Examining health system performance for indigenous people in the Peruvian Amazon through the lens of tuberculosis control.

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This project will investigate and identify the key features required by the Peruvian health system to provide high-quality health services to vulnerable populations. In order to do this, we will focus on one particularly vulnerable group: Indigenous People from the Amazon who suffer disproportionately from several health problems including tuberculosis (TB). The Project will focus on the barriers, enablers and facilitators of deliverying context appropriate, feasible and culturally respectful services to detect, diagnose and treat TB among one particular indigenous group: the Ashaninkas from the Central Amazon of Peru, located in the región of Junin.Ashaninkas are the largest Peruvian Amazonian IP group, and have a higher prevalence of TB compared with other urban areas in Peru. Most health care policies in Peru, including TB policies have been designed with an urban approach making such policies inappropriate and ineffective in rural areas such as the Amazon.This Project aims to address the limitations of current health system delivery strategies in rural areas through the study of TB health policies and implementation practices in the Peruvian Amazon. Through interviews with different stakeholders such as indigenous TB patients, community leaders, representatives of indigenous organizations, regional and national health care officials we aim to identify the constraints in service delivery for vulnerable groups and the opportunity to make feasible changes. We will focus on cross-cutting systemic issues to provide high quality health care. Through a systematic analysis of the data collected and one workshop with each type of stakehodler we aim to develop using a participatory approach, a comprehensive package of scalable interventions in order to improve the quality of care delivered by the NTP to Peruvian Amazonian communities and other vulnerable groups.