Committee on Economic, Social and Cultural Rights


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Physical health

189. The health system comprises two subsectors: the public system (MINSA, Essalud, and the Health Service of the Armed Forces and the Police) and the private sector (health service providers, clinics, etc.).

190. Generally speaking, doctors, nurses, obstetricians and dental surgeons are concentrated in the most developed departments and regions. The Ministry of Health administers 84.7 per cent of the establishments in the sector. The regions with the greatest availability of health establishments are Madre de Dios, Pasco and Amazonas.

191. For ten years, vaccination coverage for all the main diseases has been over 85 per cent. Pre-natal care coverage (4 or more tests) is 87 per cent, while the figure for institutional births is 70.4 per cent. The use of contraceptives is high in the country. 70.5 per cent of women of childbearing age with partners use some form of contraception (46.7 per cent use a modern method, 22 per cent traditional methods and 1.8 per cent folk methods)

192. Since its introduction, coverage under the Comprehensive Social Security Scheme has been increasing, with some 3.5 million joining it in 2005. Membership is greater in rural areas and among the poorest quintile.

Please indicate whether Peru has a national health policy. Indicate whether it has adopted the WHO approach to primary health care as part of its health policy. If so, what measures have been adopted to provide primary health care?

193. Peru has a Coordinated National Health Plan97 (PNCS), drawn up on the basis of a broad participative process98, which sets the objectives and health goals in the medium and long term for the period 2007-20011.

194. In this Plan, the country’s health problems are grouped under three main headings: hygiene problems, problems concerning the functioning of the health service and problems relating to the determinants of health. It also emphasizes that problems relating to water and sanitation, food security, education, public safety, safety of the working environment, lifestyles and poverty necessitate the participation of other government sectors.

195. Various experiments and technical and social processes attempting to identify the the country’s main health problems have been matched in Peru by political cooperation initiaves and agreements aimed at directing efforts and resources to overcome them. These problems may be summarized thus:

High rate of maternal mortality. This occurs mainly in the poorest regions excluded from the rest of the country, and is due to the high rate of pregnancy among adolescemts, to pregnancy, childbirth and postnatal complications and to lack of access to family planning methods.

High rate of child mortality. This is caused mainly by perinatal problems, acute diarrhoea and acute respiratory problems occurring mainly in the poorest and most excluded parts of the country.

High percentage of chronic child malnitrition (proteins, calories and micronutrient deficiencies) – mainly in the poorest and most excluded parts of the country

High prevalence of transmissible diseases (malaria, tuberculosis, HIV, AIDS).

High incidence of regional transmissible diseases (dengue, bartonellosis, Chagas disease, leishmaniosis, plague).

High rate of cancer mortality (neck of the uteris, breast, prostate, stomach, lung, skin and mouth)99.

196. Peru also works in close collaboration with the Pan American Health Organization and the Regional Office of the World Health Organization. In this connection, it has developed the Primary Care Services Portfolio100, which is a set of measures aimed at the different population groups (children, adolescents, women, pregnant mothers, adults and the elderly), responding to the needs and demands of the insured population101.

197. The ESSALUD Primary Care School has also been established, further to the recommendation to invest in the development of institutional human capital. It is designed as a functional organization responsible for the skill development and training of ESSALUD staff102.

Please indicate what percentage of GNP, and of national and/or regional budgets, is devoted to health. What percentage of these resources goes to primary health care? Compare this situation with that existing five and ten years ago.

198. Expenditure on health at the national level represents 4.4 per cent of GDP, the contribution of the state health budget being 1.3 per cent, while in relation to the general budget of the Republic it is 5.38 per cent. For more details, see table 29 of annex IV.

Please supply, if available, the WHO indicators in relation to the following:

Rates of infant mortality (as well as the national rate, please indicate the rate by sex, by urban and rural areas and also, where possible, by socioeconomic and ethnic groups and geographical areas. Please include the national definitions of urban and rural areas and other subdivisions).

