SANITATION for HEALTH

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WORKSHOP REPORT ON MULTISECTORAL PLANNING FOR THE CONTROL OF CHOLERA LIMA, PERU JUNE 1991

Field Report No. 343 December 1991

WATER AND

SANITATION for HEALTH PROJECT Sponsored by the U.S. Agency for International Development Operated by CDM and Associates ~~1ih\1;illcic!i~\I(f~£L

WASH Reid Report No. 343

WORKSHOP REPORT ON MULTISECTORAt~PLANNll'JG FOR THE CONTROL OF CHOILERA LIMA, PERU

JUNE 1991

Prepared for the USAID Mission to Peru under WASH Task No. 253

by Joseph Haratani David Schrier William Hanson assisted by Marlella Bautista

and

Ce.c:ar Rub:

December 1991

Water and Snnitntion for Health Project Contract No. DPB-S973-Z-OO-B03I-OO, Project No. 836-1249 is apOf.sored by the OffICe of Health. BUC'el!lu fOf ReEelU'Ch nndl IRvelopment

U.S. Agency for International Development W611hington, DC 20523

Related WASH Reports

Field Report No. 331, Cholera In Peru: A Rapid Assessment of the Country's Water and Sanitation Infrastructure and Its Role In the Epidemic, by Joseph Haratanl and Daniel Hemandez. May 1991. Field Report No. 302, Planning for Water and Sanitation Programs In Bolivia, Ecuador, and Peru, by David Ey. June 1990. Field Report No. 201, Final Evaluation 0/ USAID/Cathollc Relief Services Water and Sanitation Program In Ecuador, Peru, Guatemala, Honduras, and the Dominican Republic, by Oscar R. Larrea, Rose M. Schneider, Richard Duncan, and Homero Silva. January 1988. Field Report No. 134-5, A Summary of the Progress Evaluation of the Rural Water Systems and Environmental Sanitation Project In Peru, by Jacques Falgenblum. March 1985. Field Report No. 38, Recommendations for the Rural Water and Environmental Sanitation Project In Peru, by David Donaldson and Charles S. Pineo. April 1982. Field Report No. 30, UNICEFjPAHO Joint Worlcshop on Drlnlefng Water and Sanitation In Rural and Urban Slum Areas, Lima, Peru 17·22 November 1980, by Emil T.

Chanlett. December 1981. Field Report No.1, Socia-Cultural and Economic Characteristics of Conditions In Ancas and La Libertad, Peru, with Special Emphasis on the Callejones de. Huaylas and Conchucos: In an Evaluation of CARE-sponsored Water, Sewage, and Health Projects, by Charlotte I. Miller. November 1980.

CONTENTS

ABOUT THE AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ACRONYMS ACKNOWLEDGMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. EXECUTIVE SUMMARY

1.

2.

vii I"

INTRODUcrION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

1

1.1 1.2 1.3 1.4

Background. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Scope of Work Purpose. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Metl1odology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

1 2 2 3

WORKSHOP PLANNING. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

5

2.1 2.2

. . . . . . . . . . . . . . . ..

5 7

. . . . . . . . . . . . . . . .. ................

7

2.3

2.4 2.5 2.6

2.7 2.8 2.9 2.10

3.

iii v

Background. . . . . . . . . . . . . . . . . . . . . . . Initial Agreements Selection of Key Players . . . . . . . . . . . . . . . Selection of Intenfaew Respondents. . . . . . . . Interview Results Analysis of Interview Responses. . . . . . . . . . Workshop Design Review and Revision of the Workshop Design Final Workshop Design . . . . . . . . . . . . . . . . Workshop Schedule and Venue .... . . . . . .

3.2 3.3 3.4 3.5

10 . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . ..

11 11 12

,...................

13

Day One=-Initiation of the Workshop . . . . . . . . . . . . . . . . . . . . .. Day Two Day Three Day Four Post-workshop Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

13

WORKSHOP ACfIVITIES 3.1

. . . . . . . . . . . . . . . ..

8 8 9

14 15 15 '6

4.

WORKSHOP OUTCOMES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

17

4.1 4.2

Background. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Production of a National Plan Initiating the Collaboration Process. . . . . . . . . . . . . . . . . . . . . . .. Workshop Issues

17 17 17

5.

CONCLUSIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

21

6

RECOMMENDATIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

23

6.1 6.2 6.3 6.4 6.5

To the GOP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. To the CNMLCC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. To USAID/Peru To A.I.D./Washington To WASH

23 23 23 24 24

Executive Summary from WASH Field Report No. 331 . . . . . . . . . . . . . .. Interview Questions Preguntas a Efectuarse Durante las Entrevistas . . . . . . . . . . . . .. Agenda: Reunion de Coordinacion Interagencial para el Control del Colero en el Peru . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., letter of Introduction to Interviewees _ .. , Ust of Persons Interviewed Workshop Oesigfl"=First Draft (English) . . . . . . . . . . . . . . . . . . . . . . . . .. Workshop Design-Final Version (Spanish) Objectives, Methodology, and Norms of the Workshop (Spanish) Problems/fhemes Derived from Interviews (English and Spanish)

25 31

4.3 4.4

18

APPENDICES A. B. C.

D. E. F. G.

H. I.

J. K. L. M. N. O.

Small Group Reports: Problems, Causes, and Effects . . . . . . . . . . . . . . . .. Organization of the CNMLCC (Spanish) Plan of Action (Spanish) Memorandum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. List of Participants and Their AffUiations . . . . . . . . . . . . . . . . . . . . . . . ..

Ii

33 35 37

39 41 45 51 53

59 65 85 91 93

ABOUT THE AUTHORS

Joseph Haratani has a diverse background in project design, implementation, and evaluation; civil and sanitary engineering; and coordination of Peace Corps prograrl'1s In SouLt, America. Since 1983, he has served as a public health advisor to A.J.D. In the area of water supply and sanitation, participating in project design as well as advising field missions In management and evaluation of development programs. He is fluent in Spanish.

David Schrier holds a doctorate in organizational development and an MBA in International business from the George Washington University. He has consulted for 20 years In international development, recently specializing In survey..guided strategic planning at the country level. While Dr. Schrier has worked in central and southeast Asia and western and southeast Africa, he specializes in Latin America and is fluent in Spanish.

William Hanson is a training consultant with 25 years of experience in Asia, Africa, and Latin America. He has carried out a number of short-term training assignments for WASh over the past five years including several recent activities in Ecuador. He speaks fluent French and Spanish.

Marlella Bautista is currently pursuing a master's degree in management. Until mid-1991, she had been a full-time member of the faculty in the computer science department at Pacifico University in Uma, Peru. She is expert in Lotus, dBase 4, and WordPerfect systerns and uses these programs frequently to undertake management studies. She served as a researcher and planner dUring the workshop. Ce$t1lr Ruiz is a civil engineer with more than 15 years of experience. He has worked for Peruvian National Oil Company (PETROPERU), with responsibility for the supervision of civil

and sanitary works. He has been a technical advisor for the urban water system of Aucayacu City. More recently he was employed by USAID/Peru where he supervised rural water supply projects.

Hi

ACRONYMS

AIDIW

U.S. Agency for International Development, Washington, D.C.

CEPIS

Centro Panamerlcano dl lngenlerfa Sanitaria y Clenctas del Amblente (Pan American Center for Sanitary Engineering and Environmental Science {WHO/PAHO)J

CNMLCC

Comlslon Naclonal Mu ItIsectorlaI de Lucha Contra el Colera (National Multisectoral Commission to Fight Against Cholera)

GOP

Government of Peru

ONG (NGO)

Organizacl6n Non-Gul):~rnamental (Nongovernmental organization)

PAHO

Organlzacl6n Panamericano de la Salud (Pan American Health Organization)

USAID

U.S. Agency for International Development Mission in Peru

WASH

Water and Sanitation for Health Project

WHO

World Health Organization

v

ACKNOWLEDGMENTS

We wish to thank Director Craig Buck, USAID/Peru and his staff for the wholehearted support given during our assignment In Peru. The workshop could not have talten place without the concerned support of Deputy Director Barbara Kennedy and USAID staff members Dr. Edgar Necochea and Gerardo Arabe. We also express our appreciation to Dr. Eduardo Salazar, CNMLCC President; Engineer Manuel Barron, SENAPAj Engineer Julio Burbano, OPSj Engineer Alberto Aorez, CEPIS; all of the workshop participants for their interest and cooperation in making the event the success. The post-workshop deliberations to complete the action plan were carried out by the special work group consisting of Jorge Izaguirre (SENAPA), Nora Razzeto (MOH), Jorge Villena (INAPMAS), and Roger Castillo (lNP). This work group was given valuable support by Marlella Bautista who contributed her precise and clear ideas as a consulting team member. Cesar Rulz also provided significant contributions based on his first-hand knowledge of Peru's water supply and sanitation situation as a project engineer and evaluation team member for the recently completed Rural Water Systems and Environmental Sanitation Project sponsored by USAID/Peru. Special thanks are due to Zoila Segura, MOH secretary, for her dedicated work l'lnd to USAID secretaries Myriam Sareo and Carla Salazar for their cheerful and efficient response to our unending requests for assistance. Muehas gracias a todos!

vii

EXECUTIVE SUMMARY

Background In late January 1991, Peru was struck with a massive cholera epidemic. While its medical forces did a good job of treating and curing cholera patients, the institutions responsible for controlling the spread of the disease were making valiant but uncoordinated efforts which did not control the epidemic. In early March, USAID/peru asked the Water and Sanitation for Health Project (WASH) to field a team to make a rapid assessment of the water supply and sanitation situation where the epidemic was having its greatest impact. As a result of this assessment, the team concluded that the main reason the preventive measures were. not effective was lack of coordination among Government of Peru (GOP) agencies involved. Among other items, the team recommended that USAID/peru sponsor a workshop for the inter-ministerial committee to assist in its design of a unified national cholera control plan. This report describes the planning and execution of the workshop.

Planning the Workshop In late April 1991, USAID asked WASH to field a team to plan and conduct such a workshop. An advance two-person team arrived in Peru in late May to plan the workshop. One of the difficulties faced by the team was the fact that the President of the newly formed Comfsfon Nacfonal Multfsectorfal de Lucha Contra el Colera (National Multisectoral Commission to Fight Against Cholera or CNMLCC) had not agreed to endorse the proposed workshop. Therefore the team's first task was to obtain his approval and support for the workshop, which it did dUring the first two days. To begin the task of designing the workshop, the consultants drew up a questionnaire to use in interviewb1g prospective participants. The questions were framed in a way to produce information which would help in designing the workshop. Twenty-one persons were interviewed and their responses collated and a content analysis made. Two sets of information derived from the responses were most valuable in preparing the design. The first set consisted of problems described by the respondents. This provided much of the content of the workshop. The second set related to tile respondents' view of how the workshop should be run. This provided insights for the structure of the workshop proceedings. Based on this information and meetings with the Commission President and a planning committee, a four-day workshop was planned. The workshop was to begin on June 26 and end on June 29. A total of 45 persons were invited to attend. Because of previous commibnents, the President had to miss the first day and the lead facilitator had to miss the

Ix

last day of the workshop. With the schedule and venue decided, the advance team members left Peru on June 11 and June 12.

Conducting the Workshop One Tuesday, June 18, the WASH team, now including the lead facilitator, travelled to Peru to apply the finishing touches to the design and to complete the final arrangements for the workshop. The workshop began slightly behind schedule on June 26 due to a strike of transportation workers. During the next four days, a few changes had to be made in the workshop program, largely due to the reluctance of the participants to work in an unstructured setting. Because of these changes, the planned product-a national action ptan--was not completed. However, arrangements were made for its completion in the weeks immediately following the workshop by a special action plan work group. By far, the greatest impact of the workshop was on the participants, who were energized by their first opportwlity to meet and work cooperatively with counterparts from many GOP and other agencies. The expression of appreciation from the participants for having this unique opportunity to work together as colleagues was more than enough reward for the WASH team members as they completed their assignment.

Conclusions The task of providing assistance in the fonn of a workshop which does not have comple~e support of the host government representative is difficult and may not fully attain its objectives. However, in the case of this particular activity in Peru, there may be other payoffs; the seeds of inter-agency cooperation planted dUring the workshop may germinate and bear fruit in the future. o

Planning and conducting a workshop is subject to all the vagaries of the real world. No matter how much advanced planning is done, last minute changes have to be made. To get the job done requires making many compromises. The key ingredient needed Js a heavy dose of old-fashioned flexibility. Planning and conducting a workshop appears deceptively simple. It takes more human, temporal, and financial resources than one imagines at the start. Workshop sponsors and designers must be generous in the planning for these resources.

x

Recommendations To the CNMLCC •

The CNMLCC through its special work group should complete the multisectoral cholera control plan by describing the specific actions that need to be taken by the CNMLCC. The plan should include a timeline for each action and the institutions and individuals responsible for taking the action. These actions should be illustrated in an implementation schedule showing beginning dates and completion dates, if applicable, or shown as continuing long-term actions. Once the action plan is completed, the CNMLCC should immediately begin to carry out its mandate of coordinating the water supply and sanitation cholera control activities as its first order of priorities.

To the GOP Consider upgrading the CNMLCC and putting it in the Office of the Presidency to give it more political power. Based on the success of the CNMLCC, offer assistance to countries which may be facing a similar cholera epidemic soon. To USAID/Peru e

Stay infonned about the CNMLCC operations. Offer assistance to the GOP for workshops to improve cooperation among national, regional, and municipal governments. Advise USAID Missions in neighboring countries of Peru's experience in combatting the cholera epidemic.

To AID/VV Through USAID, stay in touch with the operation of the CNMLCC and with the work of PAHO and CEPIS in Peru. •

Act as liaison between USAID/peru and PAHO/Washington, WHO/ Geneva, and other concerned institutions-.

xi

To WASH •

Consider forming a pool of consultants who would be available on short notice to repeat the type of work performed in Peru if cholera breaks out in neighboring countries next summer.

xii

Chapter 1

INTRODUCTlON

1.1

Background

During late January 1991, a cholera epidemic broke out in Peru. While the Government of Peru (GOP) reacted promptly and effectively in the curative aspects of treating cholern patients, preventive measures related to improving water supply and ~nitation systems had l1ct been as successful. It is these preventive measures in the aredS 0: watp.f supply 8'nd sanitation which are needed to stop the spread of the epidemic. In ea~'ly March, t;~·.. U.S. Agency for Int~mationai Devekipment (USAID) (·l1isslon in Peru "ontacted the VJ~.f~' aui &,,( :t£ltYon for Health Project rNASH) and requ~5ted tha f a twomember team be Sea'lL; '.I :' '_dduct i' rapid assessment ,..J the water supply and :;O.1iiation condH.:ons in trat a\r(~a~ ii lOst severely impacted by the epidemic. TW0 sanitary eng~aeers arrived in Puu on Me,,'~ il 18, performed theh' assessr, I~, It of the northern coastal cities, prepared a draft re;x-.',t for U 5AID, i)nd -j'j:;drt 'd the country on April 6, 1991. 1 Based on a review of relevant document::;J An~e':views with knowledgeable persons, and field visits to Chimbote, Uma/Callao, and Piura, the team was able to draw a number of specific conclusions and recommendations for both USAID and the GOP. (See Appendix A for the executive summary of the report on this rapid assessment.) One of the study's Itey conclusions was that there tNas little coordination among GOP agencies Involved In addressing water supply and sanitation factors related to the epidemic. Furthermore, a recommendation was made that USAID sponsor a workshop to develop a national cholera emergency campaigl1 plan based on cooperation among key GOP institutions. On April 2, 1991, a National Multisectoral Commission in the Aght against Cholera (Comision Nacional Multisectorial de Lucha Contra el Colera or CNMLCC) was formed within the Ministry of Health (MOH). While the CNMLCC is responsible for coordinating a wide range of actions based on both curative and preventive aspects of the cholera epidemic, the proposed workshop was intended to focus on the coordination of preventive actions related to water supply and sanitation. The GOP institutions and the nation's community of organizations related to water supply and sanitation had been acting independently without a coordinating body, As a result. Peru

Joseph Harata!1i and Donald J, Hernandez, Cholera in Peru: A Rapid Assessment of the Country's Water and Sanitation Infrastructure and its Role in the Epidemic. WASH Reid Report No. 331. Arlington, Va.: WASH Project. May 1991. 1

1

had so far not b(~~efittecl f10m a centralized mechanism that could assist In the deployment of its S
1.~

Scope of Work

Before the workshop, the consultants were to review re~evant background materials and parUcipate in a one and one-half day team planning m~ctir:J. Upon drawing up a list of questions, they were to interview workshop participantc; and to gather information on current status and topics to focus on at the workshop. The next step was to design the schedule and delineate topics to address and activities. The consultants were to conduct a three to five-day workshop to produce an intersectoral master action plan on water supply and sanitation services to complement the current anticholera campaign. Following the worksh0p, the team was to present a draft action plan ~o USAID and draft a report on the whole process for possible use in other countries facing the cholera epidemic.

1.3 The workshop was intended to produce a national plan of action to involve interagency cooperation and coordination to improve condltlom' in the water supply and sanitation sector. The workshop design was to be based on participative methods where participants representing key GOP Institutions were to create the actual plan. Where proposals for improving water supply and sanitation had previously been drafted by each separate institution, the workshop was to focus on the formation of strategic alliances among the Institutions involved. Organizations workln3 together to solve problems would capitalize on the comparative advantages of each institution. The workshop participants were to be instructed to produce a design of the CNMLCC that outlined Its role, operating methods, resources, and functions. It was hoped that coordination and cooperation among GOP institutions would be facilitated by the newly designed CNMLCC.

