the quality of the service.

At Con Corazón, after this experience, we make sure that all the staff are trained through talks, explaining the benefits of using disinfectants. We also encourage our staff good habits that can be emulated by our patients and other people who observe us.

These types of solutions can be achieved through:

Monitoring

It can be defined as an ongoing function that uses systematic data collection to provide management and stakeholders with an indication of progress in the use of funds, the achievement of goals, and the degree of progress. Its objective is to determine whether or not the planned objectives have been met.

We use tools on a regular basis to achieve this, for example, through observation. Thus, we can identify deficiencies and successes in the daily use of resources.

Evaluation

It can be defined as the process of determining the value or importance of a development activity or program. In this way, we determine the relevance of the objectives, the effectiveness of the design and implementation, the efficiency or use of resources and the sustainability of the results. An evaluation should allow the lessons learned to feed into the decision-making process of both the partner and the donor.

Evaluations at Con Corazón are usually annual. There we can learn from the results of all our interventions. In this way, we make important decisions to implement new projects or correct and improve others.

Monitoring and Evaluation (M&E) is a critical element of any successful health program. M&E enables programs to track and demonstrate progress, as well as diagnose programs to enable better results.

Getting better and better

In order to improve our organization, we review the implementation of health services to identify and recommend the necessary revision of the whole program. In doing that, we contribute to better health planning. Periodically we document the results achieved by a project to know if desired outcomes are being achieved and identify corrective actions. This action leads us to improve health projects and health infrastructure as well as the right allocation of resources in the current and future program. We aim to make health activities more relevant, more efficient and more effective.

Who does the evaluation at Con Corazón?

Our director Saulo Gamarra understands and apply evaluation concepts and principles when evaluating facilities, projects and programs in the health sector using his personal and technical skills in evaluation and consulting. It is important to apply principles and processes for evaluation. He also identifies, adapt and use tools within an evaluation.

Determining what is to be evaluated then stablish standards and criteria is one of the tasks, subsequently plan the methodology. Once we are done with the previous, we gather information and analyze the results. All of this will lead us to take action. Re-evaluate makes a continues cycle that lead to improvement.

Approaches such as the Plan, Do, Study, Act cycle, which is part of the model for improvement, a commonly used tool to test and understand small changes in quality improvement work may be used to undertake formative evaluations.

To evaluate a program, the methodology must be planned

This establishes the purpose of evaluation in our Con Corazón program, including the standards and criteria for conducting the evaluation.

Collection of information: The data we require is obtained mainly from our direct beneficiaries. For this, we do individual in depth interviews and focus groups interviews with open questions. The use of observation as a tool for data collection and subsequent transcription is also a useful instrument. Through the Ministry of Health, and other organizations, we obtain mortality and morbidity statistics.

Analysis of results: It must be done in the shortest time possible. A discussion of the results should be held with all members and stakeholders.

Take action: For evaluation to be truly effective, the emphasis must be on actions to support, strengthen, or modify our services. As a consequence, there may be changes in priorities, revision of objectives or development of new programs to satisfy previously unidentified needs. The reevaluation aims to make health services more relevant, more efficient and more effective. Taking action also means progressing and establishing transparency in the workplace which is key to creating a positive organizational culture and solidifying employee loyalty and engagement.

Acquiring consultancy skills

In Con Corazón, we make sure that our staff have knowledge in the matter. Our managerial practice requires us to be prepared and up-to-date on these types of issues and for the potential challenges coming ahead. For this, Dr. Saulo Gamarra has taken a refresher course called “Consultancy Skills in International Health: Evaluation of health facilities, projects and programs” last summer at Heidelberg University in Germany.

Dr. Gamarra earned many techniques to carry out evaluations in the health sector. He also learned that improving our quality of health services is a constant need. The course includes the following topics:

1. An Overview of Evaluation in International Health, including evaluation purpose, methods, develop tools, gather and analyze data and make decisions.
2. Health Systems & Health Sector Reform: current concepts and terms.
3. Evaluation in the Health Sector: Principles, Methods, Techniques and Tools.
4. Planning and conducting an evaluation, including logistic plans.
5. Effective writing techniques, trying to make it easy for the readers to quickly find out the main points.
6. Critical review of Evaluation reports, where we had the opportunity to do a Meta Evaluation of a report. It was an intense team work.
7. The Consultant: Expectations from the course attendees and experiences from current consultants in the market.
8. Important skills and activities for consultancy career plan. Writing a personal SWOT analysis about, helped us to understand more about ourselves.

