This document outlines a project to expand access to specialized healthcare for poor and excluded populations in Peru's Ancash region. It notes that while over 86,000 people in the region require specialized care, only around 6% receive it due to economic, geographic, cultural and functional barriers. The project aims to address this inequity by developing new mobile healthcare strategies to link different levels of care. It will create a model to deliver specialized services in remote areas via basic healthcare centers and involve local actors. The intervention will focus on the Ancash region, serving over 427,000 people across 390 dispersed communities located far from the existing limited specialized care options in major cities.

1. 11/1/2010
CONTENTS
EXPANDING ACCESS TO I. General Information
SPECIALIZED HEALTH CARE II. Problem
FOR POOR AND EXCLUDED III. Objectives
POPULATIONS IN THE
ANCASH REGION – PERU IV. Scope of Intervention
Authors: V. Methods
Inga Salazar, Richard
Nino Guerrero, Alfonso
VI. Results
Vigo Obando, Ina VII. Conclusions
I. GENERAL INFORMATION I. GENERAL INFORMATION
Peruvian Health System Information
Peru: Total population
28,220,764 inhabitants 73% of the population seeks medical attention in public
services provided by the Ministry of Health, which are not free.
The rest of the population seeks attention in: Social Security:
Urban population 17.9%, Armed Forces: 3%, Private: 5.9%.
75.9 %
In 2001 the Peruvian government created Public Insurance,
Poverty rate: called the “Integral Health Insurance” (SIS) to provide free
healthcare for the extremely poor and excluded population.
2005:54.%2010: 39.3%
Currently SIS coverage reaches 18.5% at a national level.
Mortality rate per 1000
Health establishments: First level centers: 8,486
live births: 6 Hospitals: 469
II. THE PROBLEM: INEQUITY AND
II. PROBLEM: INEQUITY AND EXCLUSION
EXCLUSION
In the Ancash Region, the BARRIERS ACTIONS CARRIED OUT LIMITATIONS
POPULATION OF THE PROJECT : 427,141
poor and excluded PEOPLE. BY THE GOVERMENT
NEED SPECIALIZED CARE: 86,429
population: ECONOMIC Integral Health Insurence Benefits plan includes little specialized
5,186 people receive
6%
(SIS) for the poor and healthcare.
specialized care
excluded population.
86,429 people require
specialized healthcare GEOGRAPHIC Basic attention brigades for Insufficient regarding numbers.
excluded and disperse
No reciben
Not received populations (AISPED)
Only 6% receive it 94%
atención
specialized
especializada
care FUNCTIONAL The offer is insufficient and
concentrated in the big cities.
Specialized doctors in Ancash: 0.13
Excluded and Disperse Population: area with the greatest population dispersement at a surgeons per 10,000 residents, 0.4
regional level, located more than four (4) hours on a track and by river, or the means of pediatricians per 10,000 children.
transport most frequently used by the healthcare center. R.M. 478-2009/MINSA. CULTURAL Vertical births, waiting Partially implemented.
Technical Regulation for Integral Healthcare for Excluded and Disperse
homes for pregnant women
Populations.
1

2. 11/1/2010
III. OBJECTIVE IV. SCOPE OF INTERVENTION
407 Km. Northeast of Lima
Expand access to specialized healthcare for the
427,141 (37% of regional total:
poor and excluded population through the 1’154,523 residents)
development of new mobile healthcare
390 disperse and excluded
strategies, linking the attention levels and communities
involving local actors in the Ancash Region,
44 first level centers
Peru.
10 hospitals
ANCASH REGION
V. METHODS COMPONENT 1
Component 1: Development of a mobile C C C
specialized healthcare model.
AISPED: Basic Attention and selection of cases that need
specialized healthcare Educational
Institutions
1.1 1.2 1.3 1.1 EE.SS.
c First level
c
c Specialized
Selection of Cases that need specialized healthcare
healthcare campaigns in
schools
Specialized Specialized
Selection of
healthcare healthcare 1.3
cases on the
campaigns in campaigns in Specialized healthcare campaigns
first level 1.2
local hospitals schools in local hospitals
Referrals to level II hospitals, National Hospitals and Institutes via SIS
1.1 SELECTION OF CASES ON THE FIRST LEVEL 1.2 SPECIALIZED HEALTHCARE CAMPAIGNS
IN LOCAL HOSPITALS
B
Training for the selection of cases based on prevalent E Analysis of the volume Coordination with Adaption of the
F and type demanded in the main hospital installations and
pathologies by specialty to personnel from the AISPED brigades
O order to program and local actors processes
and first level centers. R specialties
E
Standardization of instruments by specialty for the selection of
cases.
D
U Admission and External Surgery: RxQx, Monitoring the
Improvement of the brigades’ equipment for the selection of R registration of consultation, Informed consent, perceived quality,
cases: Snellen card, occlusometer, speculum, glucotest, PRAT I patients, based diagnostic aid security checklist, satisfaction
N on programming exams, medicine hospitalization surveys
equipment.
G
A
F Clinical Records Referrals via Post op follow up Report to
T Archive in the Public Insurance and delivery of Regional Health
E Main Hospital (SIS) glasses Board
R
Ophthamology Gynecology Internal Medicine Surgery
2