2

1.4

Methodology

The work plan for the assignment was to consist of two phases. The first phase was to plan the workshop and the second phase was for conducting the workshop. The WASH team was to consist of three corlsultants: the team leader, a strategic planner/fz.cllitatoT, and a lp.ad facUitator. The workshop planning phase was to be carned out by the team leader and the strategic plannerIfacUitator. The workshop Itself was to be conducted by the full team Including the lead facilitator. Additional staff SUP;lort was to be Identified and obtained as conditions required. Two Peruvian technicians, an ex~cutlve secretary/assistant facilitator, and a civil engineer/assistant facilitator were hired to provide support to the consultants. Prior to travetltng to Peru to plan the workshop, the advance team met with WASH staff for a one and one half day team planning meeting. Topics covered dUring the meeting Included the purpose and scope of the assignment, team members' roles, consultant/client relationships, workshop objectives and planning process, and tentative work plan and report outline. The final team planning activity was a b:';eflng given by the consultants to staff from WASH, AJD/W, PAHO, and Peace Corps covering the topics noted above. The key output of the team planning meeting was a preliminary list of questions to be used In interviewing prospective workshop participants ~n Peru. (See Appendixes Band C In English and Spanish, respectively.) Upon arrival In Peru, the consultcmts were to meet with USAID staff to receive an up-to-date status report on the arrangements for the proposed workshop. This meeting was to be followed by an introduction to the newly appointed President of the CNMLCC for the express purpose of obtaining his approval and support for the proposed workshop and an endorsement to proceed with the workshop planning process. Once th~e formalities had been completed, the first step in the process was to draw up a Ust of prospective participants drawn from GOP agencies involved in the water supply and sanitation aspects of the cholera campaign. A total of 30 to 35 participants were planned for the workshop. The second step in the workshop planning process was to Interview as many of the prospective participants as possible within the time allotted applying the list of questions prepared dUring the team planning meeting. The verbatim responses of each person interviewed were to be recorded by the interviewers. These responses were then to be listed under each of the nine questions asked. The third step was to review and" analyze all of the responses under each question to derive a set of water supply and sanitation related problems described by the respondents. These problems were to be used as a point of departure for the tasks to be addressed in the

3

workshop. The workshop was to be designed ~o encourage participants to work together In small work groups and plenary sessions to accomplish a series of specific tasks which would culm~na~e in the production of a multlsectoral water supply and sanitation cholera control plan. Once the workshop planning process had been completed, the advance team of consultants would return to the U.S. until approximately one week before the actual start of the workshop. At that time the full workshop team of three consultants, now including the lead facUitator, would travei to Peru to add the final details to the workshop design and make final arrangements.

4

Chapter 2

WORKSHOP PLANNING

2.1

Background

DUring the week of April 29, 1991, the Pan American Health Organization sponsored a seminar entitled "Semlnario Sobre Prevencion Y Control De Colera" in Washington, D.C. The recently appointed President of the CNMLCC, Dr. Eduardo Salazar, attended the seminar and made a presentation on the status of cholera in Peru. When asked, he appeared to have no knowledge of the earlier rapid assessment or of the proposed workshop. This response did not conform with the information WASH had been receiving from USAID/Peru. Although this apparent information gap raised some doubts about the advisability of fielding the workshop design team as scheduled, it was decided to go ahead with the visit to avoid missing out on the existing window of opportunity. Therefore, the advance planning team left for Peru as scheduled on Tuesday, May 28, 1991. On reporting to the USAID office the follOWing momlr.~ to begin their assignment, instead of receiving an update on the status of activities relating to the proposed workshop, the consultants were asked to attend the week-long seminar sponsored by the CNMLCC entitled "Reunion de Coordinacion Interagencial para el Control del Colera en el Peru." At this point the consultants had not yet met Dr. Sarazar. It was sugge~ted that this would be a good opportunity to do so-to get acquainted "vith him and to obtain some insights about the status of the ongoing cholera campaign. The two consultants attended the "Reunion" on Wednesday and Thursday. Topics presented on Wednesday dealt with communications and health education. The Thursday morning session was dedicated to presentations on water supply and sanitation which were of direct interest to the consultants. During the Wednesday morning coffee break, the consultants were introduced to the President of the CNMLCC. For the following two days, the consultants took every opportunity to meet and talk with him. During these meetings, and especially at lunch, the consultants were able to explain the reason for thel!: presence in Peru at this time and to offer their assistance. The presentations made dUring the two days of the "Reunion" attended by the consultants were essentially an update of the status of activities related to the topics on the agenda. The Issue of the ne~d for coordination among institutions was not directly addressed. The printed agenda (see Appendix 0 for "Reunion" agenda) identified the need to plan activities in a coordinated manner as one of the objectives of the "Reunion. However, the preparation of a coordinated plan to obtain technical assistance from external sources was not scheduled II

5

until the final session of the seminar. The two WASH consultants did not attend the Friday sessions but learned later that such a plan was not developed. On Thursday afternoon, the Commission President proposed, in a plenary session, that the "Reunion" be followed by a 'Taller" (workshop) to produce a coordinated water supply and sanitation plan to control cholera. This proposal received unanimous support from the participants, which gave the consultants the needed endorsement to Initiate the workshop planning process. The initial workshop planning meeting was scheduled with the Commission President that very evening. Due to his tight schedule, It was a brief meeting where only the broad outline of the workshop planning process, the interview questions, and the overall strategy could be presented. Since the President did not have the time to assimilate and approve the proposed approaches at this meeting, a second meeting was scheduled during the coffee break at the "Reunion" the following morning. This also was a short meeting but the President gave his approval to initiate the interviews with prospective workshop participants utilizing the questions he had reviewed. A third meeting was scheduled for the following morning, Saturday, at 9:30 a.m. A letter of introduction was drafted in English and translated into Spanish to be sent to prospective participants who were to be interviewed. (See Appendix E for sample letter of introduction.) Because of the short time span available for the interviews, it was decided that the letters should be sent by courier, which was done. Because of the lack of lead-time and also the respondents' busy schedules, only one interview was arranged and conducted on Friday. However, the single interview was \mportant in that it provided a field test of the questionnaire. The questionnaire did produce the type of information needed to design the workshop. Additional interviews were scheduled for the following week. During the meeting on Saturday morning, the list of prospective participants, which was started on Thursday evening, was expanded and additional interview respondents were identified. The workshop schedule was discussed but not finalized due to conflicts with the Commission President's travel schedule. The question of the workshotJ venue was also raised to consider the physical space requirements for both the plenary sessions and for the number of breakout rooms. Another factor considpred was the desirability of isolation away from the usual demands of the participants' office. The consultants agreed to collect information on the availability, sUitabUity, and cost of possible conference facilities.

6

The consultants had prepared a draft of the design of the workshop the night before. This was presented to the Commission President; he agreed In principle with the draft and advised the consultants to proceed with the workshop planning process. He also stated that he wanted the consultants to work from an office In the MOH and not at the USAID/Peru office. He reasoned that since the purpose of the workshop was to produce a Peruvian national plan, the work of the consultants needed to be viewed by the participants as coming from a Peruvian office and not from the outside. This was agreed to by the consultants and cleared with the USAID Mission. On Monday, June 3, the consultants set up office and hegan to work out of the MOB "Despacho." However, from time to time, it was necessary to utilize the USAID computer and printing facilities. Frequent scheduled and unscheduled meetings were held with the Commission President during the balance of the workshop planning process to k.aep him tnfonned of the progress being made and to involve him in the many decisions that had to be made.

2.2

Initial Agreements

The initial relationship with the CNMLCC President was based on the need by the GOP to activate the Commission into providing a national water supply and sanitation plan. It had been proposed that this could be accomplished by organizing a group of "key players"~ representatives of GOP agencies involved in the cholera campaign and from technical assistance agencies with technical resident staff who were knowledgeable about the water supply and sanitation situation in Peru. The task of the WASH consultants was to assist the Commission President in selecting and assembling the "key players" at a workshop and to initiate the process of resolving issues of common interest in a collaborative way. The Commission President recognized the need to start the process of getting officials representing a wide range of GOP agencies--who previously had no practical knowledge of or working relationships with each other-·to begin this process of working together. He saw this proposed workshop as the needed follow-on to the "Reunion" that he had sponsored.

2.3

Selection of Key Players

The selection of key players was based on two criteria: (1) individuals with high-level positions in institutions playing (or potentially playing) an important role in the water supply and sanitation sector in the cholera control plan and (2) individuals with broad vision regarding the possible approaches toward solving the interagency coordination problem.

7

In addition, technical representatives from multilateral technical assistance agencies (specifically PAHO, CEPIS, and UNICEF) who had substantlallmowledge of Peru's water supply and sanitation situation would be Invited to attend the workshop as technical resource persons. Participants were also invited from the engineering university faculty, the Peruvian sanitary engineering association, and from nongovernmental organizations (NGOs) working in the water supply and sanitation sector.

2.4

Selection of Interview Respondents

Interview respondents were selected from the list of approximately 40 prospective participants. The main consideration was to obtain respondents from as broad a range of Institutions as possible. Due to the short time available, the respondents selected were those who could fit the interview session into their schedules. A total of 21 respondents representing 18 institutions were selected and interviewed. (See Appendix F for list of persons interviewed.) All of the respondents were very accommodating, adjusting their schedules when there were delays due to transportation problems. The respondents (on occasion there would be a panel of agency staff responding) were keenly Interested in the proposed workshop and almost all expressed a strong desire to be included in the list of people to be Invited to the workshop.

2.5

Interview Results

The background and purpose of the questionnaire was explained to each respondent. Each was also Informed that the responses would remain anonymous since all responses would be aggregated under each respective question. In spite of this assurance of anonymity, a few respondents were unwilling to make any critical responses, especially about the issue of interagency cooperation In a few cases, the respondent chosen was not the best person to represent the institution. In these cases, an alternative representative who was more knowledgeable about the subjects of water supply and §anitatlon was chosen. (A summary of responses to the interviews is available on requ~st to the WASH Project.) After the first eight or ten respondents were interviewed, a pattern of responses began to emerge. The majority recognized a problem in interagency cooperation. There was near unanimous agreement that the spread of cholera was the result of inadequate water supplies and poor sanitation. While there were differences as to areas of specific interest related to the activities of the respondent's Institution, there was a clear recognition that the control of the cholera epidemic would largely depend on improvements in the water supply and sanitation sector.

8

In response to the first question regarding coordination among agencies, over half of those interviewed said there was a lack of coordination. These responses supported the conclusion reached dUring the rapid assessment conducted earlier in the year. The responses to the second question regarding the need for an overall pla·n to coordinate the activities of the institutions involved were almost unanimous in affirming the need. These responses to the first two interview questions provided the raison d'etre fC"r the workshop. Responses to the third question provided the names of organizations that should participate in developing the plan to coordinate activities and the responses to the four question asking If the respondents wanted to participate in the proposed workshop were overwhelmingly positive. The fifth question asked respondents to name essential topics which should be addressed in the plan. The five major topics suggested for the workshop were water supply, excreta disposal, solid wastes, food handling, and personal hygiene. A few respondents also mentioned vector control, appropriate technology, treatment plant equipment, and health education as additional topics. The sixth question referred to the types of activities in which the respondents' institution was involved. The responses provided a list of water supply and sanitation-related activities of the institutions represented. The seventh question addressed the capability of each institution's staff to carry out its responsibilities. The general response was that there existed a shortage of qualified staff largely due to the low salaries paid by the GOP. The eighth question asked respondents to make a Judgment on the number of days it would take to come up with a plan. Most respondents thought that it would take from fOUf to five days. Question 9a and 9b requested respondents to provide their ideas and recommendations on the design and fonnat of the workshop. Highly useful information was given which included the need for a workshop outline prepared in advance and the utilization of small work groups to carry out tasks.

2.6

Analysis of Interview Responses

The interview results were first collated as a random list of verbatim responses. The full set of responses was reviewed and discussed by the consultants and then discussed with the Commission President. Since the questions had been framed to provide information which would be useful in preparing the workshop design, each set of responses was analyzed with that purpose in mind.

9

The responsp,s to the question relating to the problem of interagency cooperation confirmed the need to design the workshop around this issue. The responses to the question identifying key topics that should be addressed In a national water supply and sanitation plan provided the substantive content of the workshop. Anally, the responses to the questions regarding respondents' advice on workshop design and the actual conduct of the workshop were very usefulln determining the workshop methods and procedures to be used. A content analysis was made of the responses. Key issues and topics were abstracted from the responses. These issues and topics fonned the matrix around which the workshop was designed.

2.7

Workshop Design

The workshop was designed with two main objectives in mind. The first and foremost was to start the process of interagency communication and cooperation by getting representatives of various agencies to work together on problems they themselves identified in the interviews. The second objective was to produce a plan of action for the CNMLCC to implement to control the spread of cholera. (See Appendix G for the initial workshop design.) The final design was a four-day workshop consisting each day of two morning and two afternoon sessions. The entire focus and atmosphere would be that of working full-time in a cooperative manner to produce a specific product-a plan of action. It was also decided that there would be no formalized opening or closing ceremonies. The workshop was to be strictly a working affair. The main thrust of the workshop proceedings was to present specific tasks to be executed in small work groups. General infonnation and guidance would be provided to the participants in plenary sessions. These presentations would be followed by a question-andanswer period after which the participants would break out into their work groups to carry out their tasks. Each work group was to be composed of participants representing as diverse a cross-section of the institutions represented as possible. The purpose was to get people who were not acquainted with each other to start working together on problems identified by them and to become acquainted with each other in a cooperative, problem··solving atmosphere. The problem-solving strategy began with the task of redefining the problems derived from the interviews and determining their causes and effects. The second task was to prioritize these problems according to the participants' own set of criteria.

10

After completing these tasks, the groups were to be reassembled In plenary session to identify and describe attitudes and activities in each work group which were help!ul in resolving the issues at hand and also those that created barriers to the process. Using the insights gained from the preceding wqrk group sessions, the participants were to be formed Into new work groups to design a conceptual framework for preparing a multisectoral water supply and sanitation plan to control the spread of cholera, One group was to be chosen to carry out the special task of preparing a list of criteria to be used In evaluating each proposed framework, Each national action plan framework was to be presented by a spokesperson from each work

group and evaluated using the set of criteria developed by the special work group. The best framework or combination of frameworks was to be used to guide the actual preparation of the multisectoral plan of action.

2.8

Review and Revision of the Workshop Design

A group of five key participants was selected by the Commission President to form a workshop planning committee to review and approve the final workshop design. This group met on Tuesday evening, June 11. In reviewing the design, there was general agreement on the overall design. However, a few changes in the design of specific workshop sessions were suggested and agreed to. Based on this review, a second draft of the workshop outline was prepared. The design would undergo two additional reviews and modifications before appearing in its final form. This final version was Included in the packet of information provided to the participants as they arrived and registered for the workshop. Throughout the review and modification process, the main objective and strategy of the workshop remained unchanged. Only the content of specific sessions were changed. The main concern of the Commission President was to avoid unnecessary focus on group dynamics and to concentrate on drawing up a specific work plan.

2.9

Final Workshop Design

A copy of the final workshop design may be found In Appendix H. Day One was planned to introduce participants and to explain the workshop process, to present an overview of the dimensions of the cholera epidemic and its relationship to Peru's water supply and sanitation infrastructure, and to describe the main problems facing the sector.

11

Day Two focused on the formation of strategic alliances among institutions, on the analysis of cooperative behaviors, and the design of the framework for the multlsectoral plan. Day Three began with a group decision process for selecting the optimal framework for the multisectoral plan; this was to be followed by dividing into five work groups to address the five major segments of the plan; and, in plenary session, the spokesperson for each of the work groups would present the content of their segment of the multisectoral plan. On the last day the five segments of the multisectoral plan were to be compiled into a unified plan. After this was accomplished, the work groups were to prepare a presentation of their assigned part of the unified plan. The final session of the workshop consisted of presentations by the five work groups to an invited audience of donor representatives.

2.10

Workshop Schedule and Venue

Because of conflicts between the travel schedules of the Commission President and the lead faclllta~or, a compromise workshop schedule was finally agreed upon. The workshop was to begin with registration at 8:30, Wednesday morning, June 26, and to continue until 5:00 p.m. Saturday, June 29. This did not represent an ideal schedule since the last day was on a weekend and a national holiday. It also meant that the President would not be present on the opening day. The facility chosen for the workshop was the Grand Hotel Miraflores, a less-than-luxury and not so grand hotel. This facility was chosen over other, more isolated out-of-town locations which would have included lodgings for all participants and thus assured their full-time attendance and attention. The selection was made for two reasons. First, the Commission President did not want the workshop to be held in a luxurious facility especially at a time when the nation was experiencing a severe economic crisis. The second reason was cost: the GOP did not have funds for the workshop facility and it was deemed prudent to present a reasonable budget to the prospective donor (A.I.D,/Washington).

