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PAHO Basic Health Indicator Data Base This is a multidimensional query tool that offers a collection of 108 indicators from 1995 to 2005. The system presents data and indicators on:
- demography
- socioeconomic
- mortality by cause indicators
- morbidity and risk factors
- access, resources and health services coverage.
Selected indicators are disaggregated into age groups, sex and/or urban/rural region. Generated tables can be exported and printed.
The data presented is updated annually with the latest country information.
GENERAL SITUATION AND TRENDS Peru is divided into 25 departments, 193 provinces
and 1,828 districts. In 2000, the country had an estimated population of 25,661,690
(an average density of 20.0 population/km2). Up until 1997, the abatement
of violence in the country, fiscal austerity with restructured public spending,
a deregulated market, and incentives for private investment stimulated the national
economy. Starting in 1998, economic activity severely contracted due to delays
in implementing State reforms for public administration, State modernization
and consolidation of the democratic system; flight of capital in connection
with international financial crises; effects of the El Niño weather phenomenon;
falling export prices; and the political crisis that ended in removal of the
elected president in 2000 and installation of the Constitutional Transition
Government in July 2001.
Demography: The average annual population growth
rate has declined from 2.8% in 1961-1972 to 1.7% in 2000. The global fertility
rate declined from 3.4 children/woman in 1993 to 2.9 in 2000 (2.3 urban and
4.6 rural; 5.1 for women without schooling ). In 2000, 72% of the population
was urban; 33.4% were under 15 years and 7.2% 60 years and over.
Economy: The real GDP per capita was US$ 2,180
in 2000. That year, 10.2 % economically active population (11.9 million) were
unemployed and 50.8% were underemployed. From 1993 to 2000, the per capita social
spending increased from US$ 91.30 (3.9% of the GDP) to US$ 180.20 (7.9%). In
addition, extreme poverty decreased from 26.8% of the population in 1991 to
14.8% in 2000, while the poor population fluctuated from 57.4% in 1991 to 50.7%
in 1997 and to 54.1% in 2000. Between 1997 and 2000, the income distributive
inequality, expressed by the ratio of the richest quintile to that of the poorest
quintile, increased from 4.9 to 7.8.
Education: Literacy
in the population aged 15 and over increased from 90.9% in 1994 to 92.8% in
2000, and the greatest improvement was among women living in rural areas, whose
rate increased from 69% to 77%. Even so, the overall literacy rate for women,
at 89.2% in 2000, remained lower than the rate for men, which was 96.7%. That
same year, the average years of schooling completed by the population over 15
was 8.5 years. Mortality:
There has been a steady drop in the crude death rate, from 21.6 to 6.5 per 1,000
population between the 1950-1955 and 1995-2000 periods, while life expectancy
at birth increased from 43.9 to 68.3 years in the same period. Nevertheless,
living conditions reflect the persistence of inequalities: the risk of dying
was three times higher in Huancavelica (13.0 per 1,000) than in El Callao (3.6
per 1,000). Worse yet was the 21-year difference in life expectancy at birth,
which was 56.8 years in Huancavelica and 78.0 years in El Callao. It is estimated
that nearly 50% of the deaths in Peru go unregistered. The adjusted estimated
communicable disease mortality dropped from 247.5 to 146.4 per 100,000 population
between 1987 and 1997. Mortality from cardiovascular diseases and from perinatal
conditions decreased to a lesser extent; in contrast, mortality from external
causes and neoplasms increased.
SPECIFIC HEALTH PROBLEMS Analysis by population groups Children (0-4 years): Thee
infant mortality rate fell from 88.2 per 1,000 live births in 1987 to 45.0 per
1,000 during the period 1995-2000. In 1998, diseases preventable by immunization,
acute respiratory infections, intestinal diseases, meningitis, septicemia, malaria,
and nutritional deficiencies all targeted by the Integrated Management of Childhood
Illness (IMCI) strategy, caused 42% of all deaths in less than 5 year-old children
(2,9 million). The risk of dying from acute diarrheal disease, septicemia and
malnutrition was 8-10 times higher among children living in the highest poverty
stratum.
