Table of Contents
Peru is a country of contradictions and turbulent history, which naturally has been influencing the lives of its people. Since all the aspects of the country’s development are interrelated, healthcare issues cannot be considered separately from the major spheres. Economy, education, geographical location and climate peculiarities impose conditions for the population’s health. Therefore, the state of health of the nation is a multicomponent phenomenon which should be addressed through all the aspects influencing it.
Peru is subject to investigation as a country with high adult and child mortality rates. Numerous factors contribute to the poor health of the population, which could be improved through corresponding initiatives and reforms. Identification of factors that influenced the development of Peru and resulted in poor living conditions and healthcare in the country would be helpful in determining the top-priority aspects that need improvement.
Analysis of the geographic location of the Republic of Peru is pivotal for understanding the influence of the country’s landscape, resources, and living conditions on public health. The country borders on Ecuador, Brazil, Colombia, Bolivia, and Chile, and the Pacific Ocean in the west (Central Intelligence Agency [CIA], 2017). The flora and fauna of Peru are outstandingly diverse, and the landscape is characterized by both plains and mountains (CIA, 2017). The majority of the population lives along the coastal zone and mostly inhabits the metropolitan city of Lima.
The key geography-related concerns of the country are air pollution, water pollution, desertification and deforestation (CIA, 2017). The climate changes with the alteration of the geographic landscape: eastern areas have a tropical climate; there are mostly dry desert areas on the west, and the climate in the Andes varies from temperate to frigid (CIA, 2017). The geographic location and climate are believed to influence the public health in Peru since natural disasters such as flooding usually undermine the capacities of the health care system. Hence, the Peruvian government should take into consideration natural threats and include potential expenditure on rescue and recovery programs in the national budget of the country.
The population of Peru is diverse and unevenly provided with healthcare services. About thirty percent of the country’s population inhabits the coastal zone in the west, and the number of nurses is the greatest in this part of the country. Approximately fifty percent of Peruvians resides in the Andean highlands, while only a small portion of the population inhabits the eastern side of the Andes Mountains (CIA, 2017). The population constitutes 31,036,656 people as of July 2017, which makes Peru the 43rd largest country in the world in terms of population (CIA, 2017). The population consists of 45% Amerindian, 37% of mestizo, 15% of Caucasians, and the rest 3% comprise black, Asian and other ethnicities (CIA, 2017). The majority of the population – 40% – is young, with the average age ranging between 25-54 years. The next major age group consists of children and adolescents, amounting to more than 25% (CIA, 2017). The proportion of males and females is slightly unequal among infants and teenagers, with the slant towards males, while in adolescent years the proportion is balanced. Starting from 25 years, the proportion slant shifts to a greater number of females, and this tendency persists further throughout the lifespan. The growth rate of the population can be considered an issue since it constitutes only 1%, which puts Peru to the 111th place in the world rate (CIA, 2017). The urbanization level is 80%, and the average life expectancy is approximately 73 years (CIA, 2017). These data are average, and mostly describe the prospects of the urban population.
Health expenditure appears to be insufficient. Thus, currently the healthcare expenses amount to 5.5% of the country’s GDP (CIA, 2017). The availability of healthcare professionals is 1.12 physicians per 1,000 population (CIA, 2017). One of the major health issues that endanger the population health is the risk of infectious illnesses such as hepatitis A, bacterial diarrhea, malaria, Zika virus and others (CIA, 2017). The government aims to solve these issues by implementing corresponding programs.
