ABSTRACT
This chapter examines Primary Health Care (PHC) through the establishment of the Comits Locales de Administracin de Salud1 (CLAS) system in Per within the debate between comprehensive and selective PHC. The main goals of CLAS are characteristic of a comprehensive approach, and include the delivery of PHC as a poverty-reduction strategy, decentralizing health services, including community participation and fostering cultural sensitivity. Neoliberal economics were applied to cut social spending in a variety of sectors, including education, welfare and health services as a result of influence from international funders. Specifically in health services, selective strategies were favoured in order to reduce social spending, and increased economic efficiency trumped all the other objectives. Neoliberal health reform in Per began in 1991 under the Fujimori government through the introduction of user fees when the health system, like the rest of the economy, was in shambles. Study overview research is situated within a health geographies framework, as described by Kearns and Moon.