The participants were from different parts of the world with different backgrounds. We have learned the importance of working as a team. “I recognize that sometimes I do not like to work in teams, but experienced has taught me that working in a group helps me to handle with the details and the deadlines. Another advantage is that more ideas are flowing at the same time and the burden is lighter”, says Dr. Gamarra.  As an African phrase reads: “If you want to go fast, go alone but if you want to go far, go together.” remarking the importance of a team.

October 2022

A sustainable future for all, with day-to-day global challenges, such as poverty, inequality, climate, environmental degradation, prosperity, peace and justice.

The Sustainable Development Goals (SDGs) are a series of measures to end poverty, protect the planet and guarantee the global well-being of people. One of the greatest achievements in sustainability has been the approval of the 2030 agenda of the United Nations and with it these objectives as a master plan for the future of our planet. They show an integral, interconnected, indivisible look and a renewed international collaboration. Together, they build a vision of the future that we all want.

The Emergence of a Great Idea

Just a few decades ago, the world was a very different place where economic growth prevailed over everything else. So much so that people and nature were relegated to the background. Development and progress became the destruction of life.

Industrialization, pollution and the burning of fossil fuels were the engine of economic activity. The consequences were not long in manifesting themselves on the planet: greater emission of greenhouse gases, progressive increase in temperatures, melting of the poles, etc. We were transforming the world and not precisely to improve it.

Luckily, in the 1980s, science brings to the table the necessary evidence and data to open the eyes of humanity. The current concept of sustainability appears for the first time in the Brundtland Report of 1987 and alerts for the first time of the terrible environmental consequences of economic development and globalization. But it not only underlines the problems, but also offers solutions to industrialization or population growth.

The publication of the Brundtland report was only the first step. Humanity realized that it faced many challenges to ensure that all people have the same opportunities for development and well-being. In the year of 2000, the United Nations adopted eight goals to meet the main needs of the poorest, the Millennium Development Goals (MDGs).

The MDGs have been fundamental, for example, in getting 51 million more children into school, drastically reducing deaths from AIDS, tuberculosis and malaria, and have also been part of a historically dramatic drop in child mortality. Poverty, measured by living on less than $1.25 a day, was cut in half.

From the Millennium Development Goals to the Sustainable Development Goals

While the MDGs were aimed at the poorest countries, the new SDGs are designed to be universal. This is a monumental shift in thinking about sustainable development, in which rich nations support the development of poorer nations, to avoid destabilizing important parts of the Earth's life support system. The SDGs are a universal call to action to end poverty, protect the planet and improve the lives and perspective of people everywhere.

World leaders met in New York to agree that the SDGs are successors to the MDGs. The idea came from the Rio+20 Summit in 2012, the largest summit in UN history. Colombia and Guatemala proposed goals to follow up on the MDGs, established in 2000.

It was shown that setting goals works in a complex world, organizations and countries can align their agendas and prioritize funding to meet these goals.

An Universal Agreement

The new goals are the result of a three-year process involving 83 national surveys and more than 7 million people, making it the largest consultation in UN history.

The nations eventually agreed on a list of 17 goals. This agenda is an action plan for people, the planet and prosperity. From governance experts to climate researchers to the academic community are very supportive of the goals.

Not everyone agrees. The Lancet described the targets as "fairy tales, dressed in the bureaucracy of intergovernmental narcissism, adorned in the robes of multilateral paralysis, and poisoned by the acid of nation-state failure." This may be true, but it ignores the fact that the goals have been heavily negotiated, having broad legitimacy among all parties.

Why are the SDGs Important?

The breadth and depth of the proposed SDGs is unprecedented. The new agenda aims to leave no one behind and promote the social inclusion of the most vulnerable groups. At the same time, it sets the environmental limits and critical natural thresholds for the use of natural resources.

The final document Transforming our World: The 2030 agenda for Sustainable Development States in its preamble: “This agenda is a plan of action for people, planet and prosperity”, and affirms “the interlinkages and integrated nature of the SDGs are of crucial importance in ensuring that the purpose of the new Agenda is realized”.

Which Country is most Likely to Complete the Goals First?

According to a recent study by Germany's Bertelsmann Foundation, the countries best positioned to achieve the new UN goals are the four Scandinavian nations: Sweden, Norway, Denmark and Finland, with Switzerland in fifth place. The lowest ranked nations are the US, Greece, Chile, Hungary, Turkey and Mexico.