Immigration level in Peru was high at the beginning of the 20th century, when the country was on the rise of its economic development. However, it was followed by an opposite tendency for emigration because of economic downturn after the civil war (CIA, 2017). With the gradual improvement of the economic environment, emigration level decreased, although emigrants still constitute a considerable number of 2 million citizens over the decade (CIA, 2017). Peru belongs to countries that were previously denoted as developing and are now referred to as low- and middle-income countries (LAMICs). The government managed to successfully combat poverty, which has significantly reduced over a decade, although the poverty rate is still high (30% in urban areas and more than 55% in villages) (CIA, 2017). Healthcare initiatives have also been effective and allowed the government to reduce the level of malnutrition, improve sanitary conditions, promote hygiene, and provide clean water to the Peruvian population (CIA, 2017). Moreover, the government succeeded in addressing educational issues with improved school enrollment and a reduced level of child labor (CIA, 2017). Although the country managed to positively address the issues of school enrollment and child labor, the major problem is the high rate of poverty that forces children to earn a living.
Therefore, general characteristics of the population and lifestyle demonstrate consistent improvement due to effective healthcare-related reforms and initiatives. To improve economic and social conditions, the government of Peru has to concentrate on the major spheres of the citizens’ well-being such as employment, education, and healthcare. The governmental approach should be well-coordinated and aligned with other influential sectors such as economic, political, and social spheres.
Government and Economy
The form of government of Peru is a presidential republic. The country consists of 25 regions and one province (CIA, 2017). Three major sectors that contribute to the economy of the country are service (57.7%), industry (34.7%), and agriculture (7.6%) (CIA, 2017). The unemployment rate slightly exceeds 6% in major cities, whereas underemployment is spread throughout the country. An important factor that contributes to inadequate healthcare is a high level of poverty, which totals more than 22% of the population (CIA, 2017). The country’s GDP per capita amounts to $12,900 (CIA, 2017). Silver and copper are among the major extracted resources that make Peru the second biggest producer in the world (CIA, 2017). Their production contributed to the growth of the economy due to increased international prices for exported minerals and metals (CIA, 2017). The fall in these prices marked a downturn in the economic growth in 2014-2016 (CIA, 2017). The impact of the international economy can be considered a significant influence factor which makes Peruvian economy vulnerable and dependent on global economic changes.
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As it has been mentioned, the poverty rate is high in Peru. Despite the fact that it has been considerably reduced due to the government initiatives and international cooperation, more than one fifth of the population suffers from poverty. An initiative of social inclusion and equality in income distribution showed positive initial results but failed to contribute to further economic expansion.
Economic growth affected mostly densely populated coastal areas but failed to reach non-coastal zones because of insufficient infrastructure (CIA, 2017). In 2014, the government successfully implemented initiatives stimulating investment in Peru’s economy, namely the mining sphere. Nevertheless, 2015 was marked with the global downturn in prices for this production, and Peru immersed in social controversies resulting from poverty (CIA, 2017). The revival of economy is also marked with the formation of the Pacific Alliance coalition between Peru, Chile, Colombia, and Mexico (CIA, 2017). Overall, the government concentrates on the mining industry as the major contributor to the country’s economy. The corresponding international agreements and alliances are likely to establish Peru as a reliable partner for cooperation and investment. The country has to eliminate scandalous occurrences such as the corruption issue that negatively affected the economic growth of Peru in 2017 (CIA, 2017). Consequently, although the government aims at improving economic characteristics by attracting investors and developing the leading industry sector of mining, the efforts require elimination of negative factors such as corruption rows.
State of Health
High mortality rate is the major determinant that identifies the success or failure of healthcare efforts. High adult and children mortality rates indicate that Peru has a dysfunctional system that cannot ensure proper healthcare provision. The mortality of the population younger than five years results from prematurity, pneumonia, injuries, neonatal causes, diarrhea, and HIV/AIDS (Global Health Workforce Alliance [GHWA], 2017). The mortality rate of infants and children under five years nowadays constitutes 19 deaths per 1,000 births (GHWA, 2017). The number demonstrates gradual reduction over the last three decades.
