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Item type:Publication, Good Health Indicators are Not Enough: Lessons from COVID-19 in Peru.(National Institutes of Health, 2020-12-01)Peru received international acclaim for being one of the first countries to implement a comprehensive package of measures to control the spread of the COVID-19 pandemic. The government imposed a general lockdown, combined with social protection measures--mainly cash transfers and the distribution of food parcels. This was an attempt to mitigate the impact of the lockdown, in a country where 70% of the population works in the informal sector. Yet despite this, the transmission rate remained high, and as of early June Peru's COVID-19 mortality rates were amongst the highest worldwide. The pandemic has shed a stark light on Peru's failure to guarantee the right to health and the limits of the tools used to assess the health system's performance. Over the past two decades Peru has been praised for introducing a series of reforms aimed at achieving Universal Health Coverage (UHC), primarily through the expansion of health insurance across low-income groups. Nevertheless, reforms have failed to overcome the historical fragmentation of the system, where access to services is determined by income, gender, and geographical location. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Comparing experiences of constitutional reforms to enshrine the right to water in Brazil, Colombia, and Peru: opportunities and limitations(MDPI, 2021-12-01)In this paper we compare recent efforts towards the constitutionalization of the right to water in Brazil, Colombia, and Peru to understand the opportunities and limitations related to the attempts to enhance access to piped water to the highest normative level. Peru passed a constitutional amendment in 2017 while Brazil and Colombia have seen much right-to-water activism but have not succeeded in passing such reforms. We explore the role of the existing domestic legal frameworks on drinkable water provision and water management towards the approval of constitutional amendments. We find that all three countries have specialized laws, water governing institutions, and constitutional jurisprudence connecting access to water with rights, but the legal opportunity structures to enforce socio-economic rights vary; they are stronger in Colombia and Brazil, and weaker in Peru. We argue that legal opportunity structures build legal environments that influence constitutional reform success. Legal opportunity structures act as incentives both for social movements to push for reforms and for actors with legislative power to accept or reject them. Our findings also show that in some contexts political cost is a key element of constitutional reforms that enshrine the right to water; therefore, this is an element that should be considered when analyzing these processes. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Peru – progress in health and sciences in 200 years of independence(Elsevier, 2021-12-20)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 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. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Missed opportunities for vaccination in Peru 2010–2020: a study of socioeconomic inequalities(Elsevier Ltd, 2022-10-01)Background: Missed Opportunities for Vaccination (MOV) represent a major risk in the re-emergence of immunopreventable diseases. However, in the region, there are few published studies on MOVs using national databases such as demographic and health surveys (DHS). This study aims to describe the frequency and trends of MOVs for the first dose of vaccines against the leading causes of infant morbidity and mortality, their complete vaccination coverage, and trends in socioeconomic inequalities at the national and departmental levels for an 11-years period. Methods: Using DHS data from an 11-year period (2010–2020), we calculated frequencies and trends in MOVs of vaccines for the leading causes of child morbidity and mortality, estimated inequalities in MOVs using the Slope Inequality Index (SII) and conducted a spatial autocorrelation test to identify clusters of higher or lower inequality in MOVs at the national level. Findings: We found that, at the national level, greater inequality was concentrated in the wealthiest categories of each socioeconomic variable. We identified that departments with higher poverty rates concentrated higher levels of inequality in the MOVs in the lowest strata of the socioeconomic variables. In addition, we found that some departments with similar geographic and socioeconomic characteristics had spatially correlated levels of inequality on MOVs. Interpretation: These findings can help to identify the heterogeneity that exists in the distribution of MOVs among departments and socioeconomic strata, which would help to prioritize specific areas and subpopulations for national immunization strategies. Funding: No additional funding source was required for this study. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Anti-abortion mobilization in Latin America: Signs of a field in transformation(Fundacao Getulio Vargas, Escola de Direito de Sao Paulo, 2022-01-01)Gender and sexuality have become a focal point of the political divide in Latin America. In many countries, religious actors, political leaders, pro-life and pro-family nongovernmental organizations (NGOs), among others, have come together to promote a neoconservative shift in contemporary regional politics. Despite the constant public presence of religious actors and their long-standing influence on public policies in the region, recent challenges to sexual and reproductive rights have come from a field in transformation. The anti-abortion mobilization shows important signs of adaptation and mutation on different fronts – networks, alliances, strategies, and frameworks. Finally, this process of renovation has led to the expansion of this dispute towards a broader anti-gender alliance, and the increasing importance of legal strategies and tools by anti-abortion actors is remarkable. The transformations in the anti-abortion field were globally put into action after the conservatives’ defeat in the UN Conference in Cairo, and they also interacted with different local processes, in response to the relational dynamics between movement and countermovement. However, we can see important convergences among Latin-American cases. Drawing on evidence from case studies of countries in the region, this article analyses the main characteristics of contemporary anti-abortion activism in Latin America. It identifies significant commonalities among the cases and raises the hypotheses that shifts in the composition of the anti-abortion networks, in mobilization strategies and frames are inserted in a trend that has been transnationally diffused and subject to different processes of vernacularization. This article ultimately calls attention to the need for more empirical research to address the regional dynamics of transnational actors, diffusion processes, and local adaptations. