Weekly review (September 27 – October 3)

President Alan García continues to dominate the political scenario and for the moment there is no opposition in sight. García’s proposals have been ranging from the death penalty for rapists to the evaluation of teachers, not to mention the salary reduction for public servants, water-access programmes and a new campaign for alphabetisation. The latest announcement concerned the health sector: García launched the “Salud para todos” (Health for everyone”) programme and promised a universal health insurance. On the other hand, a survey conducted by Apoyo and UNICEF shows that Peru’s social expenses are way below the Latin American average.

Health for everyone?

The health programme promises access to health services for everyone. However, that is not the objective in the short run. The measures for the first 180 days aim at improving infrastructure: Buying more medicines, additional immunisation campaigns and better equipment for hospitals. In addition, there are measures like the distribution of preventive information and the reallocation of doctors in order to enhance their representation on an nation-wide scale.

On the long run, the government’s aim is to raise the health spendings significantly: From 2,5 % of the Gross National Product spent in 2005 to four percent in 2011, which will be García’s last year in office (source: Correo).

Meanwhile, the Minister of Health, Carlos Vallejos Sologuren, assured that 84 percent of the public hospitals have already extended their regular opening times into the afternoons (source: El Comercio).

But what about the promise of giving “health to everyone”? That task corresponds to the “Seguro Integral de Salud” (SIS) which was created in October 2001 and covers medical attention for those who do not have a formal job and are therefore not entitled to participate in the regular public health insurance called “Essalud”. The SIS is publicly funded and counts nearly 10 million affiliates, largely neonates and children between zero and 17 years.

Accomplishing one of his many electoral promises, Alan García granted the drivers of three-wheeled taxis (called “mototaxis” in Peru) the right to affiliate to the SIS by paying ten soles a month (equivalent to slightly more than three U.S. dollars). Why did he choose the “mototaxistas” and not the ordinary taxi drivers, the bus drivers, the small merchants on the street, those who do not have a job or just those who have less and need more? This measure does not appear to have much sense unless there would be a gradual incorporation of other sectores.

For now “health for everyone” is just a nice slogan.

Measuring the social spending

The survey conducted by the pollster Apoyo and the United Nations Children’s Fund (UNICEF) was presented on 29 September and is available online in PDF format (click here to access it, in Spanish language). It comprises 60 pages, therefore I will confine myself to some few points.

To begin with, it is useful to take a glance at the definition of social spending. The survey assumes that social spending comprises public investments in the following fields: Education and culture, social prevision and protection (that is, payment of pensiones and direct subsidies), accomodation and urban development, labour, health and sanitation.

The survey highlights Peru’s economic growth over the last couple of years but at the same time criticises that this growth has not conducted to a substantial reduction of poverty. And that despite of the fact that social spending has increased, too: Between 2000 and 2005, social spending grew 58,1 %.

According to the survey, a vast amount of this money was spent in salaries and financial obligations (e.g. pensions). Remember that over the last five years the salary of teachers doubled. The salary of those working in the public health sector also experienced a considerable raise. On the other hand

there were not enough advances in the reform of public policy-making so as to improve the quality and the impact of social programmes (introduction).

It is not enough to hire social workers and to distribute money. Developing concepts, criteria and schedules in order to measure the efficiency of these programmes is as much if not even more important.

Furthermore, the survey holds that Peru’s social spending is below the Latin American average:

The social spending per citizen for the period 2002/03 amounts to US$1,071 in Uruguay and US$1,283 in Argentina. On the other extreme there are countries like Ecuador and Nicaragua who spend US$76 and US$68, respectively. The Latin American average is about US$610 per citizen, being more in Brazil, Panama, Chile, Costa Rica, Uruguay and Argentina […]. Peru spends about US$170 which is significantly below the regional average (page 12).

In a nutshell, one could say that we need to spend more but also in a better way.

Evaristo Pentierra