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Geographical Locations - Peru
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- A Model of Dental Public Health Teaching at the Undergraduate Level in Peru
There has been a growing interest among dental educators regarding the opportunities offered by community-based dental education as a means to allow dental students to assume their role as health professionals in the real world. Although several dental schools have integrated community-based education into their curricula, most have not engaged their students in the development of competencies to address dental health needs at the community level. The purpose of this article is to discuss the teaching-learning experiences in dental public health at the undergraduate level in the Faculty of Stomatology at the Universidad Peruana Cayetano Heredia (FS-UPCH) in Lima, Peru. The teaching-learning activities in dental public health at the FS-UPCH consist of two well-defined stages: experiences in low-income urban communities and experiences in low-income rural communities. Both stages have been designed to make it possible for students to acquire competency in addressing oral health needs at the community level as well as to enlarge and deepen their knowledge about the social and health situation in Peru. In community-based dental education, students are not only placed in community settings to treat individual patients, but also challenged to consider dental public health issues, including the administrative aspects of dental services. [author abstract] [Journal of Dental Education, Vol. 70, No. 8, pp.875-883, August 2006]
- Access to health care in relation to socioeconomic status in the Amazonian area of Peru
"Access to affordable health care is limited in many low and middle income countries and health systems are often inequitable, providing less health services to the poor who need it most. The aim of this study was to investigate health seeking behavior and utilization of drugs in relation to household socioeconomic status for children in two small Amazonian urban communities of Peru; Yurimaguas, Department of Loreto and Moyobamba, Department of San Martin, Peru."
- Are health interventions implemented where they are most needed? District uptake of the Integrated Management of Childhood Illness strategy in Brazil, Peru and the Republic of Tanzania
In this article from the Bulletin of the World Health Organisation (2006;84:792-801),"... Cesar Victora et al. assess the Integrated Management of Childhood Illness (IMCI) strategy by looking at how well it reached poor areas within three countries. Their findings are sobering: overall, the strategy seemed to be implemented least energetically in the areas where it was most needed. This illustrates one of the many cruel ironies of efforts to help the poor: the tendency of service programmes to be much weaker in deprived areas than elsewhere."
- Bribery in Health Care in Peru and Uganda
In this paper, I [author, Jennifer Hunt] examine the role of household income in determining who bribes and how much they bribe in health care in Peru and Uganda. I find that rich patients are more likely than other patients to bribe in public health care: doubling household consumption increases the bribery probability by 0.2-0.4 percentage points in Peru, compared to a bribery rate of 0.8%; doubling household expenditure in Uganda increases the bribery probability by 1.2 percentage points compared to a bribery rate of 17%. The income elasticity of the bribe amount cannot be precisely estimated in Peru, but is about 0.37 in Uganda. Bribes in the Ugandan public sector appear to be fees-for-service extorted from the richer patients amongst those exempted by government policy from paying the official fees. Bribes in the private sector appear to be flat-rate fees paid by patients who do not pay official fees. I do not find evidence that the public health care sector in either Peru or Uganda is able to price-discriminate less effectively than public institutions with less competition from the private sector. [author abstract]
- Changes in iron status during pregnancy in Peruvian women receiving prenatal iron and folic acid supplements with or without zinc
Background: Iron deficiency anemia is the most prevalent nutrient deficiency during pregnancy, yet there are few data on the effect of prenatal iron supplementation in women in developing countries. Objective: Our objective was to describe the effect of iron supplementation on hematologic changes during pregnancy, and the effect on those changes of adding zinc to the supplements. Design: Pregnant women were enrolled in a randomized, double-masked study conducted at a hospital in a shantytown in Lima, Peru. Women were supplemented daily from 10–24 wk gestation to 4 wk postpartum with 60 mg Fe and 250 mg folic acid with or without 15 mg Zn. Hemoglobin and ferritin concentrations were measured in 645 and 613 women, respectively, at enrollment, at 28–30 and 37–38 wk gestation, and in the cord blood of 545 neonates. Results: No differences in iron status were detected by supplement type, but hematologic changes were related to initial hemoglobin status. Women with anemia (hemoglobin <110 g/L) showed steady increases in hemoglobin concentration throughout pregnancy whereas women with relatively higher initial hemoglobin concentrations had declining values during mid pregnancy, then rising values by 37–38 wk gestation. Women with an initial hemoglobin concentration > 95 g/L showed increases in serum ferritin by the end of the pregnancy. Despite supplementation, women with poorer hematologic status; who were younger, single, and multiparous; and who consumed fewer supplements were more likely to have anemia at the end of pregnancy. Conclusions: These hematologic changes are congruent with the effects of iron supplementation reported in placebo-controlled trials and the addition of zinc did not significantly affect them. [author abstract] [Am J Clin Nutr 2000; 71: 956–61]
