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Systems Innovation for Access to Medication in Amazonian Peru

December 12, 2019
Last Updated
February 21, 2023

The Napo River Region of Peru is situated in the heart of the Amazonian Jungle, with communities rich and diverse in history, language and beliefs; yet all challenged by remoteness. Communities within the region grapple with several interlocking challenges that pose an insurmountable barrier to their ability to seek healthcare. Lengthy boat journeys lasting hours up-river, high service and medicine costs, and poverty co-exist with a health care system that is slow to respond to regional healthcare needs.

Stema built on pre-existing partnerships with DB Peru, the Altro Foundation and Peruvian communities to partner and co-design a unique solution responsive to Napo River Region communities expressed needs. Spending days actively listening and fostering relationships with communities and local community health volunteers (known as 'promotores') led to a deep understanding of community needs and challenges. Promoters pinpointed central medicine distribution as a detrimental challenge to treat health conditions requiring antibiotics, pain alleviation and peptic ulcers. Continual engagement, led entirely by the community, catalysed the mapping and unlocking of both human and natural resources that yielded high potential to guide the path to innovation.

Promotores and community members expressed interest in and dedication to the idea of community based pharmacies, known as botequins, to bring medicine and treatment closer to the community. Previous research undertaken by Stema indicates that the best interventions for health are ‘multi-modal’; they target multiple areas. As promotores were a key asset to the community, the construction of botequins aimed to instigate a health worker program to upskill and build capacity to distribute the medicines. Simultaneously, Stema initiated the up-skilling of community members to create micro-enterprises and a local economy for selling medicines to overcome the previous cost barriers.

To overcome issues with access to medicines identified by promotores and community members in the Napo River, Stema proposed a decentralised, community-led medication procurement, storage, and delivery system.

To deliver this, Stema facilitated and co-ordinated access to a major source of funding otherwise out of reach to the community to construct the botequins. Local community members were employed and led the construction of the botequins. As a result of the botequin project, STEMA partner DB Peru was able to initiate a secondary grant to purchase essential medicines boxes.

Flow diagram of the collaborative research and intervention process.