Peru's Healthcare System
In the past 20 years, the South American country of Peru has undergone a drastic healthcare reform. The country’s population can more easily access quality healthcare, decreasing the national rates of malnutrition and several causes of mortality. However, Peru still spends less than 3% of its GDP on healthcare and the system has been defunded for the past few years. Peruvian healthcare also suffers from core issues that have prevented rural impoverished regions from receiving the benefits of the country’s healthcare reform. Here are six facts about the current state of Peru’s healthcare system.

6 Facts About Peru’s Healthcare System

  1. Decentralization: The structure of Peruvian healthcare is decentralized, meaning the system is comprised of a combination of public and private organizations. Five entities work to administer healthcare throughout the country: The Ministry of Health (MINSA),  Armed Forced (FFFA), National Police (PNP), EsSalud and the private sector. Decentralization has caused issues with communication that have increased medication costs and impeded understanding of the care patients receive between health provider entities (such as current medications a patient is taking or their medical history). Consequently, progress in designing a better healthcare system and in the reform of universal healthcare has focused on centralizing these five entities.
  2. Maldistribution: Though the statistics for national health have projected country-wide progress in healthcare accessibility, rural areas of Peru suffer from lack of resources and are excluded from the reform of Peru’s healthcare system. Rural areas in Peru have the slowest national poverty reduction rates and suffer from a severe lack of healthcare funding. The 28% of Peruvians that live in these rural areas, including the Andean and Amazonian regions, have limited access to healthcare professionals and the medical resources that they need. Because of this inequity, the Ministry of Health in Peru created health policy guidelines in the “Institution Strategic Plan 2008-2011” that focus on improving rural health care through universality, equity and social inclusion.
  3. Underserved populations: The maldistribution of resources is especially problematic, as it keeps Peru’s healthcare system from reaching indigenous populations. The lack of resources getting distributed to these regions causes problems for the access and treatment of populations like the women of Asháninka, an indigenous group that lives in central Peruvian rainforests and has a population of around 45,000 people. For an Asháninka woman to access a hospital they must develop trust for healthcare providers and overcome both distance and the cost of medication. The healthcare providers who are able to see an indigenous woman are often unable to keep their trust due to the poor quality of treatment or long waiting time for test results. The limited number of healthcare providers in these regions have few resources and are often unable to see all of the patients that request care.
  4. Reform: Peru’s government has taken major steps to create a universal healthcare system. The most momentous changes are the results of legislation signed in the past 20 years. Specifically, the Framework for Universal Health Coverage adopted in 2009 and 23 pieces of legislation passed in 2013 quickly effected change by setting goals around centralizing healthcare and increasing findings for healthcare providers in Peru. This encouraged reforms for accessibility among both the public and private sectors.
  5. Universal Health Coverage: Peru has made great strides in the spread of accessible healthcare. This progress has been monumental since the establishment of Health Sector Reform in 1998, as more than 80% of the 31 million people have some access to Peru’s healthcare system. This statistic is reflected in the increased number of women giving birth in hospitals and in the significant drop in both maternal and infant mortality rates. Additionally, malnutrition rates dropped from 29% to 15% in a short three-year span of 2010 to 2013. These encouraging movements towards a healthier population continue to be achieved through legislation from Peru’s government and the increased accessibility of private sector healthcare.
  6. Aid: USAID has been a supporter of the Peruvian Ministry of Health and its goals for reform, while also advocating health insurance reform. The organization played a part in designing Seguro Integral de Salud (SIS), a health insurance financial platform for Peruvians. USAID has also contributed to universal health for Peru by implementing health projects that helped create the Health Finance and Governance project (HFG). The HFG Project in Peru works to streamline healthcare in various ways, such as creating electronic records, developing human resources, and costing medications. In addition to the SIS and the HFG, USAID has been instrumental in passing legislation in Peruvian Congress that promises a future of reform.

Peru’s healthcare system provides both an optimistic view of the progress a country can make for its citizens and an understanding of what improvements still need to be made to create equitable care. With the continued work of the HGF project and the passing of legislation that increases healthcare funding to rural areas, Peru can move even closer to its goal of creating accessible healthcare for all of its citizens.

Jennifer Long

Photo: Flickr

10 Facts about Poverty in GuineaGuinea is a small, impoverished West African country that has been featured in the news due to the 2015 Ebola outbreak. The virus strained the nation’s already struggling economy. Despite this, the disease did not affect the average life expectancy. Still, Guinea faces many issues that are harmful to life expectancy. Here are nine facts about life expectancy in Guinea that reflect these concerns.