However, diseases are not the only factor that influences the state of health in the country. Such factors as violence, accidents and disasters are believed to be interrelated and have a considerable impact on population’s heath (Kahhat, 2017). Accidents constitute another contributing factor, causing the mortality rate of 3,000 people every year (Miranda et al., 2014). Researchers claim that the likelihood of armed conflicts is inversely related to income per capita, and the same dependency exists between natural disasters and income level (Kahhat, 2017). Thus, low income increases probability of conflicts and deadly consequences following disasters. Besides, people with low income have fewer possibilities to cope with the health challenges resulting from these life hardships. Peru is struggling with the health consequences of the ongoing internal conflict.
Therefore, high mortality rates stem from diseases and are increased by conflicts and disasters. The Peruvian healthcare system is currently unable to resolve these difficulties. Apart from purely healthcare issues, such as lack of nursing personnel, equipment, and awareness among the population, poverty and social issues also contribute to the problem.
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Peru is the country with significantly widespread traditional or indigenous medicine. The popularity of this treatment approach can be attributed to the historical tradition and current economic circumstances (Bussmann, Glenn, Meyer, Kuhlman, & Townesmith, 2010). Although full integration of alternative medicine to the healthcare system is unlikely to happen, taking into account frequently conflicting practices and treatment protocols, traditional medicine is still crucial for the population deprived of state healthcare services. Therefore, traditional medicine in Peru wins certain recognition in comparison to complementary allopathic medicine within the framework of the Social Security System of Peru (Bussman et al., 2010). Some researchers are positive about the potential prospects of traditional medicine as an alternative part of healthcare within the national healthcare system of Peru (Bussmann, 2013). Consequently, traditional medicine plays an important part of healthcare support in the regions which were not reached by official healthcare. Despite the fact that alternative medicine remains officially unrecognized as a part of healthcare, it serves its social function of helping the poor population that lack access to healthcare from official medicine. While the issue of traditional medicine effectiveness remains controversial, it represents an alternative to temporarily absent official healthcare services.
Healthcare System and Delivery
Demographic factors are determinative in terms of healthcare services availability and provision. The economic gap between urban and rural populations deepens when it comes to healthcare. However, the government has implemented an effective program to provide more equal distribution of healthcare personnel throughout the country, with a particular emphasis on rural population. This initiative forms the basis of the SERUMS program that ensures retention of nurses and their decentralized performance in remote areas of the country (GHWA, 2017). The key advantages of the program are well-developed implementation stages, regulatory guidelines, use of evidence-based research related to similar programs integration, and cooperation between national sectors. Other achievements of Peru in the healthcare sector involve the implementation of a national health plan, which pursues the strategy to enhance human resources for healthcare and the development of human resources for health observatory (GHWA, 2017). Such unprecedented coordination is likely to continue benefiting the country’s healthcare, thus supporting the statement of considerable dependency that exists between various sectors of national performance. Hence, healthcare should not be considered separately from economic or social development of the country.
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Government Health-Related Agencies
The healthcare system in Peru is decentralized. It is governed by the Ministry of Health (MINSA) and EsSalud, which together cover 90% of the population needs in healthcare. The majority of services is provided by MINSA and constitutes 60% (GHWA, 2017). Other agencies that contribute to the national health maintenance cover 10% of the population needs and include the Armed Forces, National Police, and private healthcare institutions (GHWA, 2017). A high number of healthcare provision institutions and bodies contributes to misalignment and unsystematic measures, which adversely affects the national health on a large scale. Poor economy adds to the issue by making healthcare specialists take more than one job in the healthcare sector to earn their living.
The bodies that contribute to the nursing retention program include the Health and Social Security Commission, Secretary of Decentralization, civil society, Ministry of Finance and Economy, Ministry of Education, and international organizations (GHWA, 2017). Hence, the Peruvian government correctly evaluated the threat of adverse influence of poor health on the well-being of the country’s population. Coordinated effort that involves economic and educational sectors as well as foreign support is likely to be successful in terms of health resources retention and improvement of the quality of healthcare services.
