Quite limited social security and a fragile health care system left Peru unprepared for an increase in COVID-19 cases
With 200,000 COVID deaths among a population of less than 33 million, the impact of the pandemic in Peru has been particularly devastating: the country has the highest per capita COVID death rate in the world. It is also estimated to have one of the world’s worst rates of children being orphaned or losing their caregivers as a result of COVID.
Still, compared to many other countries, Peru was relatively well placed on paper to deal with COVID. It’s an upper-middle-income country — and it was doing well economically before COVID. Life expectancy had risen and poverty had fallen, and it had made good progress in improving public health, increasing access to health care.
Peru was also one of the first Latin American countries to require people to stay at home to curb the spread of the virus. Unlike some other hard-hit Latin American countries, such as Brazil or Mexico, authorities in Peru have not denied the threat of the pandemic.
So how did it end up in such a bad situation anyway?
Not built for lockdown
On March 15, 2020, with 28 confirmed cases and no reported deaths, the Peruvian government declared a state of emergency. This quickly introduced a series of strong control measures, including closing borders, restricting movement across the country and banning crowds from congregating. Schools, universities and churches were closed. In general, all non-essential activities or services were limited, including non-emergency primary health care.
But unfortunately, the early adoption of these measures was not enough to mitigate the impact of the pandemic. The cases immediately started to rise.
The government had acknowledged that it would be difficult to adopt a strict lockdown. Peru has a large informal workforce and a fairly limited social security system – meaning staying at home, not working, would be difficult for many. Therefore, the government announced a series of policies, such as cash transfers, to try to protect people’s livelihoods and ask them to stay at home.
But the state did not have the capacity to provide money and food in a way that prevented citizens from going out. People still had to go out and form long lines at banks to receive their money transfers. Many also had to travel daily to food markets. Both became potential infection hotspots.
Weaknesses in healthcare
Increasing cases subsequently revealed structural weaknesses in the Peruvian health system. Despite recent economic growth and general public health improvements, the country’s overall health infrastructure was still poor before the pandemic.
As of January 2020, according to the Ministry of Health, 78% of health and medical centers had insufficient capacity to provide services, including outdated, non-functioning or insufficient equipment. By the beginning of 2021, this had increased to 97% of primary services.
Similarly, before the pandemic, Peru had 29 intensive care beds per million people, fewer than other countries in the region such as Brazil (206), Colombia (105), Chile (73) and Ecuador (69). Staffing was also insufficient to allow many health facilities to function properly. All this hampered Peru’s ability to respond effectively to a crisis situation.
The health system is also highly fragmented, making coordinating the COVID response across the country a challenge, compromising its effectiveness in protecting the most vulnerable. In addition, there are persistent inequalities within the system, with access to health care often determined by wealth, gender, ethnicity and geography.
For example, the indigenous peoples of the Peruvian Amazon are among those who have suffered the most from the epidemic. Their lack of access to health services, water and sanitation, as well as their high rates of poverty and child malnutrition, placed these ethnic groups in a situation of greater vulnerability.
An expensive system
Despite Peru making some progress towards free universal health care, it is estimated that between 10% and 20% of the population still have no access to health care at all. Even those who access care through public health facilities have to pay some fees — and before the pandemic, these out-of-pocket health care expenditures increased.
The pandemic then revealed how drastically expensive this could be. And for those who don’t have private insurance or access to good state-provided care, the costs can be even higher, as medications and care are billed at exorbitant rates in some private hospitals. For some, the cost will leave them seeking no care at all. Income is another barrier to accessing care.
The problem is that in Peru there is little regulation of the health sector. The same private company can eventually provide health insurance, health services, and drugs and medical supplies without any price control mechanism.
The private sector has also had a negative impact elsewhere. Peru also suffered from a shortage of medical oxygen, which was exacerbated during the early stages of the pandemic by the country’s history of producing oxygen at a concentration higher than the international standard (meaning there was less to do).
The Peruvian competition authority concluded nearly a decade ago that there was no good scientific reason for doing so — and that the standard was adopted to represent the interests of several private oxygen producers in the country. The treaty was only annulled during the oxygen crisis in the country.
As vaccination levels have increased from mid-2021, cases and deaths in Peru have fallen and stabilized at low levels. However, the crisis has exposed the fragility of the country’s health system, and in particular the potential negative impact of the private sector. The capacity and accessibility of the Peruvian health system needs to be much improved, otherwise disasters like this could happen again.
Camila Gianella Malca, Director of the Center for Sociological, Economic, Political and Anthropological Research, Pontificia Universidad Católica de Perú; Jasmine Gideon, Reader in Gender, Health and International Development, Birkbeck, University of London, and María José Romero, PhD Candidate in Development Economics, SOAS, University of London
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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