The mortality rate is an indicator of the population health within a country. It provides the first cue for the situation of the health care system and allows identifying possible inequalities among different social groups. The choice of illustrating the case of Peru stems from cultural, professional, and personal factors. Peru is a nation with a rich history, marked by the Incas Empire, the largest pre-Columbian civilization.
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Over the last three decades, massive efforts have allowed Peru to reduce the mortality rate. The government has adopted a series of prevention policies, setting universal health coverage as a significant goal for the year 2021. However, many challenges are still to be faced, including reducing inequalities and attaining improved health care delivery. Moreover, the sudden rise of outbreaks, such as the Zika virus in 2018, does not allow lowering the guard. Finally, part of my family has Peruvian origins, which adds a sense of belonging to that culture.
Location and Geography
Peru is located on the Western side of South America, lapped by the Pacific Ocean and dominated by the Andes Mountains. The Northern area of the country folds decidedly inwards and borders with Ecuador and Colombia. The central region borders with Brazil and Bolivia, while Chile defines the Southern limit. Though located in the tropical area, Peru has a unique and varied morphology which is mirrored by different climates, ways of life, and economies (Pulgar-Vidal, Preston Moore, Burr, Davies, & Kus, 2018).
The Northern region is part of the Amazonian Rain Forest. Here, the Andes merge with the forest, and the landscape is characterized by low hills and dense tropical vegetation. The climate is typically tropical with high rainfall and hot, humid conditions.
The coastal area is a narrow plain limited by the ocean and the mountains and is characterized by one of the world’s driest climates. The Andean region, the cradle of the Inca civilization, runs from the Northern Amazonian region to the high peaks of Chile. From a geological perspective, the Peruvian Andes are a recent formation, as attested by the frequency of settling earthquakes. Part of the range consists of active volcanoes, while the Southern part of the region is more of a high plateau landscape. The Andes are formidable natural barriers and the highness of most passes has always hindered communications and transports across the country.
The geographical variety is reflected in the differences among the population, consisting of various ethnic groups, each carrying its own culture and way of life. Quechua Indians represent almost half of the inhabitants of Peru. They are the descendants of pre-Hispanic civilizations and are scattered across the mountainous areas of the country. Quechua Indians live in extreme poverty and look at the rest of the world with a sense of indifference (Pulgar-Vidal et al., 2018). The Mestizos, made up of people of both Indian and European descent, are the second largest ethnic group and they account for a third of the total population. Other minorities, such as Japanese and Aymara Indians, are also present.
The minorities of European descent hold most of the political power. Until the turn of the millennium, the most recent history of Peru is marked by harsh internal struggles where the violation of human rights was the norm. Since 1993, Peru is a representative democratic republic, and the legislative function is performed in the unicameral Congress of the Republic. The president, elected every five years, holds the highest office within state institutions and designates the council of ministers; the prime minister and two vice-presidents assist the president in ruling the country. Peru is divided into 25 administrative regions, which are further divided into departments, provinces, and districts.
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Most of the economy of Peru revolves around the fishing industry and exportation of raw materials. Peru is especially rich in silver, copper, zinc, lead, and bismuth. The scarcity of cultivable lands and the cyclical destruction of agricultural plants and transportation roads make farming unproductive on a large scale. Despite a series of privatizations that boosted the economy over the 1990s, Peru is still a developing country, with a sizable share of population below the poverty line, especially among Quechua Indians (“Peru population below poverty line,” 2018).
Currently, Peru is implementing international economic policies to improve the economy further. For example, in 2011, Peru, Mexico, Colombia, and Chile created the Pacific Alliance to improve intraregional commerce, encourage integrated production, and promote investment (Reyes, Cheyne, & Useche, 2018). Privatization and efforts at adequate production and trade up to international standards express Peru’s desire for a modern and stable economy.
State of Health (Diseases/Violence/Accidents)
Social inequalities and difference in accessing health care and sanitation are significant in defining the determinants to estimate the state of health in Peru. For example, the percentage of people living in total poverty was 21,8% in 2015, but the rate increased in rural areas to 32,5%, and even more among the Aymara Indians – 33,4% (Pan American Health Organization, 2017). Differences are also evident in access to sanitation.
In 2015, 66.8% population had access to the public sewerage system, with 84.9% in urban areas and 15.6% in rural areas (PAHO, 2017). The most common causes of death are associated with respiratory diseases – 21% – followed by neoplasms and circulatory problems. External causes, such as accidents and murders, account for 11% (PAHO, 2017). The recent insurgence of dengue fever and Zika virus infection is a warning about the possible recrudescence of dramatic epidemics.
Traditional medicine is deeply rooted in Peruvian culture and it holds a significant part in the economy of the country. The use of herbal remedies in the Peruvian Andes dates back to the Inca Empire and it has been documented in the fifteenth century for the first time (Elferink, 2015). Today, the Inca tradition survives in popular healing practices and common habits in everyday life. Remarkably, 50% of the Peruvians resort to traditional medicine as the preferred treatment (Ablard, 2016).
