Table 5 Major policy and programmatic changes related to maternal, newborn and child health in Peru (1970-present)
1970s | 1980s | 1990s | 2000s | 2010- to date | |
|---|---|---|---|---|---|
Political background | Military dictatorships | Transition to democracy (1980) Social violence (Shining Path: 1982–1992) with rural areas most affected | Continued democratic period, followed by an auto-coup (1992) and political instability Shining Path defeat (1992) Weak public and civil society institutions | Consolidation of democratic system and decentralisation process with mixed results Strengthened participation of civil society in policymaking and accountability | Stable democracy with continued decentralisation process with mixed results Continued strengthened participation of civil society in policymaking and accountability |
Economic growth | Economic stagnation | Inflation and foreign debt crisis Economic stagnation and recession Poverty increase | Control of inflation, sustained economic growth and GDP increase Poverty reduction Persistence of social and economic inequities | Fast economic growth and GDP increase. Further poverty reduction. Persistence of social and economic inequities. | Fast economic growth and GDP increase. Further poverty reduction. Efforts to reduce the equity gaps. Social inclusion policies. Rural areas and indigenous populations still lagging behind. |
Cross-cutting contextual policies | Agricultural reform Nationalisation of main economic industries | Economic liberalisation Formal restoration of civil rights, but with crisis of governance | Re-insertion into the international financial community Anti-terrorist policies implemented | Consolidation of market economy | Market economy consolidated. Efforts to increase investment and exports and to reach economic diversification. Extension of road infrastructure Public sector reform (including education and health) for improving efficiency and equity |
Macro health policies & systems | Establishment of 3-tiered system: Ministry of health and charitable services for poor (“Beneficencias”), social security and private | Continued implementation of 3-tiered system: Ministry of health and charitable services for poor (“Beneficencias”), social security and private | Creation of Maternal-Infant Insurance programme (1998) Continued implementation of 3-tiered system Health system strengthening efforts | Creation of Comprehensive Health Insurance (SIS) (2002) Continued implementation of 3-tiered system Health system strengthening efforts | Universal Health Insurance (AUS) (2009–2010) Continued implementation of 3-tiered system Health system strengthening efforts |
Demographic factors | Slow urbanisation Decrease in fertility rate | Urbanisation Decrease in fertility rate | Urbanisation Decrease in fertility rate | Urbanisation Decrease in fertility rate | Urbanisation Decrease in fertility rate |
Maternal & neonatal health programmes | None | None | Maternal-Infant Health Insurance programme (1998) Family planning & contraceptive initiatives (government and NGOs) Debate about violation of women’s reproductive and sexual rights. | Expansion of SIS (2002), with focus on under-5 children and mothers Cross-cutting programmes: introduction of Strategic Maternal-Neonatal Programme (2007) Stagnation of sexual & reproductive programmes | Cross-cutting programmes: scaling-up of Strategic Maternal-Neonatal Programme (2010) Stagnation of sexual & reproductive programmes |
Child health programmes | Establishment of National Immunisation Programme (1972) | Consolidation of child health vertical programmes and national immunisation campaigns Focus on child survival with low visibility of mothers and newborns | Consolidation of child vertical programmes and national immunisation campaigns IMCI introduction (1996) Focus on child survival with low visibility of mothers and newborns | Expansion of SIS (2002), with focus on children under-5 and mothers Cross-cutting programmes: introduction of Articulate Nutritional Programme (2007) | Expansion to SIS, with focus on under-5 children and mothers Cross-cutting programmes: scaling-up of Articulate Nutritional Programmes (2010) |
Non-health sector programmes | Establishment of National Program of Food Support (ONAA) and Programme of Direct Aid (PAD) Limited expansion of water supply & sanitation | Continuity of food supplementation programmes (PRONAA) Expansion of water supply & sanitation, with rural areas lagging behind | Continuity of food supplementation programmes (PRONAA) Expansion of water supply & sanitation, with rural areas lagging behind Improvement of women’s education | Introduction of conditional cash transfer programme (JUNTOS) (2005) Cross-cutting programmes (results-based budgeting) Continuity of food supplementation programmes (PRONAA) Expansion of water supply & sanitation, with rural areas lagging behind Improvement of women’s education | Scaling-up of JUNTOS Integration of social assistance programmes (MIDIS) & further emphasis on social inclusion beyond anti-poverty programmes Improvement of women’s education Non-health sector cross-cutting programmes (results-based budgeting) |