Pro-poor Policies in the
Peruvian Public Health Sector
Betty Alvarado Pérez and Rony Lenz
This chapter analyzes the state of the health sector in Peru. It is an abbreviated ver- sion of a health study conducted by the World Bank for the Accountability in Social Reform in Peru (Renditión de Cuentas para la Reforma Social de Perú, RECURSO) Project, which includes a review of issues related to health, education, and social programs. Its objective is to contribute to the dialog and to include some pro-poor policies in the debate agenda with an eye to improving the performance indicators of the health sector and, more specifically, the health of the poor. The analytical framework that guides this investigation can be found in the World Bank’s 2004 World Development Report (WDR). Within this framework, both institutional factors and accountability among actors in a country—policymakers, providers, and users—are crucial to improving health care services for the poor.
The evidence of inequality of access to health care is abundant. Access to health care is proportional to income level: the poor are 4.8 times more likely not to receive attention than the rich. Moreover, the percentage of the population lacking health insurance is 48.4 percent, and citizens are required to finance 39 percent of the system’s costs, the majority of which goes to covering the purchase of medications.
Although the indicators of the state of the health system point to a significant reduc- tion in the national infant mortality rate (approximately 23 for every 1,000 live births in 2003), indications still exist of inequities related to geography and income level. Perinatal and maternal mortality rates remain high due to the aforementioned inequities. While the Latin American average is 85.1 for every 100,000 live births, Peru’s average in 2002 was 163.9. Peru’s goal is to meet the Millennium Development Goal of 66.2 by 2015.
The Peruvian Health System is complex and includes both public and private providers. This study focuses on the public sector, and a specific analysis of the Ministry of Health