- eHealth in Peru: A country case study
"While Peru has had impressive economic growth (GDP growth rate of 8.0%) half of the people live in poverty with uneven access to health care (Lima and coastal cities greatest access). Infectious diseases like tuberculosis, HIV/AIDS, malaria, leishmaniosis, Chagas’ disease, dengue, Bartonellosis, yellow fever, anthrax, and plague remain major public health problems – most of which are under surveillance with mandatory notification either on individual forms or tally sheets. The Peruvian Health System is characterized by the fragmentation in various attention subsystems: the public health system (Ministry of Health, EsSalud – the Social Security System and the Military Health System – Armed Forces, Navy, and the National Police-); and the private health system (clinics, private doctor's offices, and NGOs). The telecommunications market, meanwhile, has experienced great growth after the privatization of the sector, although there is room for further growth, especially outside Lima and in rural areas. Mobile telephony is the most dynamic sector. The rapid growth rate of mobile telephony could be a great opportunity for the deployment of mobile health applications, not only for health care workers but also for the general public. Under the current disease monitoring system, it can take up to one month (or more) for a notification from a remote area to reach the central level. A disease monitoring system used by the Navy leverages the already existing telephony infrastructure (fixed, mobile, or satellite) to increase the reach of its system and to dramatically reduce the time of remote notifications to get to the central level. Currently, there is no systematic and wide use of mobile health applications in the Ministry of Health and EsSalud (the two biggest players in the health care sector). Up to now, the use of mobile health applications has been mainly restricted to pilot projects and the delivery of SMS alerts. In addition, the unique popularity and low cost of Internet cafes in the country open new possibilities for developing future eHealth systems that can reach the majority of the population." [American Medical Informatics Association – Second version, August 2008]
- Emergency Contraception in Peru: Shifting Government and Donor Policies and Influences
Inclusion of emergency contraception in national family planning programmes is consistent with international agreements that countries should strive to ensure access to a wide range of contraceptive methods and promote voluntary, informed choice. Yet in 2005, USAID/Peru requested that its NGO grantees in Peru take a ‘neutral’ position on emergency contraception in activities or materials that involve its funds. For many decades, donor countries have viewed conservative religious forces in low-income countries as an obstacle to expanding family planning programmes. Today, however, far-right organisations in the United States are having an unprecedented influence on US public policy, including in countries such as Peru. This article analyses shifts in USAID/Peru’s policy on emergency contraception in Peru since 1992. In Peru today, there is widespread official and public support for making emergency contraception available. Given USAID’s long support for family planning internationally and in Peru, the current policy appears to be the result of attacks by US far-right organisations carried out in synergy with sympathetic US public officials and anti-choice Peruvian allies. [author abstract] [Reproductive Health Matters 2007; 15(29): 139–148]
- From Anti-Natalist to Ultra-Conservative: Restricting Reproductive Choice in Peru
This article examines Peru’s population policy since the 1994 International Conference on Population and Development and assesses to what extent its policies and programmes have affected reproductive health and rights. It is drawn from data collected during ongoing monitoring of sexual and reproductive health policies and programmes in Peru since 1998 for the Center for Health and Gender Equity (CHANGE). Accomplishments since 1994 in Peru demonstrate good faith on the part of the government and foreign donors to make progress towards fulfilling the ICPD agenda by addressing key reproductive health concerns and promoting women’s rights. Unfortunately, this progress has not been consistent. It has been overshadowed by two periods of anti-choice policies and interventions. The first, in 1996–97 under the Fujimori government, was a demographic approach that used numerical targets and undue pressure on women to accept sterilisation as the government’s main poverty reduction strategy, which led to documented abuses. The second, in 2001–03 under the Toledo government, was a far-right approach that worked to limit access to essential services, including emergency contraception, condoms and post-abortion care. In spite of their contradictory nature, these two policy approaches have been the greatest obstacles to making long-lasting improvements to reproductive health and rights in Peru. [author abstract] [Reproductive Health Matters 2004; 12(24): 56–69]
