ELD ERL Y A D UL T
PR OFILE
PERÚ – INTRA II
2004
DEVELOPING INTEGRATED RESPONSES OF HEALTH CARE
SYSTEMS TO RAPID POPULATION AGING
INTRA II – PERÚ
General Coordinator
Dr. Luis Varela Pinedo
Coordinator Team
Dr. Helver Chávez Jimeno
Dr. Antonio Herrera Morales
Dr. Francisco Méndez Silva
Dr. Miguel Gálvez Cano
MULTIDISCIPLINARY TEAM
Dr. Luis Varela Pinedo
General Coordinator INTRA II-Peru Project
Director, Gerontology Institute
Universidad Peruana Cayetano Heredia
Dr. Helver Chávez Jimeno
Titular member, Gerontology Institute, Universidad Peruana Cayetano Heredia
Dr. Antonio Herrera Morales
Correspondent member, Gerontology Institute, Universidad Peruana Cayetano Heredia
Dr. Fernando Portocarrero Salazar
Medical Director, Military Geriatric Hospital
Dr. Carlos Sandoval Cáceres
Resident Tutor in Geriatrics, Medicine Faculty, Universidad Nacional Mayor de San Marcos
Dr. Elizabeth Sánchez Yturrizaga
Executive coordinator, Consorcio Perú Envejecimiento y Desarrollo (NGO)
Dr. José Francisco Parodi García
Geriatric Physician, San Martin de Porres University
Dr. Pedro Vera Vílchez
Elderly Adult Social Program responsible, Hospital Nacional Cayetano Heredia
Dr. Juan del Canto y Dorador
Elderly adult program responsible
Health Ministry (MINSA)
Dr. Carmen del Pilar Estela Benavides
Elderly adult general direction
Woman and Social development Ministry (MIMDES)
Dr. Francisco Méndez Silva
Correspondent member, Gerontology Institute, Universidad Peruana Cayetano Heredia
Dr. Miguel Gálvez Cano
Resident Geriatric Physician, Universidad Peruana Cayetano Heredia
Dr. Luis Álvarez Cóndor
Physician, Geriatrics Service, Geriatric Institute Peruvian Aerial Force (FAP)
Dr. River R., Cersso Bendezú
Coordinator SBS, Elderly Adult Pilot Program, DISA II, Cañete-Yauyos, South Lima
Dr. Diana Rodríguez Hurtado
Scientific investigator office and technological development chief,
Arzobispo Loayza Hospital
Dr. María del Pilar Gamarra
Elderly Adult Attention National Commission President, Social Security (EsSalud)
Dra. Isabel Benate Gálvez
Elderly Adult Affairs Responsible
Primary Health Care, EsSalud
Dra. Blanca Deacon Castillo
Association Pro-Vida Peru President (NGO)
Dr. Felipe Aguirre Salinas
Executive Director, Association Pro-Vida Peru (NGO)
INTRODUCTION
During the last 50 years a decrease of the world's population natality and mortality
had been leading to the world's population aging. In the Latin American countries (Peru
among them) the population's aging is also a demographic characteristic. This has a great
importance, because it implies economic and social consequences; as well as changes in
work, housing, recreation, and education areas, and mainly in the health necessities that
will take place.
According to census and estimates, in 1970 the elderly adult population in Peru
constituted 5.54% of the national total. According to 1993 census, it was of 6.34%; that
means that in a 23 year period the elder adult population grew in less than 1% of the total
population. A real growth took place in the last 11 years, since for the end of 2004, it is
calculated that this population will arrive to 7.55% and for the 2025 will represent 13.27%;
this means that in next 20 years the proportion of elder adult population will be almost
duplicated. We are witness of a process of a quick demographic transition, so is our duty to
be prepared to confront these changes and their consequences.
The expectation of the Peruvian population's life has also changed in the last years.
In 1970 this was 53 years, for the 2004 is of 70 years, and is considered that it will reach 75
years for the 2025.
1. GENERAL CHARACTERISTICS
1.1 GEOGRAPHY
Peru is in the western and central region of South America, it limits for the west
with the Pacific Ocean, for the East with the countries of Brazil and Bolivia, for the North
with Ecuador and Colombia; and for the South with Chile. It presents a surface of 1 285
215 km², being the third country in territorial extension of South America after Brazil and
Argentina.
Located in a tropical region, the typical climate would be expected. However, due to
a great number of geographical peculiarities, as the Peruvian current that affects the
temperature of the adjacent sea and the Andes mountains that crosses the country from
north to south; Peru presents a wide climatic and ecological variety. Traditionally are
considered three geographical regions:
The Coast: to the west, next to the Pacific Ocean, is constituted by a narrow desertic
fringe that concentrates most of the Peruvian population (52%).
The Sierra: Central mountainous region that constitutes around 30% of the national
territory. It is conformed by mountain ranges and an extensive plateau. This configuration
implies that around 30% of the national territory it is located between the 2000 and the
4000 meters over sea level. 34.48% of the Peruvians habit this region.
The Forest: to the east, it constitutes the forest plains of the Amazon basin. This
region occupies 60% of the territory, but only 13.52% of the Peruvian population's habits it.
Since the year 2004 the country is conformed by 25 regions (the old 24 departments
and the constitutional county of Callao) whose first representatives, were elected in
November of the 2003. With this current and recent process of decentralization it is
expected that the country overcome the strong centralism that has characterized it for five
centuries. These regions are divided in counties (188) and these in turn are formed by
districts (1595).