Adolescents (10-19 years): Fertility
among women aged 15-19 years of age decreased by 16 % between 1986-2000; in
2000, 15% of them were already mothers or were bearing a child for the first
time. Mortality in adolescents is lower than in the general population, external
causes being the leading cause of death.
Adults (20-59 years): External
causes among males and cancer of the uteri and breast among females were the
main causes of death in the 20-59 year-olds. Between 1996 and 2000, the use
of modern contraceptive methods among childbearing-aged women increased from
41.3% to 50.3%. Coverage of partum by trained professionals was 59.3% in 2000
(28.7% rural). Maternal mortality was estimated to be 185 deaths per 100,000
live births.
Analysis by type of health problem Diseases preventable by
immunization:In 2000, 102 cases of acute
flaccid paralysis (1.2 per 100,000 population under 15 years) were reported.
Since the epidemic in 1992, there have been no reported deaths from measles;
of the 5,256 suspected cases of measles-rubella reported through the integrated
surveillance system in 2000, only one measles case was confirmed. That year
10 cases of neonatal tetanus were reported, compared with 94 cases in 1995.
Also, 41 suspected cases of jungle yellow fever (7 confirmed; 4 fatal) and 1,148
confirmed cases of hepatitis B were reported in 2000. Since 1990, vaccination
coverage under the Expanded Program on Immunization (EPI) has maintained levels
of over 90%.
Intestinal infectious diseases:
In 2000, the prevalence of diarrhea in children under 5 years was 15.4%, compared
with 17.9% in 1992 and 31.9% in 1986. In 2000, 68% of children with diarrhea
received oral rehydration therapy. Cholera continued declining steadily from
42,000 suspected cases during the El Niño phenomenon (case fatality 0.09%) to
934 in 2000.
HIV/AIDS: Up
to 2000 the country had a cumulative total of 11,310 reported cases of AIDS
(1,189 in 1996); the male-female ratio declined from 11:1 in 1990 to 3:1 in
2000. In the historical series, sexual transmission accounted for 95.7% of the
cases, 70% among young adults (20-39 years). In 1999 the number of HIV carriers
was estimated at 76,000 (18,000 women). HIV seroprevalence in sexual workers
increased from 1% in 1994 to 2% in 2000; among homosexual males the seroprevalence
rate was 11% in 2000, while in pregnant women the rate was 0.3% in 1999.
Sexually transmitted infections: In
2000, 629 cases of congenital syphilis were reported in the country; 266 in
1999. The seroprevalence of syphilis was 1.0% in the blood banks of the Ministry
of Health in 2000.
Vector-borne diseases:
It is estimated that 2.5 million inhabitants live in areas at risk for malaria
transmission; in the year 2000 the annual parasite index was2.7 per 1000 population
(10.0 in 1998). The proportion of P. falciparum cases increased from 19.7% in
1995 to 30.2% in 2000 (41.6% in 1999). The population in areas of dengue transmission
risk in estimated at 3.4 million. In 2000, all four serotypes of the dengue
virus were isolated and the cumulative incidence was 21.7 cases per 100,000
population. In the first 26 weeks of 2001 a total of 23,454 cases of dengue
were reported, including the country's first cases of hemorrhagic dengue were
reported (206 cases; 3 deaths). A total population of 600,000 is estimated to
live in areas of Chagas ' disease transmission. In 1999, the screening of donated
blood yielded a rate of 0.8% positive results. In 2000, a total of 9,588 cutaneous
and 863 mucocutaneous cases of leishmaniasis were reported.
Chronic communicable diseases: Tuberculosis
has been on the decline since 1992 to an incidence of 155 per 100,000 population
in 2000 (133 pulmonary; 88 with positive bacilloscopy ). The proportion of tuberculosis
cases with HIV coinfection was 1.3%, or a rate of 2.2 per 100,000 population.