- Health in the Americas 2007: Peru
As a health agency, the Pan American Health Organization’s core discipline is epidemiology, which enables the measurement, definition, and comparison of health problems and conditions and their distribution from the perspectives of population, geography, and time. This publication on Peru addresses the issue of health as a human right, taking into account both the individual and community contexts, and examines various critical determinants of health, including those of a biological, social, cultural, economic, and political nature. That examination reveals the existence of gaps, disparities, and inequities that persist in Peru, especially those related to access to basic services, health, nutrition, housing, and adequate living conditions as well as to the lack of opportunities for human development—all of which contribute to the greater vulnerability to diseases and health risks of some population groups. [Adapted from the preface of Health in the Americas 2007]
- Health Worker Salaries and Benefits: Lessons from Bolivia, Peru and Chile: Final Report
"Bolivia, Peru and Chile are: i) shortage of health workers, disparity of skills (many specialized physicians, few general physicians or public heath specialists), ii) poor distribution of health workers, iii) inadequate working environments, including technological deficiencies; and, iv) low knowledge about the characteristic of HWSB, which impedes planning. The data collected about Bolivia, Peru and Chile shows that in general, the wages of doctors during the last fifteen years have had to increase more than the wages of other works (a similar phenomenon occurring with education workers). Health workers salaries respond to many different criteria. The basic salary represents between half and two-thirds of the total income. The rest is made up of time-on-the-job bonuses, bonuses for working in remote areas, adjustments for advanced studies and other special designations. Several political and economic variables play in the determination of salary levels. Amongst the political factors are the bargaining power of unions and other groups (professional bodies, for example). In the economic arena, economic growth and inflation are important factors. Regarding policies oriented to recruit and retain health worker, the public sector continues to be, in these countries, the largest employer and in general has no major problems finding employees, with the exception of specific specialties which arise from time to time. Retention, however, is growingly difficult due to the fact that the private sector offers better working conditions. In face of this, the public sector in these countries has chosen to allow health workers to make their services available both to the public and private sectors." [WHO, April 2008]
- Human Rights & Mental Health in Peru
"Human Rights & Mental Health in Peru presents the findings of a joint investigatory mission of Mental Disability Rights International (MDRI) and the Asociación Pro Derechos Humanos (APRODEH, Association for Human Rights) in October 2002 and February 2003 on the human rights of people with mental disabilities in Peru. During these investigations, the research teams met with a broad array of non-governmental advocacy groups, including human rights organizations, mental disability rights groups, family organizations, the Association of Psychiatrists, communities displaced by political violence, and government representatives. Investigation teams also visited facilities for people with psychiatric and developmental disabilities, a prison ward, the psychiatric units in a social security and a police hospital, and general health services in a rural community. This report assesses Peru’s compliance with national and international standards for the treatment of persons with mental disabilities, highlights successful community-integrated programs in Peru, and provides recommendations for reform of mental health and social service systems." [Mental Disability Rights International, September 2004]
- Informe Nacional sobre los progresos realizados en la aplicación del UNGASS. Perú. Periodo 2006-2007
"Cuando se habla de la epidemia del VIH/Sida en el Perú, nos remontamos a 24 años atrás; es decir al año 1983 en que el primer caso de SIDA fue reportado, y según datos oficiales de la Dirección General de Epidemiología (DGE) – MINSA, se tiene 19,748 casos SIDA y 28,178 casos VIH notificados hasta diciembre del 2006. En el último reporte a noviembre del 2007 se reportan 20394 casos de SIDA y 30282 casos de VIH pero requiere ser actualizado por las regiones que todavía no han realizado sus reportes a la DGE. La mayoría de los casos proceden de las ciudades y departamentos con mayor concentración urbana de la costa y de la selva (Lima-Callao, Loreto, Ica, Lambayeque, La Libertad, Ucayali, Arequipa, Junín, Piura, Ancash) y su diseminación correlacionaba con la mayor densidad poblacional y los flujos migratorios: Lima y Callao contienen el 73% de los casos registrados."