Peru’s capital is the city of Lima, located in the central coast of the country. This
city was founded in 1535, beside Rimac River by the Spanish conqueror Francisco Pizarro.
From the beginning of the Spanish colonization until today Lima has been the center of the
political and economic power; configuration that has been prejudicial for the development
of the rest of the country and that has generated deep social and economic inequalities.
According to the 1993 census, Lima city had 5 854 608 inhabitants; the projections
of the National Institute of Statistics (INEI) for the year 2004 give it a population of 7 208
794 people that almost represents the fourth part of the national total
The second city of the country is Arequipa located at 2360 meters over the sea level,
in the Peruvian Andes. With 851 750 inhabitants, and located in the region of the same
name, concentrates 2.95% of the Peruvian population's.
1.2 POLITICAL - ECONOMIC SYSTEM
1.2.1 Historical aspects
Peru was one of the last countries in South America that reached its independence
that was proclaimed in 1821. Almost from the beginning of Peru’s republican life, the
government’s system was democracy, based on the division of the powers of the state,
government's alternation and congress's renovation by means of elections.
Peru has had 13 constitutions, the first one promulgated in 1823, and the last one in
1993.
1.2.2 Political Aspects
The Peruvian State is conformed by three autonomous powers:
a) Executive Power: The Peru has a presidential government's system. The executive
power resides in the President of the Republic who has chief of state functions. It is him
who directs the government politics, supported by a political-electoral majority, determined
by popular vote.
b) Legislative Power: Resides in the Congress that at the moment consists of an unique
Camera. The number of congress members is one hundred twenty. The Congress is chosen
by a five-year period. Their main functions are to give the laws and permanent inspection,
as well as the eventual reformation of the Constitution.
c) Judicial Power: Is integrated by jurisdictional organs that administer justice on behalf of
the Nation, and for organs that exercise their government and administration. The
jurisdictional organs are: the Supreme Court of Justice, the Superior Court, specialized and
mixed Tribunals, and Peace Tribunals. The Full Room of the Supreme Court is the
maximum organ of deliberation of the Judicial Power.
Parallel to these three powers, there are autonomous organisms that are:
· Republic General Controllership
. National Elections Jury
· People Defensory
· Public Ministry
1.2.3 Economic process in the last two decades
The Peruvian economy in the 80s decade had one of the highest hyperinflations in
the world, the reduction of the per capita income, and the increment the foreign debt. Peru
was also excluded of the support of the IMF and of the World Bank (ineligible country),
due to the incomplete payment of the foreign debt. In the 90s answering to this situation,
were applied programs of macroeconomic adjustment, commercial opening and structural
reformations that considered among other measures, the privatization of public companies,
and modifications in the administrative structure of the public sector. These measures
reduced the inflation drastically and created the conditions to recapture the route of the
growth and sustained development as well as a progressive reinsertion in the international
economic system. This process entered in crisis at the end of the 90s due to the impact of El
Niño phenomenon in the agriculture, the financial crisis of Asia, and the political instability
due presidential re-election of Alberto Fuijmori and its subsequent renouncement. All of
these factors limited the growth among the years 1998 to 2001. In July 2001 Alejandro
Toledo assumed the presidency; from then on the Peruvian economy has presented a slow
but stable growth.
The growth of the National Gross Product for the year 2002 were 4.85%, registering
an increment of 5.5% regarding the year 1998 that registered negative values. The rate of
inflation of the year 2003 was of 2.48%, something superior to that of the 2002 that was of
1.10%. The Chart 1.1 summarize some socioeconomic indicators and their evolution among
1993 - 2003
Chart 1.1 Socioeconomical indicators and their evolution among 1993 - 2003
1993
1995
1997
1999
2001
2003
National Gross Product
(NGP)
Millons of NS$
87375
107025
117214
117507
121132
130817
NGP growth, %
4.76%
10.69%
4.67%
0.13%
1.53%
3.92%
Inflation rate, %
39.50%
12.80%
9.15%
4.85%
3,90%
1.79%
NGP per-capita
Nuevos Soles per hab
3842.3
4548.3
4809.6
4657
4642.8
4853.9
Source: Análisis estadístico, Perú en números 1993 – 2002, Cuanto
1 dollar = 3.5 Nuevos Soles
The Social situation of the country is also reflected in the PBI structure. The
agriculture that contributed with 23.8% of the NGP in 1950, drop to almost the half by the
end of the 90’s. While the commerce, that in the 50s represented 4.1% of the PBI grew in
important form, reaching 14.4%; being the small and the informal commerce those that
contributed in great measure to this increment. Fishing that contributed in 1950 with 0.2%
it grew six and half times, reaching to 1.3 %. Graph 1.1
Graph 1.1 Evolution of the structure of the NGP, Peru 1950 - 1996
National Gross Product Structure, 1950 - 1996
100%
80%
60%
1996
40%
1950
20%
0%
Agriculture
Agricultura
Industry
Manufactura
Mining
Minería
Fishing
Pesca
Commerce
Comercio
Peru’s Poverty evolution is summarized in the chart 1.2. Total poverty is defined
like a situation in which the home income don't reach to satisfy a group of minimum
necessities (food and not food), contained in the Consumption Minimum Basket. The total
poverty diminishes from 1993 to 1998, while starting from 1999 increases due to the period
of economic crisis mentioned previously.
