Improving Education, Health
Care, and Social Assistance
for the Poor
This book identifies the achievements and challenges of social policy in Peru. Its objective is to provide the new presidential administration of Peru with a diagnostic of the main problems that need to be overcome to improve education, health care, and anti-poverty programs, and with recommendations on how to overcome these problems. The diagnos- tic uses international comparisons that put in context the achievements in coverage, qual- ity, and equity, and presents an analysis of the evolution and distribution of public expenditures and of the service delivery institutions. In recent decades, there have been sev- eral attempts to solve some of the problems identified in this study through the introduc- tion of reforms; the analysis of the success and limitations of these reforms is used to obtain lessons and to make recommendations. The analysis of each sector uses a combination of quantitative data from surveys and administrative information systems and qualitative information from hundreds of interviews with parents, children, teachers, nurses, doctors, and municipal, regional, and ministerial authorities in different regions of the country. Before the publication of the book, the recommendations were discussed with government authorities, political groups, academics, and representatives of civil society. This first chap- ter summarizes the findings and recommendations of the book.
The main conclusion is that Peru needs a change of culture to shock the system out of the low-level equilibrium in which it finds itself. The change of culture would be reflected in a society where all the stakeholders of the social services would demand more from each other. To make that possible, it is necessary to lift the veil that prevents society from rec- ognizing the poor quality of results that prevail in many parts of the system. Lifting the veil requires establishing transparent standards of service and systems to measure the quality