- Late-life depression in Peru, Mexico and Venezuela: the 10/66 population-based study
Background: The proportion of the global population aged 60 and over is increasing, more so in Latin America than any other region. Depression is common among elderly people and an important cause of disability worldwide. Aims: To estimate the prevalence and correlates of late-life depression, associated disability and access to treatment in five locations in Latin America. Method: A one-phase cross-sectional survey of 5886 people aged 65 and over from urban and rural locations in Peru and Mexico and an urban site in Venezuela. Depression was identified according to DSM–IV and ICD–10 criteria, Geriatric Mental State–Automated Geriatric Examination for Computer Assisted Taxonomy (GMS–AGECAT) algorithm and EURO–D cut-off point. Poisson regression was used to estimate the independent associations of sociodemographic characteristics, economic circumstances and health status with ICD–10 depression. Results: For DSM–IV major depression overall prevalence varied between 1.3% and 2.8% by site, for ICD–10 depressive episode between 4.5% and 5.1%, for GMS–AGECAT depression between 30.0% and 35.9% and for EURO–D depression between 26.1% and 31.2%; therefore, there was a considerable prevalence of clinically significant depression beyond that identified by ICD–10 and DSM–IV diagnostic criteria. Most older people with depression had never received treatment. Limiting physical impairments and a past history of depression were the two most consistent correlates of the ICD–10 depressive episode. Conclusions: The treatment gap poses a significant challenge for Latin American health systems, with their relatively weak primary care services and reliance on private specialists; local treatment trials could establish the cost-effectiveness of mental health investment in the government sector. [author abstract] [The British Journal of Psychiatry 2009 195: 510-515]
- Mainstreaming mental health policy in Peru
"The late 1990s in Peru marked the tail end of 20 chaotic years of violence between Shining Path revolutionaries and government forces. Caught in the crossfire were millions of indigenous, rural and poor Peruvians. Some 70,000 died or disappeared, and a million-plus were displaced into crowded cities, with traumas often leading to mental or behavioural disorders. Individuals bore the mark of a wider social epidemic of violence to others, self-inflicted injury, suicide, gender violence and other psychosocial reactions. Yet governments, development funding agencies, NGOs and society shunned attempts to address mental health issues." [University Partnerships in Cooperation and Development (Canada), March 2006]
- Measuring medicine prices in Peru: validation of key aspects of WHO/HAI survey methodology
Objectives: To assess the possibility of bias due to the limited target list and geographic sampling of the World Health Organization (WHO)/Health Action International (HAI) Medicine Prices and Availability survey used in more than 70 rapid sample surveys since 2001. Methods: A survey was conducted in Peru in 2005 using an expanded sample of medicine outlets, including remote areas. Comprehensive data were gathered on medicines in three therapeutic classes to assess the adequacy of WHO/HAI’s target medicines list and the focus on only two product versions. WHO/HAI median retail prices were compared with average wholesale prices from global pharmaceutical sales data supplier IMS Health. Results: No significant differences were found in overall availability or prices of target list medicines by retail location. The comprehensive survey of angiotensin-converting enzyme inhibitor, anti-diabetic, and anti-ulcer products revealed that some treatments not on the target list were costlier for patients and more likely to be unavailable, particularly in remote areas. WHO/HAI retail prices and IMS wholesale prices were strongly correlated for higher priced products, and weakly correlated for lower priced products (which had higher estimated retailer markups). Conclusions: The WHO/HAI survey approach strikes an appropriate balance between modest research costs and optimal information for policy. Focusing on commonly used medicines yields sufficient and valid results. Surveyors elsewhere should consider the limits of the survey data as well as any local circumstances, such as scarcity, that may call for extra field efforts. [author abstract] [Rev Panam Salud Publica. 2010; 27(4): 291–299]
- Medicine Prices, Availability, Affordability and Price Components in Peru
"In 2006 Health Action International’s Coordinating Office for Latin America and the Caribbean (AIS-LAC) undertook a survey measuring medicine prices, availability, affordability and component costs in Peru, using the World Health Organization and Health Action International (WHO/HAI) price measurement methodology. The purpose of the study was to measure the price people pay for medicines, and their availability, in various sectors and regions of the country as well as the government procurement price, the affordability of standard treatments for patients on low wages, and all the costs in the supply chain from the manufacturer to the patient (taxes, mark-ups etc)." [Health Action International, Latin American Coordination Office, July 2007]
