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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 INTRODUCTION Over the past 5 years, the Peruvian government has developed

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THE PROBLEM OF ETHNIC HEALTH INEQUALITIES IN PERU (1997 – 2000)

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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


INTRODUCTION


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.


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?


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.


METHODOLOGY


Study design

- Rolling cross sectional study

- Living Standards Measurement Survey (LSMS)

- Surveys were conducted between April-June in pqw1997 and 2000

t 2

t 1

2000

Survey 2

1997

Survey 1


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 )


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


Measures

- Report illness past two weeks

- Recent illness and consulted health facility

- Recent illness and seen by physician

- Ethnicity


Potential confounders:

Age, sex, educational attainment, per capita household income,

marital status.


  • 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.


RESULTS


Descriptive characteristics of the population studied

(*): 2 SD below poverty line


Differences in selected indicators,

Spanish speaker vs Non-spanish speaker

1997 and 2000

(Spanish - Non Spanish)

Source: Peru, LSMS 1997 and 2000.


Report illness past two weeks

Peru, 1997 - 2000

1997

2000

Source: LSMS, 1997 and 2000


Recent illness and consulted health facility

Source: LSMS, 1997 and 2000


Recent illness and seen by physician

Source: LSMS, 1997 and 2000


Differences in selected indicators,

Spanish speaker vs Non-spanish speaker

1997 and 2000

(Spanish - Non Spanish)

Source: Peru, LSMS 1997 and 2000.


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.


CONCLUSIONS


  • 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.


Author affilitiation:

Juan Seclén Palacín, MD, MGS

Monitoring and Evaluation Health Services and Research Unit

Project 2000

Ministry of Health

Peru

E-mails: jseclen@pathfind.org

jseclen@yahoo.com


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.


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