trition still shows a huge variation from 2 to 54 percent across departments, and from 4 to 45 percent across income quintiles. Although health service coverage is 93 percent in urban areas, it has reached only 59 percent in rural areas, even after large increases in coverage. The sharp disparities in both access and outcomes are attributed to living conditions, affordability of health care services, and the lack of available medical personnel in more remote areas. Health expenditures increased considerably in absolute amounts but remained at about 5 percent (3 percent public expenditures and 2 percent private) of GDP during the review period.
Although health service coverage is 93 percent in urban areas, it has reached only 59 percent in rural areas, even after large increases in coverage. Health insurance coverage rates rose substantially between 2003 and 2009, with SIS coverage rising from 20 percent of the population to 37 percent, and EsSALUD from 17 percent to 21 percent, leaving about 40 percent still uninsured. World Bank Group Engagement The WBG sought to support broad achievements in healthcare quality and access through substantial sector policy lending. The WBG sought to: (i) help improve access of the poor to basic health services as well as to support “second generation” reforms, such as the expansion of health insurance; (ii) encourage the role of the private sector; (iii) strengthen management contracts for health provision; (iv) reform the formal sector health insurance program (EsSALUD) and public hospital management; and (v) build public institutional capacity in the sector. Bank lending comprised: (i) four social sector DPLs implemented between FY2001–05 that supported increased public spending on health services, improved targeting of public expenditures, and modernization of health insurance institutions; (ii) a FY2000 Health Reform Project Adaptable Program Loan (APL) that focused on maternal and child health care services for the poor; and (iii) a second series of DPLs in FY2007–09 to support further expansion of health insurance, development of targets,
monitoring, and management of parental expectations in nutrition and health, and further measures to address maternal mortality and chronic malnutrition.
The expansion of Integral Health Insurance (SIS) contributed to an increase in access to and utilization of health services by reducing economic barriers to utilization, although physical access continues to be a binding constraint in rural areas. The Health Reform APL was expected to include a follow-up, Stage II in FY2005. However, the APL was redesigned and delayed to FY09, and a planned intervention in nutrition did not take place. As a result, the Bank had no new investment lending in the health, nutrition and population sector between FY2000–09. AAA interventions included coverage of health, nutrition and population in the Accountability for Social Reform Project (RECURSO) (see section on education below), which emphasized the need for measurement and accountability of health outcomes. Also included was a study on human resources in the health and education sectors (FY06), and a study on SocioEconomic Differences in Health, Nutrition and Population (FY07). IFC did not have any health operations in Peru. It competed unsuccessfully for an investment with a major private hospital group, and is currently engaged in a proposed large public-private partnership (PPP) for new hospitals to serve lower-middle-income areas in Lima. Outcome of World Bank Group Support WBG support for access to maternal and child health care services by the poor retained its relevance throughout the review period and helped achieve important gains. Key Bank contributions included support for the consolidation and targeted expansion of the SIS, a basic health insurance plan targeted to low-income citizens, and for expansion of community-managed health clinics (CLAS) that deliver a package of basic health services. SIS beneficiary numbers exceeded targets countrywide and the proportion of the population covered by SIS rose from 20 percent to 37 percent. The program was relatively well targeted, with over 60 percent of beneficiaries belonging to the bottom two income quintiles.2 The expansion of Integral Health Insurance (SIS) contributed to an increase in access to and utilization of health services by reducing
The World Bank Group’s Contribution to Enhancing Human Development
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