THE PROBLEM OF

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Second International Conference about Equity in
Health Toronto, June 14-16, 2002
THE PROBLEM OF ETHNIC HEALTH INEQUALITIES IN PERU
(1997 2000)
Juan Seclén Palacín, MD, MGS
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INTRODUCTION
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Over the past 5 years, the Peruvian government
has developed health programs and projects to
improve health conditions among the Peruvian
population, increasing their access to
public health care facilities. An important
health policy target is to improve access to
public health care facilities among poor, rural,
illiterate and selected ethnic groups through
the expansion of basic health care
supply. Thus, some public health system
interventions were developed (new hospitals and
health centers) in order to have a health sector
with equity, quality of care and efficiency.
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For this reason, it is necessary to assess if the
targets have been reached and the health
inequalities gaps have been reduced. In this
study I use an outcomes evaluation approach to
examine the aforementioned public health
interventions.
Research question Did ethnic health inequality
and in access to public health facilities change
between years 1997 and 2000?
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OBJECTIVE

• To compare the health status, access to health
  care
• facilities, and access to medical care of the
  indigenous
• Peruvian population as compared with the
  Spanish
• speaker population, during 1997 and 2000.

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METHODOLOGY
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Study design - Rolling cross sectional
study - Living Standards Measurement Survey
(LSMS) - Surveys were conducted between
April-June in pqw1997 and 2000
t 1
t 2
2000 Survey 2
1997 Survey 1
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Study Area
PERU Located in South America (western
coast) Official Language Spanish and Quechua
(indigenous). Population 26.3 millions 49.4
males Illiterate rate 7.2 Indigenous
population 14.8 Population below poverty level
54.1 IMR 45 per 1,000 live births MMR 185 per
100,000 live births (2000 year data )
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Population studied
Two-step stratified geographic regions and
census tracts 3,843 (1997), 3977 (2000)
households 19,575 (1997), 18754 (2000)
individuals Representative sample of the
Peruvian people
LSMS
Households
Individuals
Cluster / geographic region
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Measures - Report illness past two weeks -
Recent illness and consulted health facility
- Recent illness and seen by physician -
Ethnicity
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(No Transcript)
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Potential confounders Age, sex, educational
attainment, per capita household income, marital
status.
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• Data collection
• Interviews were conducted with all members of
  selected households aged 15 and over.
• - Interviewers were specially trained in the
  application of the questionnaire (households and
  individuals).
• Data analysis
• Simple frequencies, mean differences, bivariate
  analyses.
• - Multivariate analysis adjusted odds ratios
  with 95 CI, using logistic regression, SPSS.

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RESULTS
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Descriptive characteristics of the population
studied
() 2 SD below poverty line
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Differences in selected indicators, Spanish
speaker vs Non-spanish speaker 1997 and
2000 (Spanish - Non Spanish)
Source Peru, LSMS 1997 and 2000.
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Report illness past two weeks Peru, 1997 - 2000
1997
2000
Source LSMS, 1997 and 2000
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Recent illness and consulted health facility
Source LSMS, 1997 and 2000
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Recent illness and seen by physician
Source LSMS, 1997 and 2000
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Differences in selected indicators, Spanish
speaker vs Non-spanish speaker 1997 and
2000 (Spanish - Non Spanish)
Source Peru, LSMS 1997 and 2000.
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Adjusted and Non adjusted effects of ethnic group
on recent illness, consultation (health
facility) and medical care () 1997 and 2000.
Odds ratios adjusted for age, sex, educational
attainment, percapita household income (by fifths
within region). Logistic regression was used to
examine the relations. Source Peru, LSMS 1997,
2000 years.
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CONCLUSIONS
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• Ethnic health inequalities persist in Peru.
  However, health care inequalities seem to be
  slowly decreasing.
• The indigenous population has worse health
  status and the
• ethnic gap increased over the period.
• Access to health services increased over the
  period for both populations and the ethnic gaps
  decreased. However, only one of every two ill
  Peruvians utilizes health services.
• Medical care increased in both populations but
  ethnic gaps persist. In adittion, only one third
  sick indigenous people had medical care during
  2000.

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Author affilitiation Juan Seclén Palacín, MD,
MGS Monitoring and Evaluation Health Services and
Research Unit Project 2000 Ministry of Health
Peru E-mails jseclen_at_pathfind.org
jseclen_at_yahoo.com
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Acknowledgements The data bases used in this
research were avalaible through the Pan American
Health Organization (PAHO) Peruvian
Bureau. This research was funded partly by PAHO
Peruvian Bureau.