12

Chap1l:er 3

WORKSHOP ACTIVITIES 3.1

Day One-Initiation of the Workshop

Registration began at 8:30 a.m. on Wednesday, June 26. By 9:00 a.m., the scheduled starting time for the workshop, only 8 or 10 of the participants had arrived and registered. The facilitators were worried that they had misjudged the interest of those they had interviewed and may not have convinced them of the importance of the workshop. One of the participants, upon learning of the consultants' concern, advised them that the city transportation workers were on strike and that would delay the arrival of some of the participants. By 9:20 some 25 participants had registered and the facilitators, now somewhat relieved, decided to start the workshop. During the initial session, another 6 to 8 participants had registered raising the total to over 30. That range was to become the average attendance for the rest of the workshop. DUring the first session, the workshop schedule, objectives, methodology, tasks, and working nOims were explained. (See Appendix I for workshop objectives, methodology, and norms) This presentation was followed with introductions by each person attending the workshop. The second session consisted of brief presentations by seven participants describing the status of the cholera epidemic and its relationship to the water supply and sanitation situation In Peru. Also, the status of interagency cooperation and organizational relationships as well as that of foreign technical assistance were presented. Each presentation was followed by a brief question and answer period. For the third plenary session, the participants were presented with problems which were derived from responses to the interview questions (see Appendix J). Since over 45 persons were invited to attend, there were to be eight work groups. With approximately 30 to 35 participants attending, the number of work groups was reduced to five. In order to accommodate this change, the original set of eight problems was restructured into five sets of problems. Participants were divided into five groups of six or seven individuals representing as broad a spectrum of institutions as possible. Each group received a set of problems and was instructed to redefine the problem in their own words and to describe the causes and effects of the problems. The work groups met in their assigned breakout rooms to carry out their tasks.

13

For the fourth session, a spokesperson from each group presented the results of their work to the plenary group. (See Appendix K for Problems, Causes, and Effects.) The presentations by the five groups were followed by a discussion period. Prior to recessing for the day, the following day's agenda was described to allow the participants to prepare for the next day's work.

3.2

Day Two

Day two began in a plenary session by looking back at the results of the previous day's output-the redefinition, causes, and effects of problems specified in the interviews. The participants were then asked to identify actions, events, or attitudes which supported or enhanced cooperation among the work group members. They were also asked to identify those factors which tended to create uarriers to cooperation. These items were noted on flipcharts and were used to remind the participants of factors that helped and those that hindered cooperation within the work groups as they continued their work. During the first session, the plan was to instruct each participant to select from the list of redefined problems the one of greatest interest or significance to him or her. Based on their common interests, the participants were Instructed to form new groups to discuss ways of organizing themselves in a way to effectively address and resolve the selected problem. Most of the participants responded to these instructions with dismay saying that they were not prepared to participate in an exercise which had no clear strccture. After a lengthy and spirited debate, the proposed session was canceled and a role-play by one of the worl{ groups to portray how it was functioning in addressing its task was substituted. The second session of the day began with the role-playing by the group that had volunteered. After this activity and the ensuing discussion were completed, the facilitators decided to advance the introduction of tile following session. This new task required each work group to prepare a conceptual framework within which a national action plan could be drawn up. For this task, four new work groups were formed and a fifth group was given the special task of formulating a set of criteria with which to evaluate each proposed framework. These new work groups retired to their newly assigned breakout rooms to commence their work. These work groups continued their task after the lunch break working through the entire third session. Session four was another plenary session where the spokesperson for each new group presented the results of their work. Because some of the presentations and subsequent discussions took more time than had been anticipated, there was no time left to discuss the evaluation process that was to begin in the morning. The workshop was adjourned for the day.

14

3.3

Day Three

Because of the change in the workshop plan and the disruption caused by forming new work groups, the first session of Day Three commenced with commentaries and requests by the participants of their desire to go back to their original work gn.iups. The facilitators readily agreed to these requests as it also coincided with what had been planned for the remainder of the workshop. The first session of Day Three was designed to apply the criteria developed to evaluate each of the proposed frameworks. Because of the diverse manner in which these frameworks were presented, it was not possible to make an objective evaluation of them. Instead, all four proposed frameworks were retained as guides for preparing the national plan. The second session opened with a discussion of what elements should be included in the national plan. Five major segments were identified and agreed upon. These were: (1) a description of the CNMLCC, (2) prioritization of sector activities, (3) a short-term plan, (4) a long-term plan, and (5) a project proposal for a specific local project. Each of the five work groups were assigned one of the segments of the national plan and each began drafting a plan for presentation dUring the last session of the day. All five groups were to make a presentation during this last session, however, due to the length of the presentations, only four were able to do so. It was decided that the fifth group would make its presentation the first thing in the morning and the session was adjourned for the day.

3.4

Day Four

The final day of the workshop began as agreed LO with the presentation of the work of the fifth group. This was foHowed by a discuss!n". ~f the tasks remaining to produce a unified national plan. The consensus of the pl.er:ary se&"ion was that a clear definition and understanding of the role, functior.s, and organization of the CNMLCC was needed in order to be able to combine the segments into a unified national plan of action. Since the group working on the organization of the CNMLCC had not been able to come out with an agreedupon set of roles, functions, and organization, it was decided that each work group would continue to refine its product while the CNMLCC organization group hammered outs its differences and decided on one proposal. The groups were also instructed to be prepared to make a final presentation in front of a group of donor representatives during the last session of the workshop. During the penultimate session of the workshop, the CNMLCC group agreed on one proposed description of the role, functton, and organization for the CNMLCC. All five groups made their final presentations at the last session. (See Appendix L for the final

15

presentations.) Of the donor agencies invited to attend this session, only USAID/Peru was represented. All other invitees were not able to attend. The USAID/peru representative raised several important questions concerning the mechanics of funding and implementing a complex multisectoral project such as that presented for the situation in Lor ,~to in the Amazon watershed. These serious issues were acknowledged by the presenters and retained to be addressed in preparing the unified national action plan. Because a final unified plan could not be completed within the time allotted for the workshop, the facilitators suggested that a special meeting be held with the planning committee members in order to decide on a course of action to complete It.

3.5

Post-workshop Activities

The special post-workshop meeting of the planning committee took place on Tuesday, July 2. At this meeting a special work group was formed consisting of four participants representing four major GOP agencies, one facilitator, and two assistant facilitators. This group agreed to meet daily from 2:00 to 5:00 p.m. at the offices of the Pan American Health Organization to complete the national plan. The second V/ASH facilitator left Peru the following morning. The third facilitator agreed to remain in Uma an extra three days to meet and work with the action plan group. At the end of this time a draft of the action plan was prepared as was a revised proposal for the organization and functions of the CNMLCC to be reviewed and approved by the CNMLCC President and the planning committee. (See Appendix M for the action plan and revised CNMLCC.) Plans for a final meeting between the Commission President and the WASH !:~~ultant were thwarted by the sudden departure of the President early Thursday morning to accomrany the Minister of Health on an urgent visit to Iquitos in the Amazon \wterJhed. The consultant drafted a brief memorandum to the President describing the work accomplished by the action plan work group (see Appendix N). The consultant also reiterated the need for continued financial support for the two assistant workshop facUltators to continue their work with the action plan group. On that note, the last of the three WASH consultants departed Peru on Saturday, July 6, 1991. What remains to be done is for the CNMLCC through Its special work group to complete the action plan. This can be accomplished by developing a chronological activity plan describing specific actions to be taken, the institutions and individuals responsible for taking action, and the resources needed. This activity plan should be accompanied by an implementation chart showing beginning dates and completion dates (if applicable).

16

Chapter 4

WORKSHOP OUTCOMES

4.1

Background

The purpose of the workshop was twofold. The stated objective was to prepare a multisectoral water supply and sanitation action plan to control the spread of cholera. While this action plan was recognized by all involved in the workshop as the tangible product to be produced, there was aiso a tacit understanding that the other objective was to begin the process of getting officials from the various GOP agencies to work together as colleagues In addressing issues and solving problems of common Interest.

4.2

Production of a National Plan

The production of a national water supply and sanitation plan for the control of cholera was not completed during the wor!
4-.3

Inlti"ting the Collaboration Process

Before the workshop began, most of the participants were acquainted with a few of the other participants. However, most had never visited the offices of the other participants' Institutions and almost none had ever directly collaborated in a formal or informal working relationship with any of the other participants. Therefore the workshop provided, for the first time, the setting, the common inter~'i:s, and the opportunity to set aside institutional and personal barriers and to begin to collaborate as colleagues In working toward a common goal.

17

During the workshop, the members of each work group qulcldy developed meaningful personal relationships with each other. By the second day, these relationships had talum on a degree of Importance that, when the new work groups were formed, the unmistakable feedback from the group as a whole was a strong desire to return to the original worlt groups. On the last day of the workshop, one of the facilitators asked several participants If they would want to ~eep in contact with each other through an Informal directory of all the participants. There was unanimous Interest and support for the idea. (See Appendix 0 for names and affiliations of participants.) In response to this Interest, photographs were taken of each participant present which were to be attached and copied with their biographical data and reproduced. A complete set will be distributed to each participant. Another arrangement to keep the lines of communications open among the institutions was formation of the special action plan working group to finish the task of completing the national action plan. It was planned that this group would continue to meet daily for the next several weeks to complete the plan and to see that the necessary actions are taken to Implement the pian. As mentioned previously this did not happen largely due to a lack of commitment by the CNMLCC President to sustain the effort once support from USAID/WASH ended. I

4.4

Workshop Issues

It seems that no matter how much time and effort are invested In the planning and operation of a workshop, the end result is a product of any number of compromises. Compromises must be made on practically every decision starting from its ba51c design down to Its schedule and venue. The most critical Issue was the need to strike a balance between the attention paid to the workshop product and to Its process. By focusing too much attention on producing a tangible product, I.e., the national action plan, the second objective of encouraging participants to work together in a collaborative manner could easily have been lost. Another important issue was that of striking a balance between the need for sufficient workshop time to reach the objectives and the need to keep It short enough to enable prospective participants to be able to fit it Into their busy schedules. A third Issue was the need to balance the amount of control over the workshop proceedings by the facilitators against the need to allow enough fleXibility for the free flow of Ideas among the participants.

18

A fourth issue was the need to trade off the advantage of holding the workshop in an isolated venue to assure the full-time attendance and attention of the participants against the need to keep the cost within reasonable bounds. Finally, a difficult compromise had to be made regarding the workshop schedule. The absence of the CNMLCC President on the opening day and the premature departure of the lead facUitator made this a less-than-ideal schedule. In spite of all of these and many other compromises made, the key elements of the workshop design and strategy were not compromised. The outcome was a workshop that made a significant Impression on the participants, as evidenced by their commentaries that this was the first time they ever had the opportunity to work together and fonn strong ties with each other. The workshop also gave the facilitators and their assistants the satisfaction of a job well done.

19

Chapter 5

CONCLUSIONS If a host government official has doubts about the need for assistance and resources, the tasl{ of providing that assistance becomes difficult and of questionable value. This was the situation facing the WASH consultants. Whereas the very idea of participating In a tightly designed, product-oriented workshop was exciting to the respondents of the planning Interviews and exhilarating to the actual participants, the government representative was less sanguine about its prospects. For the workshop participants, there seems to be a good possibility that the seeds of interagency collaboration planted during the workshop may germinate and bear fruit. Another conclusion Is that the provision of external technical assistance, especially in the form of a workshop, is subject to all of the vagaries of the real world. As became acutely apparent, everyone Involved In the workshop planning and implementation process had his or her conflicting agenda. The facilitators had comrnibnents beyond this specific assignment. The Commission President had travel plans which kept him from being present the first day of the workshop. Any number of compromises, large and small, had to be made. The conclusion to be reached is that the provision of technical assistance, especially in the ~orm of a workshop, requires a great deal of old-fashioned fleXibility, no matter bow well the plans have been laid. Another conclusion to be drawn is that most compromises have little or no significant impact on the undertaking; however, there are some compromises that have a major impact on the process and should be avoided if at all possible, tZVen if it requires postponing the event. Were it not for the urgent need to act while international interest remained strong for providing assistance to control the cholera epidemic, the workshop could have been postponed to a time when the Commission President was able to attend the complete workshop event. A final conclusion is that a workshop such as this requires significantly more resources, I.e., human, temporal, and financial, than would appear to be necessary. It would be better to err a bit in having too much than to end up not having enough.

21

Chapter 6

RECOMMENDATIONS

6.1

To the GOP



The highest authority of the Government of Peru should consider upgrading the political and organizational status of the CNMLCC including the possibility of placing it directly under the Office of the President to give it the political support and visibility it needs to be able to obtain the human, institutional, material, and financial resources needed to implement a multisectoral cholera control program. Once the CNMLCC has begun to implement its action plan, the GOP should offer assistance to neighboring countries to control the spread of cholera based on its successful experience in Peru.

6.2

To the CNMLCC The CNMLCC through its special work group shC'uld complete the multisectoral cholera control plan by describing the specific actions that need to be taken by the CNMLCC. The plan should include a timeline for each action and the institutions and individuals responsible for taking the action. These actions should be illustrated in an implementation schedule showing beginning dates and completion dates, if applicable, or shown as continuing long-term actions.



6.3

Once the action plan is completed, the CNMLCC should immediately begin to carry out its mandate of coordinating the water supply and sanitation cholera control activities as its first order of priorities.

To USAID/peru USAID/peru should keep in close contact with the CNMLCC to stay apprised of its operation and continue to offer support. •

USAID/Peru should continue to offer technical assistance to the CNMLCC, especially for follow-up workshops to improve cooperation

23

among offices at the national, regional, and municipal levels of government. USAID/peru should advise USAID missions In neighboring countries of the sequence of work carried out by WASH in response to the cholera epidemic in Peru-efforts which may be needed elsewhere.

6.4

To A.I.D./Washington



6.5

A.I.D./Washington should maintain close contact through USAID/Peru with the CNMLCC, PAHO/peru, and CEPIS/Peru In order to monitor progress in the completion and Implementation of the multisectoral water supply and sanitation cholera control plan. It should act as the liaison office in these cholera activities with PAHO/Washington, WHO/Geneva, and other international development organizations.

To WASH WASH should consider identifying a pool of consultants who are qualified to conduct the type of assignments that were involved in responding to the Peruvian cholera epidemic. Although the total number of new cases has dropped significantly, the epidemic continues to spread into the interior of the country. It would not be surprising if tllere were a series of epidemics in several areas of both South and Central America when the summer season arrives late this year or early next year.

24

Appendix A

EXECUTIVE SUMMARY FROM WASH FIELD REPORT NO. 331 Introduction Peru's cholera epidemic, which began in late January 1991, elicited a rapid response from the Government of Peru (GOP) medical establishment for the treatment of patients In Uma/CaIlao and the north coastal cities of Chancay, Chlmbote, TruJUlo, and PiUla, The timely domestic response to the epidemic was followed by a flow of medical supplies and equipment from International donors. In the several weeks following the outbreak, the epidemic had spread from the coastal area inland into the Amazon watershed and across the national border into the neighboring counbies of Ecuador, Colombia, and Chile. While the response (or the treatment of cholera patients and the donations of medical supplies and equipment have been commendable, very limited activities have been conducted and a totally inadequate amount of water and sanitation supplies and equipment have been provided by donors to stem the transmission of the disease. The major environmental measures taken to date have been increased chlorination and surveillance of existing urban water systems and distribution of home water purification chemicals and residual chlorine monitoring kits. For a variety of reasons, including the resignation of the Minister of Health In mid~March, what had begun to develop into a coordinated antl-eholera campaign had, by 100te March, dissolved into a series of uncoordinated field actions by various govemment agencies. While each of these field activities is important and necessary, at their present level of effort they are not producing the impact needed to stem the spread of the disease.

Rapid Assessment of Water Supply and Sanitation In view of th~ !W verity of the cholera epidemic and Its rapid spread, USAID/Peru requested the Water and Sanitation for Health Project (WASH) to field a two-person team to make a rapid assessment of the water supply and sanitation situation. The main focus of thIs assessment was to be In the areas hit hardest by the epidemic, namely, the dties along the north coast of Peru. After a review of pertinent reports and related docwnents and briefings by $Aff from the major agencies involved In controUing the cholera epidemic, the WASH team of two sanitary engineers made field visits to Chlmbote, Un1a/Callao, and Plum and their environs to assess the water and sanitation situation. In essence, the field visits confinned the information provided in the earlier briefings, namely, thai:

25



Prior to the epidemic, chlorination of water supplies was an exception to the general rule. Since the epidemic, more water supplies are being chlorinated.



With the possible exception of limited areas in Lima, urban water supplies are operated on an intermittent basis and are thus subject to contamination from leaks, back-siphoning, and cross-connections.



Even when safe water Is delivered to the home, there is the ever present danger of contamination because of inadequate hygiene practices related to the storage and use of water in the majorlty of households.



Most households in peri-urban neighborhoods (pueblos jovenes) are not connected to the piped water or sewerage systems. These families receive water from public standpipes or buy water from tanker trucks. About half of the residents do not have fonnal excreta disposal facilities and are forced to defecate in any open area available.



Organized garbage and solid waste storage, collection, and disposal are nonexistent in pueblos jovenes and inadequate in many areas of the central city. The poor and homeless often defecate in the same areas where garbage and solid wastes are disposed of and thereby increase the danger of cholera transmission from direct contact by scavengers or indirectly through disease vectors such as rodents and flies.



Among the poor, due to a low level of education and lack of material resources, fundamental health and sanitation practices are often either unknown or not applied.

Emergency Short-term Measures Befing Taken Three agencies of the GOP (INAPMAS and DIGESA of the Ministry of Health and SENAPA of the Ministry of Housing and Construction), with significant technical assistance from CEPIS, have taken the lead in field activities designed to blunt the spread of cholera. As noted earlier, the main efforts have been to increase the chlorination of existing water supplies and to instruct residents in the use of and distribution of hypochlorite packets or solution for purifying water in the home. Additionally, technical assistance has been provided to regional and local government agencies in organizing local cholera committees, developing anti-cllolera campaign strategies, and assisting in initiating the campaigns.