- Poverty, Health Infrastructure and the Nutrition of Peruvian Children
After the Peruvian economic crisis of the late 1980s, the 1990s witnessed a significant pro-poor expansion of the country’s health infrastructure that was instrumental in increasing preventive and primary health care expenditures. Using empirical evidence, this paper discusses the effect of this expansion in health infrastructure on child nutrition in Peru, as measured by the height-for-age z-score. Using a pooled sample from the 1992, 1996 and 2000 rounds of the Peruvian DHS, this analysis controls for biases in the allocation of public investments by using a district fixed effects model. The econometric analysis finds a positive albeit small effect of the expansion of the last decade. After desegregating by type of location, however, the effect was found to be significant only in urban areas. Furthermore, the effect is highly nonlinear and has a pro-poor bias. The estimated coefficient for health infrastructure in less endowed districts is 10 times higher than that in the better-endowed districts. The pro-poor bias refers to the fact that the estimated effect is larger for children of less educated mothers. In this sense, this policy seems to have had a pro-poor bias within urban areas, while at the same time excluding the rural population, a traditionally marginalized population group in Peru. These findings support the idea that reducing distance and waiting time barriers may be necessary, but that more explicitly inclusive policies are required to improve the health of the rural poor, especially indigenous groups, so that they can escape this kind of poverty trap. [publication abstract] [Inter-American Development Bank (Banco Interamericano de Desarrollo) & Latin American Research Network (Red de Centros de Investigación), Research Network Working Paper #R-498, March 2004]
- Prevalence of HIV, Herpes Simplex Virus-2, and Syphilis in male sex partners of pregnant women in Peru
Background: Sexually active heterosexual men may represent an important risk factor for HIV infection and STI transmission to their female partners and unborn children, though little is known about the prevalence of STIs in this population. We sought to determine the prevalence of HIV, herpes simplex virus type 2 (HSV-2), and syphilis infection and associated risk behaviors among male sex partners of pregnant women in Peru. Methods: Survey and seroprevalence data were collected from 1,835 male partners of pregnant women in four cities in Peru. Serum was tested for antibodies to HIV, HSV-2, and syphilis. Results: Among the 1,835 male participants, HIV prevalence was 0.8% (95% CI = 0.5-1.4%), HSV-2 16.0% (95% CI = 14.3-17.8%), and syphilis 1.6% (95% CI = 1.0-2.2%). Additionally, 11.0% reported a lifetime history of intercourse with men, and 37.1% with female sex workers. Unprotected intercourse with men during the previous year was reported by 0.9% and with female sex workers by 1.2%. Conclusions: Pregnant women’s sex partners reported lifetime sexual contact with core risk groups, had an elevated prevalence of HSV-2, and demonstrated the potential to spread HIV and other STIs to their partners. Though the prevalence of HIV in the population was not significantly higher than observed in other samples of heterosexuals in Peru, the risk of HIV transmission to their female partners may be exacerbated by their increased prevalence of HSV-2 infection. Further study of heterosexual populations is necessary to fully understand the epidemiology of HIV/STIs in Latin America. [author abstract] [BMC Public Health 2008, 8:65]
- Prevalence of smoking and other smoking related behaviors reported by the Global Youth Tobacco Survey (GYTS) in four Peruvian cities
Introduction: In 2004, Peru ratified the Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) and in 2006 passed Law 28705 for tobacco consumption and exposure reduction. The Global Youth Tobacco Survey (GYTS) provides data on youth tobacco use for development of tobacco control programs. Findings from the GYTS conducted in four main cities in Peru in 2000 and 2003 are reported in this paper and can be used to monitor provisions of the WHO FCTC. Methods: The GYTS is a school-based survey that uses a standardized methodology for sampling, questionnaire construction, field procedures, and data management. In total, 5,332 and 7,824 students aged 13 to 15 years participated in the 2000 and 2003 surveys conducted in Huancayo, Lima, Tarapoto and Trujillo. Results: In both years, Lima had the highest lifetime (54.6% and 59.6%) and current use of tobacco (18.6% and 19.2%) of the four cities. According to gender, boys smoked more than girls and less than 20% of students initiated smoking before the age of 10. Among smokers, more than 60% bought their cigarettes in a store with no restriction for their age, and approximately 12% had ever been offered “free cigarettes”. Around 90% of students were in favor of banning smoking in public places. Changes between 2000 and 2003 included an increase in the percentage of smokers who wanted to have a cigarette first thing in the morning in Tarapoto (from 0% to 1.2%) and a decrease in exposure to tobacco at home in Huancayo (from 23.7% to 17.8%) and Trujillo (from 27.8% to 19.8%) Conclusion: While few changes in tobacco use among youth have been observed in the GYTS in Peru, the data in this report can be used as baseline measures for future evaluation efforts. At this time, tobacco control efforts in Peru need to focus on enhancing Law 28705 to include enforcement of existing provisions and inclusion of new laws and regulations. Most of these provisions are required of all countries, such as Peru, that have ratified the WHO FCTC. [author abstract] [BMC Public Health 2008, 8 (Suppl 1): S2]