Since the late 1990s, Peru has been developing a program to integrate traditional medicine within the formal health system. The project is the result of a joint effort among PAHO and several clinics and hospitals (Caceres, Ribas, Gaioli, Quattrone, & Macchi, 2014). Obesity, asthma, and migraine headache are some of the conditions treated with traditional medicine.
Healthcare System and Delivery
Peruvian health system constitutes public and private agencies and insurers. The Ministry of Health should provide funds to cover the whole population, but most public hospitals do not receive enough funding; also, insurance payment procedures are so complicated that many Peruvians pay for their treatment (World Health Organization, n.d.). Recently, the government has determined universal health coverage as a primary goal.
By the year 2021, the entire population should have access to comprehensive care, regardless of their social status, income, and geographical location (“Ministerio de Salud”, 2018). Apart from universality, the program aims at improving equity, efficiency, solidarity, and sustainability, among others. To date, however, the delivery of health care is characterized by the lack of hospitals and health care facilities, and by the shortage of nurses and physicians.
Governmental health-related agencies and health regulatory organizations
Within Peruvian health system, five distinct groups provide health care services:
- The public sector, comprising the Ministry of Health and the regional governments;
- Social Health Insurance; the Armed Forces and National Police health service;
- The Metropolitan Solidarity System, which operates within the Lima metropolitan area;
- Private sector.
Healthcare personnel and hospitals
In 2012, there was a ratio of 151 nurses and 113 physicians per 100,000 population. The number of beds per 100,000 population was 150, distributed across more than 450 hospitals, clinics and healthcare centers around the country (Jiménez, Mantilla, Huayanay, Mego, & Vermeersch, 2015; WHO, n.d.). A large amount of private clinics are also available; however, due to their steadily increasing amount and the lack of adequate research in the private sector, it is difficult to quantify its coverage.
Nursing education system and accrediting organizations
Several schools and universities offer training programs for nurses. In 2003, there were 25 public and 19 private accredited institutions (WHO, n.d.). In 2013, 45 universities had enrolled at the National Council of University Evaluation and Accreditation, responsible for accrediting university education in Peru (Jiménez et al., 2015). A 2018 research on nursing education identified 72 universities offering nursing training (Condor, Sanchez Alvarez, & Bidman, 2018). Some of the universities providing nurse training are the Universidad Peruana Cayetano Heredia, the Universidad Católica Los Angeles de Chimbote, and the Universidad Peruana Cayetano Heredia.
The spread of the nursing profession is demonstrated by the increasing number of nursing associations. General associations include the Federación de Enfermeros de Peru, the Asociación Peruana de Enfermería, the Colegio de Enfermeros del Perú, and the Federación de Enfermeras del Ministério de Salud del Perú. Some associations are more specialized, such as the Asociaciòn Peruana de Enfermeros en Oftalmologìa, and the Instituto Nacional de Enfermedades Neoplásicas.
Although Peru is on the right path to developing an efficient and sustainable health care system, the country is still far from reaching the goal of universal health coverage in 2021 and the creation of a modern infrastructural sanitation system is yet to be developed. From the structural perspective, decentralization is a priority to deliver improved health services across the whole country, reshape bureaucracy, and strengthen management abilities.
From the state of health perspective, the Ministry of Health should undertake a series of measures aimed at reducing the weight of infectious diseases and at monitoring yellow fever, dengue, malaria, and Zika infection. Efforts should also be made to spread the culture of prevention of chronic non-communicable conditions such as neoplasms. Finally, educational training for nurses should be improved, thus, increasing uniformity among different programs and promoting the exchange of information among various health care sectors.
Conclusion: Nursing Implications
The Peruvian government has set a series of steps for a modern culture of the health care delivery, but many obstacles hinder the full and quick achievement of the targets. Within this scenario, the role of nurses is paramount to raise awareness of health care in several ways. First, they should spread their knowledge among the population, explaining the benefits of a healthy lifestyle, raising a collective consciousness of improved hygiene, and pushing decision-makers to adopt policies for adequate sanitation.
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Secondly, nurses should share their experience to influence society into shaping appropriate working environments, where patients are the focus of the system, and where nurses and clinicians can perform their functions safely and effectively. Nurses play an irreplaceable role, raising their voice to stand for human rights, influencing changes policies, and promoting a healthy lifestyle among the population.
Ablard, K. (2016). Exploring aromatherapy as a form of traditional aromatic plant medicine in Peru. Web.
Caceres, G. P., Ribas, A., Gaioli, M., Quattrone, F., & Macchi, A. (2014). The state of the integrative medicine in Latin America: The long road to include complementary, natural, and traditional practices in formal health systems. European Journal of Integrative Medicine, 7(1), 1-8. Web.
Condor, D. F., Sanchez Alvarez, K., & Bidman, A. (2018). Nursing informatics training in undergraduate nursing programs in Peru. Studies in Health Technology and Informatics, 250(81). Web.
Elferink, J. G. R. (2015). The Inca healer: Empirical medical knowledge and magic in pre-Columbian Peru. Revista de Indias, LXXV(264), 323-350. Web.
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