26

The MOH and other entities have developed, printed, and distributed anti-cholera posters and leaflets providing messages on boiling water, sanitary food preparation, and good personal hygiene practices. The MOH is also broadcasting public service messages on ways to avoid contracting cholera.

Emergency Short-term Measures Needed In order to control the spread of cholera, the following actions must be taken: •

Chlorinate all existing water supplies.



Expand the household water purifying programs to aU pueblos jovenes.



Execute a mass media campaign on safe water, sanitary excreta disposal, good food sanitation, and personal hygiene.



Execute an anti-cholera and health and sanitation education program through all schools to reach all students and their families.



Execute a food sanitation program to instruct and train all food handlers including street vendors.



Execute a nationwide garbage and solid wastes collection and disposal program.

Medium and Long-term Prugrams The major actions needed on a medium and long-term basis to control the spread of cholera and other transmissible diseases will require, at a minimum, a tenfold increase in Inv£stment in water supply and sanitation Infrastructure. Annual capital Investment In the order of $100 to $120 million is needed to provide 80 percent urban and 50 percent rural water supply coverage and 75 percent urban and 50 percent rural sanitation (excreta disposal) coverage by the year 2000. In addition, further increased invesbnents must be made In health, sanitation, and personal hygiene education programs, food sanitation training for food handlers, and expanded garbage and solid wastes collection and disposal.

27

Conclusions Resources:



Peru has sufficient human (professional and technical) and institutional resources and many of the material resources needed to plan and mount an effective, unified anti-cholera campaign.



Peru has an existing health services delivery system in place that reaches down to the district and municipal levels.



Peru has an existing public education structure which reaches almost all towns having populations of 2,000 or more.



Peru has a well-developed mass media industry which can be mobilized to disseminate health and sanitation information to a majority of the population.

Constraints:



At the time of this study, there was no recognized central authority in complete charge of an anti-cllolera campaign nor was there a unified campaign organization or strategic campaign plan.



The ongoing decentralization of government will make the planning and execution of a national anti-cholere campaign more comple}{.

Recommendations To USAID/Peru:

Hire a full-time Peruvian engineer to act as the key USAID contact and action person and to collaborate with pertinent GOP offices and international agencies. •

Actively support reorganizing the MOH inter-ministerial cholera committee.



Form a USAID/Peru working group to assist the full-time engineer in collaborating with GOP officials and international representatives in developing a national emergency anti-cholera campaign plan.

28



Obtain emergency assistance funding to provide technical assistance and support for the emergency campaign plan.



Re-activate USAID/peru's Involvement In the rural water supply and sanitation programs.

To the GOP: •

Appoint a "cholera czar" to organize a cholera task force responsible for planning, funding, and executing a unified campaign. This Is the single most Important action that must be taken by the GOP.



Establish an emergency task force to plan, fund, and execute an emergency antl-cholera campaign plan.



Establish a technical advisory group to provide unified technical advice to the emergency task force.



As quickly as possible, shift the emphasis from a reactive (curative) effort to a pro-active (preventive) anti-cholera program.

29

Appendix B

INTERVIEW QUESTIONS

1.

Are there any problems coordinating the water and sanitation activities among the institutions involved in the fight against cholera?

2.

Would it be useful to develop a comprehensive water and sanitation plan to coordinate the activities of the vartious institutions involved?

3.

Which institutions should be involved in

developing a plan for coordinatinq water and

sanitation activities (where possible please name key people). 4.

Given that full time attendance would be required, would you be interested in participating in the upcoming workshop to develop Peru's comprehensive water and sanitation plan?

5.

What are some of the key issues that should be included in the comprehensive water and sanitation plan?

6.

What activities in your institution are related to the water and sanitation area?

7.

Does the staff in your institution lack any important skills in carrying out these actitivies?

8.

How many days would be required for a group of thirty people to develop the comprehensive water and sanitation Plan? Four or five? A.

What advice can you give us for the design of the workshop?

B.

What advice can you give the facilitators on how to conduct the workshop?

31

Appendix

e

PREGUNTAS A EFECTUARSE DURANTE lAS ENTREVISTAS 1.

¿Existe algún problema para coordinar las actividades sobm agua y sanidad entre las instituciones involucradas en la lucha contra el cólera?

2.

¿Considera que sens útil desarrollar un plan general sobre agua y sanidad para coordinar las actividades entre las distintas instituciones involucradas?

3.

¿Qué instituciones deberlan participar en la elaboración de un plan para coordinar las actividades sobre agua y sanidad? (Donde fuera posible, las agradecemos indicar las personas claves.)

4.

En vista que se requerirá una asistencia a tiempo completo, Gestarla interesado en participar en al próximo taller de trabajo que se llevará a cabo para desarrollar el plan general sobre agua y sanidad del Perú?

5.

¿Cuáles son algunos de los puntos esenciales que se debe enfocar en el plan general de agua y sanidad?

6.

¿Qué actividades dentro de su institutión están relacionadas al area{???) del agua y sanidad?

7.

¿Los miembros del personal du su institución caracen de alguna de las calificaciones importantes para llevar a cabo estas actividades?

8.

¿Cuál seria el número de dias que se requeriris para que un grupo de treinta personas desarrollen el plan general de agua y sanidad? Cuatro o cinco?

9.

A.

¿Qué consejos podria damos para diseñar el taller de trabajo?

B.

¿Qué consejos podria d~rle a los coordinadores sobre la fonna de llevar a cabo este taller de trabajo?

33

Appendix

o

AGENDA: REUNION DE COORDINACION INTERAGENCIAL PARA EL CONTROL DEL COLERA EN EL PERU Uma, Peru, 27-31 mayo 1991 Oblectlvos

1.

Revisar la situación actual de la epidemia del cólera y las acciones desarrolladas y planeadas.

2.

Identificar los exitos, problemas y dificultades en las actividades de control el cólera.

3.

De!inlr prioridades de apoyo externo y planear las acciones de manera coordinada.

AGENDA TENTATNA Lunes 27 de lT'.ayo (14:00 hora) Visión generál de la situación del cólera en el Perú. Visión generál de la situación del cólera en las Americas y a nivel mundial. Programa Andino de Emergencia en Salud frente al cólera. Consecuéncias y contexto económico de la epidemia del cólera en el Perú. 28 al 31 de mayo Las sesiones serán estructuradas de la siguiente manera: Habrá una presentatción a cargo de un funcionario del Ministerio de Salud en cada sesión sobre: La situación actual Las acciones desarrolladas . Los éxitos y problemas Identificados Discusión Actividades planeadas Prioridades de cooperación technlca Discusión.

35

Martes 28 de mayo (am) Vigilancia Epidemiológica y Laboratorio. Martes 28 de may (pm) y Miércoles 29 de mayo (am) Organización de Servicios Manejo de casos Oferta y distribución de SRO, antibiotlcos y fluidos endovenosos. Miércoles 29 de mayo (pm) Communicación/educaciónpara la salud. Jueves 30 de mayo (am y pm) Abastecimiento de agua, saneamiento y vigilancia epidemiologica. Viernes 31 de mayo (am) Consideraciones económicas y movilización de recursos. (pm) Preparación de un plan coordinado de apoyo tecnico para el control del cólera en el Perú.

36

Appendix E

LETIER OF INmODUCTION TO INTERVIEWEES Lima, 3 de junio de 1991

Dr. Alberto Gayoso V. Director Técnico Estimado colega: Mediante la presente deseo presentarles al Ing. Josepb Haratani y al Dr. David Scbrier. Ellos son consultores de la Agencia para el Desarrollo Internacional de los Estados Unidos (USAID) en elPelÚ.

