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Peru’s Healthcare System Assessment

Peru

This paper focuses on Peru, a country in South America. The paper first explains location, population, government and economy before exploring the status of health in the country. Aspects of Peru’s health under scrutiny include determinants of health, health indicators, the burden of disease, healthcare system and delivery, health priorities and nursing implications. The paper ends with a conclusion that summarizes key points.

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Location/Geography

Peru is located on South America’s western coast. Bordering countries include Columbia and Ecuador on the North, Bolivia and Brazil on the East and Chile on the South. Peru stands between the Equator and 20 degrees South latitude (Crespi, 2005; West, 2001).

Primarily, the state has three different geographical areas. The first area is the Sierra, a region of the high plateau and soaring peaks created by the Andean Mountain chain, which divides the state from North-West to Southeast. The second region is the Costa, the region with a thin coastal plain that borders the Pacific Ocean. The third region is the Selva, which is a largely undeveloped tropical area that forms the western area of the immense Amazon River Basin.

Ilama, which is the capital city, rests between the high plains of the South and central Peruvian Andes (West, 2001). Peru’s climate differs widely depending on aspect and altitude. The mean annual temperature at 3,000m above sea level is around 140C, although there is a wide daily temperature range. Rainfall is inconsistent, and thus, extremes of flooding and drought are common. Heading East from the Andien Sierra, the environment changes swiftly from semi-arid vegetation to the fertile jungle (West, 2001).

Population

Presently, Peru has a population of 29,549,517. 28.1% of this population is between 0 and14 years with 4,218,138 men and 4,074,436 females. 19.5% are between 15 and 24 years with 2,881,481 men and 2,880,772 women. 38.9% are between 25 and 54 years with 5,555,777 male and 5,953,150 female. Seven% are between 55 and 64 years with 1,008,297 male and 1,048,615 female. Last, 6.5% are 65 years and above with 916,029 men and 1,012,822 females. This data indicates that the majority of Peru citizens are at their reproductive stage (between 25 and 54 years). The data also indicates that Peru has a young population, one-third of which is below 15 years. The country has an average growth rate of 1.016% per year and the expectation is that this rate will remain steady over the next few years.

In 2010, Peru’s population below 18 years was 10447, 000, while children under 5 years were 2909, 000. The population annual growth rate between 1990 and 2010 was 1.5% and the annual population growth rate between 2010 and 2030. Is projected to be 1. The numbers of crude deaths and births have reduced over the years with the latest figure standing as 5 and 20, respectively. In 2010, 77% of Peru’s population lived in urban areas. The average growth rate of the urban population between 1990 and 2010 was 2% and the expectation I that this figure will further decline to 1.4 in the period between 2010 and 2030. This implies that rural areas have begun to develop, and thus, urban areas are not attracting many people as before.

The Coastal region has the largest population in Peru. Records show that 55% of Peruvians live on the Coast, while only 35% live in Sierra. Cities along the Coastal strip have better standards of health, access to infrastructure and better prospects for finding jobs. Eastern Amazonia has the least number of people due to underdevelopment. Peru’s largest city is Ilama, while its second-largest city is Arequipa.

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Government

Peru’s government is a constitutional republic. The republic has 25 regions and 1 province. Peru’s current head of state and President is Ollanta HUMALA. Peru has never achieved political stability although the country attained independence in 1821. Tracing back from the time of independence, Peru has had 109 presidents. Among these, only 18% entered the office through democratic elections. The rest of the presidents gained power through direct appointment by congress, president replacements, or through a military coup. Peru’s political parties have an affiliation to one person, atypical of Latin American states. The interesting bit is that the government’s leading party has never had a president.

Economy

Between 1990 and 2010, Peru experienced a Gross Domestic Product (GDP) per capita average annual growth rate of 3% and Gross National Income (GNI) per capita of US$, 4710 (UNICEF, n.d. ). The average annual rate of inflation at this time was 10%, with 10 % of the population below the international poverty line of US$1.25 per day. The economy of Peru mirrors its diverse topography, whose representation appears through a dry coastal region, the flooded Amazon and the central high sierra. Peru’s mountainous regions have different mineral resources while its deep rivers offer excellent opportunities for fishing. Since 2002, Peru has had an average economic growth of 6.4% yearly. Besides the country has had a stable exchange rate along with low inflation. According to estimations, Peru’s rate of inflation is likely to go below 3%.

