This case study analyzes the progress of Peru's Comprehensive Health Insurance (SIS) and evaluates the challenges that remain to achieving universal health care coverage. Peru is an upper-middle-income country with a gross domestic product (GDP) per capita of just over US$10,000 (purchasing power parity). The country has grown rapidly in the last decade; the average growth rate was 6.5 percent. However, 28 percent of the population lives in poverty (2011), which is estimated with regionally differentiated poverty lines between US$1 and US$2 per capita per day. In addition, only one in four individuals has employment with social security coverage. The SIS aims to reduce economic barriers through the elimination of user fees for a package of services. Although its budget has been low, the SIS has played an important role in the reduction of maternal and child mortality. However, the improvements expected to the overall health system have not materialized. Meanwhile, when the decentralization process transferred funds and authority to the regions, it did so in a context of weak management capabilities, and it failed to clearly define the relationship between the national and regional governments. A major effort to strengthen the technical capacity of the Ministry of Health (MOH) should accompany the strategies outlined above. This effort should emphasize a review of health priorities, the design of effective interventions within a fiscally sustainable benefits package, and the introduction of incentives and new payment mechanisms at hospitals and other health facilities.
Adolescent sexual and reproductive health and rights in Nicaragua : an analysis using a sexual and reproductive health framework and human rights
In an effort to integrate operational and analytical work on adolescents and youth sexual and reproductive health (SRH) and Human Rights in Nicaragua, the World Bank, in coordination with the Nicaraguan Ministry of Health, the Pan American Health Organization (PAHO), and the United Nations Population Fund (UNFPA) conducted the study titled: sexual and reproductive health among youth in Latin America: adding a human rights perspective. The study was conducted within the umbrella of the ongoing Family Community Health World Bank project. To gain a better understanding of the SRH and Human Rights in the country, the study, funded by the Nordic Development Trust Fund (NTF), reviewed the national legal framework and the school curricula; consulted focus groups for adolescents from representative samples in four geographic regions; and integrated the results of the study into a national multi-sectoral strategy on adolescents sexual and reproductive health and rights (SRHR). The strategy will inform the Banks operational plans and agreements for the next five years.
Despite international support for adolescent and youth sexual and reproductive health (SRH) and rights (SRHR) (for example, the 1994 International Conference on Population in Development), young people consistently face high levels of unmet need for contraception, unplanned pregnancies, unsafe abortions, sexually transmitted infections (STIs), and maternal mortality and morbidity. At the global level, adolescent females 10 to 14 years of age are twice as likely to die in childbirth as adult women, and half of all new HIV infections occur in young people between 15 and 24 years of age (Pathfinder International, 2011). Young people, particularly adolescent girls and young women, continue to face challenges in meeting their SRH needs and rights, impeding their ability to contribute to the countrys development. Within this context, the World Bank conducted a quantitative and qualitative study in El Salvador to understand how the country is addressing adolescent SRH and SRHR, among 1,495 adolescents 10 to 19 years of age. The study was funded by the Nordic Development Trust Fund (NTF) within the Banks Operations Policy and Country Services (OPCS) Units knowledge and learning program. The study aimed to: (a) evaluate associations between adolescent SRH, human rights, and economic development among adolescents and youth; (b) assess the operational implications of integrating human rights instruments into SRH services; and (c) systematize and disseminate the results of these activities in order to support a regional and multi-sectoral dialogue on adolescent SRHR. This knowledge brief summarizes the results of this study.