Chart 1.2: Perú: Total poverty evolution, 1993 – 2001
Total
Urban
Country side
Lima (city)
1993
56,80%
42,40%
90,10%
--
1995
45,30%
37,40%
59,40%
28,30%
1997
42,70%
29,70%
66,30%
25,40%
1998
42,40%
29,70%
65,90%
24,10%
1999
47,50%
34,70%
71,80%
31,40%
2001
49,80%
35,70%
75,90%
35,70%
Source: Encuesta Nacional de Hogares 1995 -2001; INEI
Extreme poverty is defined as the situation in which the home doesn't have enough
income to acquire a Minimum Consumption Alimentary Basket that satisfies the nutritional
minimum requirements in terms of calories and proteins. The evolution of this indicator is
in the Chart 1.3
Chart 1.3: Perú: Extreme poverty evolution, 1993 – 2001
Total
Urban
Countryside
1993
28,30%
16,10%
56,90%
1995
19,30%
8,90%
38,40%
1997
18,20%
5,30%
41,50%
1998
17,40%
5,20%
40,00%
1999
18,40%
4,70%
44,40%
2001
19,50%
5,70%
45,20%
Source: Encuesta Nacional de Hogares 1995 -2001; INEI
In chart 1.4 is observed that the unemployment level has stayed almost constant
during the last years, while the sub employment has grown almost 10% since 1995.
Chart 1.4 Peru: employment evolution, 1995 - 2001
Employment rate
Unemployment rate
Sub employment rate
1995
1996
1997
1988
2000
2001
92,50%
7,50%
--
92,90%
7,10%
42,60%
92,50%
7,50%
41,80%
92,10%
7,90%
44,10%
92.60%
7.40%
52.20%
92.20%
7.80%
55.70%
Source: Encuesta Nacional de Hogares 1995 -2001; INEI
1.3 HISTORY OF PERU AND THEIR ELDER ADULTS
In Peru, there are human evidences of human life that has more than 15 thousand
years of antiquity. Chavin culture is considered the most ancient of Peru, after this culture,
diverse cultural groups and towns developed in different regional spaces, among these
groups are the Paracas, Nazca, Mochica, Huari, Tiahuanaco, Chimu and the Inca cultures.
The Inca expansion takes place by the middle of the 12th century, reaching a
remarkable level of political and administrative unification based on conquest or
annexation of other towns or cultures of the Andean area. They extended the use of the
Quechua as the common language and built an extensive net of roads and tambos (depots).
They also redistributed the resources inside of an organizational system of social economic
planning that unified and respected the diversity of towns and cultures, as well as the
natural resources and economic areas, also very diverse.
Toward the year 1500, the Inca political organization had incorporated most of the
Andean social formations, forming the Tahuantinsuyo whose territories embraced from the
south of the current Colombia until the center of what today is Chile, also included Bolivia
and the north of Argentina. This vast and complex social economic formation had
sustenance in a theocratic government model, in which the Inca elite was located in the
peak of the system and were considered divinities.
In the Incan Empire, the base of the social and economic organization was the ayllu
that was conformed by groups of families. The Inca economy was based on the collective
work, the elderly adults maintained their labour status in a permanent way, carrying out
appropriate works to his biological condition. When arriving to very advanced ages the
ayllu took charge of their maintenance.
About other pre-inca towns and cultures, we doesn't have information regarding the
elderly adult's situation; but is probable that they were in disadvantage just as it was in
almost all the civilizations of the past.
In the year 1532, a conflict for the succession and control of the Inca throne started
between the brothers Atahualpa and Huáscar. The scale had leaned in favour of Atahualpa
when a group of Spaniards, led by Francisco Pizarro and Diego de Almagro arrived to Peru.
They went to the encounter of Atahualpa in Cajamarca and seeing the favourable
conditions, they captured and later execute him; this action began the process of the
conquest of the Inca Empire and of other towns of South America.
Socially a division took place between the colony of Spaniards and that of Indians;
arising intermediate sectors - the mestizos - characterized for their struggle to differ from
the Indians and resemble to or be assimilated by the Spaniards. The African Americans
were introduced in America like slaves. They constituted a category apart from the social
structure; their social inclusion has meant a long process. In this way, the Peruvian society
became multi-ethnic, multi-cultural and of many languages.
In this new economic structure the only native who was worth, was the one capable
of work, giving place to the abandonment of those no capable, among them the elderly
adult. The natives had to pay a tribute until they were 50 years old; the epidemics brought
by the conquerors and the implanted mining exploitation system raised the mortality
(especially the masculine one) at alarming levels. For these reason only a few people were
able to reach the age of 50 years.
It was also during this time that took place the establishment of medical institutions;
being founded hospitals and hospices under the help of the Catholic Church. After that the
teaching of a medieval medicine settled down
Peru’s independence was achieved by Simon Bolivar’s troops in the battle of
Ayacucho in 1924. After Bolivar leaved the country, each one of his lieutenants wanted to
take control of the new created Republic, this situation faced them in multiple wars for
political power. In this way, the first decades of independent life were characterized by a
political and social economic chaos. The country would not enjoy order neither peace up to
1845, year in that the general Ramón Castilla, was made president. Castilla was a skilled
ruler that began numerous and important reformations in the two periods of its presidency,
as the abolition of the slavery, the construction of railroads and of telegraphic facilities, as
well as the adoption of a liberal Constitution in the year 1860. Castilla also began the
exploitation of the natural resources of the country, as the deposits of guano and the nitrate.