Durante la semana pasada, el Ministerio de Salud auspició una "Reunión de Coordinación Interagencial para el Control del Colera en el Perú". Uno de los resultados importantes de esta conferencia fue la decisión que se adoptó para realizar un taller de trabajo de seguimiento con el fin de elaborar un plan general sobre abastecimiento de agua y sanidad ambiental para controlar la propagación del cólera. El Ing. Haratani y el Dr. Scbrier se encuentran actualmente en el Perú para ayudar a desarrollar un taller de trabajo diseñado para elaborar el plan genera~ antes mencionado, para controlar el cólera. Como primer paso para el desarrollo de este taller de trabajo, el Ing. Haratani y el Dr. Schrier necesitan obtener información con respecto a sus actividades, puntos de vista, ideas, inquietudes sobre la epidemia del cólera y sobre su interes en participar en dicho taller de trabajo, a realizarse durante la semana del 24 de junio. Considerando que sólo estarán disponibles para las entrevistas hasta el mediodía del viernes 7 de junio, les solicito su gentil apoyo para contar con su presencia cuando se les contacte para una cita. Agradeciendoles gentilmente su cooperación en este esfuerzo. Atentamente,

~~~-
Appendix F

LIST OF PERSONS INTERVIEWED 1.

2. 3. 4. 5. 6.

7. 8. 9. 10. 11. 12.

13. 14. 15. 16. 17. 18. 19. 20. 21.

Dr. Julio Acosta, MIN-SALUO Dr. Carlos Carrillo, INS Engr. Alberto Aorez, CEPIS Engr. Julio Burbano, OPS Engr. Oscar Caceres, Pachamama/ONG Engr. Herbert Schembri, UNICEF Engr. Manuel Barron, SENAPA Engr. Fortunato lari, SEDAPAL Lie. Carlos Jimlnlez, MIN-ED Ora. Guadalupe Sanchez, IMARPE Dr. Carlos Rivadeneyra, CERPER Ora. Martha Montero, OPS Col. Carlos Diaz, MIN-INT Lie. Alfredo Arecco, MIN-RBLEXT. Sr. Jorge Becerra, FOPTUR Arg. Leukisa Angelo, INDC Sr. Pedro Femandas, PREDES/ONG Lie. Estela Roeder, MIN-SALUO Engr. Francisco Alvizurl, OIGESA Engr. Cesar Tupac-Yupanqui MIN-EN .MIN Engr. Lucio Salazar

39

Appendix G

WORKSHOP DESIGN-FIRST DRAFT (ENGLIStl) Days are divided into four sessions: Session Session Session Session

is from 9:00am to

I II III

is from 10:50am to 12:20pm • from 1:30pm to 3:00pm .lS .1.S from 3:20pm to 5:00pm

.

IV

.

Therefore the design includes 16 seSS.lons

DAY ONE

Inscription Sign in starts at days the workshop begins at polaroid foto; personal and Coffee and brenkfast snacks Session One:

8:30am on day one (for all other 9:00am) and will include: institutional data sheet. will be available

Exercise for Presentation Participants . Ice~Breaking

of.~

Brief introduction of the workshop facilatators by Dr. Eduardo Salazar Lindo followed immediately by a pairing exercise to introduce participants. ~esion

Two:

Workshop Goals and Methodology

The goals of the wor]cshop will be presented followed by a session by session explanation to the design. Particular attention will be paid to explain the MultiSectoral concept and the use of the Plan by the MultisEctoral Comittee. Finally, the model of constituencies will be exPlained, that is: Ministers; Regions/Municipalities; Key Players; Non Governmental orqanizations; and Donors Session Three: Characterization of the Relationship of Conditions in Water and Sanitation to the Colera Epidemic Fishbowl presentation to characterize the current state of water, sanitation, solid waste, untreated sewage let into the ocean, use of untreated water for agricultural irrigation and an epidemiological overview of the cholera epidemic

41

session Four:

Definitions of Water and Santtat..iQJl Problems According to a New Fram~ork

Divide the participants into working qroups according to the classification of problems derived from the interview data. The working groups will define each problem in practical terms; and, explain the background and causes of the problem. Each group will select a member to report their findings to the main group in a plenary session the next day DAY TWO

Session One:

Agreement and Prioritization of Problems Facing Peru Related to Water and Sanitation

Each group will present definition, background and causes of the problem within five minutes. Plenary discussion will follow for another five minutes. This session will produce an understanding of problems to be addressed by the MultiSectoral Comittee. Finally, each participant will vote privately to priortize these problems in order of importance session Two:

Forming strategic Alliances Among Institutions

This session will develop initial ideas for cooperative agreements among institutions represented based on the definitions of problem areas just completed. Following a brief presentation on the need for institutions to cooperate with one another based on their comparative adantages, participants will be guided throuh an organic/structureless session to discuss possible . cooperative projects with other institutions. These cooperative agreements are intended to be the first step in forming strategic alliances among Peruvian institutions to solve problems jointls Session Three:

Presentation of Discussions Regarding Possible Institutional Collaboration

Pariticpants will report back to the plenary qroup on efforts to begin cooperative agreements among instittutions represented in the workshop. Reflexion of the new classification of problems to access collaboration will be included

42

Session Four; The Design of the outline/Esguema for Designing the Multisectoral Plan

CQnceptua~

Before work begins on writing the plan itself, the plenery group will design the conceptual framework, the outline, of the plan. A comprehesive list of factors to be adressed in the plan will permit the assignment of descrete sections of the MiltiSectoral Plan to be written by work groups assigned to each section. One possible method for the design of the outline/esquema conceptual is to divide the plenary group into four work groups. Each of three groups would design a complete outline/esquema concpetuali one of the groups would design a decision mechanism for the plenary group to deciden upon the best design (the best design could be a combination of all three). The day would end with this session, each group would be instructed to report back the next day. DAX THREE Session One:

Presentation of Plan outlines/Esquema Conceptuales

work group would their outline/esquema concpetual of the Multisectoral Plan. Each of the three presentations on the outlines/esquemas would be for five minuetes to be followed by questions and answers. Finally, the decision process would be presented and discussed. E~ch

Session Two;

Decision on the Decision Process and Agreement on Plan Outline/Esquema Conceptual

The decision process selected in the previous

session will be applied systematically to the three outlines/exquemas conceptuales of the MultiSectoral Plan in order to select/design the final outline to be used to write the plan. Finally, once a decision has been made and the outline selected, the plenary group will examine the effectiveness of the decision process and make any modifications required to the decision process for improvement The improved model will be used to make the upcoming decisions on the Multisectoral plan. 0

43

sessions Three and Four;

Work Groups Dj,yided ~ectioDS of the Plan Outli,ne to Wr:.ij;,.e the MultiSectoral Plan

Seven work groups would be used to write each section of the Multisectoral Plan. The. facilitators will monitor the progress of each group and when all groups have finished, we will return to the plenary session for presentation of each section. It is likely that the day will end with each of the seven work groups having written their section of the plan, and, ready to present it to the plenary group during the first morning session DAY FOUR

Se~sion

One:

Presentation of Each section of the Multisectoral Plan

Each group will present the section they have written of the MultiSectoral Plan, some discussion will follow session Two and Three:

continuation of Presentation and Discussion of Each section of the Plan and Begin the oeci§ion Process for Agreement on The Plan

When the presentation and discussions are completed, the plenary group will apply the decision selected previously to the sections of the plan presentedo This process will end at the afternoon coffee break with agreement of the Multisectoral Plan for Peru. session Four:

The Roles Organization and Resources Needed in the Comite MultiSectoral En La Lucha Contra El Colera to Meet the Needs of the Community

At this point the workshop has already produced the National Plan for the MultiSectoral Comittee Fight Against Cholera. The last tarea before the close of the workshop is to design how that Committee functions and what resources it will requires This design of community Needs (the institutions that are "key players"), the way the comitee is Organized, and, the specification of resources that are required by the Committee will end the workshop.

Appendix H

WORKSHOP DESIGN-FINAL VERSION (SPANlSH) Los cuatro dias están divididos en cuatro sesiones: Sesión Sesión Sesión Sesión

1 11 111

IV

de 9:00 a.m. hasta de 10:50 a.m. hasta de 13:30 p.m. hasta de 15:30 p.m. hasta

10:30 12:30 15:00 17:00

a.m. p.m.

p.m. p.m.

Por lo tanto, el evento incluye 16 sesiones de trabajo. PRIMER OlA INSCRIPCION La inscripci6n comenzará a las 8:30 a.m. durante el primer dia, en los demás el horario de actividad comenzará a las 9:00 a.m. (Se ofrecerá café). 8ESION 1

PRESENTACION DE LOS PARTICIPANTES Y OBJETIVOS Y METODOLOGIA DEL TALLER El Dr. Augusto Meloni Navarro, en representación del Dr. Eduardo Salazar Lindo, hará la presentación de los facilitadores seguida de la presentación de los participantes. Se definirán los objetivos del taller y se explicarán, cada una de las sesiones de acuerdo a la metodologla de trabajo establecida. Se pondrá especial énfasis en el contenido de los conceptos "Multisectorial" y "Multidisciplinario" que deberán incorporarse en diseño del Plan por el Comité responsable de su elaboraci6n. SESION XI

CARACTERIZACION DE LA RE~~CION ENTRE LOS SERVICIOS DE AGUA Y SANEAMIENTO Y LAS CONDICIONES AMBIENTALES SANITARIAS RELACIONADAS CON LA EPIDEMIA DEL COLERA Se realizarán las siguientes exposiciones: Descripci6n Panoramica de la Epidemia del Cólera y Factores de Riesgo de Transmision. Dr. Luis Seminario Breve descripción de las condiciones actuales de los servicios de agua y de saneamiento ambiental en Lima. 1n9. Fortunato Lar! 45

Breve descripci6n de las condiciones actuales de los servicios de agua y de saneamiento ambiental en el PGrü. 1n9. Manuel Barron Problemas generados por el vertimiento al mar de aguas servidas sin tratar. Dra. Guadalupe Sanchez Problemas generados por el uso de aguas servidas en el riego de hortalizas. 1n9. Lucio Salazar Cooperaci6n Técnica y Desarrollo de Investigaci6n en Agua y Saneamiento Ambiental. 1n9. Alberto Flores Perfil de cooperaci6n interinstitucional y relaciones estructurales en el sector. 1ng. Julio Burbano Discusi6n. SESION XII

DEFINICIONES, CAUSAS Y EFECTOS DE LOS PROBLEMAS ~E AGUA Y SANEAMIENTO DENTRO DE UN NUEVO MARCO INTEGRADOR

Los participantes serán divididos en grupos. Estos grupos de trabajo definirán cada problema explicando sus antecedentes causas y efectos. Un representante.de cada grupo de trabajo presentará un informe sobre los resultados al grupo en plenaria que se realizará en la Sesión siguiente. SESION IV

ACUERDO Y PRIORIZACION DE LOS PROBLEMAS SOBRE AGUA Y SANEAMIENTO DENTRO DEL NUEVO MARCO

Cada grupo presentará en cinco minutos la definición, antecedentes y causas del-problema, seguida de una discusión del grupo en pleno durante los siguirntes cinco minutos. En esta sesión se alcanzará un acuerdo respecto a cuáles problemas serán considerados, por el Comité Multisectorial y cuál la prioridad de cada uno de ellos. SEGUNDO DrA . SESION X

FORMACION DE GRUPOS DE COOPERACION POTENCIAL Basados en las definiciones alcanzadas el Miercoles se trabajará en: Desarrollo de las ideas generadas para lograr acuerdos de cooperación de cada instituci6n. 46

Breve exposici6n en base a las ventajas comparativas del trabajo intersectorial. Ejercicio de posibles proyectos de cooperación entre instituciones. 8ESION 11

DISCUSIONES CON RESPECTO A LA POSIBLE COLABORACION ENTRE LOS PARTICIPANTES

-

Razones que aclaran los niveles de cooperación entre las instituciones de los sectores: agua, desagues, disposición de excretas y manejo de residuos sólidos. Autoanálisis de los participantes sobre:

- Los exitos conseguidos,

Problemas enfrentados en el ejercicio que acabamos de conquistar, Impedimentos para lograr una cooperación mutua exitosa, - Acciones a implementar para enfrentarlos. Análisis global de estos cuatro tipos de comportamiento a fin de sugerir estrategias que aumenten los niveles de colaboración. SECCION 111

DISEñO DEL ESQUEMA .CONCEPTUAL PARA EL PLAN MULTISECTORIAL Para ello, el Grupo y los Grupos de Trabajo deberán: Preparar una lista de los puntos prioritarios que enfocará el Plan. Dividirse en grupos de trabajo con el propósito de obtener los siguientes resultados: Un grupo diseñará un mecanismo viable para la toma de decisiones a fin de que el grupo en plenario decida cuál es la propue$ta más adecuada. (puede ser una combinaci6n de las propuestas sugeridas). Los otros grupos de trabajo prepararán Uh esquema conceptual del Plan Multisectorial, asi como una propuesta de colaboración y participación en la formación de la Comisi6n Multisectorial. aBStON IV

PRESENTACION DE LOS ESQU~mS CONCEPTUALES DEL PLAN Para ello, previamente los grupos habr~n trabajado con el objetivo de cada uno de ellos preparar su esquema conceptual del Plan Multisectorial. 47

Posteriormente se harán las presentaciones de cada uno de los grupos durante cinco minutos, seguidas de preguntas y respuestas Finalmente, el Plenario discutirá el proceso para la toma de decisi6n.

o

TERCER OlA SESXON X

PROCESO DECISIVO Y ACUERDO SOBRE EL ESQUEMA CONCEPTUAL El proceso de toma de decisiones seleccionado se aplicará a cada uno de los esquemas conceptuales del Plan Multisectorial. El fin es determinar cuál de estos esquemas es el más viable y por tanto el que se utilizará para la formulaci6n del Plan. Tomada la decision, el grupo en plenario analizará la potencial efectividad del proceso de toma de decisiones e introducirá las modificaciones requeridas. El modelo aprobado con los ajustes respectivos, será utilizado en la toma de las decisiones futuras sobre el Plan Multisectorial. SESIONES II Y III

ELABORACION DE LAS SECCIONES DEL ESQUEl1A DEL PLAN POR LOS GRUPOS DE TRABAJO

El Plenario se dividirá en un número de grupos de trabajo igual al de cada una de las secciones que compongan el Plan Multisectorial a fin de elaborar independientemente cada una de ellas. Los facilitadores cooperarán en los avances logrados por cada grupo y cuando todos hayan completado su trabajo se regresará al Plenario a presentar los productos de cada grupo. Al finalizar la tarea del dla se espera que cada uno de los grupos haya preparado la sección que le correspondi6 del Plan y se prepare para presentarla en la proxima sesi6n de la Plenaria. 8ESION IV

PRESENTACION DE LAS SECCIONES DEL PLAN MULTISECTORIAL

Cada grupo presentará su respectiva secci6n del Plan Multisectorial, elaborada en la sesi6n anterior, seguida de breve discusión. 48

CUARTO DlA

SESIONES 1 Y XI

.

CONTINUA LA PRESENTACION y DISCUSION DE LAS SECCIONES DEL PLAN Una vez culminadas las presentaciones y discusiones, el Plenario adoptará una decisi6n respecto a las secciones del Plan que han sido presentadas. Este proceso culminará .con un consenso sobre el contenido del Plan Multisectorial para el Perú. 8E8ION 111

FUNCION, ORGANIZACION y RECURSOS REQUERIDOS POR LA COMISION MULTISECTORIAL DE LUCHA CONTRA EL

COLE~A

Una vez alcanzada la tarea de elaborar el Plan Nacional de agua y saneamiento para el Comité Multisectorial de Lucha Contra el C6lera, un grupo de trabajo presentará la función, organizaci6n y recursos requeridos por la Comisi6n Definidas las necesidades de servicios de la Comunidad y de las instituciones que desempeñarán un papel clave en su ejecución, comprendiendo la organización y recursos requeridos se dará por conclu1do el Taller. 8EBION IV

PRESENTACION A LOS INVITADOS DE LOS RESULTADOS DEL TALLER Se presentará los siguientes resultados del Taller: Definición y Priorizaci6n de problemas claves. Desarrollo de un esquema para el diseño del Plan Multisectorial. Resultados de la elaboraci6n del Plan Multisectorial.

49

Appendix I

OBJECTIVES, METHODOLOGY, AND NOltMS OF TIIE WORKSHOP (SPANlSH) -

Objetivo del Taller: El objetivo de este Taller es la elaboraci6n de un Plan de Multisectorial que abarque las áreas de agua potable y saneamiento ambiental como parte de las medidas para el control de la epidemia del c6lera en el PerO

Acci~n

Hetodoloqia:

El Taller esta diseñado para involucrar a cada participante en forma directa, en el proceso de preparaci6n del Plan de Acción Multisectorial, facilitando el desarrollo de una mejor relación y comunicaci6n entre los participantes para llegar a acuerdos sobre las siguientes tareas: Definici6n de los problemas claves en las áreas de agua potable y saneamiento ambiental, que se han hecho mAs notorios corno resultado de la epidemia del c6lera. Priorizaci6n de dichos problemas Desarrollo de un Multisectorial.

esquema

para

el

diseño

del

Plan

Elaboración del Plan Multisectorial Elaboración de la Presentaci6n de los Resultados del Taller. Normas de Trabajo: A continuación detalla~os algunas normas cuyo cumplimiento será necesario para el mejor desarrollo del Taller: Participación activa Exposición clara de ideas Puntualidad Cumplimiento de la agenda Participación a tiempo completo Comunicación constante Autoc:ontrol Salvo casos de emergencia , no interrumpir sesiones de trabajo Por favor, no fumar

51

Appe ndix J

PRO BLE MS/ THE MES DERVIED FRO M INTERVIEWS (ENGLISH AND SPANISH) Qve rall vj.ew Peru has spen t very litt le on wate r and tatio n, and wha t it has spen t has been spen t badl y. This sani misd irec tion ef scar ce reso urce s is base d on conf usio n of ends and Se orie nto al sect or de sane amie nto, de cobe rtur as de mean s. cons truc i6n de serv icio s, en vez de preo cupa rnos meta s de salu d. El resu ltad o fué una peor cali dad de aguaen . Conc eptu alme n~e se hizo un fin las cons truc cion es en vez de la cali dad de agua . Se conf undi eron med ios y fien es y por eso el agua está mal y el c6le ra es un prob lema grav e. Prob lems /The mes 1.

