Peru has achieved major increases in health coverage in recent decades, especially for the poor.1 Health sector reform began in the 1990s, and health service coverage rose above 80% of the population by 2014.2Along the way, successful steps toward scaling up were supported by broad political consensus along the way. Health reform measures were introduced by the country's ruling political party in 1998 but eventually gained the cross-party approval of a Universal Health Insurance scheme.3 This bipartisan support was particularly important in a decentralizing health system where the national government sets overall policies and frameworks, to be carried out by local and regional authorities.4 Peru’s progress towards universal health coverage was initially based on pilot schemes, which it scaled up over time, eventually expanding health legislation to include full population coverage.3 In the early 2000s efforts were made to promote policy dialogue and consensus around health sector reform, helping to strengthen the foundation for this progress. These were followed by efforts to strengthen capacity and governance capabilities of the Peruvian Ministry of Health as well as within regional and local entities.2 

Peru’s progress towards comprehensive health care began seriously in the late 1990s. In 1999 specific categories of workers were guaranteed health coverage. This was expanded in 2002 to include informal sector workers and the poor. Over the next few years, public health services provision began to be regionalized, moving management of public health centers, supervision and control of production, and organization of levels of care from the central to regional governments.5 In 2007, a semi-contributory regime was introduced, in which public funds were combined with private contributions.6 Finally, in 2009, legislation instituting universal health insurance was passed7 and in 2010 the Universal Health Insurance Law was created as a regulatory framework to achieve universal health coverage by integrating the two main social insurance funds that had been established in prior years.8 Following this, in 2012 the president requested health reform guidelines be developed to ensure access and quality of health services.7 Peru’s policy successes have resulted from a strong emphasis on planning, consensus-building, inclusive participation by the public and private health sectors, and progressive legislative reforms.2

References:

  1. Maeda A, Araujo E, Cashin C, Harris J, Ikegami N, Reich MR. Universal Health Coverage for Inclusive and Sustainable Development A Synthesis of 11 Country Case Studies. World Bank. 2014. http://documents.worldbank.org/curated/en/575211468278746561/Universal-health-coverage-for-inclusive-and-sustainable-development-a-synthesis-of-11-country-case-studies
  2. Paving the way for universal health coverage in Peru. USAID Health Finance and Governance. (https://www.hfgproject.org/paving-the-way-for-universal-health-coverage-in-peru/, accessed 20 May 2019.)
  3. Ozano K, Simkhada P, Porcellato L, Khatri R. Discussions around Primary Health Care and the Private Sector during the Global Symposia on Health Systems Research 2018. January 2019. https://www.healthsystemsglobal.org/upload/other/Discussions-around-Primary-Health-Care-and-the-Private-Sector.pdf
  4. Primary health care systems (PRIMASYS): case study from Peru, abridged version. Geneva: World Health Organization; 2017. https://www.who.int/alliance-hpsr/projects/alliancehpsr_peruabridgedprimasys.pdf?ua=1
  5. Francke P. Peru’s Comprehensive Health Insurance and New Challenges for Universal Coverage. The World Bank, Washington DC, January 2013. http://documents.worldbank.org/curated/en/371851468086931725/pdf/750090NWP0Box30r0Universal0Coverage.pdf
  6. Petrera M, Valdivia M, Jimenez E, Almeida G. Equity in health and health care in Peru, 2004–2008. Rev Panam Salud Publica. 2013;33(2):131–6. http://iris.paho.org/xmlui/bitstream/handle/123456789/9208/08.pdf?sequence=1&isAllowed=y
  7. Vermeersch C, Medici A, Narvaez R. Country summary report for Peru: universal health coverage for inclusive and sustainable development. Washington, DC: World Bank, 2014. http://documents.worldbank.org/curated/en/437741468076132999/Peru-Universal-health-coverage-for-inclusive-and-sustainable-development-country-summary-report
  8. Mboi N. Indonesia: On the Way to Universal Health Care. Health Systems & Reform 2015, 1:2, 91-97. https://www.tandfonline.com/doi/full/10.1080/23288604.2015.1020642