In 1864 these deposits would unchain the first Pacific war (1864-1866) between Peru and
Spain, country that had taken possession of the rich guano islands of Chincha. Ecuador,
Bolivia and Chile helped Peru, defeating the Spanish forces in 1866.
The relationships between Peru and their neighbours were difficult from the
beginning of its republican life. The bordering problems mainly with Chile, gave place to
the second Pacific War with this country in 1879, in which after five years of war, Peru lost
part of its territories in the south. The period of post-war was characterized for a destroyed
economy and a conflict for power between the military commanders defeated by the
Chilean army; for this reason the next 30 years the Peru was governed by successive
dictators. After this period democracy returned but our republican life since then has been
characterized by the alternation between elected governments and civil or military
dictatorships.
In the initial period of the republic, the elderly adult population's marginalization
persisted. They were considered a devaluated work force, with very little acceptance in the
labour market.
By the middle of the XIX century, with the development of the national medicine,
under the influence of French, English and German medicine, the interest arose to satisfy
the necessities of the elderly adult’s attention, especially those of popular sectors.
The Society of Charity of Lima (Sociedad de Beneficencia de Lima) was founded in
1834 during the government of the general Orbegoso with the purpose of offering attention
to the helpless. This society established several hospices with limited functions, as the
Manrique, Castaño, Ruiz Dávila, and Corazon de Jesus housings among others.
In 1924 the San Vicente de Paul Asylum was built, today Geriatric Home,
belonging to the Society of Charity of Lima, for the attention of helpless elderly adults.
The creation of an Obligatory Public Health for the workers in 1936 is important,
because for the first time the workers had insured their medical care during their old age,
after the jubilation. This type of attention was extended in 1951 in the form of the Social
Insurance. The Pensions National System of the Social Security was created in 1973,
replacing the Pensions Fund of the Social Security, the Employee's Social Security and the
Jubilation Special Fund for Employees of Non-governmental companies.
The Peruvian Armed Forces created services of geriatric attention in the Military
Central Hospital, in 1975; in the Police Forces Hospital, in 1982; in the of Aeronautics
Central Hospital, in 1983 and in the Navy Central Hospital, in 1985.
In August 27 of 1982, were inaugurated in the district of the Rimac the geriatric
asylum that takes their benefactor's name, Ignacia Rodolfo widow of Canevaro.
In 1998 was created the Geriatrics Service in the Social Security Hospital,
“Guillermo Almenara Irigoyen”, while in the hospital “Edgardo Rebagliati Martins”, also
of the Social Security was created a unit of geriatric evaluation.
Recently, Geriatrics Services have been created in some hospitals of the Health
Ministry, such as “Cayetano Heredia”, “Archbishop Loayza”, “2 de Mayo”, “Sergio
Bernales” , but they are not implemented to work in a proper way yet.
The Geriatrics began as a discipline in our country by the middle of the XX century
by a group of physicians interested in this relatively new specialty; they decided to found
the Peruvian Society of Geriatrics in 1953, and their first president was Dr. Eduardo
Valdivia Ponce. This society was made member of the International Association of
Gerontology in 1957. Later on this group went in crisis because their members didn't know
how to come to an agreement in the identity of the institution.
In 1978 another group of physicians believed necessary to form the Peruvian
Society of Gerontology and Geriatrics. Their first president was the Dr. Miguel LLadó.
This society is recognized by the Peruvian College of Medicine and had been acting
through medical education courses of the specialty and through it official organ, the
magazine Geronto whose first number appeared in 1982.
In the city of Arequipa, the University Health Center “Pedro P. Díaz” of the
National University of San Agustín, created in 1979, has among its activities Elderly Adult
Programs and social projection programs as: psychological campaigns of Attention to
Children, Adults and Elderly Adults. In the Catholic University of Santa María, the
infirmary program includes, among it objectives, to guide their students actions towards the
human necessities of the women, newly born, boy, adolescent, young adult and elderly
adult in chronic and critical states
Most of geriatric institutions are concentrated in Lima. However, in the last years,
the Social Security has been carrying out an active work of forming services of geriatric
attention and other similar ones, in the main cities of the country.
In the year 2002 was approved " THE NATIONAL PLAN FOR THE ELDERLY
ADULT 2002-2006"with the objective of implementing coordinated actions between the
government organizations and the civil society in order to increase the participation and the
elderly adult's social integration. The coordination and evaluation of this plan is in charge
of the Ministry of Promotion of the Woman and Human Development (MIMDES).
The Health Ministry also had considered the medical attention according to the
stages of the vital cycle, developing norms for the elderly adult's attention in an integral
model of health attention.
August 26, day of the death of Santa Teresa Jornet Ibars, co-founder of the Order of
the Sisters of the Abandoned Elderly Adults, has been instituted as the Peruvian Elderly
Adult’s Day.
In the educational and formative field, the geriatrics course has been integrated in
some universities. Also, the specialty of geriatrics is integrated in the resident program.
Mastery programs in gerontology are dictated in diverse universities. In 1989, the Peruvian
University Cayetano Heredia creates a gerontology institute, which has for mission to carry
out and to foment the investigation in the geriatrics and gerontology area in Peru.
2. DEMOGRAPHIC TENDENCIES
According to the Pan-American Health Organization report on the "State of the
Aging and Health in Latin America and the Caribbean, the socio-economic situation of the
elderly adults", presented in January of the 2004, the region has been divided in four subregions. Peru is located in the sub-region of Andean Countries together with Bolivia,
Colombia, Ecuador and Venezuela where the aging index will be duplicated in next two
decades and the rural area will continue being important for elderly adult population.