199. Infant and child deaths per thousand births fell from 43 (urban 28 per cent and rural 60 per cent) and 59 respectively in 1996 to 21 and 29 per thousand births (urban 17 per cent and rural 27 per cent) in 2004-2006, that is to say, there was a reduction of just over 51 per cent as a result of improvements in health service coverage in rural areas, narrowing the traditional gap between urban and rural health indicators. For more details of the causes of death, see tables Nos. 7 to 11 of annex VI.

Access to adequate water supply (please distinguish between the urban and rural population).

200. The Peruvian Government, through the Ministry of Housing, Building and Sanitation, approved the National Sanitation Plan “Water is Life” 2006-2015103. The 2007 Census revealed that 3,504,658 private residences with occupants present had a domestic connection to the public network, representing 54.8 per cent nationally; 568,800 had access to the public network outside the home but within the place of residence (8.9 per cent) and 243,241 had access to drinking water through a public standpipe. At the other extreme, 16.0 per cent of homes (1,024,654) used water from rivers, irrigation channels or springs and 8.1 per cent (515,589) obtained their supply from wells. For more details, see tables 7 to 9 of annex IV.

Access to adequate sewage services (please distinguish between the urban and rural population).

201. The 2007 Census revealed that 3,073,327 (48.0 per cent) of private homes with occupants possessed sanitation connected to the public sewage system, representing 48 per cent; and 1,396,402 homes (21.8 per cent) had a cesspool or latrine. Households using rivers, irrigation channels or canals for sanitation purposes totalled 114,074 (1.8 per cent), and homes lacking such a service numbered 1,110,779 (17.4 per cent). For more information, see tables 10 and 9 of annexes IV and V.

Children immunized against diphtheria, whooping cough, tetanos, measles, polio and tuberculosis (with a breakdown by urban and rural areas and by socioeconomic group and sex).

202. According to the most recent figures available, the following percentage coverages were achieved in 2002:94.5 for polio; 94.8 for whooping cough; 95.2 for measles and 92.1 for tuberculosis. For more information, see tables 10 to 12 in annex V.

Life expectancy (with a breakdown by urban and rural areas and by socioeconomic group and sex).

203. Since 1950 the gross mortality rate in Peru has tended to fall, which is largely attributable to the decline of infant mortality. For more details, see tables 13 and 14 of annex V. The average age of death of a Peruvian is 52 years, while half the deaths in the country occur before the age of 63 – figures that vary in the interior of the country104.

204. Acute respiratory infections, disorders of the urinary system and circulatory diseases are the main causes of death, with rates of 83.5, 28.0 and 25.9 per 100,000 inhabitants respectively. Deaths by cirrhosis, events of undetermined cause (mainly traffic accidents), HIV/AIDS and tuberculosis are more prevalent among men than among women

205. In the rural environment, deaths produced by events of undetermined cause, respiratory disorders among newborn children and emergency surgery pathologies such as apendicitis have mortality rates above the national average.

Proportion of pregnant women with access to trained staff during pregnancy and the proportion assisted by such staff at childbirth. Please give figures on maternal mortality rates, both before and after childbirth.

206. In the case of women with access to trained personnel during pregnancy, there has been an increase in maternal care: prenatal care and institutional births, particularly in rural areas. For more information, see tables 21 to 26 of annex VI.

207. In 1997, the number of recorded maternal deaths was 769, compared with 513 in 2007. For more information, see tables 17 to 19 of annex VI.

Proportion of children with access to health care by trained staff. (Please give a breakdown of data by urban and rural areas and by socio-economic groups).

208. On this question, see tables 14 to 16 of annex IV.

Is it possible to say from the breakdown of any of the indicators used or by any other means whether there are some groups in the country whose state of health is considerably worse than that of the majority of the population? Please define these groups as precisely as possible, giving details. Which geographical areas of Peru, if any, are in a worse situation with regard to the health of the population?

209. The priority areas include the jungle, where the population is sparse and subject to many serious health problems because of climatic conditions favouring all kinds of tropical diseases. Responding to them is difficult because of the inaccessible nature of the areas where the native communities are located. The Sierra, for its part, contains scattered populations subject to extreme poverty, who are assisted sporadically and with great difficulty because of the financial cost of the operation.

