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Background: Even though strengthening primary health care (PHC) is now widely accepted as essential for achieving global health goals, evidence regarding the long-term effectiveness of comprehensive PHC programs remains limited. In contrast, the evidence for effectiveness of selected interventions assessed over shorter periods of time is abundant. Objectives: This report is the second in a series of two papers. The first paper describes the history and implementation features of the census-based, impact-oriented (CBIO) approach by the Consejo de Salud Rural Andino (CSRA)/Montero Comprehensive Primary Health Care Program that has been in operation for three decades, since 1988. This second paper in the series presents evidence of program effectiveness, including long-term trends in child and maternal mortality. Methods: We reviewed available documents, prior evaluations, and health information system data. We carried out interviews with 19 key informants. Finally, we reviewed data from the program’s health information system, which contains vital events and related information (including cause of death) arising from routine systematic visitation of all homes in the program area at least every six months. Results: A comprehensive PHC program that incorporates principles of the CBIO approach has achieved near-universal coverage of key child survival interventions and achieved levels of child and maternal mortality comparable to those in the United States. The CSRA/Montero Comprehensive PHC Program is now also addressing non-communicable diseases. Community collaboration, routine systematic home visitation, and targeted visits to high-risk households are vital components of the program. Conclusions: The CSRA/Montero Comprehensive PHC Program provides an example worthy of replication, expansion, and further rigorous evaluation. CBIO principles are relevant for strengthening the PHC movement, achieving Universal Health Coverage, ending preventable child and maternal mortality, and eventually reaching Health for All. *Correspondence to: Henry B Perry, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, E-mail: hperry2@jhu.edu

preventive medicine and community health

Implementing the census-based, impact-oriented approach to comprehensive primary health care over three decades in Montero, Bolivia: 2. Program achievements, including long-term trends in mortality of children and mothers