In Peru’s decentralized healthcare system, the country’s Ministry of Health (MINSA) offers free basic healthcare to 60% of the population through the Seguro Integral de Salud program, while EsSalud, a social security program funded by employer taxes, covers 25% of the population.
In the 1990s, Peru, like other South American countries, embraced the Washington Consensus, implementing market-oriented reforms and privatization under the influence of international organizations, like the World Bank and the International Monetary Fund. In the healthcare sector, this led to the use of Public-Private Partnerships (PPPs) to expand service coverage.
Today there are four PPPs in the health sector, one with the Ministry of Health and others with EsSalud, including the one at the Alberto Leonardo Barton Thompson Hospital, criticized for a lack of transparency and cost overruns.
The hospital, originally planned as a Level III facility, was downgraded to Level II, affecting the population insured. Quality and outcome indicators, particularly related to women’s health, fell short of targets. Labour rights, especially for women workers, were not respected, leading to concerns about working conditions, income, and personal protection during the COVID-19 pandemic.
This 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 do not correspond to the services it provides by the PPP, compromising investment in care provided by other health services. This experience has underlined the need for a centrally managed and coordinated, well-funded public health system that provides equitable quality services to all.
Camila & Irene
The film tells the story of Berhane and her family, who live in rural Ethiopia, where the government has adopted a Public-Private Partnerships model to improve the severe electricity access gap.
A powerful reflection on the challenges of the Peruvian healthcare system through the eyes of two women who represent the diverse realities of healthcare access in the country. The short film reveals the negative effect of an overwhelmed and fragmented healthcare system under a public-private partnership model, that ends up providing services for a select group of people while draining public resources away from the needs of the majority of the population. Beyond the despair, the story delivers a message of resistance: Camila and Irene come together to advocate for a high-quality freely available comprehensive public healthcare system, urging others to fight for healthcare equality and social justice.
Strengthening the public healthcare system is the best path to follow. PPP services cost the government much more than public clinics and hospitals. Companies are only concerned about their profits.
The Podcast
In this episode, we delve into the Peruvian experience with Bethsabé Andía Pérez, the author of the case study on the Public-Private Partnership Hospital III Alberto Barton-Callao. Bethsabé, a prominent feminist economist with extensive experience in women’s rights, will guide us through the inconsistencies in the Peruvian healthcare system and their impact following the COVID-19 pandemic, emphasizing the importance of the social movement in defence of deep cultural values in response to neoliberalism.
Connect The Dots
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.
Read now Alberto Barton-Callao Hospital III PublicPrivate Partnership and its Primary Care Center, of the Health Care Network La Red Asistencial Sabogal de EsSalud by cAndia Perez!