A Commitment that must be Regularly Reminded

A key challenge is how to engage the public in support of a complex agenda. The concern now is how to get people interested in the SDGs. If no one notices them, they won't attract the attention they need to build momentum. This is a very real problem because they have been largely ignored by the media to date.

As with all intergovernmental agreements, success will be due to political support and governments implementing it. Here, a key role for stakeholders will be to continually remind governments of their commitments. These governments will change in the next ten years in many countries and successive governments must be educated and reminded of these commitments.

Con Corazón Lined with the SDGs

We've seen how, with passion and dedication, the world's serious problems can be tackled head-on, and we've seen that most people in the world really, passionately want that to happen.

When the morning news fills you with fear and nervousness, when people are working against each other, when we see things falling apart, it is so crucial that we all work together. We believe that long days and nights were needed to reach an agreement and promote the fulfillment of these objectives. Although it is much more comfortable for everyone to be at home in pajamas.

Governments have made a serious decision to make the new goals not just a sequel, but to turn them into a more mature set of goals, trying to address the complex nature of poverty. This is an extremely profound and admirable undertaking. But it also presents a very big communication challenge. It is important to communicate them and make them clear, digestible, emotionally resonant and famous.

We encourage the UN Member States, so deeply involved in the process and the politicians in the country, to take very seriously the challenge of communicating the new goals and making them famous throughout the world.

We believe that the MDGs were not famous enough. Hardly any of our friends and certainly family, had heard of them. The MDGs would have been more effective and powerful if more people outside of government and NGOs circles in more countries had known that they were something to support and fight for.

The new goals could be one of the most powerful and effective documents the UN has ever produced. In that expectation, many others and Con Corazón are lined with the plans to bring a concise version of the goals to all the people around us and in contact with our project, for example, through presentations, on television, newspapers, the Internet, radio, schools. If the targets are well known, if they're famous, if they're popular, they could be a wake-up call to all who fight against poverty and injustice. They could create a generation of well-informed politicians and citizens who have a shared direction and fight together to achieve it.

The goals must ultimately be owned by the citizens of all countries. The goals do not belong only to governments. There should be a version of them that could be placed on the wall of every classroom and etched into the heart of every activist for the years to come. Every government and leader must have a realistic list of things that they are committed to achieving. They must see that if they don't, their citizens will know and hold them accountable. It's not just about communication, it's about implementation.

Con Corazón, has a clear mission, which is caring for the health of human civilization and the state of the natural systems on which it depends. Our goal is to improve planetary health, with a better balance of human needs and the preservation of the earth, to maintain the health and well-being of future generations. We are working in projects following our vision through concrete activities as we want all people have access to health services and education. We give sustainable solutions to vulnerable people - especially in the Peruvian Andes - to increase their quality of life. We achieve this from women’s empowerment to microcredits and community projects. "It means that our activities are part of something bigger, and we are making our valuable contribution to achieving the UN's goals that have been set," says Con Corazón founder Danièle Turkier.

A Plan to Follow

The SDGs are a blueprint, a roadmap, a to-do list for the planet, a planetary declaration of rights. The goals for which all those heroes we most admire in all countries have fought. We hope that in the near future everyone will be able to lead a decent life without destroying the potential of the planet and to provide for future generations. We encourage everyone involved to commit to making sure their work really works. When leaders sign the document, it is not only 193 countries that commit, it is more than 7 billion people who commit. Today's complex challenges, ranging from stopping the spread of disease to preventing conflict between nations, cannot be dealt with efficiently if each country tackles it on its own. We need integrated solutions that tackle in depth the problems of people's daily realities. It is necessary to remember that when we work to guarantee the sustainability of the planet, we are talking about preserving and protecting life on the only home we know. Achieving compliance with the SDG agenda before 2030 is the only possible path to survival.

 May 2022

“I hardly have any money to pay my bus ticket to the city of Cusco. Now it costs too much to bring food to my house.” Vidal Quispe, a resident of Marampaqui.

On the 24^th February, 2022, Russian troops invaded the territory of Ukraine, starting an armed conflict that has lasted more than several months. In addition to the human and material losses, the war is also causing strong effects on the economy, mainly affecting the reduction of growth expectations and an increase in inflation all over the world.

Vidal Quispe surprised with the new prices.

