Peru: Improving Health Care for the Poor - Summary Two

Overview of Health Sector Financing and Delivery Systems

The health sector of Peru is composed of 5 primary sectors: the Ministry of Health (MINSA), the Peruvian Institute of Social Security (ESSALUD), several smaller public programs, a large private sector, and several NGOs. While all of these play an important role in various aspects of the Peruvian health sector, MINSA and ESSALUD are the largest government programs and supply the majority of the financing for the public in general. From 1988 to 1993, financing for health care services dropped significantly due to the decrease in personal income caused by the hyperinflation of the 1980s.  Even though rapid recovery took place from 1994 to 1997, the amount of money spent on health in Peru is very low compared to other countries in Latin America and around the world.

Taxes are a primary source of revenue for many of the health sectors. MINSA also receives monetary support from external loans as well as user fees. According to this report, "about half of the health financing is provided by households, mainly as out of pocket payments" in Peru.

MINSA has control of the majority of the assets and staff in the health care sector. It is in charge of most of the Primary Health Clinics as well as most of the large hospitals, employing the majority of Peruvian health care professionals. Additionally, the primary sector is exceptionally large, with other 200 small private clinics that employ 33% of the physicians.

Since 1992, there has been a substantial increase in the amount of health services available, especially in primary health clinics. MINSA and ESSALUD also have set into motion various reforms that encourage clinics to expand their hours of operation. Additionally, in the years since 1992, there has been a rapid increase in the amount of health professionals available.

MINSA plays many important primary roles, including supplying nearly all public health interventions. This includes coordinating the entire immunization program and all vector control operations. Vector control refers to the process of working to limit or eradicate vectors such as insects or animals that transmit disease pathogens. MINSA also shares responsibility in controlling food and water quality. MINSA is the primary and most essential provider of services for the poor. Its main role is played in rural areas in the highlands and in the jungle, although it is also crucial as the most important health care provider in urban areas as well.

"Most of the inequality in health care consumption results from the assignments of greater amounts of private expenditure to health care by the rich than by the poor... This is a common pattern as health care is a good whose consumption normal rises with income or faster." 

As a whole, the amount spent by MINSA on health care services somewhat reduces the inequality but it is not substantial enough or well directed towards the poor to completely equalize expenditures. MINSA is most important for people with the lowest income.

Although this report was written 15 years ago, I know that MINSA still is playing a significant role in the Peruvian health care sector today. I have seen many MINSA workers at the clinic at which I am volunteering. The infant development and growth charts that I have been working with (and mentioned in a previous post) are all approved and provided by MINSA. According to MINSA's website the current mission of MINSA is to protect personal dignity, promote health, prevent sickness, and guarantee integral health attention to all the inhabitants of the country... and so on (http://www.minsa.gob.pe, translation mine).