The annual risk for tuberculosis infection in children aged 5-6 years old fell
from 2.0%-2.5% at the beginning of the 1990s to 0.9% in 1997-1998. Primary resistance
to at least one of the antituberculosis drugs occurred in 17.8% of the cases
showed, while primary resistance to the multidrug scheme was 3.0 % (acquired:
13.5 and 12.3%, respectively) in 1999. Also in 1999, there were 180 prevalent
and 7 new leprosy cases under treatment. All were in persons over 15 years of
age, had grade-2 disability and were reported in the jungle region.
Zoonoses:
Eight cases of canine-transmitted human rabies and 302 cases of rabies in dogs
were reported in 1997; in 2000, the figures were 2 and 54, attributed to broader
canine vaccination coverage, from 51.4% in 1996 to 73.9 % in 2000. Laboratory-confirmed
cases of plague fell from 55 in 1997 to 17 in 2000, an improvement credited
to the use of metal silos in the endemic zones. The incidence of human brucellosis
decreased from 2,525 cases in 1996 to 1,085 in 2000.
Nutritional and metabolic diseases: There
prevalence of anemia among children under 5 years was 50% in 2000 (57% in 1996);
among women 15-49 years it was 30% (34% in 1996). The prevalence of vitamin
A deficiency among children under 5 years was 50% in 1996-1997 and that of low
serum retinol 20%. Iodine deficiency has been brought under control; urinary
iodine excretion levels remained above 100 mg/L during 1997-2000.
Diseases of the circulatory system:Between 1986 and 1997 the mortality rate for diseases
of the circulatory system fell from 132.7 to 104.9 per 100,000 population. In
1998-1999, the prevalence of hypercholesterolemia was 30.2% in men and 24.2%
in women, and for arterial hypertension 17.5% and 9.2%, respectively.
Malignant Neoplasms: Mortality
from malignant neoplasms did not change significantly between 1987 and 1997,
but the proportion of deaths from cancer increased from 9.0% to 14.2%, and the
potential years of life lost from tumors increased 33.4%, indicating more premature
death. In the mortality profile for women the leading sites of malignant tumors
are the uterus, stomach, and other digestive organs, while in men the primary
sites are the stomach, lung, and prostate.
Accidents and violence:Subversive
violence has declined considerably, from 2,779 acts in 1990 to 144 in 1999,
and the number of victims from 1,477 to 55. There was an increase in motor vehicle
transport accidents from 52,633 in 1990 to 79,695 in 1999. The rate of physical
assaults was 2.5%; after food pension disputes, family violence and abuse was
the second leading reason for consultation at the Municipal Children and Adolescent
Defense Leagues in Metropolitan Lima.
Oral health: The
prevalence of dental caries was 84% and the DMFT index 5.6 for children 12 years
of age in 2000; the prevalence of periodontal disease was 85% and that of malocclusion
70%.
Natural disasters: Between
1993 and 1997, a total of 1,478 natural disasters occurred, with 1,667 deaths,
872,750 people affected, 38,360 houses affected and 131, 855 destroyed, 254,000
agriculture hectares damaged and US$100,4 million of direct economic loss.
RESPONSE OF THE HEALTH SYSTEM National Health Policies and Plans: The
Ministry of Health (MINSA) actions were guided by the 1995-2000 Health Policy
Guidelines, which defined the bases for the sector's reform process. The 5 directing
principles were: universal access to public health services and individual care;
modernization of the sector; re-structuring functions of financing, provision
and regulation; prevention and control of priority health problems; and, promotion
of healthy living conditions and life styles.
Sectoral reform: The
Basic Health Program for All promoted the offer of basic health care packages
for children, adolescents, women of childbearing age, and adult population,
defined by MINSA since 1994. The project for Health Services Strengthening was
aimed at shoring up infrastructure and delivery related operational systems
in its own services. Since 1997 the School Health Insurance program was implemented,
and in 1998 a pilot program for Maternal and Child Health Insurance was initiated
to cover mothers during pregnancy, delivery, and the puerperium , as well as
children up to the age of 2 years. Participative processes based on the model
of local health administration committees ( CLASs ), in which health facilities
are administered jointly by Ministry of Health authorities and members of the
community, are in place in nearly 20% of the Ministry's health centers and health
posts. An emphasis was made on decentralization of basic health care and recovery
of the resolutive capacity of the primary level, in particular in areas of higher
poverty. In 1997, 62 % of the health public subsidy went to health centers and
posts. The distribution of this expenditure by income quintiles followed a progressive
pattern at the primary care level. The institutional coverage of care to individuals
with symptoms of disease or accident increased from 32.2% in 1994 to 43.5% in
1997 and 49.3% in 2000.
