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

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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  1. 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

  2. INTRODUCTION

  3. 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.

  4. 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?

  5. 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.

  6. METHODOLOGY

  7. 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

  8. 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 )

  9. 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

  10. Measures - Report illness past two weeks - Recent illness and consulted health facility - Recent illness and seen by physician - Ethnicity

  11. Potential confounders: Age, sex, educational attainment, per capita household income, marital status.

  12. 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.

  13. RESULTS

  14. Descriptive characteristics of the population studied (*): 2 SD below poverty line

  15. Differences in selected indicators, Spanish speaker vs Non-spanish speaker 1997 and 2000 (Spanish - Non Spanish) Source: Peru, LSMS 1997 and 2000.

  16. Report illness past two weeks Peru, 1997 - 2000 1997 2000 Source: LSMS, 1997 and 2000

  17. Recent illness and consulted health facility Source: LSMS, 1997 and 2000

  18. Recent illness and seen by physician Source: LSMS, 1997 and 2000

  19. Differences in selected indicators, Spanish speaker vs Non-spanish speaker 1997 and 2000 (Spanish - Non Spanish) Source: Peru, LSMS 1997 and 2000.

  20. 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.

  21. CONCLUSIONS

  22. 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.

  23. 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

  24. 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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