For the last few years, Peru has maintained its GDP, because of an increase in private investment, particularly in the extraction segment, which makes up over 60% of Peru’s entire exports. Overemphasis on minerals and metal exports and less concentration on agriculture subjects the country’s economy to fluctuations in global prices, despite Peru’s strong macroeconomic performance. Besides, underdeveloped infrastructure hampers the extension of growth to areas that are remote to the Coast.

Since 2002, Peru’s fast growth together with cash transfers and related programs have enabled the country to record a 23 % reduction in poverty. However, inequality has remained the greatest challenge for the Ollanta HUMALA government, which has introduced a policy of equitable distribution of resources together with social inclusion. In 2009, America signed an accord with Peru, to promote business and investment between the two countries. This has largely contributed to the positive economic growth present in the economy. Two years later, Peru entered into trade agreements with three other nations including Japan, Korea and Mexico. While Peru has sustained good relationships with these countries, disputes to do with resource extraction are likely to arise, and thus the country’s economy is at stake.

State of Health

Key Determinants of Health

Gender

As of 2010, the life expectancy of females as a percentage of males was 107. This denotes that women have a higher life expectancy than men do. The adult literacy rate of females as a percentage of males at the same time was 89, implying that more men were literate than women. The number of women who enrolled in primary school was similar to the number of men, but the number of women in secondary schools and those who completed all the grades decreased.

This implies that women have a problem in transition and maintenance in secondary schools (Stewarta, Doradob, Diaz-Granadosc, Rondond, Saavedrae, Posada-Villaf, & Torres, 2009). Contraceptive prevalence in 2006-2010 was 74%, full antenatal care coverage was 93% and skilled attendant at birth was 84. This implies that the numbers of maternal deaths due to blood loss or infant mortality due to breech births are reduced (Lin, L’Orange, & Silburn, 2007).

Health Services

The government finances basic vaccines fully. In 2010, over 92% of children obtained immunization against Tuberculosis, yellow fever, Polio and Measles. Similarly, 85% obtained immunization against tetanus and 68 % of children below five with suspected pneumonia and those with diarrhea got services from healthcare providers. This implies that health services among Peruvians are easily accessible.

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Healthy Child Development

Averagely 8% of infants had low birth weight in 2010. Between 2006 and 2010, an average of 51% of children was breastfed in their early days, but less than 68% were exclusively breastfed (UNICEF, n.d. ). About 61 % of children were breastfed at age 2 and more than 81% of children became introduced to semi-solids and formulas at 6 months. This implies the nutrition of children in their early years was proper, reducing the chances of most diseases and underdevelopment of the brain. Between 2006 and 2010, only 4% of under-fives suffered from moderate & severe underweight.

Personal Health Practices and Coping Skills

Personal health practices determine health (Skolnik & Skolnik, 2012). As of 2008, 82% of the population used improved drinking water sources. However, there was a disparity in the number of people using improved drinking water sources in rural (68%) and urban areas (90%). This implies that rural populations are more prone to water-borne diseases than the urban population. In addition, 91 % of households consumed iodized salt as of 2006-2010. Thus, only 9% of the population had exposure to goitre disease.

Income and Social Status

Between 200 and 2010, 12 % of the population had the lowest share of household income at 40%, while 53 of the population had the highest share of household income at 20%. In Peru, social status mostly depends on whether one lives in a rural or urban area. Persons in urban areas have a higher social status than those in rural areas. However, Peruvians are generally poor.

Education and Literacy

Between 2007 and 2010, the primary school enrolment ratio was 97 %. In the same period, the gross enrolment ratio in the lower secondary was 98% while the Upper secondary gross enrolment ratio was 75% (UNICEF, n.d.). This implies that about 23% of students in lower secondary did not transit to upper secondary.

Between 2005 and 2010, male youths (15-24 years) had a literacy rate of 98%, while female youths had a literacy rate of 98%. This indicates that the number of literate men is more than that of women. Finally, the adult literacy rate between 205 and 2010 was 90%.

Key Health Indicators

Infant Mortality

In 1990, the infant mortality rate of children below 1 year was 55%, while this figure reduced to 15% in 2010. This indicates that the quality of health services provided to children as well as nutritional practices improved over the years.

Life Expectancy

Life expectancy at birth in Peru has increased from 48 years in 1960 to 73 years in 2008 and 74 years in 2010. This shows that standards of living have improved over the years.

Neonatal Mortality Rates

The proportion of neonatal mortality rate as of 2010 was 9%, which is rather a low amount. This indicates that post-sputum health services are excellent and more people now access health centers during child delivery.

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Under-five Mortality Rates

In 1970, the under-5 mortality rate was 164 per year and this figure reduced to 78 in 1990, 41 in 2000 and 19 in 2010. The average annual reduction was thus 7.1%. This could be due to enhanced childcare services and good feeding of children during their early years.

