title: Constraints, synergies and avenues for scaling up breastfeeding, antibiotics for pneumonia and IMCI interventions in the Cusco region, Peru.
abstract: OBJECTIVE
  The purpose of this qualitative case study was to assess the feasibility of scaling up exclusive breastfeeding for 6 months, antibiotics for pneumonia and integrated management of childhood illness (IMCI) child interventions in three districts of the Cusco region, Peru.
  
  
  METHODS
  During field visits, constraints, synergies and solutions to the implementation of the selected interventions were collected through observational recording and interviews of mothers, health workers, and health managers/decision makers. Results are presented for each intervention according to the health system level where they occurred: mother/community, health worker, health centre, and political/managerial levels.
  
  
  RESULTS
  This case study demonstrates that it is feasible to scale up exclusive breastfeeding, antibiotics for pneumonia and IMCI interventions in poverty-stricken rural areas of a low-income country. Factors that helped and hindered the implementation were identified for each intervention.
  
  
  CONCLUSIONS
  The need for a coherent multi-sector approach that includes regulation, implementation and monitoring of health policies and education of all involved stakeholders was apparent. This study also demonstrates that global health interventions need to undergo local adaptation. Identifying local constraints and facilitating factors in a systematic way as proposed in this study is a useful step to increase their effectiveness and reach at the local level and to identify areas for improvement in the original intervention policies.
authors.affiliation: Berlin School of Public Health, Charite University Medicine, Berlin, 10117, Germany.
authors.forename: Giselle
authors.initials: G
authors.lastname: Sarganas
authors.affiliation: Health, Nutrition, Water, Environment & Sanitation, UNICEF, Beijing, 100600, China.
authors.forename: Robert
authors.initials: R
authors.lastname: Scherpbier
authors.affiliation: Peninsula CLAHRC, National Institute for Health Research, Peninsula Medical School, Plymouth University, Plymouth, PL4 8AA, UK ; The Wesley Research Institute, Brisbane, QLD 4066, Australia.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Gericke