The components that determine the growth, size and the structure of the populations
are the natality, the mortality and the migration rate. In our country the growth is mainly
consequence of the interaction of these first two demographic factors. The rate of mortality
and natality have diminished in the last 30 years and it is expected they continue
diminishing up to the 2015; starting from this year the mortality will began to increase
while the natality will continue diminishing. The changes in the fecundity in Peru have
been notorious and it is expected that the global rate of fecundity diminishes up to 2.1
children per woman for the 2025. Chart 2.1
Chart 2.1 Peru: Natality, mortality and fecundity rates, 1970 - 2025
Year
Natality
Global
Mortality
Rate ( per mil)
Fecundity Rate
(children per women)
Rate
( per mil)
6.30
5.01
4.36
3.90
3.45
3.02
2.72
2.48
2.29
2.15
2.10
14.01
9.83
8.31
7.27
6.68
6.29
6.07
5.99
6.00
6.06
6.36
1970
1980
1985
1990
1995
2000
2005
2010
2015
2020
2025
Source: INEI
42.35
35.64
32.49
30.42
27.7
24.52
22.18
20.38
18.84
17.29
16.48
In the Chart 2.1, can be observed an increase of the longevity; that it is measured by
means of life expectancy at birth that has increased from 53.47 years in 1970 to 70.4 years
for the present year, 2004. (chart 2.2)
Chart 2.2 Peru: Life expectancy at birth, 1970 – 2025
Life expectancy at birth ( by years)
Year
Men
53,88
59,46
62,08
64,40
65,91
67,34
68,68
69,93
71,08
72,14
Total
55,52
61,55
64,37
66,74
68,32
69,82
71,23
72,53
73,75
74,87
1970 – 1975
1980 – 1985
1985 – 1990
1990 – 1995
1995 – 2000
2000 – 2005
2005 – 2010
2010 – 2015
2015 – 2020
2020 – 2025
Source: INEI
Women
57,25
63,75
66,77
69,20
70,85
72,42
73,90
75,27
76,55
77,73
The rate of the population's growth is defined as the relationship between the annual
surplus of the births and the deaths of the population, measured in the period of observation
and it is expressed in percentage (chart 2.3).
Chart 2.3 Peru: Evolution of the population's growth rate, for five year period, 1980 - 2025.
1980 1985
1985 1990
1990 1995
1995 2000
2000 2005
2005 2010
2010 2015
2015 2020
2020 2025
2,41
2,19
1,85
1,7
1,5
1,4
1,31
1,19
1,04
Source: INEI
Between the years 1970 and 2004, the group with ages of 50 or more years
increased their participation. The projections for the year 2025 indicate that the population
of elderly women would reach, 13.7% and the elderly men, 11.53% (Chart 2.4)
Chart 2. 4 Peru: Structure of the population according to age and gender (% 1970 - 2025)
1970
1990
2004
2025
Total
0 - 14 years
13192677
5805842
21753328
8313015
27546574
9013296
35725458
8606711
%
44.01
5927997
38.21
10815052
32.72
14531002
24.09
19030660
44.93
727904
49.72
1307885
52.75
1923141
53.27
3659460
60 +
5.52
730934
6.01
1317376
6.98
2079135
10.24
4428627
%
5.54
6.06
7.55
12.40
Men
Total
0 - 14 years
6648691
2949225
10944495
4222387
13852228
4585173
17879352
4391704
44.36
2998457
38.58
5458566
33.10
7330314
24.56
9615530
45.10
358957
49.88
647925
52.92
955095
53.78
1811267
60 +
5.40
342052
5.92
615617
6.89
981646
10.13
2060851
%
5.14
5.62
7.09
11.53
Women
Total
0 - 14 years
6543986
2856617
10808833
4090628
13694346
4428123
17846106
4215007
43.65
2929540
37.84
5356486
32.34
7200688
23.62
9415130
44.77
368947
49.56
659960
52.58
968046
52.76
1848193
5.64
388882
6.11
701759
7.07
1097489
10.35
2367776
5.94
6.49
8.01
13.27
15 - 50 years
%
50 - 60 years
%
%
15 - 49 years
%
50 - 59 years
%
%
15 - 49 years
%
50 - 59 years
%
60 +
%
Source: INEI
If the changes are analyzed inside the group of elderly adults; it can be observed that
among 1970 and 2025 the group of 75 years old or more presented a sustained increase
inside the group of elderly adults. (Chart 2.5)
Chart 2.5 Peru: Structures of the population elderly than 50 years by five-year age groups,
1970 – 2025
50 - 54 years
55 - 59 years
60 - 64 years
65 - 69 years
70 - 74 years
75 - 79 years
80 years o +
1970
1990
2000
2010
2025
26,79%
23,11%
18,78%
13,71%
9,64%
5,32%
2,65%
27,18%
22,64%
17,61%
13,07%
9,20%
6,09%
4,21%
26,38%
21,27%
17,60%
13,76%
9,65%
6,14%
5,20%
26,68%
21,66%
16,78%
12,78%
9,66%
6,61%
5,83%
24,39%
20,86%
17,51%
13,60%
10,08%
6,78%
6,78%
100,00%
100,00%
100,00%
100,00%
100,00%
Source: INEI
In the graph 2.1 is the population elder than 50 years current percentage distribution.