9 Facts about Life Expectancy in Guinea

  1. The average life expectancy is only 59.8 years with 59.4 for men and 60.4 for women. Guinea ranks about average when compared with its West African neighbors. For instance, Sierra Leone is among the lowest at only 54 years in 2017, while Ghana is among the highest at 63 years. 
  2. Guinea’s life expectancy has increased steadily over time since 1960 with a slight dip in the early 2000s. Despite the fatal impact of Ebola on individuals and communities, the virus did not affect the course of growth for the average life expectancy in Guinea. 
  3. The country has extremely high infant and maternal mortality rates. In 2015, the maternal mortality rate was one of the worst in the world with 549 deaths per 100,000 live births. The infant mortality rate was 60.3 per 1,000 live births in 2016.
  4. About 55 percent of Guinea’s citizens live below the poverty line. This is thought to be due to the prolonged political instability since the nation’s founding in 1974. Furthermore, while 90 percent of the country’s exports come from mining, few such jobs are available; Guinea employs only 2.5 percent in this sector. 
  5. Approximately 24.4 percent of children face chronic malnourishment due to widespread poverty. During the 2018-19 school year, The World Food Programme provided hot school meals to 131,895 children in 896 schools in addition to take-home rations to 12,155 girls who are in their final year of school.
  6. About 14 million people in Guinea experience year-round transmissions of malaria and 25 percent of hospitalizations among children under 5 can be attributed to the disease. USAID support through the President’s Malaria Initiative aims to reduce the malaria mortality rate by 50 percent in Guinea as well as other sub-Saharan African countries. 
  7. Only half of the country’s population has access to public health care services. Access to health services (under 30 minutes) is 38.9 percent with a rate of use of 18.6 percent. This makes Guinea especially vulnerable to pandemics such as the recent Ebola virus. A major hurdle for the country will be expanding health coverage nationwide by strengthening the delivery of such services.
  8. In rural regions, 142 out of every thousand children die each year. This is because rural regions in particular lack clean water, access to health services and a proper sanitation system. Of those living below the poverty line, 80 percent live in rural areas. U.N. and NGO assistance makes up 26.9 percent of all expenditure on health
  9. USAID’s Health Finance and Governance project is working with Guinea’s Ministry of Health to improve transparency and accountability in the delivery of health services. Such methods include better responses to crises such as the 2015 Ebola outbreak. 

These nine facts about life expectancy in Guinea reflect that the nation still has much to improve on before life expectancy reaches the levels seen in western countries. To reduce high mortality rates from tropical diseases such as malaria, better access to health care is a must. Fortunately, some of the funding from the President’s Malaria Initiative is tackling some of these issues.

– Caleb Steven Carr
Photo: Flickr

Kyrgyz USAID Tuberculosis
How can a government ensure that resources devoted to health are used efficiently and effectively? Which performance-based incentive is really providing the desired outcome? How responsive are health policies to the actual needs of its target community? The Health Finance and Governance (HFG) project was launched by USAID in 2012 to help answer these questions. It is a five year- 209 million dollar global project to improve health finance and health governance in partner countries. The end goal is to improve health outcomes and access to health care, as well as generate evidence on the most efficient improvements to health management.

HFG works on five broad topics relating to financing health projects: transparency and accountability, pricing and management, development of evaluation metrics, and capacity building. Perhaps the single most important factor in dealing with these issues is that local, regional and cultural aspects contribute to the problems and the solutions. No one solution can fit all countries or even all target populations within one country. Let us consider just one example of HFG’s work.

In 2013, the Kyrgyz Republic had a tuberculosis (TB) incidence rate of 141 for every 100000 people. It is among the countries suffering from the most high multi-drug resistant TB (MDR-TB) burden in the world, yet TB detection rate at 66 percent, and drug susceptibility testing coverage, at 25 percent is still low. The WHO cites poor coordination of TB data management, insufficient oversight of treatment and monitoring of adherence to treatment, and non-compliance by patients and health providers to the prescribed antibiotic regimen as well as poor infection control as causes for rampant prevalence of TB and the spread of MDR-TB.

In the 1990s, the Kyrgyz Republic transitioned its general hospital system to case-based financing, where funds are provided to a hospital based on the previous years bed occupancy levels. This incentivized hospitals to increase hospitalizations, which not only is not always required leading to ineffective use of funds, but also exposes the patient to an infection-rich environment where depressed immune systems can acquire secondary, drug resistant infections.

The HFG assisted the Kyrgyz Republic to transition to a financing system that is based on the number of patients treated. Under this model, the hospital would receive a set fees for complicated MDR-TB cases and a lower fees for less complicated cases. This kind of financing structure also stimulated hospitals to require bacterial confirmation of the disease as opposed to a more subjective clinical diagnosis, which would reduce the number of cases treated in error. To complete this transition successfully, the government had to be fully involved to ensure that finances saved by reduced hospitalizations would be reinvested to provide better support for TB outpatient services like patient transportation, supplies, and social support.

In this region, this kind of approach integrates well with more standard approaches of launching rapid diagnostics like the work done by the National TB program and TB Reach, or providing access to new antibiotics like the End TB Erogram run by Partners In Health, Medecins Sans Frontieres, Interactive Research and Development and UNITAID. There is still a long way to go and a lot of gaps to fill. As about 44 percent of the financing for TB projects in Kyrgyzstan comes from foreign aid, assistance in mobilizing domestic resources can make health projects more sustainable. This would parallel the work of HFG in Nigeria where it is working to increase the resource mobilization capacity to support HIV/AIDS treatment.

When the various arms of the government work effectively with each other and with private sector and donor organizations, inefficiencies and wastage in development projects can be resolved. However, the first step remains identifying these gaps and designing novel solutions to fill them. When the HFG completes its term in 2017, a full measure of its successes can guide further development decisions.

Mithila Rajagopal

Sources: HFG, Medecins Sans Frontiers, StopTB, WHO, The World Bank
Photo: USAID