- Public health infrastructure and equity in the utilization of outpatient health care services in Peru
This article analyzes the magnitude and nature of socioeconomic differences in the utilization of outpatient health care services in Peru. In particular, it explores the potential equity-enhancing effect of the expansion and improvements in the network of health centres during the 1990s. The Peruvian health reform made relatively little progress in terms of the reform agenda promoted internationally during the 1990s. Nevertheless, the expansion of the public network of health centres and the improvements in their equipment has been noteworthy during the same period. Using the 1997 survey of the Peruvian Living Standards Measurement Study (PLSMS), we find large differences in the utilization of outpatient health care services. The richest to poorest quintile ratio is 1.9, and even larger in rural areas. Estimating a probit model with random effects at the district level to control for the systematic geographic bias associated with the optimal public allocation of such infrastructure, we find the income effect to be very large, even after controlling for other socioeconomic characteristics. Finally, we also find that the expansion of the public network of health centres has indeed an equity-enhancing effect, but this is rather small. These results indicate that although the expansion of the public network of health facilities may be necessary, it is not sufficient to promote equity in the utilization of health care services by Peruvian adults, especially in rural areas. It is important to look deeper into the costs of consultations and drugs as economic barriers to the utilization of health services by the poor. In particular, the expansion of health insurance mechanisms for the poor should be carefully monitored and evaluated. [author abstract] [Health Policy and Planning; 17 (Suppl 1): 12–19, 2002]
- Reappearance of Aedes aegypti (Diptera: Culicidae) in Lima, Peru
We report here the reappearence of Aedes aegypti in the Rimac district, and summarize the history of this mosquito species in Peru since its first detection in 1852. On March 17 2000 were found Ae. aegypti and Culex quinquefasciatus in Mariscal Castilla town, Flor de Amancaes, San Juan de Amancaes, El Altillo and Santa Rosa in the Rimac district, Lima Province. [author overview] [Mem Inst Oswaldo Cruz, Rio de Janeiro, Vol. 96(5): 657-658, July 2001]
- Serologic Evidence of Human Ehrlichiosis in Peru: Short Report
A serosurvey for human ehrlichiosis caused by Ehrlichia chaffeensis and Anaplasma phagocytophilum was performed in different regions of Peru by using indirect immunofluorescence assays (IFAs). Regions included an urban community in a shantytown in Lima (Pampas) and three rural communities located on the northern coast of Peru (Cura Mori), in the southern Peruvian Andes (Cochapata), and in the Peruvian jungle region (Santo Tomas). An overall E. chaffeensis seroprevalence of 13% (21 of 160) was found by IFA. Seroprevalences in females and males was 15% (16 of 106) and 9% (5 of 53), respectively. Seroprevalences in Cura Mori, Cochapata, Pampas, and Santo Tomas were 25% (10 of 40), 23% (9 of 40), 3% (1 of 40), and 3% (1 of 40), respectively. Seroprevalences in Cura Mori and Cochapata were significantly higher than in Santo Tomas or Pampas (P < 0.01). No sera were reactive to A. phagocytophilum . These findings suggest that human infection with E. chaffeensis occurs in Peru. Further studies are needed to characterize Ehrlichia species in Peru, their vectors and their clinical significance. [author abstract] [Am. J. Trop. Med. Hyg., 80(2), 2009, pp.242–244]
- The Effects of Education on Fertility in Colombia and Peru: Implications for Health and Family Planning Policies
Previous studies have found that education and fertility are inversely related. However, the extant literature on the effects of education in Latin America has been limited by certain methodological problems. In particular, previous studies have used estimation methods that were prone to statistical bias, and they have frequently neglected to examine rural areas, where education is likely to have a large effect on fertility. In this paper, we attempt to improve upon our understanding of education and fertility in the region. Employing data from some of the most recent Demographic and Health Surveys (DHS) in Latin America, we test complementary hypotheses about the effects of education on fertility in Colombia and Peru. The effects of the independent variables are estimated using negative binomial regression. We also discuss the broader implications of the findings for family planning policies and regional public health governance in Latin America. [author abstract] [Global Health Governance, volume I, no. 2 (Fall 2007)]
