Abstract

This case study describes the process of privatization of the State since the 1990s, as well as the institutional system developed with the advice of international organizations in order to promote the implementation of Public Private Partnerships (PPPs) as a solution to the infrastructure deficit in the country. It analyses in depth the Alberto Barton-Callao Hospital PPP and its Primary Care Centre of the Health care network La Red Asistencial Sabogal de EsSalud, which is currently in operation, observing that it is a complex project, which has not been adequately negotiated, since there are gaps in the contract in relation to the level of the establishment, the definition of the services, the periodicity for the follow-up of the indicators and for their modification, among others; in addition, addenda have been signed that are detrimental to EsSalud, with serious signs of corruption.

Regarding transparency, it is evident that the main actors have not been consulted, either within or outside EsSalud, and that the documents that support decisions made regarding the contract and addenda have not been published. The monitoring reports that allow citizen oversight are not being published either.

This situation increases the tension between the interests of the operating company -to obtain as many benefits as possible- and EsSalud, which must look after the interests of the users. This has an impact on the quality of the services that these users must receive. The company has not met targets of quality and results affecting mainly the health of women, and infringing on the labour rights of its personnel, the majority of whom are women.

We conclude that the Barton PPP has produced higher costs than direct public investment and management, both in the financing of infrastructure and in the cost of operating the services. The annual payments that EsSalud will make for 30 years does not correspond to the services it provided by the PPP, compromising investment in care provided by other health services.

In the face of this, union and social movements continue resisting and avoiding the implementation of PPPs and the privatization of public services, with the aim of guaranteeing quality services for the population as a whole.