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Table 5 Major policy and programmatic changes related to maternal, newborn and child health in Peru (1970-present)

From: Examining national and district-level trends in neonatal health in Peru through an equity lens: a success story driven by political will and societal advocacy

  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)