The reform of the health system in Peru aimed to make health universal, equitable and solidarity. It established a path towards a system that protects the right to health for all people. The reform responded to accumulating reforms over time, including the National Agreement in 2002, a Political Parties Agreement in 2005, and laws in 2009 and 2011. The reform achieved more protected people through expanded health insurance, especially for the poor. It provided more and better care by bringing services closer through integrated primary care networks. The reform also strengthened protection of user rights and improved governance through better coordination between different levels of government.

1. THE PROCESS OF HEALTH REFORM IN PERU
JOSÉ CARLOS DEL CARMEN SARA

2. Why a Health
Reform?
We want to eliminate restrictions that
keep people from excercising their
RIGHT TO HEALTH
Establishes the path
towards a health system
that is UNIVERSAL,
EQUITABLE AND SOLIDARY
The Reform answers
to an
ACCUMULATION
PROCESS
The Reform
PROMOTES
CORRESPONSABILITY

3. The challenge against inequality
Source: ENDES 1996, 2000 and 2012. INEI.
Child mortality rate in Peru

4. THE POLICY OF HEALTH INSURE IN PERU AS A
RESULT OF AN ACUMULATION PROCESS
2002: National Agreement (13th
Policy)
2005: Political Parties Agreement
Maternal and child health
Infectious diseases
Health sector decentralization
Universal securing of health
Financing and focalization
Social participation
2007: Concerted National Plan
2009: AUS Framework Law
2011: AUS Financing Law

5. MORE
protected
people
MORE
and better care
MORE
proteccion of
rights
MORE
stewardship and
governance of
the system

6. Source: ENAHO 2002-2012
Tendency of the health insurance according to the level of poverty. 2002-2012
MORE PROTECTED PEOPLE

7. MORE PROTECTED PEOPLE
Afiliation to SIS for poor people without coverage (inhabitants of remote
areas, undocumented, residents of shelters, etc).
Afilliation to SIS for priority populations that do not have health
protection: pregnant women, children from 0 to 5 years old, students of
the initial and primary level in public schools.
Afilliation free of charge to the SIS for small independent contributors
without health insurance.
On the path to establish a model of Social Protection in universal Health,,
we are increasing SIS insurance coverage

8. Source: ENAHO 2002-2013
Tendency of the health insurance according to the level of poverty. 2002-2013
MORE PROTECTED PEOPLE

9. Source: ENAHO 2004-2013
Tendency of the health insurance in Peru according to kind of IAFAS. 2004-2013
MORE PROTECTED PEOPLE

10. MORE PROTECTED PEOPLE

11. MORE AND BETTER CARE

12. Place where people insured at SIS go for health problems attention. 2005-2011
Source: ENAHO 2005-2011
MÁS Y MEJORES CUIDADOSMORE AND BETTER CARE

13. Source: ENAHO 2005-2011
MORE AND BETTER CARE
Place where people insured at ESSALUD go for health problems attention. 2005-2011

14. Bring closer the health interventions and
services thorugh integrated nets of primary health
attention, including specialized attention
Establish a remunerative policy that encourages
the primary health attention, the specialized attention,
the work in remote areas, the responsibilities of
leadership and adequate performance
Expand the use of the existing public offer
through exchange and the provision of
complementary services
Reduce pocket spending on medication through
improvement of access to generics for people insured
by SIS
Strengthen the public offer of health services,
modernizing the management of investments and
complementing it with APP
MORE AND BETTER CARE

15. (Percentage)
Childbirths in health facilities 2000 - 2013
Urban
Total
Rural
Source: INEI - ENDES 2013
MORE AND BETTER CARE

16. Urban
National
Rural
Latin America
Death of children under one year old for each pert thousand
live births
Peru 2000-2013
Source: INEI - ENDES 2013
MORE AND BETTER CARE

17. MORE PROTECTION OF RIGHTS
Gestionar el riesgo operativo de las instituciones del sistema
Orient and protect the rights of users
Propose appropriate models of providers
Monitor the adequacy of the categorization and of accreditation of providers
Monitor the compliance with standards in the provision of health services
The National Health Superintendence is the institution that, through its
actions, induces to aggregate value to the operations of the health system
in benefit of users

18. MORE STEWARDSHIP AND GOVERNANCE
OF THE SYSTEM
Reorganize the ministry with emphasis in public health and
multisectorial actions about the social determinants of health
Strengthen the intergovernmental articulation on health
Strengthen the capacity of Regulation and Fiscalization of the health
related markets
Develop the Sectorial System of Health Information connected to the
system of monitoring and evaluation of the objetives and goals of health
and reform
Guarantee the public service in emergency situations
To make possible and sustainable the measures designed for the people

19. MORE STEWARDSHIP AND GOVERNANCE OF THE
SYSTEM

20. MORE STEWARDSHIP AND GOVERNANCE
OF THE SYSTEM
Of Coordination: Para generar acuerdos
intergubernamentales.
Of Colaboration: Bilateral and reciprocal support.
Of Cooperation: In the framework of the
respective competences.
In search of eficacy, quality and good orientation of State
intervention
Mechanisms for the Process
• Management Agreements (Convenios de Gestión) with the Regional Governments for
compliance with institutional goals, performance indicators and improvements in services,
under the DL N°1153.
• Convenios entre el SIS y los Gobiernos Regionales para pago “capitado” que estimule las
actividades de prevención y la mejora de los indicadores sanitarios.

21. MORE STEWARDSHIP AND GOVERNANCE OF THE SYSTEM
Multisectoral and Intergovernmental Alliances
Lima Respira Vida Juntos against Tuberculosis
September 11th, 2011
Agreement MINSA – ESSALUD – Regional Governments
Performance Exchange
Plan Integral Peste – Macro Norte Region
egional La LibertadRepresentants
OPS/OMS
Provincial Mayors
Plan TB Cero
Eco. Victor Salcedo R.
Mayor El Agustino
Arq. Alberto Sánchez A.
Mayor La Victoria
Coronel® Marco Álvarez
Alcalde San Borja
Dra. Carmen Masías
Presidenta DEVIDA
Preventorium for children a and adolescents