Institutional organization:The
public subsector comprises MINSA, the Social Security system ( EsSalud ), and
the health services of the armed forces and the police. Altogether, it has 51%
of the country's hospitals, 69% of the health centers, and 99% of the health
posts. There are several subsystems with limited functional coordination. Social
security coverage was reduced from 40.7% of the economically active population
in 1987 to 23.4 % in 1995. In 2000, 32.% of the population suffering from a
disease, other health condition, or accident had no access to any subsystem.
In 1997, the public monopoly for provision of health care to those covered by
EsSalud was modified, allowing the enrollment in private provider institutions
( Entidades Prestadoras de Servicios de Salud ) for low complexity health care
needs.
Developments in health legislation: MINSA
is the regulatory entity in the health sector; the Ministry of the Presidency
regulates sanitation services.
Health care of populations: The
country is carrying out the following priority strategies: "Stop Tuberculosis,"
using DOTS (directly observed treatment, short course) and DOTS-Plus; eradication
of polio and measles; elimination of neonatal tetanus; Integrated Management
of Childhood Illness (IMCI); "Roll Back Malaria"; elimination of leprosy; elimination
of Triatoma infestans from household environments and interruption of the transfusion
transmission of Chagas ' disease; elimination of urban canine rabies; surveillance
of antimicrobial resistance; safe blood supply; and surveillance, prevention,
and control of other emerging and re-emerging diseases. The national epidemiological
surveillance system includes 3,500 notification units. The public health laboratory
network consists of 16 regional laboratories with diagnostic capability for
priority diseases; the National Institute of Health (INS) is the national reference
center. Information on morbidity from outpatient care and hospitalizations is
processed in each facility and centralized periodically. The MINSA is responsible
for processing mortality information. There is a limited development of health
situation analysis capability functions at the local level. In 2000, the coverage
of homes with water supply and sanitation was 88.6% (78.1% rural) and 80.8%
(53.0 % rural), respectively. Food assistance programs benefited 11 million
people (investment of US$ 260 million; 90% from the public treasury). In 2000,
2.33 million households (46.6%; 72.7% in the poorest decile ) received food
assistance.
Individual health care services: The
institutions in the public sector organize their services by levels of complexity.
Adequate referral mechanisms between the different levels of complexity are
lacking, health facilities do not share resources, nor are they organized into
networks, and the allocation of resources at the different levels of complexity
is unbalanced. In 2000 there were 144 collection centers and 100 blood processing
centers registered, which together received 332,800 units of blood (1.7% from
paid donors); 100% was screened. In 2000 the country had a 1.2 hospital beds
per 1,000 population.
Health supplies:
In 1999 the pharmaceutical market had a total of 11,241 drugs on the official
register (65% imported; 5.6 % generic).
Human resources:
Between 1992 and 1996 the supply of professionals increased in all categories:
the rate of physicians per 10,000 population rose from 7.6 to 10.3; professional
nurses, from 5.2 to 6.7; dentists, from 0.7 to 1.1; and obstetricians, from
1.1 to 2.1, persisting a centralist and inequitable distribution. In 1999 the
Ministry of Health employed 11,157 physicians (7,557 in 1992), and EsSalud 5,237
(3,476 in 1992). In 2000 there were 27 schools of medicine (14 in 1990) and
43 schools of nursing; there were also 21 Master-level Public Health programs
with 11 major areas.
Health sector expenditure and financing: In
1998 the country spent 4.3% of its GDP on health. The main sources of financing
were household spending, employer contributions, and the national budget. In
1998-1999 a total of 102 health projects were financed by international technical
cooperation, for a total sum of US$ 452 million
