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Peru – Progress in health and sciences in 200 years of independence

  • Rodrigo M. Carrillo-Larco
    ,
  • Wilmer Cristobal Guzman-Vilca
    ,
  • Fabiola Leon-Velarde
    ,
  • ,
  • M. Michelle Jimenez
    ,
  • Mary E. Penny
  • Universidad Peruana Cayetano Heredia
    ,
  • Imperial College London
    ,
  • Universidad Peruana Cayetano Heredia
    ,
  • UNICEF
    ,
  • Instituto de Investigación Nutricional
    ,
  • Pontificia Universidad Católica del Perú
Research Output: Contribution to journal Review article Peer-review

Open access

Publication Information

Output type

Research Output: Contribution to journal Review article Peer-review

Original language

English

Article number

100148

Pages from-to (Number of pages)

Pages 100148

Journal (Volume, Issue Number)

The Lancet Regional Health - Americas (Volume 7)

Publication milestones

  • Published - 03/2022

Publication status

Published - 03/2022

Publication IDs

  • Scopus: 85127007551
  • PubMed: 36777656

Abstract

Peru celebrates 200 years of independence in 2021. Over this period of independent life, and despite the turbulent socio-political scenarios, from internal armed conflict to economic crisis to political instability over the last 40 years, Peru has experienced major changes on its epidemiological and population health profile. Major advancements in maternal and child health as well as in communicable diseases have been achieved in recent decades, and today Peru faces an increasing burden of non-communicable diseases including mental health conditions. In terms of the configuration of the public health system, Peru has also strived to secure country-wide optimal health care, struggling in particular to improve primary health care and intercultural services. The science and technology infrastructure has also evolved, although the need for substantial investments remains if advancing science is to be a national priority. Climate change will also bring significant challenges to population health given Peru's geographical and microclimates diversity. Looking back over the 200-years of independence, we present a summary of key advances in selected health-related fields, thus serving as the basis for reflections on pending agendas and future challenges, in order to look forward to ensuring the future health and wellbeing of the Peruvian population. Resumen (translated abstract): El Perú cumple 200 años de independencia en 2021. Durante estos dos siglos de vida independiente, junto con periodos sociales y políticos turbulentos, incluyendo un conflicto armado interno, hiperinflación y la inestabilidad política de los últimos 40 años, el Perú ha experimentado importantes cambios en su perfil epidemiológico con repercusiones directas en la salud de la población. En las últimas décadas, los indicadores de salud materno-infantil y de las enfermedades transmisibles muestran mejoría importante, pero el país se enfrenta de manera simultánea a una carga cada vez mayor de enfermedades no transmisibles y de salud mental. En cuanto a los sistemas de salud pública, se han realizado esfuerzos por aumentar la cobertura y calidad de la atención de salud en todo el país, apostándose en particular por mejorar la atención primaria. La ciencia y tecnología relacionadas con la salud también han mejorado, aunque si se quiere que la ciencia sea una prioridad nacional, son necesarias inversiones sustanciales. El cambio climático traerá importantes desafíos para la salud de la población, dada la diversidad geográfica y de microclimas del país. Para conmemorar los 200 años de vida independiente del Perú, presentamos un resumen de avances clave en diversas áreas y temas relacionados con la salud. Este repaso sirve como base para reflexionar sobre agendas y desafíos pendientes y futuros, con el fin de asegurar la salud y el bienestar de la población peruana en las próximas décadas.

