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PACE EH in Peru

What are the environmental health issues?

  • Poverty-stricken informal settlements in peri-urban areas of Latin America have numerous environmental health problems, typically related to a lack of infrastructure and basic services.
  • Residents of these communities suffer from preventable health problems related to the environmental conditions in which they live.  Environmental problems include limited access to sufficient quantities of safe drinking water, inadequate sanitation, erratic solid waste services, poor air quality, and food handling practices that allow for contamination.
  • National and local environmental health programs often lack the resources and personnel to prevent and respond to these problems.  Also, poor coordination exists between laboratory, epidemiological, and environmental health services.

What have the Centers for Disease Control and Prevention and Partners Accomplished?

CDC, in collaboration with CARE Peru, applied the Protocol for Assessing Community Excellence in Environmental Health (PACE EH) in the Peruvian communities of San Juan de Lurigancho, in Lima, and Manuel Cardozo Davila, in Iquitos. PACE EH is a methodology for involving the community in an environmental health assessment. PACE EH guides public health officials and the community through a process to identify and prioritize environmental health problems, design and implement an action plan, and monitor improvements to reduce environmental health risks. Program accomplishments include

  • Formation of inter-institutional committees to improve environmental health (CIIMSA).
  • Conduct of broad-based and in-depth needs assessments.
  • Identification of the top three environmental health priorities based on community values in both project sites.
  • Development of strategic and operational plans for a 5-year time frame.
  • Development of project proposals, including action plans for resolving selected environmental health priorities.
  • Securing of a 3.5-year cooperative agreement from the Unites States Agency for International Development (USAID) to conduct community environmental health assessments in three additional communities in Peru.

Examples of PACE EH in Action in Manuel Cardozo Davila include

  • Installation of a Condominial Water and Sewerage System to serve 1023 households (approximately 6150 residents).
  • Development of a local environmental health-risk monitoring system partly managed by community residents.
  • Organization of a voluntary environmental health promoter group to collect and disseminate environmental health information.
  • Adoption of a local environmental health-risk monitoring system and community environmental health assessment process by the Loreto Regional Health Directorate.
  • Reduction of diarrheal disease, promotion of healthy hygiene behaviors, and increased use of chlorine in properly stored and secure drinking water.
  • Development of a Spanish version of the PACE EH guidebook and other guidance documents.

What are the Next Steps?

CDC continues to work in cooperation with CARE Peru and Regional Health Directorates to implement the PACE EH process in Iquitos and Tarapoto, Peru. CDC is preparing an implementation manual titled, PACE EH en la Práctica: La Experiencia Peruana de CARE Perú y el CDC (PACE EH in Practice: The Peruvian Experience of CARE Peru and CDC), which shares lessons learned from experiences in San Juan de Lurigancho and Iquitos. Additionally, CDC will publish guidance documents for developing local environmental health risk monitoring, an environmental health problem-solving manual for implementing a local environmental health-risk monitoring system, and a technical training manual for local environmental health technicians.

For further information about PACE EH, visit CARE Peru’s Web site:



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Conference: November 3-5, 2014