The Cusco Project is an innovation in public health service because:

1. It is a low-cost, yet effective intervention: the implementation of a new methodology to improve policy delivery completely changes the way that a public primary healthcare establishment deploys healthcare workers to attend patients’ needs, improving health service culture and patients’ trust vis-à-vis public services.
2. It focuses on both patients’ and providers’ needs: to fix a “broken connection” between both type of actors, the intervention incorporates both patients’ and providers’ fears, doubts, challenges, needs, and aspirations.
3. It empowers public healthcare establishments and workers to continue doing a great work after the intervention: the main goal is to permanently change the culture of doing things.
4. It includes the use of social media (Tik Tok) to engage with patients in a novel way and the implementation of digital applications instead of paper to manage personnel shifts.

The current status of the Cusco Project is “diffusing lessons”, as we are using what we have learned to inform other projects and are exploring how we can replicate this model in other contexts. Specifically, the Regional Government of Cajamarca, Peru, wants to replicate the same intervention in the region's public hospital, specifically because of the remarkably positive results of Cusco’s project.

This project was born because of a study on the hurdles of health budget execution in Peru, lead by Health Movement 2030 and a Global Health systems expert from Harvard. This innovation was possible thanks to a strategic partnership between Cusco’s Regional Government and Roche Pharmaceutical. As a local partner and implementer, Roche Pharmaceutical financed and implemented the project in Peru through Kero Lab, its health policy innovation lab that focuses on design and implements projects to transform the health system. Kero Lab is the local partner of the Health Movement 2030 in Peru, and their team developed the strategy to socialize the results of the study within Regional Governors with the Lima Chamber of Commerce and hired Delivery Associates to implement the project with the Cusco Regional Government. Through this partnership, Roche Pharmaceutical hired Delivery Associates to implement the Deliverology(R) methodology and achieve results. Roche Pharmaceutical in Perú created Kero Lab, a Health Policy Innovation Laboratory that focuses on design and implements projects to transform the health system. Also, Kero Lab is responsible of the project's communication strategy to seek new allies and scale up the intervention.

The Regional Government of Cusco, Delivery Associates, and Health Movement 2030 each realized how the culture can change to achieve better results, even in challenging circumstances. The users, the medical and administrative staff of Cusco’s Northern health network were empowered by this new methodology to do their job much better. The beneficiaries of the project were the medical and administrative staff of Cusco’s Northern health network and the patients that today receive an improved primary health service.

The Cusco’s Project achieved the following results, in only 5 months since the beginning of its implementation, and during the Covid-19 pandemic:

• 14% increase in baby consultations
• 5% increase in pediatric vaccinations
• 14% increase in nutritional supplementation for infants
• 5% increase in prenatal and postpartum consultations for women
• 12% increase in family planning visits

These results were measured with indicators in terms of outcomes and processes, such as percentage of children who receive full vaccination or average of medical consultations per shift hour. To develop these indicators, policymakers along with healthcare workers defined the corresponding codes and parameters to capture the information in the new digital system. In the future, we expect these results to continue permeating and transforming the work culture in the public hospital to offer a better healthcare service to low-income individuals.

The project has faced several challenges, mainly:

• The Covid-19 pandemic, which put additional pressure on healthcare staff to implement the project.
• Coordinating efforts from different divisions in Cusco’s Public Health Network in a work environment that usually operates in
  silos.
• Managing resistance to change, especially regarding the incorporation of digital technology in daily activities.
• High levels of staff turnover, especially among high-level positions.

These challenges were responded to by:

• Prioritizing goals and measures
• Being flexible in activity planning
• Raising awareness among app users and new public officials
• Monitoring and communicating progress on a regular basis

In terms of failures, the onset of the project implementation was rocky because of the internal work dynamic between high-level and low- and mid-level positions. This initial failure was responded to by raising awareness and providing public officials in charge of the implementation with technical skills.

The conditions that were necessary for the success of the project had to with:

• Showing strong leadership and support from high-level positions to achieve goals
• Raising awareness constantly among innovation users
• Involving potential users in the development of the innovation to make it more friendly
• Involving the hospital staff constantly to assure the sustainability of the innovation

The innovation has not been replicated yet but efforts are being carried out, mainly in terms of fundraising, to replicate the project in the Cajamarca region in Peru.

The most important lessons learned during and after the implementation of the project have to do with the importance of:

• Having flexibility to adapt and adjust the original plan, especially in the presence of circumstances that can delay the implementation
• Having permanent staff for the implementation of the project
• Creating an institutional resolution that provides the implementation team with support
• Understanding the institution from within, including its internal work dynamics, its conflicts and problems