The estimated under-five mortality rate for Peru is about 33/1000 live births. Acute respiratory infections and diarrhoea account for about 20% of deaths; deaths from malaria or measles are not common. Malnutrition is highly prevalent; stunting affects 25% of under-fives. IMCI was introduced in 1996, but only a few of Peru's 24 departments have training coverage above 30%.

Unlike most developing countries, large amounts of departmental data are available on children. Data sources include the 1996 and 2000 DHS surveys (to be repeated in 2004–2008), official vital statistics, and Ministry of Health data on provision, utilization and coverage of health services.

As in 1999 IMCI implementation was beginning and data were plentiful, of good quality and highly representative, Peru provided an excellent opportunity for a low-cost evaluation of IMCI impact. While the relatively low mortality rates would make it difficult to detect an impact of IMCI, the high prevalence of malnutrition should permit an obvious impact on nutritional status. Also, the evaluation would provide a wealth of data on the evolution of several process indicators during IMCI implementation. Finally, MCE in Peru should enhance the global picture in that, being a nation-wide analysis, it differed considerably from the other MCE sites.

Peru MCE provided a nationwide analysis of data on health and related variables; it included a mixed (retrospective and prospective) ecological analysis of IMCI impact. See details below. Its objectives were:

• to document IMCI trends in Peru's 24 departments from 1996 to 2004;

• to document trends in indicators of health-services coverage and impact (mortality and nutritional status) for the same period;

• to correlate changes in (1) and (2);

• to attempt to rule out contextual factors (socioeconomic and demographic trends, natural disasters, other interventions) that might affect observed trends and correlations;

• to collect information for contribution to a further study of IMCI-associated costs.

The study has now been completed. The research team:

• visited the country’s 34 health districts and completed in each a 180-item questionnaire. The responses were analysed for time trends and geographical distribution, and have been included in the Annual Progress Report to WHO;

• reviewed all known sources of information and prepared a comprehensive description of child health in the country’s 24 departments;

• performed correlations between changes in IMCI implementation and impact and intermediate indicators;

• performed partial correlation analyses, taking into account contextual factors. It proved very difficult to obtain accurate information on objective 4  "to attempt to rule out", particularly on coverage of other interventions. Selected contextual factors were included in the final analyses;

• obtained information on costs of child health programmes from the MoH, central level.

• performed equity analyses for documenting whether IMCI was targeted at high-mortality areas in the country

The MCE in Peru showed that, after an intense period of IMCI training of health workers, there was a sharp decline in its implementation. Insufficient institutionalization of IMCI was identified at national and departmental level. These results were fed back to policymakers in 2005 and there is renewed interest in implementing the strategy.

The final report, two journal publications and a policy brief are available under publications.