Peru: Improving Health Care for the Poor - Summary One

Peru: Improving Health Care for the Poor is a report that was put together by The World Bank as a tool to be used by the government to address the ways in which the Peruvian healthcare system can continue to improve and provide increased health care for the poor. It was put together 15 years ago in 1999 when the healthcare reforms were first beginning after the massive collapse of the health sector of Peru in the late 1980s and early 1990s due to hyperinflation and terrorism. In the three years after 1994, total public and private spending on health rose by over 50 percent. While this report has recorded many of the initial steps taken to reconstruct an effective health care system in Peru, it obviously lacks any changes or improvements that have occurred in the last 15 years. I will be reading this report while working at the Santa Rosa Health Center in Cusco and plan on talking with the physicians, nurses, and staff to learn more about how the health care system currently is working in order to compare the present situation with the conditions 15 years ago and see if any of the changes recommended by the World Bank have taken place.

This report addresses three main issues that the Peruvian health sector was facing at the time it was written (and probably still is facing today). First, how to continue to reduce the large gap between the health status of the poor and non-poor. Second, how to increase the resources assigned to provide care for the poor. Third, how to increase the efficiency in the use of these resources. Essentially, at the time this report was written, reforms to the health sector had already begun to take place but the report declares that the issue lies in sustaining, expanding, and deepening the reforms. The report claims that "for that to happen, key outstanding issues in providing, financing, managing, and manning health services have to be resolved" (World Bank, 1999).

While the reform programs were successful in increasing the coverage of health services in remote areas, there were still many problems that were preventing the poor from accessing health care. The Ministerio de Salud, or MINSA (in English, Ministry of Health), covered all of part of the expenses for services, which excludes additional expenses such as pharmaceuticals. Additionally, there was no standard methodology used to recognize the poor, which created an erratic, inconsistent system with local generosity covering much of the additional expenses involved with serving the poor.

There were obviously many good aspects about the reforms started in 1994 by MINSA but good intentions were accompanied by numerous problems. This report makes it clear that the reforms were successful but it was necessary for them to be sustained, deepened, and expanded in order to ensure that the provision of primary health care services would continue to improve in Peru. My interest in the matter has definitely peaked after serving for a few days in the health center here in Cusco. I am excited to learn more about the health care system of today and how effective it is and has been at serving the poor.

World Bank (1999). "Peru: Improving Health Care for the Poor." Washington, DC: World
        Bank Publications.