SeriesThe implementation of the Plan Esperanza and response to the imPACT Review
Introduction
Although infectious and communicable diseases are endemic in Peru, the prevalence of non-communicable diseases, including cancer, is increasing.1 In Latin America, cancer is the second-leading cause of death.2 Peru has a population of 30 million, with approximately 43 000 new cancer cases and 26 200 cancer-related deaths reported annually.3, 4, 5 Cancer accounts for 18% of all deaths, second only to cardiovascular disease. In 2012, the age-standardised incidence (per 100 000 population) of new cancers was 140·9 among men and 169·8 among women.3, 5, 6 By 2030, the annual number of new cancer cases is expected to increase by 72% compared with 2012.5 6·8 million Peruvians live below the poverty line, with limited access to public health care, and in particular, costly health care, such as cancer treatment.6, 7 In Peru, most cancers are diagnosed at advanced and incurable stages, and those without access to cancer care (ie, those without insurance or who are remote from health-care infrastructure) are disproportionately affected.3, 6, 8, 9, 10, 11 See the first paper5 in this Series for more on cancer epidemiology in Peru.
Section snippets
History of cancer control plans in Peru
In 2004, the Peruvian Government began to decentralise cancer services12 to promote prevention and earlier detection of cancer, resulting in improved population health, particularly for more vulnerable populations.2 The country's funding and services are fragmented because care is delivered by both public and private sectors. The public sector includes the Peruvian Ministry of Health and the Directorate General of Health. 47% of the population have Public Comprehensive Health Insurance (SIS),
The imPACT Review and response
The imPACT Review was commissioned by the Peruvian Ministry of Health in 2013 to assess cancer control in Lima, Arequipa, and Huancayo (see appendix). The aims were to conduct a thorough assessment of the national capacity and needs for cancer control, including planning cancer control services, information management, prevention, early diagnosis and treatment, and palliative and end-of-life care; training activities; capacity-building activities, infrastructure and equipment needs; and, civil
Financing of the Plan after the Review
Peru's health budget has increased from 7% of the national budget in 2009 (PEN6 730 million) to 10·2% in 2016 (PEN16 119 million). The national cancer control budget increased from 2·25% (PEN152 million) of the national health budget in 2009 to 6·7% (PEN924 million) in 2016. These funds cannot be used for other purposes, and are guaranteed until 2019.22, 40 Figure 3 depicts the increasing public budget for health and cancer control from 2009 to 2016. The promotion, dissemination,
Conclusion
The Plan Esperanza has established a decentralised, public, population-based programme, comprising cancer prevention, early detection, diagnosis, and treatment across the country. It has achieved centralisation of high specialised oncology services through INEN, IREN-Norte and IREN-Sur, and decentralisation of more general oncology services through two cancer institutes in the Andean and Amazon regions, in alignment with the PpR Cancer–024. The cancer control programme is integrated into the
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Cited by (31)
Exploring the Cost of Radiation Therapy Delivery for Locally Advanced Cervical Cancer in a Public and a Private Center in Latin America Using Time-Driven Activity-Based Costing
2023, International Journal of Radiation Oncology Biology PhysicsPeru – Progress in health and sciences in 200 years of independence
2022, Lancet Regional Health - AmericasAssociation of healthcare system factors with childhood leukemia mortality in Peru, 2017–2019: A population-based analysis
2021, Journal of Cancer PolicyCitation Excerpt :The following reason might explain this outcome. The Peruvian government implemented the “Plan Esperanza” in 2012 to subsidize the diagnosis and treatment cost of cancer patients, including leukemia, for people living in low economic settings and affiliated to the Comprehensive Health Insurance (CHI) [32]. Therefore, despite having low economic resources, affected families still receive diagnosis and treatment for cancer.