The conf usio n of ends and mean s has caus ed a conc entr atie n on cons truc tion of new wate r syst ems inst ead af oper atio n and main tena nce of exis tinq wate r syst ems

2.

The cenf usic n ef ends and mean s has caus ed a conc entr atio n on cons truc tion ef new sewa ge syst ems inst ead ef eper atio n and main tena nce of exis ting sewa ge syst ems

3.

Of scar ce reso urce s that have been spen t on wate r and sewa ge syst ems , wate r has been emp hasiz ed at the expe nse of sewa ge

4 ..

Agua s serv idas se vota n sin trata mie nto dire ctam ente en rios , mer, lago s y para rieg os de hort aliz as

5.

Ther e is curr entl y a lack of inte grit y in wate r dist ribu tion syst ems , this woul d incl ude: ille9 a1 conn ectio ns; leak s; meas urem ent (med idor es); and cros s conn ectio ns

6.

Tanq ues elev ados , sist erna s y cami ones sist erna s de agua son fuen tes cont anam acio n

7.

Agua , extr etas , y hien e pers onal son asun tos cult ural es. Edu catio nal prog rams must reco gniz e and inco rpor ate cult ure into effo rts to chan ge peop les attit udd es and hab its

8.

Where self sufificiency is the aceptad goal for electric power¡ people expect free water and sewage services and these are not being paid ter

9.

Basuras y desechos solidos (this one needs help)

10.

Manipulacion de alimentos

54

IBTRODUCCION

Durante la visitas realizadas del 1 al 7 de junio 1991, a profesionales técnicos y directivos relacionadas con el Sector de Agua y Saneamiento, se les hizo una serie de preguntas preparadas de antemano, a fin de conocer su percepci6n con respecto a los problemas de este Sector. A continuaci6n se presentan los resultados obtenidos con el fin de que sirvan como material de reflexi6n para los participantes del taller: PROBLEMAS GENERALES

El PerÜ ha invertido muy poco de su PSI en programas de agua y saneamiento y lo invertido no ha dado los resultados esperados. Frecuentemente, la aplicaci6n no bien orientada, de los escasos recursos se debe a una confusi6n entre objetivos y medios para alcanzarlos. El mayor énfasis del Sector en cuanto a inversiones se ha concentrado en construir servicios en vez de buscar mejores niveles de salud y de bienestar o



El concepto establecido no ha dado los resultados esperados ya que se confundi6 la construcci6n de obras sin tener en cuenta que 10 fundamental es dar servicios con cobertura y calidad adecuadao Como corolario, esta confusi6n del medio con el prop6sito, convirti6 el agua y el saneamiento en uno de los principales transmisores de un problema grave de salud como es el C61erao Las instituciones responsables de los servicios de agua, desagu~~ y desechos sólidos se han aislado en su quehacer con escasa o excepcional colaboración entre ellos. Los proyectos propuestos y llevados a cabo han estado basados en intereses institucionales carentes del respaldo epidemio16gico y de los usuarios, y con la participaci6n de otras instituciones lo cual hubiese producido un mayor impacto en la comunidad. PROBLEMAS ESPECIPICOS

1.

Como resultado de la confusi6n entre medios y fines se han generado serios desequilibrios en los sectores de agua, desague y alcantarillado como: 8.

La concentración de esfuerzos en la construcci6n de obras, sin dar el énfasis a lo primordial de los servicios de garantizar su cobertura, mantenimiento y calidad a los usuarios. 55

b.

Mayor enfasis en la la construcción de sistemas de agua, con un significativo olvido de los sistemas de desague, agravado por: la agresión recibida por rlos, mares y lagos debida a los efluentes de aguas negras que se arrojan sin tratamiento alguno, ha afectado sus usos y a su vez, debido a la carencia del recurso h1drico en la zona de la Costa se utilizan directamente para el riego de cultivos de consumo crudo~

c.

La deficiente operaci6n y mantenimiento de los sistemas de alcantarillado y la inexistenci.a de recursos para facilitar el financiamiento de unidades sanitarias básicas en los grupos de poblaci6n de bajos ingresos.

d.

Se ha carecido de programas adecuados de operación y mantenimiento en especial de redes de distribuci6n de agua, permitiéndose as! un incremento de las conexiones ilegales, de fugas de agua, conexiones cruzadas y una m1nima cobertura de un sistema de medición de los consumos.

e.

Los tanques de reserva elevados de los propios servicios, cisternas domiciliarias construidas por los usuarios debido a la falta de continuidad de los servicios y los camiones cisterna, para la venta de agua, al no ser mantenidos satisfactoriamente se constituyen en fuente permanente de contaminaci6n.

2.

Las instituciones de agua y saneamiento se han caracterizado por una falta de cooperación entre ellas, habiendo casos en que se presenta el fenómeno inverso, el de la competencia en especial en la asignaci6n de recursos financierose La carencia de cooperación intersectorial ha impedido que las instituciones incrementen la eficiencia y la eficacia de sus responsabilidades y de los servicios prestados.

3.

Los programas de agua y eliminaci6n de excretas al ser vistos solamente como obras y no como servicios no han sido acompañados de sus respectivos planes educativos para cambiar actitudes e introducir prActicas y conocimientos de higiene en la población.

4.

La falta de prestigio de los servicios de agua y saneamiento hace que la gente acepte que otros servicios públicos como la energ1a eléctrica y los teléfonos sean autosuficientes financieramente y se opongan al pago de tarifas adecuadas que obliga a la permanente subvenci6n del agua y el saneamiento por el Estado. Esto causa un desaliento en la inversión en este tipo de servicios ya que a mayor construcción de obras mayores cantidades son requeridas para subvencionar su funcionamiento.

5.

La cobertura en la recolección de desechos sólidos es 56

insuficiente y peor aún la disposici6n final de las basuras que se realiza arrojándola a rlos o disponiéndola inadecuadamente en basurales a cielo abierto. 6.

Los profesionales y técnicos del Sector requieren de un cambio de actitud en cuanto a la utilizaci6n de tecnologlªs alternativas que armonicen la" capacidad de pago de los usuarios y los recursos del Pals con los costos de inversión y especialmente de operaci6n y mantenimiento de los servicios.

7.

Se requiere una mayor atenci6n por parte de los responsables del suministro de agua a fin de dar mejor atenci6n a establecimientos con demanda critica tales como hospitales, escuelas, cuarteles, y otros.

Appendix K

SMALL GROUP REPORTS: PROBLEMS, CAUSES, AND EFFECTS (SPANlSH)

GRUPO 1

1.A

1.2.-

poca inversión efectuada por el estado, se oriento a obras de agua potable y saneamiento, descuidando la operaci6n y manteni~iento. Orientacion politica de las inversiones. La

1.S 1.-

2.3.-

4.-

S.-

La falta de recursos hizo que se le diera prioridad a los sistemas de agua. No existe conciencia, a pesar de existir dispositivos legales sobre el manejo de aguas servidas. Eliminaci6n de parte de la legislación sanitaria (Art.125 del codigo sanitario). No hay conciencia que el problema de contaminaci6n e un problema de salud. Inteferencia entre poderes del estado para fines de control de saneamiento ambiental.

1.C

1.2.-

La extrema pobreza de los usuarios no permite ni permitirá pagar tarifas justas por un servicio. No existen mecanismos para financiar seervicios de saneamiento para la poblaci6n de menores ingresos.

1.0

1.-

Manejo polltico de las tarifas no p3rmite el desarollo de sus funciones.

1.E

1.2.-

Los gobiernos locales no asumen un rol supervisor de los sistemas de almacenamiento en servicos y camiones cisterna por falta de capacidad tecnica instalada. Falta de supervisión en construcción no garantiza idoneidad de servicios.

59

GRUPO 2

Problema La falta de eficacia y eficiencia de las entidades responsables por la prestaci6n de servicios. Causas Lenta integraci6n y coordinaci6n entre instituciones y sus planes y progrmas. Falta de palIticas inteqradoras para la acci6n concertada entre organismos involucrados. Soluciones de coyuntura y no estructurales básicos de largo plazo. Planes y programas sin criterios renovadores y sin la partiicpaci6n activa de la comunidad y de sus experiencias. Falta de energ1a electrica Falta de recursos econ6micos Falta de cooperación del gobierno central Tarifas politizadas. Demanda mayor que la oferta Recursos humanos insuficientes en calidad adecuada. Ausencia de participaci6n del usuario y del sector privado. Fuerte interferencia polltica mal concebida y mal practicada. Poca importancia del tratamiento de los desagueso Interrupci6n de los programas de educación sanitaria, desde los primeros dlas de vida escolarizada y no escolarizada. Ausencia de mandos medios (Tecnicos) calificados o Efectos

Real~

Servicos deficientes. Agua no tratada (consumo humano) Contaminación del mar, rios, lagos y recursos hidrobiológicos. Contamianción aire y suelo Aguas residuales,no tra1:adas para reuso multiple (Aqricultura,forestaci6n, industria, paisaje) Ausencia de servicios de recolección, reciclaje y disposici6n final de.residuos s61idos , domesticas, industriales, agrarios, hospitalarios. Manejo irracional no sostenido de los recursos hldricos para uso multiple. No hay toma de conciencia en los trabjadores del sector de la intima relación entre los servicios y la conservaci6n y promoción de la salud. Falta manejo intersectorial.

60

GRUPO 3

Definici6n Inexistencia de educaci6n sanitaria (agua potable, excretas, saneamiento. Causas Falta de concientizaci6n en los responsables de los programas de saneamiento. Descoordinaci6n multisectorial, multiinstitucional. Falta de liderazgo, credibilidad y mensajes dnicos. Escasos recursos. Ausencia de educaci6n sanitaria en la curricula escolar Efectos Segunda causa de morbi-mortalidad: enfermedades hidricas, epidemia del c61era. Falta de acci6n dnica, integral de los sectores involucrados. Perdida de recursos financieros. Alto costo social Desconocimiento, falta de actitudes y prácticas en la poblaci6n general con respecto al agua, excretas y saneamiento ambiental.

61

GRUPO 4

Definici6n Prob.4 La población no esta dispuesta a pagar por un servico que no satisface sus requerimientos básicos Causas Ineficiencia de la empresa Actitud po1itiquera Tecno1oqla inapropiada Baja cobertura de micromedici6n Anarquia en el sector No comunicación entre prestatario y usuario Ausencia de toma de conciencia Efectos Bajo nivel de salud y calidad de vida Aumento de consumo por no pago de tarifas reales Sector depende de la subvenci6n estatal cada vez más Brecha creciente entre atendidos y no atendidos Prob .. 5 Definición

Manejo inadecuado de residuos domésticos

Causas Fuente de recursos económicos para los municipios. Insumos del servicio son importados y de vida Qtil corta .. Tecnologla inadecuada Recursos Humanos inadecuados Efectos Deterioro de la salud y el medio ambiente Reciclaje de la basura en condiciones de riesgo para el recuperador y usuario del producto. Altos costos de recuperación de los lugares de dispocisi6n.

62

GRUPO 5

Definición Prob 6 y 7 Incapacidad de los profesionales y técnicos para adecuar la propuestas de acción a la realidad concretao Caysas Formaci6n profesional desligada de la realidad (Técnico, visi6n fragmentada, trabajo individualista, acritica, rutinaria, formación no social) Ausencia de una educación permanente Determinantes de la "coperaci6n técnica y fianciera internacional y de las estructuras organizativas de las instituciones" Efectos Servicos de la población inadecuados, insuficientes, mal distribuidos. Proyectos mal formulados, ineficientes, ineficaces, inequitativos. Inversiones sin priorizaci6n con criterio social. Dificultades para el dialogo con los usuarios. Incapacidad para la "negociación" con organismos internacionales.

63

Appendlx L

ORGANIZATION OF THE CNMLCC (SPANlSli)

Creada por la R.M. 094" - 91 - PC~1 ¡:inalidad:

Coordhmr acciones

l»residencia:

Ministerio de Salud

Integrantes:

Ministerios de : Vivienda Relaciones Exleriores Defensa Economia Educacion

Institutos de: Defensa Civil Seguridad Social

Interior Agricultura Pesqueria

Ahora:

- Perfeccionar las facultades de la CNf\1 Lec - Como reflejo se perfecciona la represemacion de los sectores - Reglamentar su organizaciol1 y funcioúamienlo

65

CNMLCC Oficina: MINSALUD Personal de Apoyo Informatlca

I

I Secretaria Tecnica Saneamiento

Secretaria Tecnica Atencion a las Personas

Secretaria Tecnica Educacion Sanitaria

FACULTADES

1.

Formulacion del Plan Nacional de Lucha Contra el Colera en el marco de las polltlcas sanitarias del pais.

2.

Captar y canalizar la cooperacion tecnica y financiera para le ejecucion de proyectos.

3.

Establecer canales de coordinacion multisectorial para la movilizacion de recurso para la ejecucion y supervision de proyectos.

66

_Pf2t t)tJ....J Z4 el a f\)

...

DEFINICION DEL PROBLEMA l. Transferencia y manejo de fondos

1.1 Nacional

.-> Gobierno

1.2 Sector Privado

1.3 Donantes: Internacionales Bilaterales

Flexibilidad

Negociacion Ccnlral

67

_,.~

Cuadro de Arcas vs. Grupos vulnerables

Grupos Vulnerables

Arca

Agua

Pp. Jj

Rural

C.C.P

S.n.S.

Habitas de H'19lenc, .

Pp. Jj

Rural

C.C.P.

1

Desague

Pp. Jj

Excretas

!>p. Jj

. Hosp.

Dispo.

c.e'.!>

Rural

Pobo

B.Jng

o

Basura

Pp. Jj

..,

C.C.P.

Rccol D. Final

Alimentos

Pp. Jj

Rural

C.C.P.

C.U.V.

E

Pp.Jj C.C.P. S.n.S.

e.D.V.

D

U

e

A

e

1

Pueblos Jovenes

Centros Concentrados Poblados Sistemas no satisfechos Centro de Distribucion y Venta

68

o

N

ESTUDIO DE CASOS

l. DeSagucs HOpsDitalarios

J. J Localidad: CAJ AMARCA 1.2 Responsable Primario: SALU D 1.3 Participantes Obligados: VIVIENDA, AGRICULTURA J.4 Participanles Apoyo: SEDAs, EDUCACION

1.5 Fondos: DONACION EXTERNA

JI. Eslado Actual del Mcrcc1(lo Openllivo

69

I

~~>

Ea \1 ALJJ A

0..0 ~ é.0

70

-I.

71

~~.

1.

~l\la.. C5-~'tl2AL

-7

Ct'\c..-E:---¡

l'

/c"'c~

\'I:leJ"tlftCAR oor&.JiÓ':>

Il\lt=oe.HAR.~

1

I

A"e6A'2:1

; ~T~~

-- \=Oul'lCAe.::>

~"t6'f2>.O~

/ ~'O

------.,,\re~lee>

\

E,Yll$H

/'

I I I

-::CC'lo(Ujs- - - ~ -J "0E':~5... flGll'-t6lUÁ

el

J,1.(!-lAC. '( ~ II.DC. ) "fQo~~\O~ -

lM'PtcTO

72

Plan operativo Multisectorial para el Control y Prevención del Cólera en el Perú l. Caracterización de la Problemática 1.1

La

confusión entre medios y fines ha generado serios desequilibrios en los sectores de agua desague y saneamiento. 1.1.a La politica de salud ambiental se confudió con la simple construcción de obras, descuidando el X2l preventivo de acciones de salud. l.l.b Inexistencia del manejo tecnico sanitario debido a la falta de conciencia de que el problema de contaminación es un problema de salud 1.1.c Deficiente operación y manteniMiento en los sitemas de alcantarillado y en los sistemas de agua potable 1.1.d Falta de programas adecuados en la operación y mantenimiento de los sistemas de agua potable 1. l. e Deficiencia en la construcción y mantenimiento en la mayoría de los reservorios de agua de la red pública y las instalaciones domiciliarias, asi como de los camiones cisterna. 1.2

Falta de eficacia y eficiencia de las entidades responsables en la prestación de servicios

1.3

Inexistencia de educación sanitaria (Agua potable, excretas, saneamiento e irrigación)

1.4

La población no está dispuesta a pagar un servicio que no satisface su requerimiento básico

1.5

Manejo inadecuado de residuos domesticos

1.6

Incapacidad de los profesionales y técnicos para adecuar las propuestas de acción a la ~ealidad concreta

1.7

Falta de atención en suministro de agua a establecimientos con demanda critica, como: hospitales, colegios, cuarteles, carcales, etc

1.8

Falta de control en las diferentes etapas de la cadena alimentaria (producción, distribución y consumo) sobre todo en la manipulación de los alimentos en los lugares públicos.

1.9

Falta de credibilidad en los carnés de salud otorgados por instituciones públicas a los manipuladores de alimentos por carecer de~certificados de no ser portadores sanos

73

2. Objetivos Objetivo General Controlar la epidemia del cólera y de otras enfermedades de origen hidrico, priorizando las zonas rurales y urbano marginales.

2.1

2.2 Objetivos Especificos 2.2.1 Dotar de agua de buena calidad a la población 2.2.2 Desarrollar tecnologías apropiadas con participación activa de la comunidad formalizando su aplicación mediante la normatividad correspondiente. 2.2.3 Mejorar el control sanitario en el uso de aguas servidas

con fines de irrigación

2.2.4 2.2.5 2.2.6

Sensibilizar a la población sobre la relación de las enfermedades con el agua, elimicación de excretas y la contaminación ambiental Garantizar la dotación de alimentos de buena calidad actuando en el control sanitario de todos los componentes de la cadena alimentaria Establecer un sistema de vigilancia integrado que evalúe el impacto de las acciones realizadas en cuanto a las actividades como, mejorar el agua, eliminación de excretas y el mejoramiento del medio ambiente

3. Politicas 3.1 3.2 3.3 3.4 3.5 3.6 3.7

3.8 3.9

Fortalecer y reorientar el sistema sanitario del país en sus diferentes niveles para atender y eliminar la epidemia del cólera Garantizar la calidad del agua de consumo humano Realizar acciones mul tisectoriales para la prevención de enfermedades h1dricas maximizando la utilización de recursos existentes Propiciar la participación activa de la comunidad organizada en la solución de los problemas sanitarios vinculados a la epidemia del cólera Desarrollar tecnolog+ias apropiadas para solucionar los problemas de agua, disposición de excretas, residuos sólidos y control de alimentos Desarrollar programas integrales de educación sanitaria teniendo en cuenta la realidad del país Diseñar proyectos especificos en los diferentes niveles del pais para captar el apoyo financiero nacional e internacional para mejorar los problemas que enfrenta el país en las áreas de agua, qesague y medio ambiente . Fortalecer, el sistema de control de alimentos en todQs los niveles con particpación activa de los gobiernos locales y consumidores Fortalecimiento de los sistemas de vigilancia en todos los niveles

74

4. Estrategias La gravedad que reprsenta el problema de la epidemia del cólera, as1 como las demas enfermedades transmitidads por el agua, tienen corno factores principales la situación de pobr.eza as1 como la insatisfacción.de las necesidades básicas de las mayorias nacionales, como el. agua, desague y saneamiento ambiental

