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What does COVID-19 tell us about the Peruvian health system?
(Taylor & Francis, 2020-12-07)
Peru seemed well placed to respond to the COVID-19 pandemic as a country that had achieved sustained economic growth and moved towards achieving universal health coverage. However, Peru has one of the highest rates of transmission and mortality worldwide. This article analyses what the pandemic has unveiled with regards to the health system, arguing that a focus on meeting global development targets, including by promoting public-private partnerships in health, has distracted attention from the underlying structural causes of inequalities and enabled the continuation of a highly fragmented system, with access determined by income, gender, ethnicity and geography.
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Comparing experiences of constitutional reforms to enshrine the right to water in Brazil, Colombia, and Peru: opportunities and limitations
(MDPI, 2021-12-01)
In this paper we compare recent efforts towards the constitutionalization of the right to water in Brazil, Colombia, and Peru to understand the opportunities and limitations related to the attempts to enhance access to piped water to the highest normative level. Peru passed a constitutional amendment in 2017 while Brazil and Colombia have seen much right-to-water activism but have not succeeded in passing such reforms. We explore the role of the existing domestic legal frameworks on drinkable water provision and water management towards the approval of constitutional amendments. We find that all three countries have specialized laws, water governing institutions, and constitutional jurisprudence connecting access to water with rights, but the legal opportunity structures to enforce socio-economic rights vary; they are stronger in Colombia and Brazil, and weaker in Peru. We argue that legal opportunity structures build legal environments that influence constitutional reform success. Legal opportunity structures act as incentives both for social movements to push for reforms and for actors with legislative power to accept or reject them. Our findings also show that in some contexts political cost is a key element of constitutional reforms that enshrine the right to water; therefore, this is an element that should be considered when analyzing these processes.
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A ‘common sense’ response to health inequalities in Peru? Public-private partnerships in health and the implications for the right to health and economic inequality
(Oxford University Press, 2024-11-01)
Drawing on the case of Peru, our analysis looks at the ways in which the mainstream media creates support for government policies aimed at implementing Public-Private Partnerships (PPPs) in the health sector. Peru has a highly fragmented and segmented healthcare system, and the COVID-19 pandemic exposed the deeply embedded inequalities in accessing healthcare across the country. Nevertheless, the construction of hospitals financed and managed via a PPP arrangement has been one of the major solutions proposed and implemented by successive Peruvian governments in response to the health sector’s challenges. As our analysis demonstrates, the media has played a significant role in promoting this ‘common sense’ agenda whereby greater reliance on the private sector is presented as a solution to the weaknesses of the public sector. Our article considers the wider evidence on the role of PPPs in the health sector and contends that there is very little evidence on the system-wide benefits of PPPs, thus raising significant concerns about their ability to address health inequalities effectively. It also raises important questions about how far PPPs are able to support states in guaranteeing the right to health for their citizens.
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Estigma institucional hacia personas afectadas por tuberculosis en establecimientos del primer nivel de atención de un distrito de Lima, Perú
(Instituto de Salud Colectiva, Universidad Nacional de Lanús, 2026-07-16)
A pesar de los avances biomédicos en el diagnóstico y tratamiento de la tuberculosis, la reproducción institucional del estigma como barrera terapéutica al tratamiento sigue siendo un problema persistente. El artículo analiza cómo se reproduce el estigma institucional hacia las personas afectadas por tuberculosis en establecimientos del primer nivel de atención de San Juan de Lurigancho, Lima. Desde un abordaje cualitativo, entre febrero y diciembre de 2025, se realizaron entrevistas semiestructuradas a 16 trabajadores de salud en seis centros de salud, observación no participante de los espacios de atención a la tuberculosis de tres centros de salud y análisis espacial de los seis centros de salud. Los hallazgos muestran que el estigma se materializa a través de tres mecanismos articulados: una arquitectura hospitalaria que hace estructuralmente imposible la confidencialidad mediante circuitos diferenciados y señalización visible; tecnologías de vigilancia epidemiológica que producen visibilidad forzada del diagnóstico; y condiciones de sobrecarga institucional que inhiben el cuidado integral. Se argumenta que abordar la adherencia al tratamiento requiere intervenir no solo en los procesos de determinación social de la salud, sino también en los dispositivos institucionales que producen y reproducen estigmatización.
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