Peru experiences difficulties similar to global healthcare trends such as inadequate number of nurses, which continues declining, and lack of educated and experienced personnel. Despite the recent tendency toward growing population of healthcare specialists, migration and brain drain nullify its positive effect. Nevertheless, the GHWA (2017) indicates that healthcare personnel have grown in number and constitutes 9.7 nurses for 10,000 of population. In general, the density of human resources in healthcare makes 17.8 per 10,000 of population (GHWA, 2017).
The representation of healthcare personnel is uneven throughout the country, which is related to the geographic peculiarities of Peru. Thus, similar to the majority of population, healthcare resources are distributed mostly in coastal regions and the metropolitan area of Lima. The lowest density of healthcare specialists is in Piura, Lambayeque, and Loreto areas (GHWA, 2017). Therefore, geographic location and economic conditions are the major contributors to Peru’s healthcare personnel growth and distribution.
Nursing Education System and Nursing Associations
The nursing education system in Peru has made a major shift from providing technical or vocational training to university-based education. It includes basic education levels which require passing entrance exams prior to education continuation (NUFFIC, 2015). Further education continues at institutes or universities and allows nurses to receive the degree of a bachelor, specialist, master, and doctor (NUFFIC, 2015). Moreover, online education courses can be used (Curioso, Peinado, Rubio, Lazo-Escalante, & Castagnetto, 2009). Researchers also emphasize the importance of health informatics for the evolution of healthcare in Peru (Curioso et al., 2009). Besides advanced opportunities in education, implementation of the IT technology would allow utilizing evidence-based research and the most recent health-related innovations.
The image of the nursing profession has been evolving with the growing understanding of the need in quality healthcare professionals, which can contribute to the national health levels and thus improve overall development of the country. The Peruvian Nurses Association (APE) was founded in 2015 (Lee, Palmieri, & Watson, 2017). The organization addresses support of nurses in Peru in their striving to contribute to the healthcare at individual, local and national levels. The APE is a complementary body of the National Board of Nursing that aims at promotion of the nursing profession (Lee et al., 2017). Hence, the association facilitates establishment of the healthcare standards and raises awareness of nursing implications.
Health Priorities and Nursing Implications
The change in the political sphere has marked a shift in the healthcare system priorities and programs in Peru. Thus, the President and the new Minister of Health target the areas which will benefit the Peruvian healthcare system (Fraser, 2016). Improvement of life conditions influenced by air and water pollution is one of the top priorities of healthcare in Peru (Fraser, 2016). The President Kuzcynski introduced a 5-year program to develop clean drinking water and sewer systems throughout the country, including the most remote rural areas (Fraser, 2016). Another important target is to double health-related expenditures up to 4% of the GDP (Fraser, 2016). Health priorities in terms of prevention involve full immunization inclusion and improvement of maternal and child health, which is now a matter of serious concern. These initiatives of the new government are particularly crucial for distant rural areas, where healthcare coverage is insufficient. The provision of equal healthcare services to both urban and rural population disregarding their income level and social status is the aim that the government currently pursues.
In terms of particular illnesses, fighting tuberculosis has been one of the major health priorities of Peruvian healthcare. The issue of the spread of tuberculosis is aggravated by the contributing factors such as a large number of homeless and HIV-infected populations (Wingfield et al., 2017). The problem is multifaceted and thus should involve coordinated effort of both healthcare institutions and governmental agencies. Immunization is a disease prevention tool that is also addressed by the new government. However, the major concern is the enhancement of alignment between the national healthcare bodies and health offices in the regions (Fraser, 2016). Poor conditions in hospitals and lack of modern equipment should also be targeted as these factors contribute to another healthcare issue, particularly the outflow of healthcare professionals from Peru. Electronic health records are a new technology that can be introduced in the healthcare framework to cut costs (Bar-Dayan et al., 2013). The implementation of advanced technology could essentially benefit Peruvian healthcare.