Funding Details

The financing of the health system is complex and service provision is linked to different insurance schemes, with four providers being the most salient ones. First, the Seguro Integral de Salud (SIS) is funded through general taxes, and mostly targets those in poverty to provide free healthcare for certain conditions. As of 2020, ∼65% of the Peruvian population was covered by SIS. 14 Second, EsSalud, is a contributive service that provides health care, as well as pension and welfare coverage, financed through payroll discounts and is dependent of the Ministry of Labour. Third, the Army and Police Forces are financed through budget derived from the Ministry of Defence. Fourth, there are several types of private insurance that covers a small fraction of the population, ∼10%, with some overlap with EsSalud. 14 According to the Concytec Registry of Researchers (Renacyt), Peru has ∼5,000 researchers, which means there are 140 researchers per million people; 134 , 136 this rate is smaller than in other countries from the Pacific Alliance (Chile, Colombia and Mexico) where there are ∼400 researchers per million people. 137 Nonetheless, 31% of total Peruvian researchers work in disciplines related to the health sciences. With such strength in health research, and the incorporation of biotechnology, genetics and digital technologies, special programs are being prepared to boost research in the health sector to be funded by the Inter-American Development Bank and the World Bank (personal communication by former president of the National Council of Science, Technology and Technological Innovation). This additional investment in STI will be distributed following meritocratic criteria and based on national health priorities (personal communication by former president of the National Council of Science, Technology and Technological Innovation). This investment will also aim at improving infrastructure, increasing the availability of laboratories with higher levels of complexity and biosafety. These new resources will improve drug and medical device approval mechanisms and simplify regulations and administrative processes that hinder scientific and technological progress. Finally, a new governance system for the local scientific structure has already been approved by the government in July 2021. 138 It aims to solve the fragmentation of the STI system, which is evident in the overlapping of funds and actions due to lack of coordination between national and sectoral actors. In addition, this new governance system might solve the persistent problem of brain drain, lack of competitive salaries, poor employment conditions for researchers, and the dearth of a clear career path for scientists in Peru. The new governance system also seeks to give continuity to STI health programs and to overcome our limitations to collect and systematize data, in order to propose strategies based on evidence and thus achieve larger societal gains in addition to the strengthening of the health system. RMC-L is supported by a Wellcome Trust International Training Fellowship (214185/Z/18/Z). CZ-C is supported by the National Institute for Health Research (NIHR) and Wellcome under the NIHR-Wellcome Partnership for Global Health Research (218743/Z/19/Z). JJM acknowledges having received support from the Alliance for Health Policy and Systems Research (HQHSR1206660), Bloomberg Philanthropies (via University of North Carolina at Chapel Hill School of Public Health), FONDECYT via CIENCIACTIVA/CONCYTEC, British Council, British Embassy and the Newton-Paulet Fund (223-2018, 224-2018), DFID/MRC/Wellcome Global Health Trials (MR/M007405/1), Fogarty International Center (R21TW009982, D71TW010877, R21TW011740), Grand Challenges Canada (0335-04), International Development Research Center Canada (IDRC 106887, 108167), Inter-American Institute for Global Change Research (IAI CRN3036), National Cancer Institute (1P20CA217231), National Heart, Lung and Blood Institute (HHSN268200900033C, 5U01HL114180, 1UM1HL134590), National Institute of Mental Health (1U19MH098780), Swiss National Science Foundation (40P740-160366), UKRI BBSRC (BB/T009004/1), UKRI EPSRC (EP/V043102/1), UKRI MRC (MR/P008984/1, MR/P024408/1, MR/P02386X/1), Wellcome (074833/Z/04/Z, 093541/Z/10/Z, 103994/Z/14/Z, 107435/Z/15/Z, 205177/Z/16/Z, 214185/Z/18/Z, 218743/Z/19/Z) and the World Diabetes Foundation (WDF15-1224).
FundersFunding numbers
Army and Police Forces
-
British Embassy
224-2018, 223-2018
NIHR-Wellcome
218743/Z/19/Z
National Council of Science, Technology and Technological Innovation
-
UKRI BBSRC
BB/T009004/1
UKRI EPSRC
EP/V043102/1
UKRI MRC
107435/Z/15/Z, 205177/Z/16/Z, MR/P02386X/1, MR/P008984/1, 074833/Z/04/Z, 093541/Z/10/Z, 103994/Z/14/Z, MR/P024408/1
University of North Carolina at Chapel Hill School of Public Health
-
NIMH
1U19MH098780
NHLBI
5U01HL114180, HHSN268200900033C, 1UM1HL134590
NCI
1P20CA217231
FIC
R21TW011740, R21TW009982, D71TW010877
WBG
-
IDB
-
AHPSR
HQHSR1206660
WT
214185/Z/18/Z
IDRC
108167, 106887
MRC
MR/M007405/1
NIHR
-
DFID
-
British Council
-
SNF
40P740-160366
GCC
0335-04
MOD
-
CONCYTEC
-
FONDECYT
-
IAI
IAI CRN3036
WDF
WDF15-1224

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Sustainable Development Goals

  • SDG 3 - Good Health and Well-being
    SDG 3 Good Health and Well
  • SDG 13 - Climate Action
    SDG 13 Climate Action
  • SDG 16 - Peace, Justice and Strong Institutions
    SDG 16 Peace, Justice and Strong Institutions