David Woodhead on lessons from Peru

It was dusty and hot. Young children played with shards of coloured glass. Dogs barked. Concrete houses nestled between piles of rubbish. Pollution obscured my view and Lima was out of sight. I was surrounded by poverty. People had nothing; they were living in dirt.

We turned a corner. The road was blocked by crowds of people. Some held pickaxes, others carried stones. 'They're building a new road', the driver explained. 'The authorities will not do it so they're doing it themselves'. Eventually, the crowd parted. Children banged on the bonnet of the car. They smiled and laughed.

I got out of the van. The stench was strong: urine, rotting food, white spirit. A woman with silver hair came down the steps. We were late and she was worried we had lost our way. She introduced us to her colleagues in the women's collective. They had come to the shanty towns to escape the poverty of rural Peru, hopeful that they would find a better life. Some had fled violence. Life was still a struggle.

We went into the building - their primary care centre - where a nurse dispensed medicines and offered advice. In the waiting room, noisy children sat on mothers' knees. I met a group of local women who were trained in contraception and hygiene; they each had trained six women, who in turn were training others. The process had increased their confidence. And in the basement was a co-operative bakery. They provided affordable bread, but they also made a profit. 'These women are very shrewd', we heard.

The ground floor was a schoolroom, painted in bright colours. On the top floor, I was shown shoes made from tyres, and crafts made from rags, both of which brought in money. In the yard I found guinea pigs, with shiny coats and clear eyes. 'How sweet,' I thought. Several moments later, I realised that they were not pets but dinner, and another source of income.

The women were proud of their concrete steps - all 138 of them - which they had built to ease the burden of carrying the water that was delivered twice a week. As a result, they had halved the time and the trouble it took to carry the barrels on their backs. They had reduced back pain and spillages.

Empowering communities

When the charity which helped establish the collective invited me to the project, it was to help them evaluate their work. But in truth, I learned more from them than they did from me. I was overwhelmed by the generosity of the people I met, confirming the view that people who have the least are often the most giving.

Sometimes we have to go a long way from home to see things differently. My visit renewed my belief that communities often have the physical and emotional resources to improve their life chances, but are thwarted in their attempts to use them. It also reminded me that it makes sense to put services together, such as education and health. Above all, the users of services should have a stake in their delivery, nurturing a sense of ownership. Communities thrive when they are accountable and empowered.

Much has been written about partnerships between local people and health services. In Peru, I was reminded that poverty eats away at the fabric of communities. Action is necessary. Government has a responsibility to protect the poor. But poverty is not tackled through paternalism alone. Handouts and grand gestures do not always bear fruit. We must find ways to engage local people to solve complex problems and think differently about how resources are used.