Graph 2.1. Peru: Structure of the population elder than 50 years by decade age groups, 2004
48,05%
5,43%
16,18%
50-59
60-69
70-79
30,34%
80 or +
years
Source: INEI
When analyzing the structure changes of the population elder than 50 years between
1970 and 2025 for each gender; the women elder than 80 years increased their participation
in the group from 2.93% in 1970 to 7.68% this year, while the men increased in smaller
proportion, from 2.34% to 5.79%. (Chart 2.6)
Chart 2.6 Peru: Structure of the population elder than 50 years for each gender, according
to five-year groups of age (%, 1970 - 2025)
Men
50 - 54 years
55 - 59 years
60 - 64 years
65 - 69 years
70 - 74 years
75 - 79 years
80 years o +
1970
1990
2000
2010
2025
27.65
23.56
18.83
13.45
9.21
4.96
2.34
28.11
23.18
17.74
12.89
8.83
5.63
3.62
27.38
21.69
17.45
13.58
9.47
5.84
4.60
27.47
22.14
17.00
12.74
9.41
6.18
5.05
25.34
21.45
17.78
13.53
9.77
6.34
5.79
Total
100.00
100.00
100.00
100.00
100.00
Women
50 - 54 years
55 - 59 years
60 - 64 years
65 - 69 years
70 - 74 years
75 - 79 years
80 years o +
Total
Source: INEI
25.98
22.70
18.75
13.95
10.03
5.66
2.93
100.00
26.32
22.14
17.50
13.23
9.55
6.51
4.75
100.00
25.63
20.81
17.40
13.84
9.93
6.51
5.88
100.00
25.94
21.22
16.58
12.82
9.89
6.99
6.56
100.00
23.52
20.32
17.25
13.67
10.36
7.20
7.68
100.00
During the last five decades, the Peruvian society has been marked by a clear
tendency to the urbanization, expressed in the population territory redistribution. The
migratory flows are evidenced, through a quick growth of the population of the urban areas,
as well as of a slow growth and a relative loss of population of the rural areas. The changes
in the Peruvian population's composition between 1940 and 1993 are significant. Of a
population for the most part rural in 1940 (65%) it passes to a mainly urban population in
1972 (60%), increasing their participation in 1993 to 70% and according to estimates for
the 2004 will arrive to 72.48%.
The urban population has grown much more quickly that the rural one. The rates of
growth of the first one in the periods 1940-61 and 1981-93 were respectively of 3.7% and
2.8%. While the rural one in the same periods grew 1.3% and 0.9% respectively. It is
appreciated in the last period a relative descent of the speed of the urbanization. From 1940
to 1993, the urban population has grown 6 times, while the national population almost 3
times, and the rural one hardly in 0.6.
The evolution of the population's structure elder than 50 years, in rural environment
as in the urban one is in the chart 2.6. In 1970, it is observed that almost 2/5 of the elder
than 50 years population lived in the rural environment; in the 90s less than a 1/3 of this
group lived in the rural areas. For the 2025, is expected that only a 1/4 of elder than 50
years population will live in rural areas.
Chart 2.6. Peru: Structure of the population elder than 50 years Urban vs. Rural, 1970 –
2025
Total
50 a 59 years
60 a 69 years
70 a 79 years
80 years or +
1970
Urban
7659211
408187
260479
117683
20440
%
58.06
56.08
54.95
53.92
52.95
Rural
5533466
319717
213584
100589
18159
%
41.94
43.92
45.05
46.08
47.05
1990
Urban
14955100
896465
540693
269405
76242
%
68.75
68.54
67.13
67.10
69.04
Rural
6798228
411420
264759
132097
34190
%
31.25
31.46
32.87
32.90
30.96
Total
50 a 59 years
60 a 69 years
70 a 79 years
80 years or +
Source: INEI
2004
Urban
19966180
1486059
904713
480071
173572
%
72.48
77.27
74.50
74.15
79.86
Rural
7580394
437082
309680
167322
43777
%
27.52
22.73
25.50
25.85
20.14
2025
Urban
26838213
2939151
2059905
1112086
449683
%
75.12
80.32
81.86
81.52
82.03
Rural
8887245
720309
456399
252040
98514
%
24.88
19.68
18.14
18.48
17.97
In Chart 2.7 is the regional distribution of the Peruvian population and the
percentage of elder than 60 years in each one of them.
Chart 2.7 Peru: Elderly Adult’s total population, by regions, 2004
Regions
Total
Population
Total pop of
60 years or Population % 60
more
years or more
Elderly Adult
population
distribution
Amazonas
436073
24637
5.65%
1.18%
Ancash
1139083
93966
8.25%
4.52%
Apurímac
478315
31114
6.50%
1.50%
Arequipa
1126636
96021
8.52%
4.62%
Ayacucho
571563
41017
7.18%
1.97%
Cajamarca
1532878
95086
6.20%
4.57%
Callao
811874
74207
9.14%
3.57%
Cusco
1237802
82620
6.67%
3.97%
Huancavelica
459988
27513
5.98%
1.32%
Huánuco
833640
48541
5.82%
2.33%
lca
709556
57539
8.11%
2.77%
Junín
1274781
89590
7.03%
4.31%
La Libertad
1550796
123938
7.99%
5.96%
Lambayeque
1141228
86545
7.58%
4.16%
Lima
8011820
739089
9.22%
35.55%
Loreto
931444
44137
4.74%
2.12%
Madre de Dios
104891
3213
3.06%
0.15%
Moquegua
163757
12933
7.90%
0.62%
Pasco
277475
14780
5.33%
0.71%
Piura
1685972
108437
6.43%
5.22%
Puno
1297103
93697
7.22%
4.51%
San Martín
777694
39864
5.13%
1.92%
Tacna
309765
18495
5.97%
0.89%
Tumbes
211089
11112
5.26%
0.53%
Ucayali
Total
Source: INEI
464399
21045
4.53%
1.01%
27546574
2079135
7.55%
100.00%
It is prominent the elderly adult population concentration in certain regions of the
country that doesn't always present the highest percentages of elderly adult population's
total distribution.
