With 200,000 COVID deaths in a population of less than 33 million, the impact of the pandemic in Peru has been particularly devastating: the country has the highest COVID death rate per head of population worldwide. It’s also estimated to have one of the world’s worst rates of children being orphaned or bereft of their caregivers due to COVID.
Yet, compared to many other countries, on paper Peru was relatively well-placed to handle COVID. It is an upper-middle-income country – and before COVID had been performing well economically. Life expectancy had been rising and poverty falling, and it had been making good progress on improving public health, with access to healthcare increasing.
Peru was also one of the first Latin American countries to demand that people stay at home to stop the virus spreading. Unlike in some other badly affected Latin American countries, such as Brazil or Mexico, authorities in Peru didn’t deny the threat of the pandemic.
So how has it still ended up in such a bad situation?
Not built for lockdown
On March 15 2020, with 28 confirmed cases and no reported deaths, the Peruvian government declared a nationwide state of emergency. This quickly introduced a series of strong control measures, which included closing borders, restricting freedom of movement nationwide and banning crowds from gathering. Schools, universities and churches were closed. In general, all non-essential activities or services were restricted, including non-emergency primary healthcare.
But unfortunately, the early adoption of these measures wasn’t enough to lessen the impact of the pandemic. Cases immediately started to climb.
The government had acknowledged that adopting a strict lockdown would be difficult. Peru has a large informal workforce and a fairly limited social security system – meaning that staying at home, off work, would be hard for many. So the government announced a series of policies, such as cash transfers, to try to protect people’s livelihoods while asking them to stay at home.
But the state didn’t have the capacity to deliver cash and food in a way that prevented citizens from needing to venture out. People still had to go out and form long queues in banks to receive their cash transfers. Many also still needed to travel daily to food markets. Both became potential infection hotspots.
Weaknesses in healthcare
Rising cases then revealed structural weaknesses in the Peruvian health system. Despite recent economic growth and general improvements in public health, the overall health infrastructure of the country was still poor prior to the pandemic.
In January 2020, according to the ministry of health, 78% of health and medical centres had inadequate capacity to provide services, which included having obsolete, inoperative or insufficient equipment. By the beginning of 2021, this had risen to 97% of primary services.
Similarly, before the pandemic Peru had 29 intensive care beds per million people, below other countries in the region such as Brazil (206), Colombia (105), Chile (73) and Ecuador (69). Staffing levels were also insufficient to allow many health facilities to function properly. This all hampered Peru’s ability to effectively respond to a crisis situation.
The health system is also highly fragmented, which has made coordinating the COVID response across the country challenging, jeopardising its effectiveness at protecting the most vulnerable. And on top of this, there are also persistent inequalities within the system, with access to healthcare often determined by wealth, gender, ethnicity and geography.