Para enfrentar dicha problematica es necesario propiciar la puesta en acción de una estrategia multisectorial que asuma como uno de los objetivos el control de la epidemia del cólera y de otras enferrnedads h1dricas con el concurso de los sectores publicos, privados y la población organizada, dandole especial importancia a 150 gobiernos reg ionales, locales, ONG's e iglesia asi como la comunidad y la familia para una solución eficaz y eficiente del problema, priorizando las zonas rurales y urbano marginales en las que se encuentra la población en situación de"extream pobreza y pobreza relativa 5. Programación de acciones 5.1 Programa del agua

a. Asegurar el agua de buena calidad mediante cloración continua en poblaciones con sistemas de abstecimiento de agua.

SEDA, tolINSA, MINVI, MINED, GOn.LOC y REG, COMUNIDAD, FAMILIA, ONG'S

b. En poblaciones sin sitema de abastecimiento de agua (sin conex~on domiciliaria) implementar un programas de desinfección casa por casa (cloración, hervido, uso de yodo, etc.)

MIN5A, MLNVI, MINED, GOS.LOe y REG, COMUNIDAD, FAMILIA, ONG'S

c. Control Sanitario de los reservarios de agua y desinfección en las edificaciones públicas y privadas, asi como de reservorios intrafamiliares

GOB.LOC., MINSA COMUNIDAD, FAMILIA

d. Desarrollar acciones de vigilacia de la calidad de agua con participación comunitaria

GOn.LOC

e. Promover el uso de reservorios con cuello angosto para el consumo familiar de agua

MINED, MINSA, MINVI, GOn.LOC y REG, SEC.PRIV

f. Desarrollar un programa que permi.ta crear una cultura h1drica para evitar la perdida de agua

MINED, MINSA, MINVI, GOB. L o e y REG,SEC.PRIV, MINAGR

75

y

REG,

COMUNIDAD, MINSA

g. Vigilancia epidemiológica de los Servicios de abstecimiento de agua para consumo humano 5.2

MINSA, GOB o LOC

COMUNID, y.

REG,

ONG,

UNIVERSIDADES

Programa de disposición de excretas

a. Desarrollar sistemas de eliminación de

MIN5A,

excretas teniendo en cuenta la realidaa de las regiones del pais, adoptando en las zonas rurales el sistema de hoyos o zanjas, como alternativa de letrinas.

GOB.LOC y COMUNIDAD,

b. En áreas con sistema de alcantarillado, desarrollar proyectos locales para el tratamiento de aguas servidas

MINSA, MINAGR, SEDAS, GOB.LOC y REG, COMUNIDAD

c. Clausurar las letrinas instaladas por la población rural y urbano marginal en el curso de canales de riego y curso de agua implementando soluciones apropiadas

MINAGR,

d. Hacer cumplir el arte 196 Cap. Vllr del O.L. N.17752 Ley general de aguas y promocional la sustituciñon de cultivos en las áreas problema por cultivo de especies de tallo alto (frutales, forestales, algodon) e. establecer mecanismos de concertación para la construccibn de plantas de tratamiento de aguas servidas con fines de irrigación, con participación directa de las organizaciones de los dis~ritos de riego del pals (Junta nacional de usuarios, junta de usuarios de los distritios de riego, comisiones y comites de regantes)

MINAGR,

REG, ONG,

FAMILIA, IGLESIA

MINSA,

GOS.LOC, COMUNIDAD

SEDAS,

MINSA,

MINAGR, GOS.LOC

MIN5A, MINAGR, GOS.LOC, COMUNIDAD

5.3 Programa de Control de Alimentos

a. Prohibición de extracción de especies hidrobiológ icas en zona cercanas a los emisores de aguas servidas mediante dispositivos legales I

MINSA, MINPES, CAPITANIA DE PUERTO, GOS.LOC

I

b. Aplicar el reglamento sanitario de alimentos: . empadronamiento y registro de los vendedores ambulantes - capacitación de los manipuladores de alimentos

MINSA, GOB. Loe, MINITC, PNP, MUNICIPIOS

- Toda persona que trabaje en alimentos, manipuleo, expendio y elaboración, deberá acreditar haber asistido a un curso sobre "Manipuleo e Higiene de Alimentos" dic tado por la autoridad de salud y municipio - El carné de salud deberá ir acompañado de un despitaj e de no ser portadores sanos c. Mejorar el control de calidad de todos los componentes de la cadena aliemntaria con participación multisectorial 5.4

"

MINSA. MINPES,

MIN ITe, MINAGR, GOB.LOC y REG

Programa de disposición de residuos sólidos

a. Mejorar el sistema de recojo y eliminación de basura con implernerntacíón de tecnologías apropiadas para .el medio con partiicpación de la población organizada (creación de microempresas, utilización de triciclos, reciclaje de basura)

MINSA, GOB.LOC COMUNIDAD

MINAGR, Y REG,

b. Instalación de microrellenos sanitarios en las zonas urbano marginales y rurales.

MINSA, GOB.LOC COMUNIDAD

MINAGR, Y REG,

c. Prohibición de la disposición final de basura en los cursos de agua

MINSA, MINAGR f GOBaLOC y REG,

5.5 programa de Educación Sanitaria

a. Desarrollar programas de concientización en la problem6tica de la salud, con el saneamiento para funcionarios, profesionales, tecnicos de mando medio, escuelas, colegios y población en general b. Desarrollar programas de educación sanitaria para cada uno de los programas de saneamiento, tomando en cuenta los niveles socilas y culturales del país I

t

c. Modificar la c'l.rricula educativa orientandola hacia la salud e higiene

77

5.6

Proqrama de control Establecimientos Públicos

de

En los establecimientos de salud, cuarteles, colegios, centros . penales, mercados, ferias trnasitorias y permanentes, clubes, estadios, aeropuertos, cines, etc, se deberá garantizar lo siguiente: - p-..:-ovisión de agua de buena calidad y cantidad adecuada - Disposición sanitaria de excretas Disposición sanitaria de residuos sólidos En el caso particular de centros hospitalarios hacer enfasis en la eliminación de vomitos y excretas de las unidades de tratamiento del cólera

78

MIN5A, y REG

PNP,

GOS.LOC

Plan Acción a karqo 1.-

Pla~

Caracterización de ls Problemática Incidencia critica del cólera en la población mas deprimida Falta de educación sanitaria en la población Insuficiente cobertura en saneamiento, agua potable y alcantarillado Mala calidad del agua potable Deficiente disposición final de excretas Deficiente control operacional (operación/Mantenimiento) Deficiente supervisión de la calidad del agua potable Deficiente supervisión en la calidad de efluentes Alta prevalencia de enfermedades infecto-contagiosas Insuficiente inversión en los ultimos años Atomizacion de instituciones, insuficiente coordinación Falta de Normas (Directivas claras, perdida de capacldad normativa) Ausencia de un sistema nacional (único) de agua potable y alcantarillado Marco Legal insuficiente (ambiguo) No uso de tecnologia apropiada No uso de participación comunitaria Ineficiente formación profesional de los recursos humanos para plantear propuestas (soluciones) acorde a la realidad concreta

II.

situación Objetivo obtener niveles adecuados de saneamiento ambiental, atacando el manejo integral de los siguientes aspectos: Agua potable Manejo de excretas Alimentos Educación sanitaria Como instrumentos para la contribución al incremento de la calidad de vidad de la población

111. Estrategias

Presentar los servicios de saneamiento como cuestión de estado a través de la movilización de los diferentes agentes sociales del país Recuperar la capacidad de liderazgo y convocatoria del estado con los agentes sociales del país en los aspectos de saneamiento ambiental. Asegurar el manejo eficiente de los sistemas de saneariento y de los eco-sistemas mediante la participación democrática de los diferentes agentes sociales del país

79

PROYECTO ESPECIFICO DE AGUA POTABLE Y SANEAMIENTO EN LA REGlON LORETU

1.- Objetivo

~eneral

Controlar la epidemia del cólera mediante acciones concretas de saneamiento ambiental en la población urbana y rural, nucleada y dispersa 2.- UbicacJ.ón

Eje hidrográfico de Yurimaguas,

Nauta,

Iquitos,

Pevas y

Caballococha 3.-

Objetivos Especificos

3.1

Garantizar el suministro de agua potable a toda la poblacibn comprendida en el área del proyecto Asegurar la disposición sanitaria de las excretas Mejorar los servicos de recolección, transporte y disposición final sanitaria de las aguas servidas Desarrollar los servicios de recolección y disposición final sanitaria de residuos sólidos, domesticas y hospitalarios. Controlar sanitariamente la producción, distribución y consumo de alimentos

3.2 3.3 3.4 3.5

4.- Metas 4.1 4.2 4. :) 4 .. 4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13

Rehabilitar y optimizar las plantas de tratamiento de agua en Iquitos y Yurimaguas Implementar e instalar sistema de cloración en nauta Construir plantas de tratandento de aguas para Pavas y caballococha Ampliar y mejorar la red de distribucion de las cinGo localidades Mej orar el sistema de distribucion de agua en camiones cisterna Distribuir productos de desinfeccion para asentamientos urbano marginales y zonas rurales dispersas Instalar letrinas con tecnologia apropiada en areas urbano marginales y rurales Adquirir equipo de limpieza de alcantarillado Diseñar y ejecutar soluciones de emergencia para el tratamiento de aguas servidas Mejorar y controlar las condiciones de agua. potable y saneamiento de los establecimientos de mayor riesgo como son hospitales, escuelas, cuarteles y carceles Vigilar permanentemente la calidad hidrica y los recursos hidrobiológicos Controlar el manejo racional y sostenido del rndedio ambiehte en la zona del proyecto Recoger los residuos sólidos (basuras) con metodologías apropiadas (triciclos) 80

4.14 Disponer

sanitariamente las basuras previa recuperación manual, utilizando tecnolog1as apropiadas con participación de la comunidad (Biogas) 4.15 Implementar, rehabilitar,· los sistemas de incineración de basura de hospitales 4.16 Operativizar el sistema de control sanitario de alimnetos 5. Estrategias

••

El proyecto estará bajo la responsabilidad de una unidad ejecutora, la cual convocará a las siguientes instituciones con sus respectivas responsabilidades: Gobierno Regional: a traves de sus diferentes secretarias - Salud: Vigilancia de la calidad de agua y control de vertientes - Pesqueria: Coordinar con el IIAP, las acciones a desarrollar - Vivienda: Supervisar, evaluar y controlar las obras de agua y saneamiento ambiental - Energ1a y Minas: Controlar y evaluar la contaminación de los recursos hidricos por hidrocarburos y elementos metálicos - Educación: Desarrollar campaña de educacibn sanitaria - INP: Evaluar el proyecto despues de revisarlo - Agricultura ... Industria 5.1

Gobierno Local: - Promover la Participación de la comunidad - Hacer suyo el proyecto y liderar las gestiones requeridas para us ejecución

Instituto de Investigación de la Amazonia Peruana Evaluación de recursos hidrobiologicos - Estudios limnológicos - Promover el desarrollo de la Acuicultura Universidad Nacional de la Amazonia Peruana

Apoyo con se~~ricos de laboratorio, recursos humanos, especializados, y realzar' campañas educativas sobre proyeccion social - Firmas convenios con otras universidades para formación de recursos humamnos APIS - AIDIS

Movilizar el construcción FF.M Y PNP

-

Apoyo Apoyo Apoyo Apoyo

sector privado

.

en

consultoría,

suministros

.

logistico: aereo y fluvial , . en comun~cac~on en cumplimiento de las directivas del proyecto en educación sanitaria

Iglesia =

Promoción de la educación sanitaria y participación comunal 81

y

Agencias cooperantes ( OPB, UNICEF, AID)

Cooperación técnica y financiera, seminar.ios, becas e información técnica

consultoria,

cursos

y

502

Se potencializaran los recursos internos identifican~~ proyectos vinculados que se esten ejecutando aisladamente para su integracion al proyecto multisectorial

5.3

Viabilidad del Proyecto

-

Marco juridico por 1s Ley de Bases de la Regionalizacion, que faculta a los gobiernos r~9ionales para formular, financiar y ejecutar estos proyectos Por otro lado, la ley orgánica de Municipalidades t faculta a estas para la ejecución de proyectos sociales. Del punto de vista institucional, esta asegurada la viabilidad del proyecto porque se constituira una unidad ejecutora que coordianra el proyecto ~on todas las institu~iones que partiicparon en su fo' ~aulción y que estan comprometidas a apoyar a la CMe Desde el punto de vista econñomico-fianciero, la estrategia esta dirigida al corto y mediano plazo con la menor inversión. Corto Plazo: Se potencializará los recursos internos y de los paises vecinos. Mediano Plazo: Se preparará una solicitud de financiamiento al BID

6. Actividades 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8

6.9

Establecer la unidad responsable del proyecto, con recursos financieros iniciales . Recopilación de la información existente, complementaria e~ Lima y en la zona del proyecto Coordinar con la comisión regional y nacional de lucha contra el cólera Convalidar (replantear) el proyecto formulado con la realidad local para realizar los ajustes necesarios Trabajo de campo: Topografía, estudios de suelo, análisis de agua, evaluación de recursos hidrobiológicos, etc Elaboración del expediente técnico (estudio, diseño, costos y presupuesto) Determinar los aportes financieros y recursos humanos y fisicos de los sectores involucrados para las acciones de emergencia Ej ecutar las obras de rehabil i tación de las plantas de Iqui tos y Yurimaguas Redes de agua de Iquitos Redes de Alcantarillado de Iquitos y Yurimaguas Rehabilitar los sistemas de agua potable, sane~miento y basura de establecimientos de alto riesgo Comprar y poner en funcionamiento el equipo de limpieza de

alcantarillado 82

6.10 Asegurar suministro electricó para la planta de Iquitos 6.11 Adquirir e instalar el clorados para Nauta 6.12 Construir la primera etapa de las pIntas de tratamiento de aguas de Pevas y Caballococha 6.13 Canjear los tres depositos plasticos existentes por dos camiones cisterna con la participación del sector privado 6.14 Determinar los requerimientos de cloro para adquirir y entregar a las organizaciones populares de base para los primeros 6 meses 6.15 Ejecutar el programa de vigilancia de la calidad de agua para consumo humano 6.16 Instalar 200 letrinas (con tecnologia apropiada) mensuales durante los primeros seis meses en l~s zonas del proyecto, acompanado de un programa dinámico de educación sanif-.tria y capacitación para su construcción, uso y conservación con la comunidad 6.17 Como medida de emergencia, enterrar las excretas hasta que se cuente con las letrinas o sistemas de alcantarillado, con orientación y participación activa de la com~nidad 6.18 Ejecutar las soluciones de emergencia para controlar o minlmizar la propagación de la bacteria (vivbrio cholerae O: 1) en los puntos de las descargas de las aguas servidas 6.19 Ejecutar el programa de vigilaru::ia de los parametros inmunológicos (físico-químico) y biologicos (recursos hidrobiologicos) en los cursos de agua en el áerea del proyecto 6.20 Detectar las fallas en los procesos de instalaciones del sector minero-energetico que podrián contaminar el medio ambiente 6.21 Hacer vigilancia continua del impacto en el ambiente, en la salud de las obras que se ejecuten 6.22 Adquisición de triciclos con el apoyo de la empresa privada y entregarlos a la comunidad para el recojo de basura 6.23 Mejrar la disposición final de los residuos sólidos de las cuatro ciudades con micro-rellenos manuales 6.24 Construir cuatro proyectos piloto de biogas para un efecto multiplicador con el sector privado y la comunidad 6.25 Establecer un programu de operación y mantenimiento para el incinerador de basuras de Iquitos (En proceso de adquisición) 6.26 Realizar muestreos de cont+ol mediante ánalisis de alimentos para determinar su calidad 6.27 Capacitar a lo:; técnicos de saneamiento y poI icias municipales en control de alimentos. 1. cronograma de ejecución

8. Costos y Presupuestos I

I

9. Cooperación Multisectorial 10. Unidad Ejecutora

83

PROYECTO ESPECIFICO - COSTOS Y PRESUPUESTO Nro.

Monto

Actividad

$

6:1 6 .. 2

$2,000

6.3

6 .. 4 6 .. 5 606 6.7 6.8.1 6.8 .. 2 6.8.3 6.8.4 6.9 6.10

6.11 6.12 6.13

6 .. 14 6015 Q;' 016 qj" 17 6 .. 18 f~ 019 6 .. 20

6,,21

6 .. 22 6 .. 23 6 .. 24

$3,000 $6,000 $100,000 $380~000 e850,000 $3,000,000 $80,000 $40,000 $400,000 $2,500 $300,000 $100,000 $5,000 $10,000 $6,000 $1,000 $40,000 $10,000 $10,000 $10,000 $6,000 $?O,OOO $12,000

6 .. 25

6026 6.27

TOTAL

$10,000 $3,000 $5,406,500

Entidad

Responsable CNMLCC NAC/REG OPS/UE CNMLCC/UE UNICEF/UE UE/REGlON REGlON/SEDALORETO UE BRASIL AID/MINVI(FONAVI) UNIC F PATCE/PREMIER ELECTRORlENTE BID/OPS/SENAPA BRASlL/SEDALORETO SEC.PRIVADO/VOLVO QUlMPAC UNICEF/OlGESA/INS ETERNI'f OPS. UNI/REGlON INS.IIAP MlNEyM/JlCA MINSA/MINEyF/OPS HONDA/JICA MUNICIPIOS CEPIS/COMUNlDAD CEPlS/HOSPITAL DIGESA/DIPAZ/INS OPS

I

I

84

Appe ndix M

PlAN Of ACn ON (SPANlSH) ha sido pues ta en La vuln erab ilida d de la salu d de la pobl acio n cien educ ació n y evid enci a con la apar ició n del cóle ra, la defi cobete rtura de agua trad ici6 n sar,! tar ia auna da a la insu f icie nte os exis tent es pota ble y s;,tn eami ento, el mal mane jo de losesmedi ltad os sobr e resu fuer on los fact ores clav es que prov ocar on grav de extre ma todo en las pobl acio nes urba no marg inale s y pqbl acio nes pobr eza Hetl \s:

l. Glob al: Prot ecci on de la salu d pobl acio nalra 2. Espe cific a: cont ener la epid emia del Cole

obje tiv~ '9:

1. 2. 3. 4. 5.

Agua apta para consu mo Disp osic ion sani tari a de excr etas Disp osic ion sani tari a de resid uos soli dos Man ipule o optim o de los alim ento s Buen a higi ene pers onal

Poli tica : eger la Prom over y amp liar las activ idad es que perm itan prot salu d de la pobl acio n pa1s en sus Reo rien tar el siste ma sani tario y de cont rol del de la dife rent es nive les para cont rola r la prop agac ión epid emia del c6le ra capt adas Prom over la ejec ució n de prog rama s de empl eo temp oral por las orga niza cion es priv adas y cent ros rsio nes en Des arro llar acci ones prev entiv as, ante s que inve taria , en cons truc cion en lo refe rent e a infr aest ruct ura sani tario s el sum inist ro de agua de buen a calid ad y serv icio s sani Estr ateg ia: y mul tise ctor ial coor dina ción de cana les Esta blec er para la mul tidis cipl inar lo para la mov iliza ción de recu rsos ejec ució n de proy ecto s. exte rna Cap tar y cana liza r la coop erac ión tecn ica y fina ncie ra para la ejec ució n de proy ecto s exis tent es inte rnos recu rsos de uso el Ince ntiv ar an ser pued que o cost pref eren teme nte en acci ones de bajo impl emen tada s de inme diato or priv ado, Prom over la part icip acio n activ a del sect as prin cipa lmen te a trav es de la crea ción de micr oem pres Acti vida des: Prio rida d 1:

la oper aci6 n y mant enim iento siste mas exis tent es de agua , desa gue y Con struc ci6n de letr inas Efec tiviz ar los regla men tos, códi gos y Inte nsif icar los prog rama s de educ ació n c6le ra y las enfe rmed ades diar reic as

Mejo rar

85

y vigi lanc ia de los resid uos sóli dos leye s exis tent es sani taria enfo cand o el

Intensificar el control sanitario de los alimentos Prloridad 2: Ampliaci6n (construcci6n), rehabilit~ci6n y mejoramiento de sistemas existentes de agua, desague y residuos sólidos Modificar los reglamentos, c6digos y leyes existentes en el sentido que reflejen la realidad sanitaria del Pals Control de los desperdicios del agua Prioridad 3: Construcción de sistemas nuevos para agua, desague y residuos sólidos Implementación de sistemas de recolecci6n de resIduos sólidos Implementación de un sistema para el manejo de los alimentos

Criterios para la Identificación y Selección de los Beneficiarios: - De alto riesgo epidemiológico - Zonas de extrema pobreza - Condiciones ambientales Esquema de Responsabilidad: Actividad

Institución Clave

Institución de Apoyo

Vigilancia de la calidad del agua

MINSA Funciones?

SENAPA, SEDAs Municipio Funciones?

Recolección de basura

MINSA/MINAGR UDES Funcion?

Gob.Reg y Loe Municipios Funciones?

Sistemas de agua y desague urbanos

SENAPA,SEDAs Municipio Funciones?

MINSA Funciones?

Educación sanitaria

MINED MINSA Funciones?

MINAG MINPES MINs,etc. Funciones?

Manejo de alimentos

Municipio Funciones?

MINSA, MINAG MINPES, MINs,etc.

--~-~---~-----~---------

86

-----------

criterios de evaluacion y aprobacion de proyectos 1. 2. 3.

4. 5. 6. 7. 8. 9.

Necesidad Prioritaria en grupos de alto riesgo Multisectorialidad Viabilidad inmediata, desde· el punto de vista economico y financiero Uso de tecnologias apropiadas Utilización de recursos internos Participación comunitaria Descentralización Ndmero de puestos de trabajo Componente de Educación sanitaria

tecnico,

Proyectos: Ejemplo sistemas de Agua y Desague en Lima: SENAPA: Tratamiento de agua domiciliaria SEDAPAL: Clorinaci6n CEPIS: Asistencia técnica SALUD: Vigilancia de la calidad del agua, tratamiento de agua domiciliaria EDUCACION: Programa de educaci6n sanitaria e higiene personal AGRICULTURA: Riego con agua servida PESQUERIA: Control de productos hidrobio16qicos MUNICIPALIDAD: Residuos s6lidos, camiones cisterna en PP.JJ., alimentos Decisiones necesarias para actividades en las otras ciudades: SENAPA: - Priorizacion de otras ciudades - Criterio para priorizacion: • Existencia del colera • Mal estado de los sistemas de agua, des ague • Escasez de personal tecnico/administrativo • Falta de fondos

87

Resultados de la reunión del d1a 5 de Junio Tema:

Pautas para la Organización de la Comisión 14ultisectorial

Participantes: Jorge Izaguirre Nora Razetto Jorge Villena Joseph Haratani Mariella Bautista Cesar Ruiz Como resultado de la reuni6n de trabajo del dla 5 de junio se vio que era necesario definir claramente, cual era el sentido de la comisi6n, sus facultades y su ambito de trabaje acordandose 10 siguiente: En primer lugar se hace necesario dotar de mayor poder legal y formal a la Comisi6n Multisectorial. Formalmente no" puede su constituci6n basarse so16 en una resolución ministerial, debe basarse en un decreto o resolución suprema que le otorgue mayor legitimidad. La comisión debe tener nivel de pimer ministro, que le otorgue mayor poder de convocatoria. Por 10 tanto no debe darsele una imagen de que so16 emane del Ministerio de Salud, existe la necesidad urgente de establecer una coordinaci6n y declaraci6n de trabajo en conjunto de los principales sectores estatales involucrados , como son: Salud, Educación y Vivienda. Es necesario que dependa de un nivel superior que podrla ser la Oficina de la Presidencia Se reconoce la importancia de que este liderada por el sector salud. Desde el punto de vista de captación de recursos y relaci6n con donantes sobre a nivel internacional, es necesario: La comisión debe ser reconocida como el ente coordinador principal, para lo cual debe tener una estrecha comunicación con los sectores involucrados, el Ministerio de Relaciones Exteriores y Donantes, estableciendose claramente los procedimientos.

88

En cuanto a la organización de la Comisien, se acordo lo siguiente: La Comisión Nacional Multisectorial de Lucha Contra el Colera debe estar formada por:

CeN.M.L.C.C Pers.Apoyo Informática

I

Secretaria Técnica Finalidad: Coordinar acciones a nivel multisectorial para controlar la epidemia del cólera Coordinar el manejo y transferencia de fondos para la ejecuci6n de proyectos que beneficien principalmente a la población de extrema pobreza en lo referente a salud y saneamiento ambiental. Funciones/Facultades Formulación del Plan Nacional de Lucha contra el c6lera Captar y canalizar la cooperación tecnica y financiera para la ejecución del plan Ente decisor en la priorizaci6n de proyectos y en la orientación de fondos Responsable de señalar responsables de la ejecuci6n de proyectos (unidad ejecutora) Funciones 4e la secretaria Técnica Revisión del pr.oyeeto sectoriales definidas

de

acuerdo

a

las

politicas

Emitir opini6n sobre la viabilidad del proyecto orientar los proyectos de los sectores no involucrados para guese rijan de acuerdo a los criterios del plan.

89

Nota: Queda pendiente la definici6n de la importancia de las otras secretarias propuestas. Pautas para la evaluación de proyectos - presentación Para hacer más facil la tarea de la Secretaria técnica de la eomisi6n, podria establecerse que todos los proyectos que se . presenten cumplan con seguir el formato qUfi! usa el Instituto Nacional de Planificación, por ejemplo, en el cual se defina claramente: l. Titulo o denominaci6n del Proyecto 2. Datos Generales: Ubicación geografica, localización 3. Unidad Ejecutora y Unidad de Control 4. Recursos financieros necesarios, internos o externos, 5. Recursos teonicos, humanos 6. Duración del Proyecto 7. Objetivos, metas y resultados 8. Relacion de unidad ejecutora con otras intituciones involucradas 9. Organigrama interno 10. Cronograma de actividades

90

Appendix N

MEMORANDUM

To From Subject Date

: : : :

Dr. Eduardo Salazar Joe Baratani Cholera Commission + Working Group July 5th. ,1991 I am sorry that we could not meet as we had planned becaune of your

trip to Iquitos yesterday. Following are several items of interest to JOU: 1. The working group (Engro. Jorge Izaguirre, Bora Razetto, Jorge Villena, Cesar Ruiz and Mariella Bautista - Roger Castillol INP did not attend the work sessions on Wednesday or Thursday. We expect him to attend today Friday) met Wednesday and Thursday afternoons. 2. Attached is a copy of the Action Plan outline we have produced

so far. 3. This afternoon the working group will complete the recommended structurel organization! functions of the "Comlsion Multisectorial". 4. The working group will continue to meet daily to complete tile Action Plan within two weeks. (I hope) 5. After today, Friday, July 5, Mariella Bautista and Eng luiz will no longer b~ paid by WASH.

0

[email protected]

6. I spoke with Eng. Julio Burbano about contributing funding to pay Mariella and Cesar for the next two months. Eng. Burbano agreed to do this but he needs a formal letter from the Ministry of Health requesting this support. This support should describe the product or products that Mariell~ and Cesar will produce together with the other members of the working group at the end of two months. (Note: Please discuss this with Eng. Burbano for clarification of details. Also please discuss this with both Mariella Bautista - Telf. 72-6567 and Cesar Ruiz - Telf. 62-0945). 7. With my departure, I leave knowing that the work to be done is in good hands. I wish you the best of luck in this momentous initiative. Buena Duerte y hasta luego.

91

Appendlx O

LI5T OF PARTICIPANTS AND THEIR AFFILIATIONS Nombre: Grado: Cargo: Institución: Oficina: Domicilio: Nombre: Grado: Cargo: Institución: Oficina:

Domicilio:

Nombre: Grado: Cargo: Institución: Oficina:

Domicilio:

Nombre: Grado: Cargo: Institución: Oficina:

JULIO BURBANO DIAGO

Ingeniero Sanitario Consultor Salud Ambiental Organización Panamericana de la Salud-OPS/OMS Los Cedros 269 - San Isidro - Urna Telf.40-9200 TeJf. 42-4751 HERBERT SCHEMBRI Hidrogeológo Oficial de Agua y Saneamiento UNICEF

Parque Meliton Porras 350 - Miraflores Telf. 46-0699 FAX 47-7608 Av. 28 de julio 610 - Miraflores Telf. 45-5694 ALICIA CHANG WONG

Ingeniero Sanitario Jefe del ATea de Investigacion y Desarrollo Technológico - SENAPA Servicio Nacional de Abastecimiento de Agua Potable y Alcantarillado Av. Materiales 2762 - Urna 1 - Perú Telf. 64-0140, 64-0740 FAX (014) 72-3998 Pasaje Las Violetas 196 - Urna 32 Telf.52-5847 JORGE ALBERTO IZAGUIRRE KARACINIA

Ingeniero Sanitario Coordinador de Cooperación Técnica Internacional Servicio Nacional de Abastecimiento de Agua Potable y Alcantarillado SENAPA Domingo Cueto 120 - Piso 7 - Jesus Maria TeJf.71-9609 FAX 72-3998

93

Domicilio:

Van Dlck 418 • San Borja • Uma 41 Telf.35-7642

Nombre: Grado: Cargo:

MARCEl.A VASQUEZ VDA. DE 5AlAZAR Ingeniero Sanitario Asesor Sub-Gerencla A~entamlentos Humanos y Urbanizaciones Populares deSEDAPAL Servicio de Agua Potable y Alcantarillado de Urna Calle Monterrey 281 - Chacarllla del Estanque - Surco TeJf. 36-8471 Av. Petit Thouars 2181 . Unce Telf. 71-8897

Institución: Oficina: Domicilio:

Nombre: Grado: Cargo:

JUAN ROLANDO COLARETA MONTERO Médico CiruJano, Coronel PNP Director de Planificación y Racionalización del Servicio de Sanidad de la

Institución: Oficina:

Sanidad de la Policla Nacional del Pero Torre Tag'.e 161 - Mlraflores Telf. 47-9723 Moore 341 . La Punta· Callao Telf. 29-0725

PNP

Domiclllo:

Nombre: Grado: Cargo: Institución: Oficina: Domlclllo:

CESAR lUPAC YUPANQUI AVALaS Ingeniero Quimico Director de la Oficina de Asuntos Ambientales Ministerio de fnergla y Minas· MINEM Av. Las Artes 260 - San Borja Telf. 75-0065-Ext. 198 La Puente y Cortez 341 Telf. 61-7502

Nombre: Grado: Cargo: Institución: Oficina: Domicilio:

MARlELA DEL CARMEN ARAUJa IGLESIAS

Ingeniero Quimico Ingeniero n de la Oficina de Asuntos Ambientales Ministerio de Energia y Minas· MINEM Av. Las Artes 260 • San Borja TeJf. 75-0065-Ext. 176, 198 Independencia 406 - Opto. L· Urna 17 Telf.62-7907

94

Nombre: Grado: Cargo: Institución: Oficina: Domicilio:

SARA GUADALUPE SANCHEZ RNAS Ciencias Biológicas, Dr. Sub-Director del Area de Ecologla y Flslologla de Organismos Marinos de IMARPE Instituto del Mar de Perú - IMARPE Gamarra y Valle s/n - Callao Telf. 29-763Q-Ext. 25 Jr. Choquehuanca 196 - San Isidro TeJf.22-2936

Nombre: Grado: Cargo: Institución: Oficina:

Domicilio:

CARLOS IGNACIO RIVADENEYRA GUTIERREZ Médico Veterinario Sub-Gerente de Microbiologla Empresa Pública de Certificaciones Pesqueras del Perú - CERPER Av. Santa Rosa 601 - La Perla - Callao Telf. 65-4065-Ext. 51 FAX 65-8443 Grau 280 - Opto. C - Callao 2 Telf.29-1113

Nombre: Grado: Cargo: Institución: Oficina: Domlcl1lo:

CARLOS MANUEL JIMENEZ CASTILLO Licenciado en Administración de Empresas Director de Planeamlento y Coordinacl6n Técnica de la Oficina de Defensa Nacional Ministerio de Educación - MINED Parque Universitario s/n - Lima Telf. 28-6151 Las Rosas 564 - Chaclacayo TeJf. 97-1339

Nombre: Grado: Cargo: Institución: Oficina: Domlcillo:

ROSA MARIA BAUTISTA AZCUE Ingeniero en Industrias Alimentarias Director de Control de Calidad Estación Experimental Agropecuaria y Agrolndustrial La Molina Av. La Universidad 595 - La Molina Telf. 35-0136, 35-5484 Av. Nicolás Arriola 271 - La Victoria Telf. 72-6567

95

Nombre: Grado: Cargo: Institución: Oficina: Domicilio: Nombre: Grado: Cargo: Institución: Oficina:

Domicilio:

Nombre: Grado: Cargo: Institución: Oficina: Domicilio: Nombre: Grado: Cargo: Institución: Oficina: Domicilio:

JUAN TAMATA RAMIREZ Ingeniero Agrónomo Asesor de 18 Dirección Generdl de Aguas y Suelos Ministerio áe Agricultura - MINAG Yauyos 258 - Lima Telf. 33-4692-Ext. 256 Av. Aviación 2593 - San Borja - Lima LUIS CASTILLO ANSELMI Ingeniero Sanitario Presidente de APIS Asociación Peruana de Ingenierla Sanitaria y Ambiental Schell 225-0f. 402 - Miraflores Telf. 44-0097 FAX 44-0097 Huamanga 432 - Magdalena Telf. 62-7083 PORFIRIO CIRlLO HUAMAN MITMA Ingeniero Sanitario/Capitán FAP Proyectista del Opto. de Proyectos/Servicio de Ingenieria de la FAP Fuerza Aérea del Perú Jorge Chávez 540 - Barranco Telf. 77-4183 Jr. Mariano Baldarrago 902 - El Agustino PABLO AUGUSTO MELONI Bachiller en Medicina, MSc. Administración de Salud Director General de la Oficina de Planificación Ministerio de Salud - MINSA Av. Salaverry s/n - Jesus Maria Telf. 31-3742 BeHsario Suárez 714 - San Juan de Miraflores Telf. 67-5075

96

Nombre: Grado: Cargo: Institución:

Oficina: Domicilio:

Nombre: Grado: Cargo: Institución: Oficina:

Domicilio:

Nombre: Grado: Cargo: Institución: Oficina: Domicilio:

Nombre: Grado: Cargo: Institución: Oficina:

Domlclllo:

ESTELA ROEDER CARBO Licenciada en Comunicación Social Directora Técnica de Comunicación del MINSA Mlnsterio de Salud Av. Salaverry sin ~ Jesus Maria TeIE. '31-3671, 32-3925 FAX 32·3794 Juan Polar 179-3er. Piso - Urna 27, Pero Telf. 61-6697 FRANCISCO MARIANO ALVIZURI POMACAJA Ingeniero Sanitario Director Técnico de DIGESA Dirección General de Salud Ambiental - MINSA Las Amapolas 350-Urb. San Eugenio - Unce Te1E.40-0399 Av. 28 de Julio 363-Dpto. 402 TeJE. 24-4744 NORA MARIA RAZEITO CARRION Ingeniera Sanitaria Directora General de DIGESA Dirección General de Salud· Ambiental - MINSA Las Amapolas 350-Urb. San Eugenio - Unce TelE. 40-0399 Medlna 572 - la Punta Telf. 29-2651 MARCELA ESPERANZA RODRIGUEZ PAJARES Biólogo - Microbiólogo Residente del Programa de Entrenamiento en Epldemlologla de Campo Convenio MINSA/eDC/AJO Ministerio de Salud Camilo Carrillo 402 - Jesus Maria TeJf. 33-6140 Calle 6 No. 164-Urb. Las Lilas - Surco Telf.4&7574

97

Nombre: Grado: Cargo: Institución: Oficina:

Domicilio:

Nombre: Grado: Cargo: Institución: Oficina: Domicilio: Nombre: Grado: Cargo: Institución: Oficina: Domicilio:

Nombre: Grado: Cargo: Institución: Oficina: Domicilio:

CARLOS CARRILLO PARODI Médico, MSc., Dr. Jefe dellNS Instituto Nacional de Salud - MINSA Av. Cápac Yupanqui 1400 - Jesus Maria Telf. 71-3254 FAX 71-7443 Av Benavides 245 - Miraflores TeJf.46-9592 EUGENIO BELUDO NAMANI Ingeniero Sanitario Director de Recursos Humanos Inst. Nac. de Protección del Medio Ambiente Pachacutec 900 - Jesus Maria Telf. 23-2591 Paseo Ubertad 339 - C - Lima 21 JORGE ALBERTO VlLLENA CHAVEZ Ingeniero de Higiene y Seguridad Industrial Director General Inst. Nac. de Protección del Medio Ambiente Pachacutec 900 - Jesus Maria Telf. 23-2591, 32-3064 Los Aromos 152 - El Remanso - La Molina TeJf. 95-2610 FREDDY CORTEl ZEBALLOS Ingeniero Economista Jefe de la Oficina de Planificación Ministerio de Vivienda y Construcción - MINVC Domingo Cueto 120 - Jesus Maria TeJf.72-1998 Los Mineros P-28-Urb. Los Ingenieros - La Molina TeJf. 36-0206

98

Non.Sre: GTé~do:

Cargo: Instituci6n: Oficina:

Domicilio:

MANUEL BARRON RAMOS Ingeniero Sanitarlo/lng. Militar Presidente de Directorio de SENAPA Servicio Nacional de Abastecimiento de Agua Potable y Alcantarillado Domingo Cueto 120 - Piso 7 • Jesus Maria Telf. 72-1207, 72-399R FAX (5114) 72-3998 Los Olmos 1504-C.R. San Felipe - Jesus Maria

Telf. 61-4985 Nombre:

Grado: Cargo: Instltuci6n: Oficina: Domicilio:

Nombre: Grado: Cargo: InstItución: Oficina: DomlcUio:

Nombre: Grado: Cargo: Instituci6n: Oficina: Domicilio:

CARLCS ALBERTO VERGARA COBlAN Bachl1ler en Ciencias Económicas Consultor en Desarrollo Institucional OTHa:1izaci6n Panamericana de la Salud - OPS Los Cedros 269 - San Isidro - Lima T eH. 40-9200 Av. La Mar 1861 - Lima 21 Telf. 62-6769

ROBERTO HART R. Ingeniero Consultor OPS/OMS Organlzacl6n Panamericana de la Salud - OPS Los Cedors 269 - San isidro Telf. 40-9200 Hawal 15O-0pto A. Telr. 79-0579 JUAN ABELARDO PINEDO NAJAR Ingeniero Agronomo Presidente del Directorio de 5EDALORETO SEDALORETO Plaza 28 de Julio - Palacio de Justicia 3er, Piso Telf. 23-2428 Calle A - 9 - Urb. Tambo Telf. 23-1337

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Nombre: Grado: Cargo: Institución: Oficina:

Domicilio: Nombre: Cargo: Institución: Oficina: Domicilio:

Nombre: Grado: Cargo: Institución ~ Oficina:

Domicilio:

LUIS ALBERTO QUISPE CASTANFDA Ingeniero Civil Director de la Dirección de Salud Ambiental - Plura Unidad Departmental de Salud de Plura • UDE Ramon Castila 359 • Castilla ~ Pium Telf. 32-8921 Pasaje Sta. Clara N. 100 - Piura Telf. 32-5964 EUO TORREL PAJARES Ingeniero Civil Gerente General del Servicio de Agua Potable SEDACAJAMARCA Jr. Amazonas N. 349 - CaJamarca Telf. 92-2120 FAX 92-2120 Jr. Jequetepeque N. 125 - Cajamarca DAVID ARRIZ PIMENTEL Director Academlco de Ingenieria Sanitaria Universidad Nacional de Ingenleria Ciudad Universitaria s/n FAX 37-8289 Doña Raquel 165 - Urb. Los Rosales - Surco Telf. 48-8554 CESAR GUILLERMO ZUMARAN CALDERON Ingeniero Agricola Especialista en Hldrologla Oficina Nacional de Recursos Naturales Los Petirrojos 355 - Urb Palomar - San Isidro Telf. 41-0425 FAX 45-7237 Pral. Ayacucho 475 Torre 9 - 1D - San Miguel Telf. 62-9851

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Nombre: Grado: Cargo: Institución: Oficina: Domicllio: Nombre: Grado: Cargo: Institución: Oficina:

Domicilio:

MAX MENESES RIVAS Master en Ciencias Sociales, Doctor en Sociologla Director Ejecutivo de Planificación Social Instituto Nacional de Planificación Calle 7 N.229 - Rinconada Baja - La Mollna T e1f. 35-9487 Jr. Tomas Catari 316 - Urna 30 Telf. 74-2422 ROGER CASTILLO BAZAN Economista, Lic. en Administración Sub-Dlrector de la Direcci6n General de Programaci6n de Inversiones Instituto Nacional de Planificación Calle 7 N.229 - Rinconada Baja - La Mollna Telf. 35-9487 Maz. T, Lote 19 - Urb. San Hllarión ALBERTO A..OREZ MUNOZ Ingeniero Civil, MSc. Ing. Sanitaria Director del CEPIS - OPS/OMS CEPIS Los Pinos 259 - Urb. Camacho Telf. 35-4135 FAX 37-8289 Los Sauces 154 - Surco

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SANITATION for HEALTH

I pt-.). A ~\ ~{c-:-?- d-. ll\ ( Cr \ 1 p WORKSHOP REPORT ON MULTISECTORAL PLANNING FOR THE CONTROL OF CHOLERA LIMA, PERU JUNE 1991 Field Repor...

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