It can also be observed in the previous chart that the regions with more proportion
of elderly adult population are located in the coast, where the biggest urban centers in the
country are also located. This was expected since these regions offer to the population more
labour options as well as an easiest access to education services, culture, health, and
recreation. This in turn generates conflicts of coexistence, overalls in Lima. Lastly the
unequal regional development drives to political-social and economic conflicts when
concentrating financial resources on some few regions.
3. GENERAL CONSIDERATIONS FOR THE POPULATION OF 50 YEARS OLD OR
MORE
According to the United Nations Development Program (UNDP) the indicators of
life quality in Peru are as the one as the average of Latin America that is to say below the
developed countries. According to the index of human development, that is measured in
three basic dimensions (hope of life, educational level and income) the Peru is a country of
intermediate development, being located in the 13th place in the Latin American context
and 82nd at world level.
3.1 WORK
3.1.1 Occupation, unemployment and inactivity rates
According to the National Home Survey (ENAHO 99), only the 37.46% of the
elderly adults was economically active (EA) in the urban area; 52.07% of them were males
and 24.41% females. This difference are explained in function of the social factors
prevalent decades ago, in which the feminine presence was important at home, and at the
same time and by this excuse her participation inside the productive activity was restricted.
Chart 3.1 Peru: Elderly adult population, by gender, activity condition, Urban Area at
National Level (1999)
Activity
Total
Men
Female
Population
1,185,126
559,348
625,778
EA
Employed
Unemployed
444,004
425,193
18,811
37.46%
95.76%
4.24%
291,267
273,574
17,693
52,07%
93,93%
6,07%
152,738
151,62
1,118
24,41%
99,27%
0,73%
NON EA
741,122
62.54%
268,081
47,93%
473,04
75,59%
Source INEI- ENAHO 1999-III Trimestre
3.1.2 Underemployment and Unemployment
ENAHO 1999 also find that at Urban Peru level, the 44.7% of the population elder
than 55 years was under-employed. Chart 3.2
Chart 3.2 Urban Peru, Underemployment by age groups: 1999
Age
Total
14 - 24 years
24 - 44 years
45 - 54 years
55 or more years
Source: INEI
Underemployment
Rate
43.40%
52.50%
39.50%
39.10%
44.70%
In Peru the unemployment had increased in all age groups. Among the elderly adult
population this could be due aspects that are related with the labour offer like: health
problems, lack of qualification, or with the labour demand: lack of opportunities, age
discrimination. The unemployed population of this age could probably be looking for a job
due an subsistence objective, mainly if he/she doesn't have access to a social security
pension, own rents or family support.
For the year of 1997, 7.6% of the males and 4.3% of the females elder than 55 years
were unemployed. The males of this age group present the highest unemployment rate,
after the youths between 14 and 24 years. Due the lack of information, to be able to analyze
the evolution of the unemployment, it is necessary to restrict the analysis to Lima City. In
1990, while the unemployment only affected 3.1% of the economically active elder than 65
years population; in 1993 reached the maximum level of 9.9% and diminished lightly in
1997 remaining at 8.84%.
Lima City: Unemployment rate evolution, by age group
1986-1998
14-19
20-34
35-49
50-65
65-+
20.0
20.2
13.1
13.0 11.6
10.0
19.42
11.1
9.8
7.3
9.2 9.9
5.1
2.9
2.5
2.6
8.1 8.0 9.0
6.16
6.1
3.4
9.76
8.84
6.64
3.8
3.1
0.0
1986
1990
1993
1995
1997
If the differences are analyzed by gender, it is observed that contrarily to what
happens in other age groups, the elder males had the highest unemployment rates. This
could be probably because the women elder than 65 years are more dedicated to home tasks
or offering family support to their sons or daughters and they are not looking for an
employment actively (This means they are part of the non economically active population).
The working men elder than 50 years, had a high increment in the unemployment
rate. It rose from 3% for the period 1986-1990 to 7.7% for the period 1994-1997.
In the chart 3.3 can be observed more recent statistics about the characteristics of
the economically active population at Lima City.