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Mental health policies for adolescents and young adults in Peru: A policy analysis(RELX Group (Netherlands), 2024-01-01) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Ensuring sexual and reproductive healthcare services amidst a pandemic: Experiences from health workers in Lima, Peru(Public Library of Science, 2024-06-28)Nowadays there is an emerging interest on health system resilience capacity during emergencies as the one created by the COVID-19 Pandemic. This article contributes to this emerging field of studies by analysing the impact of the state´s policy responses COVID-19 (as lockdowns) on the Peruvian health system, specifically on the delivery of non-covid services, sexual and reproductive health services, and describe the strategies deployed by health workers to adapt to the COVID-19 crisis in Peru, a country that have been dramatically impacted by the pandemic. The article, based on the analysis of depth interviews with 11 health workers and one health supervisor working at sexual and reproductive health services at public health services Lima during 2020 and 2021, describe how pre-existing conditions of the health system (as poor infrastructure and deficit of human resources) magnified the negative effects of the measures taken to control de pandemic, undermining the “resilience” of the health system. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, A ‘common sense’ response to health inequalities in Peru? Public-private partnerships in health and the implications for the right to health and economic inequality(Oxford University Press, 2024-11-01)Drawing on the case of Peru, our analysis looks at the ways in which the mainstream media creates support for government policies aimed at implementing Public-Private Partnerships (PPPs) in the health sector. Peru has a highly fragmented and segmented healthcare system, and the COVID-19 pandemic exposed the deeply embedded inequalities in accessing healthcare across the country. Nevertheless, the construction of hospitals financed and managed via a PPP arrangement has been one of the major solutions proposed and implemented by successive Peruvian governments in response to the health sector’s challenges. As our analysis demonstrates, the media has played a significant role in promoting this ‘common sense’ agenda whereby greater reliance on the private sector is presented as a solution to the weaknesses of the public sector. Our article considers the wider evidence on the role of PPPs in the health sector and contends that there is very little evidence on the system-wide benefits of PPPs, thus raising significant concerns about their ability to address health inequalities effectively. It also raises important questions about how far PPPs are able to support states in guaranteeing the right to health for their citizens. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Corrupting Climate Change Institutions from the Inside: Systemic Collusion in the Peruvian Forest Governance(Elsevier BV, 2023-11-28)This article aims to contribute to the literature on natural resource corruption by analyzing the subnational political economy behind the little enforcement of anticorruption policies. Building on the political ecology approach to corruption, this article focuses on how economic and political interest colludes in a hybrid or ambivalent system that reproduces over and over corrupt practices. Zooming on the subnational case of Ucayali, we find four main factors contributing to understanding the poor enforcement of subnational governments of new forest regulations to reduce deforestation. The first one is infrastructural capacity, which is essential to understand the issue at hand, but it alone is insufficient to comprehend the systemic corruption in the forest sector. A second factor is the decentralization process and the subnational political economy. Our analysis shows the importance of economic and political dynamics at the subnational level in shaping national anti-corruption and deforestation reforms. A third element to consider is the divergent perspectives on the development of the Amazon. While in Peru, the environmental sector has witnessed significant growth at the national level, it still holds limited political influence. Conversely, positions advocating for economic activities that adversely impact the Amazon forest, such as extensive agriculture, exert more control over the region. A fourth factor is the historical marginalization of indigenous groups, who can serve as valuable allies in driving reforms. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Political determinants of cervical cancer control in Peru(BioMed Central Ltd, 2025-12-01)BACKGROUND: Cervical cancer (CC) is the most common and second-most deadly cancer among Peruvian women, despite national authorities' sustained political and budgetary efforts to improve Human Papillomavirus (HPV) vaccination, screening for early detection of cervical cancer, and making treatment more accessible. Considering the importance of the health system in CC prevention and control, this article examines the role of the health system as a whole in the CC screening in Peru, a dimension that previous studies have not comprehensively covered. To this end, this article utilizes the WHO's building blocks framework as an analytical tool to examine the performance of the health system when providing services to prevent, detect, and treat CC. METHODS: The research took place in the region of Madre de Dios, located southeast of the Peruvian Amazon. Madre de Dios reports the second-highest CC mortality rate in the country, and a lack of oncologic treatment (chemotherapy, radiotherapy, pediatrics, and surgical) and palliative care units. This qualitative study is grounded in in-depth interviews with key informants in Lima and Madre de Dios, as well as an analysis of report records provided by health authorities in Madre de Dios and Lima. The interviews were conducted between November 2022 and August 2023. They are policy experts with experience in designing national-level health policies, as well as health officials in Madre de Dios. Additionally, they have conducted interviews with representatives of civil society organisations in Madre de Dios. Additionally, we analyzed the anonymized records of Pap smear results collected in Madre de Dios for the years 2020, 2021, and 2022. RESULTS: Governance is crucial for organizing CC activities. Vertical national programs and policies are failing to accommodate local solutions and lack sensitivity to the unique characteristics of different contexts. CC policies in Peru are ambitious, and their implementation is challenged in Madre de Dios by the lack of trained human resources at the primary healthcare and hospital level, lack of laboratories, lack of financial resources for patient referrals, poor information system that do not allow patient follow-up, and lack of resources and political will to guarantee equipment maintenance. The analysis also highlights the significant shortcomings of organizing health system indicators around services provided, thereby ignoring indicators that assess the impact of health interventions on population health. CONCLUSIONS: The analysis demonstrated the utility of the WHO health system building blocks framework in analyzing the shortcomings of public policies aimed at preventing, detecting, and treating CC. It also provides a comprehensive view of the critical features of the health system that must be considered when designing and implementing interventions to address health conditions, such as CC.4