Please indicate what measures Peru considers necessary to improve the state of mental and physical health of these vulnerable and disadvantaged groups or those living in these underprivileged areas.

210. The measures adopted by Peru that are identified as necessary in the Coordinated National Health Plan (2007) include: reduction of infant mortality by strengthening the National Immunization Strategy so as to ensure the financing of inputs and maintenance of the cold chain; adequate training for the treatment of transmissible diseases; and the inclusion of mental health benefits in the Universal Health Plan105.

211. At the same time, the Ministry of Health is providing care for children and adolescents who are the victims of violence, sexual abuse and child commercial sexual exploitation. Its approach involves training health-care workers, according to the levels of care: the primary level consists in the prevention, detection and referral of cases when required; the secondary level has involved implementing the Child Maltreatment Care Modules strategy, of which there are twelve nationwide106.

212. A Reparations Plan embodying the recommendations of the CVR exists to provide support to the victims of political violence. In the area of mental health, priority has been given to ten regions where implementation of the relevant provisions in the Plan takes place through mental health teams responsible for treating the victims of political violence.

213. With regard to highly impoverished sectors, the National Programme of Direct Support to the Poorestc– JUNTOS has identified three priority regions for mental health care, which is being provided through teams of mental health workers (nurses, psychologists and psychiatrists).

214. Other measures being implemented include: expansion and distribution of health service staff to the most needy sectors; information campaigns on generic medicines; involvement of regional and local government in expanding and improving health provision; redirecting public health spending towards the poorest areas, particularly rural ones; introducing educational measures within the community in the areas of food, nutrition, hygiene and the environment, using tested methods based on exchanges of practice (including the washing of hands by mothers and children, demonstrations of food preparation and support groups for breast-feeding mothers); promoting civic awareness of food and nutritional safety issues.

Please set out the political measures taken by Peru, within its available resources, to bring about this improvement. Please indicate the time targets and criteria for measuring achievements in this field.

Child abuse

Establishment of 6 child abuse units to care for child and adolescent victims of violence, sexual abuse and commercial sexual exploitation;

A technical directive is being prepared to integrate these units in health facilities and provide them with their own budgets;

Also being prepared is a technical directive providing for comprehensive care for child and adolescent victims of violence, sexual abuse and sexual exploitation, designed to be of national scope and to complete the whole caring process (referral centres).

Addiction

The Rapid Addiction Response Plan has been drawn up and implemented, with the aim of strengthening networks for dealing with addiction in the various regions and facilitating access by alcohol consumers, and those consuming harmful levels of alcohol, to timely comprehensive care.

Rapid Addiction Response Units have been set up in various parts of the country to provide specialized care and serve as referral centres for their respective regional networks. In 1998, the first projects were established to cater for the remote communities on the edge of the basins of the Huallaga Central and Alto Bravo rivers in San Martín and the basins of the Ene and Tambo rivers in Junín. The aim was to provide community health care by a team made up of technical and professional staff, linking up with existing local health providers

Comprehensive Health Care for Excluded and Remote Populations (AISPED)

215. In 1998, the first projects launched were focused on the remote populations located on the edge of the basins of the Huallaga Central and Alto Bravo rivers in San Martín and in the basins of the Ene and Tambo rivers in Junín. The aim was to provide community health care through a team consisting of technical and professional staff, linking up with existing local health providers.

216. In 1999, on the basis of the results of these pilot measures, the experiment was extended to 16 Health departments. In 2000, special attention was paid to organizing, developing and systematizing the experiment, strengthening monitoring and supervisory links.

217. In 2001, the Programme for the Administration of Management Agreements (PAAG) consolidated and operationalized the work of the Itinerant Local Extramural Health Teams (ELITES) as part of the strategy for improving the access, social service cover and wellbeing of the poorest sectors of the population. The ELITES are organized along standard lines and were introduced progressively throughout the Health Department’s networks or micro-networks of primary-care health facilities107.

218. As of December 2004, 152,946 new users had been enrolled at an average cost of 30 new soles for 2.15 treatments at 14.00 new soles per treatment.

219. In 2006, the number of AISPED teams was increased to 124108. For more information, see tables 15 to 17 of annex V.
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