HIV AIDs

In 2009, HIV prevalence, among adults (aged 15-49) was 0.4 %. The estimated number of people (all ages) living with HIV, in 2009 was 75, 000. The estimated number of women (aged 15+) living with HIV, in 2009 was 18,000. This increases the risk of mother-to-child transmissions. HIV prevalence among young people aged between 15 and 24 years, in 2009 was 0.2%. Between 2005 and 2010, 19% of women (aged 15-24) who had comprehensive knowledge of HIV took preventive measures. In the same years, 33% of young women (aged 15-24), used condoms at last higher-risk sex. This implies that a big proportion of young people are likely to have HIV due to a lack of preventative measures.

Burden of Disease

The leading causes of death in Peru are diarrhea, due to the use of untreated water, and HIV/AIDs. Measured in DALYs (3,0), children below 15 years accounted for 30 percent of the world’s total burden of disease in 2010 and adults ages 15 to 59 accounted for almost 50 percent. Since Peru is a low-income country, adults below 60 accounted for a significantly larger share of the disease burden. Half of the leading causes of DALYs (3, 0) for men aged 15 to 44 are HIV/ AIDs.

Culture/Traditional Medicine

Most Peruvians have ever used traditional medicine since they have deep knowledge about the chemical composition of plants. Peruvians use word of mouth to transmit information about traditional medicine across generations. However, traditional medicine is dying slowly due to the substitution of traditional medicine with modern medicine. Presently, Peruvians use traditional medicine to sustain their cultural heritage.

Healthcare System and Delivery

Peruvian health system encompasses three groups including the Peruvian Ministry of Health, the Peruvian Social Security Health System (ESSALUD), and the Peruvian Armed Forces Health system (Garcia, Cotrina, Gotuzzo, Gonzalez, & Buffardi, 2010).

The Peruvian Ministry of Health constitutes the National STD/HIV/AIDS Control Program (ESNPETSS), the General Directorate of Epidemiology (DGE) and the National TB Control Program (ESNTB). The Peruvian Social Security Health System (ESSALUD) includes those connected to the Committee of HIV/AIDS Control (HIV ESSALUD and the Committee of Tuberculosis Control (TB ESSALUD. Peruvian Armed Forces Health system includes associated those related to TB control (TB-FFAA) and the HIV/AIDS Control and Prevention Program (COPRECOS).

Health Priorities

STD/HIV/AIDS and TB Control

Nursing Implications

Nursing professionals and nurses working in Peru should engage in clinical research aimed at establishing lasting solutions to these problems. The present healthcare workforce in Peru feels that they need more training in on particular research skills, such as protocol building and operational research design directed to prevention and treatment, rather than focus on general clinical topics such as immunology, viral and bacterial pathogenesis. The nurses desire more training in broader socio-economic aspects that surround TB and HIV diagnosis such as poverty and a culture of silence concerning HIV and TB along with human rights concerns (Barton, 2008).

In conclusion, Peru has a young population that needs health protection. The country is doing well in terms of health care delivery and this has led to a constant decline in Under 5 Mortality Rates, Infant Mortality and an increase in life expectancy. Aspects like education and Personal Health Practices and Coping Skills have significantly contributed to the well-being of Peruvians.

References

Barton, J.R. (2008). Academic training schemes reviewed implications for the future development of our researchers and educators. Medical education, 42(2), 164-169.

Crespi, J. (2005). Exploring Peru with the five themes of geography. New York, NY: PowerKids Press.

Garcia,P.J., Cotrina, A., Gotuzzo, E., Gonzalez, E., & Buffardi, A.L. (2010). Research training needs in Peruvian national TB/HIV programs. BMC Medical Education, 10(63), 1-7.

Lin, V., L’Orange, H., & Silburn, K. (2007). Gender-sensitive indicators: Uses and relevance. International Journal of Public Health, 52, 27.

Skolnik, R. L., & Skolnik, R. L. (2012). Global health 101. Burlington, MA: Jones & Bartlett Learning.

Stewarta, D.E., Doradob,L.M., Diaz-Granadosc, N., Rondond, M., Saavedrae,J., Posada-Villaf, J. , & Torres, Y. (2009). Examining gender equity in health policies in a low- (Peru), middle- (Colombia), and high- (Canada) income country in the Americas. Journal of Public Health Policy, 30 (4), 439–454.

UNICEF (n.d. ).At a glance: Peru. Web.

West, J. (2001). South America, Central America and the Caribbean. London, England: Europa.

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