Vidal lives in Marampaqui, a town three hours from the city of Cusco. Here, life is calm, however the global situation has affected his already very precarious economy. The rise in prices came as a surprise to them, like a bucket of cold water. Every time he wants to travel to Cusco by bus, he has to make an effort to pay for his bus ticket. When he arrives at the Cusco market, he is even more surprised by the higher prices of basic necessities, such as chicken, sugar, oil, bread, meat, rice, noodles, etc... On his way back to Marampaqui, he realizes that his bags with the purchased products weigh very little. He nods his head and says: "this situation will make my family have to eat less than before; we will have to endure hunger".

How does war affect the economy of a country?

The effects of war are being felt in three dimensions:

1. Higher inflation stemming from rising food and energy prices;
2. Problems in international trade and supply chains;
3. Greater uncertainty in the markets

“Russia and Ukraine are major producers of raw materials, and the disruptions have caused global prices to spike, especially for oil and natural gas. Food costs have skyrocketed; wheat, of which Ukraine and Russia export 30% of the world, has reached historical prices”, indicated the international organization International Monetary Fund (IMF).

It is warned that if this situation continues, GDP growth worldwide would fall 1 percentage point, while global inflation would increase 2.5 points.

In Turkey, there was year-on-year inflation of 54.4% in February. In Spain, inflation was close to 10% year-on-year, its highest value since 1985. And in the United States it reached 7.9% in the year, the highest figure in 40 years. In many countries around the world, inflation levels are at their highest rates in more than 30 years. International organizations announce a slowdown in growth and an increase in prices driven mainly by the rise in food and energy.

In Peru, the changes and the crisis in the global economy have had a negative effect on the increase in the prices of oil, wheat and cereals. As a consequence, we have the increase in local prices in transport and food.

The COVID-19 pandemic and the crisis

The world economic situation before the war between Russia and Ukraine was already complex. After the paralysis of the economy in 2020 as a result of the coronavirus pandemic, the sanitary restriction measures were reduced for the year 2022 and a slowdown in growth was expected. “The global economy is simultaneously facing COVID-19, inflation and policy uncertainty; public spending and monetary policies are entering uncharted territory,” said David Malpass, president of the World Bank Group, last January.

This international situation also affects the economy of the region and Peru. An IMF report maintains that in Latin America "high commodity prices are likely to significantly accelerate inflation."

In addition to the price problem, the world has delayed investment decisions in emerging countries like Peru. As for agricultural products, any increase in international prices also affects the local market.

Peru in check

The massive strikes, due to the increase in fuel costs, unfortunately left at least six dead as a consequence. The anger of the people was compounded by the discontent of farm workers, who have been hit by rising fertilizer prices, which in turn caused food prices to skyrocket. Also, exports are now affected by interruptions in chain supply.

A group of Peruvian truckers called a general strike, demanding cheaper gasoline at all costs. Drivers used their trucks to block roads, including major highways. In some regions, schools have closed and reverted to e-learning due to the COVID pandemic, fearing it would be dangerous for children to travel (if they were able to) during the unrest.

The Peruvian protests highlight the effect that the war, and the resulting price rises, are having on Latin America. The conflict could still go in any direction and there is a risk that it could worsen due to strategic failures on either side. Faced with a possible new cold war, it would be difficult for Latin America not to align itself with one side or the other, knowing that any decision will have costs and consequences.

All of this has exposed the country's economic vulnerability and triggered a wave of street manifestations, strikes and roadblocks.

When the economy was slowly recovering…

The Peruvian government has attributed the rise in fuel prices to the war in Ukraine. Peru imports most of its oil and the impact has been severe, unlike Latin American countries like Venezuela or Argentina, which have oil. To make matters worse, high fuel costs hit just as Peru's economy was beginning to recover from a pandemic that devastated the country. Peru has the highest recorded per capita COVID mortality rate in the world.

July 2022

“I feel like this is a second chance for me and this time I will do better.”

Quarantine and physical distancing measures, necessary to stop the spread of the coronavirus and save lives, generate job losses and reduce the economic income of individuals and households. The loss of income affects above all the population that is in a situation of poverty and vulnerability. In our region, labor markets are often precarious with a high proportion of informal jobs which has become endemic.

Rising Inequality

The sudden and intense spread of Covid-19 in the Latin American region has dramatically exposed and amplified the presence of inequalities and inequities. The pandemic breaks into a complex economic, social and political scenario of low growth, increased poverty and growing social tensions. In Peru, the structural inequalities that characterize our Latin American societies and the high levels of informality and lack of social protection are exposed. Due to this, the great structural gaps in the region have become evident and exacerbated and currently, we are experiencing a moment of great uncertainty in which neither the form nor the speed of exit from the crisis have yet been outlined.

