MSF's project to improve access to health care for isolated communities in the Masisea and Iparia districts, Ucayali Department in Peru has reached its targets and was transferred to the Ministry of Health in late June, with 19 health promoters and 18 traditional birth attendants have now trained in the skills needed to respond to basic health needs in their communities.

Ucayali Department, in eastern Peru, is a geographically isolated and under-developed area, with a population density of four inhabitants per square kilometre. Set in the Peruvian Amazon, it was severely affected by the violence of drug-traffickers and guerrillas in the early 1990's. Ucayali river, an Amazon tributary, is the main means of transport for the mestizo and indigenous communities, mainly Shipibo-Conibo and Ashaninka ethnic groups.

Around 40% of the population lives in extreme poverty - living on less than a dollar per day - and runs a subsistence economy: handicrafts, wood, hunting, fishing and agriculture (corn, rice, yuca, banana and beans). Barter is the main way to obtain goods and services.

Because of the department's isolation, under-development and cultural barriers, access to healthcare services was difficult or non-existent, resulting in high morbidity-mortality rates through diarrhoea diseases, respiratory infections and complications associated with pregnancy and childbirth.

In April 1995, following two exploratory missions, MSF started a project to reduce morbidity-mortality rates by improving access to basic healthcare services, with special emphasis on mother and child healthcare. The project was aimed at developing a network of services, which would be supported by the communities as answering their most urgent needs and responding to their social structure.

During these six years, MSF has worked in co-ordination with the Ministry of Health and Healthcare Centres in the area. Alongside primary level preventive and curative activities, medical teams have trained health promoters to identify recurrent diseases, to manage a basic sick-bay of essential drugs and to refer difficult cases to healthcare centres in the area.

Traditional birth attendants have been trained to focus on improving ante-natal and post-natal care, identifying high-risk births to be referred to healthcare centres in the area and improving hygiene conditions during labour. As a way of sustaining the project after MSF's withdrawal, the team has worked on the creation of a community revolving fund.

From July 2001, medical brigades of the Peruvian Ministry of Health will be in charge of supporting and following-up the health promoters' and traditional birth attendants' network, as well as offering primary healthcare in the communities.