SEATTLE, Washington — In recent decades, Peru has implemented health reforms intending to expand healthcare coverage and access. The country has also received public health assistance from NGOs. In an attempt to alleviate the public health crisis uprising from the coronavirus pandemic, Peru also implemented an early and strict lockdown. Yet, poverty in Peru has played a key role in reducing the efficiency of COVID-19 prevention measures.
Public Health in Peru
In Peru, 22% of the population lives in poverty, which is closely linked with poor health outcomes. Fortunately, in recent years the country has passed legislation to expand healthcare access. In 2009, Peru adopted Act No. 29,344: a Framework for Universal Health Insurance. Additionally, Peru issued 23 legislative decrees addressing a wide variety of healthcare issues in 2013. The implementation of these decrees had many targeted effects, including:
- making the health system more centralized
- increasing vulnerable populations’ health insurance coverage
- investing in healthcare infrastructure
- financing healthcare through public-private partnerships
- providing performance incentives for remuneration
These reforms were effective, and succeeded in increasing:
- populations’ health insurance coverage from 64% to 73% and covering 100% of newborns
- health financing by 75% and tripled the health budget
- the number of health facilities
Tuberculosis in Peru
One public-private partnership, predating the 2013 decrees, has worked to address tuberculosis, which has been a prevalent issue in Peru in recent decades. In the mid-1990s, the NGO Partners in Health discovered an epidemic of multidrug-resistant tuberculosis (MDR-TB) in a slum north of Lima. This was an unexpected discovery, given that Peruvian physicians were adhering to international standards for tuberculosis treatment.
Partners in Health worked with the Peruvian government to implement a community health model in which community health workers visited each patient’s home twice daily to confirm that patients took their medication. This model enabled Partners in Health to reach a 75% cure rate. The organization challenged the prevailing MDR-TB theory at the time, which was that MDR-TB could not be treated in resource-poor settings. Peru still has a tuberculosis incidence of 116 per 100,000, but the country has made important strides in both tuberculosis treatment and public health as a whole.
Public Health and COVID-19 in Peru
The disparity between Peru’s management of COVID-19 and the country’s spiking caseload has had a major effect on Peruvians living in poverty. Peru responded swiftly, implementing an early COVID-19 lockdown on March 15. The country adhered to the World Health Organization’s recommendations and also enforced the quarantine by utilizing the police and army. Peru has also administered 600,000 coronavirus tests. However, two months into the quarantine and the curve has yet to flatten, with 3,000 to 4,000 new cases per day. Peru was the first Latin American country to respond to the pandemic but is ironically second only to Brazil in caseload.
Poverty and insufficient healthcare infrastructure are to blame for the tragic and still-improving public health in Peru amid the COVID-19 pandemic. The lockdown was not effective because workers, especially those living in poverty, had to violate quarantine measures to work. In the words of Hugo Ñopo, a researcher at a development think tank, “there is no lockdown” when you need to work to survive.
Healthcare Resources in Peru
Additionally, while the Peruvian government has recently passed legislation to address healthcare infrastructure and access, Peru still has low levels of public investment in healthcare. This lack of resources caused the Peruvian healthcare system to be unable to respond fully and effectively to the pandemic. Peru’s indigenous population, which suffers from poverty and lack of access to healthcare at greater rates, was especially impacted by the coronavirus outbreak. For example, 72% of the members of one indigenous community, the Shipibo-Konibo, tested positive for the virus. As Hilario-Manenima, a Shipibo-Konibo leader, said, “For the communities further in the forest, it’s as if they were sentenced to die […] For the poorest of the poor, what can they do?”
Public health in Peru has improved in recent decades, but much work remains to be done. While the country acted rapidly and appropriately in responding to the coronavirus pandemic, the current state of the outbreak is exposing some of the healthcare system’s weaknesses.
– Isabelle Breier