A big Impact to the Vulnerable Community

Mario Huillca, is a man born in Marampaqui who is in charge of a large family. He has suffered the effects of the coronavirus, not only economically but also physically. During this time, the family could only eat what they had stored at home. It was impossible to have monetary incomes because there was no way to sell the products at the local fair. The children could not go to school for two years and did not receive online classes either, due to lack of devices and internet access. Almost a year ago, when he contracted the coronavirus, his relatives were very scared, fearing that death was coming to take him. He had very serious symptoms to the point of not being able to breathe and coming to believe that this was the last episode of his life. After two weeks of suffering and treatment through the Peruvian Ministry of Health, he finally recovered and later, when the vaccine arrived in his town, he was able to access it and thus avoid further contagion.

Life gives many lessons, especially in moments where it is in danger. Mario learned that effort, desire, a good attitude and optimism are the perfect combination to get ahead. He says “I feel like this is a second chance for me and this time I will do better”.

A matter of Choice

According to Dr. Tedros, director of the World Health Organization (WHO), "ending the pandemic is not a matter of chance, it is a matter of choice and the choice is in our hands." Therefore, the WHO calls for a global effort to vaccinate 70% of the population in all countries by mid 2022. Reaching this goal will help end the acute phase of the pandemic and allow countries to reopen.

End of Covid-19 Pandemic

Tomas Pueyo, an engineer who predicted the behavior of the pandemic, in his article ‘Coronavirus: Game over, it’s time to start living again’, believes that the world and the times we are entering are no longer a continuation of the last two years. We should think about the coming months in the same way that we should think about the coming decades. However, this will be counterintuitive. We have behaved differently in the last two years. New habits have appeared and these are difficult to break.

According to McKinsey & Company, the vaccination and its respective reinforcement, proved to be important in the protection against Omicron. People believe that the risks of contracting COVID-19 are not important enough to change their behavior. This could be due to vaccination status or the desire to overcome the pandemic. Some governments, such as Peru, maintain or strengthen public health policies, including vaccination mandates.

Over the months, governments have imposed smart measures to stem the impact of the virus without hurting the economy. Some want to continue with these measures, although the end of the pandemic is in sight. Now citizens distrust the government because in the past it has not generated trust in the proper management of their rights. The economic reactivation for the most vulnerable is imminent, even if the government maintains those measures.

Social Inclusion

At Con Corazón we practice inclusion without exception, working with sustainable strategies and tools that lead to the reactivation of the Marampaqui beneficiaries. This through our community projects that favor economic reactivation. If we take care of the environment that surrounds them, we will have a better quality of health and therefore greater ability to focus on economic activities that directly benefit their homes and the community in general.

As the pandemic has had a greater negative effect on the most vulnerable populations, there are calls not only to build back better, but also to build back more justly. Doing so requires strong and continued political leadership across governments to correct entrenched and structural social inequality.

Giving Perspectives to the Community

In Peru, due to informality, losing your job means looking for another source of economic income, such as selling sweets on the corners and/or even stealing, which has become endemic, just to bring a little bread and feed the family. Just as in many other places in the world, millions of Peruvians who lost their jobs due to the pandemic, without social support, as well as millions of others whose well-being is threatened by the uncertainty and political conflict that exists, deserve to regain the peace of mind to look to the future with hope.

One of the programs managed by Con Corazón is microcredits. This consists of facilitating a money loan to the people of Marampaqui to buy guinea pigs and/or trout. This must be paid without interest, after a reasonable period of time. In other words, once the breeders start selling the guinea pigs and trout in the local market, they will be able to return the money.

Mario gets up very early in the morning to do multiple activities. He and his family graze the alpacas they have, taking them to places with fresh pastures. The children also collect mushrooms that grow under the only pine forest in front of the village. The women cut the green grass to take to the guinea pigs' shed and feed them. The still small trout live in water wells, built by the family, and they are fed with products that they acquire in the local market. When the weekend arrives, the entire family prepares the products that are ready to be sold at the fair in Tinke, a town near the inter-oceanic highway that connects Cusco with the Peruvian jungle and reaches Brazil.

Saturdays, local farmers from all over the area, sell directly its production in the market of Tinke. Consumers find a very diversified offer and quality, at much more affordable prices than those offered by other distributors, as well as a new relationship with the producers, more direct, which allows them to better understand the quality and origin of the products purchased.

March 2022