- The epidemiologic transition in Peru
"In 1971, Omran formulated the epidemiologic transition theory, which builds on the demographic transition theory but also includes the changing patterns in diseases and the causes of death. He recognizes that the epidemiologic transition of non-industrialized societies differs fundamentally from the epidemiologic transition in the developed (Western) world. Omran’s non-Western transition model describes the epidemiologic changes over time in developing countries in terms of three stages: “the age of pestilence and famine,” “the age of receding pandemic,” and “the age of triple health burden.” This paper explores the epidemiologic transition in Peru." [Rev Panam Salud Publica/Pan Am J Public Health 17(1), 51-59, 2005]
- The National Response to the HIV/AIDS Epidemic in Peru: Accomplishments and Gaps — A Review
In Peru, after the first case of AIDS was reported in 1983, nearly 20,000 AIDS cases have been notified to date and between 20,000 and 79,000 persons are estimated to be living with HIV. Despite a relatively low HIV prevalence in the general population, the epidemic has importantly mobilized social actors and economic resources and has helped articulate a very active field within the Peruvian health sector. In recent years, the country has become the largest recipient of HIV funding from the Global Fund for AIDS, Tuberculosis, and Malaria in Latin America, for which a substantial national counterpart has been committed. Peru’s predictable selection as one of the 12 focal countries for the 5-year impact evaluation of the Global Fund suggested that an analysis of the response to the HIV epidemic in Peru may provide significant lessons on the possibilities of international aid in the AIDS field, particularly in the Latin American context. This article presents an analysis of the impact of the HIV/AIDS epidemic and the nature of the response articulated by the State and civil society in Peru, based on the Universal Access Principles proposed by World Health Organization, UNAIDS, and others. Relying on a number of recent secondary sources, we focus not only on the impact of the epidemic on morbidity and death but also on the changes in society as a whole, particularly in social movements and their dynamic relationship with the State. We start with an epidemiological overview and move to describe the role of social actors in response to the epidemic and then propose a framework for the analysis of the scope and limitations of the national response and elaborate on potential courses of action that may lead to strengthen accomplishments and resolve remaining gaps. [author abstract] [J Acquir Immune Defic Syndr Vol. 51, Suppl 1, 1May 2009, pp.S60-S66]
- The Politics of Health Sector Reform in Peru
"This paper provides an overview and analysis of the politics of Peru’s health sector reform process of the 1990s, thus tracing the variables and processes that led to the weak reform policies in place today. The paper begins with a general overview of the sector, including reform context, spending patterns, structure of the sector and basic health indicators. This is followed by an examination of the macro-political factors that influenced the reform process. I then shift to the national level politics involved, tracing the formulation of four major reforms. The last section of the paper comments on the politics of implementation, and how conflicts among policies at the implementation phase has affected the overall reform content and emphasis." [Prepared for the Woodrow Wilson Center Workshops on the Politics of Education and Health Reforms, Washington D.C., 18-19 April 2002]
- The Politics of Reproductive Health in Peru: Gender and Social Policy in the Global South
This article analyzes the politics of reproductive health policymaking in Peru in the context of healthcare reform initiatives undertaken since the early 1990s. In Latin America, women’s body politics are emerging within a complex architecture of institutionalized social stratification and religious lobbies. The case of Peru is approached from a gendered, specifically South-World analysis, revealing the deep embedding of a vast constellation of reproductive healthcare issues within the nascent social welfare policy-making process. Through limited national public health insurance schemes, a new social policy model, based on a targeted poverty-reduction paradigm, is now partially addressing the reproductive health needs of the majority of Peruvian women. Policy implementation, however, is highly contested, fragile, and has been subject to setbacks and deadly abuses. The article shows that, in addressing developing countries such as Peru, the role of international actors and the impact of unconsolidated democratic institutions are two key variables in the comparative analysis of social policy regime formation. [author abstract] A similar article has been published in Spanish. [Social Politics: International Studies in Gender, State and Society, vol. 14, no 1, pp.93-125, Spring 2007]
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