3. 11/1/2010
1.3
SPECIALIZED HEALTHCARE IN EDUCATIONAL
INSTITUTIONS
Odontology: Classrooms free from active cavities
Ophtamology and delivery of glasses.
Pediatric care
V. METHODS 2.1 STRENGTHENING SKILLS FOR SPECIALIZED
HEALTHCARE
Component 2: Strengthening the public healthcare
280 healthcare workers involved in specialized healthcare, trained in
sector for specialized healthcare in order to generate
service
sustainability.
35 training odontologists to manage PRAT (Atraumatic Restoration
2.1 2.2 2.3 Practice) and in surgical techniques
65 updating doctors in level I hospitals in managing transmitable
diseases, chronic illness and diagnostics through images.
30 Masters in Hospital Management
15 Masters in Medical Audit
Strengthening Improving the Strengthening the
skills for quality of reference and
specialized healthcare in counter-reference
healthcare hospitals system
IMPROVING QUALITY OF HEALTHCARE IN 2.3 STRENGTHENING OF REFERENCE AND
2.2
HOSPITALS COUNTER-REFERENCE SYSTEM
Standardization of healthcare processes for external consultations
and surgery: clinical history by specialty, pre-op evaluation and Implementation of 45 first level centers with radio
surgical risks, informed consents, surgical safety checklist in 100% communication equipments.
of the patients attended.
Implementation of medical audit system in hospitals and auto- Tele-medicine pilot: tele-electrocardiography and tele-
evaluation of quality standards. spirometry in level I hospitals, placing priority on the most
distance areas.
Satisfaction surveys carried out by external users to evaluate
quality. 84% of the attended users satisfied with the attention
received.
Improved use of information (indicators)
3

4. 11/1/2010
Chart 2: Consultations by type of specialty
Chart 1: Consultations by poverty quintile PAAES, march to November 2008
VI. RESULTS
INDICADOR DE PROPOSITO
PAAES. march to november 2008
Dentistry
24.9%
Internal
medicine
Q1 25.1%
28.54% Other
Q5
The population receiving specialized healthcare 0.01% Q2 specialties
1.9%
55.64%
increased from 6% to 27%. Q3
15.77%
POPULATION OF THE PROJECT : 427,141 PEOPLE. Q4 Surgery
.
Need Attention: 86,429 0.04% 2.7%
Pediatrics Ophthalmolog
Gynecology
23,383 people receive 12.3% 11.2% y
22.0%
specialized care
Chart 4: Ten leading causes of general morbidity
PAAES: March - November 2008 Chart 3: Attended by age group
PAAES March a November. 2008
27% 45.00%
60.0%
48.2%
40.00%
% ATD
35.00% 50.0%
% de pob 2008
30.00%
25.00% % 40.0%
ACUM
73% 20.00%
30.0%
20.7%
20.5%
15.00%
54.8%
8.75%
5.26%
4.89%
4.66%
10.00%
4.35%
4.03%
3.54%
20.0%
10.4%
2.22%
1.94%
1.90%
Not received specialty
No reciben atención 5.00%
care
especializada 0.00%
10.0% 18.6%
TRACTO URINARIO
GASTRITIS Y
DUODENITIS
VULVOVAGINITIS
PARASITOSIS
AMETROPIA
REFRACTIVO
PRESBICIE
PTERIGION
MIOPIA
CARIES DE LA
14.9%
INTESTINAL
DEFECTO
11.7%
DENTINA
Receives some kind of
INFECCION
Reciben algun tipo de 0.0%
specialized care
atención especializada Childrens Teens Adults Seniors
VII. CONCLUSIONS
CONCLUSIONES VII.CONCLUSIONS
CONCLUSIONES
It is feasible to reduce barriers to access and
The applied methodology could be
to bring specialized attention to the poor and
used by the current Public Insurance
disperse population by applying strategies
(SIS) in order to expand access to
related to a mobile healthcare, linking
disperse populations.
attention levels and involving local actors.
The project has contributed to
Providing specialized healthcare applying
improving the quality of life of the
mobile strategies to disperse and excluded
attended population by reducing
populations is more efficent than implementing
incapacity and mortality related to
a fixed offer.
pathologies that demand specialized
healthcare.
Thanks for your
attention
richard.inga@upch.pe
4