Chart 3.3 Economically Active Population in Lima City: Employment, Underemployment
and Unemployment levels, 2002
Unemployment
EA population
Men
14 - 24 years
25 - 44years
45 - 54 years
55 or + years
Females
14 - 24 years
25 - 44 years
45 - 54 years
55 or +years
Underemployment
Proper employment
9,72%
41,91%
48,37%
14,63%
5,76%
6,55%
10,10%
50,58%
34,94%
31,91%
34,43%
34,79%
59,30%
61,54%
55,47%
18,05%
10,76%
7,03%
8,01%
51,03%
44,61%
46,09%
59,79%
30,92%
44,63%
46,88%
32,20%
Source: INEI - ENAHO 2002
3.1.3 Characteristics of the elderly adult's occupation categories and work place
In the year of 1996, the age group from 25 to 44 years was the most prevalent in
most of all the occupational categories. The adults elder than 55 years represented 10.5% of
the economically active urban population, having a significant participation among the
groups of the independent workers and of employees or bosses. Chart 3.4
Chart 3.4 Peru: The Economically Active Population distribution and by age groups, 1996
Occupational
Category
Hard-Worker
Employed
Independent worker
Age groups( by years )
14 - 24
25 - 44
45 - 54
55 or +
34.0
46
12.7
7.3
22.5
59.5
12.8
5.2
11
52.1
20.2
16.7
Total
100
100
100
Professional
Non professional
Boss
Family worker non paid
Home
Others
Total
12.8
11
5.7
50.3
55.8
55.3
23.4
49.2
52.2
54.7
32.2
31.6
27.6
50.8
21.7
20.1
21.7
9.2
7.8
12.9
15.3
16.3
16.7
17.9
8.3
4.8
4.2
10.5
100
100
100
100
100
100
100
Fuente: ENAHO 1996
However, inside the group of adults elder than 55 years, most of them were independent
workers, employees and hard-workers. Chart 3.5
Chart 3.5 Peru: Urban population elder than 55 years distribution by occupational category,
1996
Occupational
Category
Hard-Worker
Employed
Independent worker
Professional
Non professional
Boss
Family work non paid
Home
Others
NEP
Total
55 or + (%)
Population
13.7
14.1
54.3
1.6
52.7
9.7
5.6
1.8
0.1
0.7
100.0
Source: ENAHO 1996
For 1996, the age group that worked more in the agricultural area was the one of 55
years or more, while the youths worked more in commercial locals or shops. Chart 3.6
Chart 3.6 Peru: Population's distribution by age groups and by work place, 1996
Work place
Commercial local or shop
At home
On the street (a fixed place)
On the street (a mobile place)
Transport vehicle
14 - 24
26.5
15.9
21.3
22.9
22.1
Age groups ( by years )
25 - 44
45 - 54
55 or more
53.7
13.6
6.2
47.9
18.4
17.8
52.8
15.9
10
53
14.1
10.0
53
14.9
10.0
Total
100
100
100
100
100
Clients home
Marketplace
Agricultural area
Others
Total
Source: ENAHO 1966
17
22.1
18.4
30.3
22.9
54.1
48.5
37.9
43.3
51.4
16.2
14.7
17.3
17.9
15.1
12.7
14.7
26.4
8.5
10.6
100
100
100
100
100
Among the group of elder than 55 years, most of them worked in commercial locals
and shops, at home and in the agricultural area. Chart 3.7
Chart 3.7 Peru: The 55 year-old urban busy population's percentage distribution and but for
age groups, according to work place, 1996
Occupational
Category
Commercial locals or shops
At home
On the street (fixed place)
On the street(mobile place)
Transport vehicule
Clients home
Marketplace
Agricultural area
Others
Total
Source: ENAHO 1996
55 or + (%)
Population
26.9
25.6
6.1
8.4
6.6
6.3
4.2
14.3
1.6
100.0
3.1.4 Characteristics of the none economically active population
It is considered none economically active population the one that is not working or
isn’t looking for employment actively. The reasons for this "inactivity" are multiple, but the
most important are: waiting the beginning of a work, home tasks, being retired or
pensioner, to be sick or disabled.
In Lima City for the year 2002, the main causes of inactivity were home tasks (also
the first cause among women) and being retired or pensioner (first cause among men).
Although illness or inability were not the most important causes of inactivity, the elderly
adult group is the age group that suffers more of these causes in comparison to other
groups. Chart 3.8
Chart 3.8 Lima City: None economically active elder than 55 years population distribution,
2002
Waiting for beginning of work
Home Tasks
Being retired or pensioner
Illness or disability
Others
Source: ENAHO 2002
% Total
0,76%
46,33%
39,57%
12,14%
1,20%
Total
4318
263335
224913
68981
6826
Men
77,86%
8,42%
57,52%
42,29%
73,33%
Women
22,14%
91,58%
42,48%
57,71%
26,67%
The elderly adult population's situation in regard to the labour activity, it is limited,
due to the scarce possibilities with which they count to stay active inside the labour
environment. Also at certain age they are pressed to leave the labour status to augment the
lines of the pensioners.
This situation can generate inside this group, anxiety states, frustrations and social
area retirement, factors that impact directly in the deterioration of health.
Also, staying subject to a fixed pension that is insufficient in most of the cases,
exercises pressure inside this group to attempt their re-insertion in the labour activity, being
in some cases, staying active after arriving to the retirement age a viable perspective.
3.2 SOURCES OF INCOME
3.2.1 The contributions according to sources of labor revenues
Given the scarce existent information of this topic at national level, we should
restrict the analysis to Lima City. During the 1986-1998 period, the elder than 65 years
population's monthly income has been only lower than the one perceived by the
population's group between 35 and 64 years. Chart 3.9
Chart 3.9 Lima City: Monthly labour income by age group (In soles of June of 1994)
Age
14 - 18 years
19 - 34 years
35 - 49 years
50 - 64 years
65 or + years
All ages total
1986-1989*
225.50
580.03
842.81
909.30
621.11
686.91
1992
211.77
406.65
573.38
568.81
469.28
475.07
1997
193.05
514.02
663.41
657.38
340.50
557.32
1998
191.55
564.97
802.52
682.46
300.91
640.24
Source: Elaboración propia en base a las Encuestas de Hogares del Ministerio
Trabajo y el INEI.
de
The group of people elder than 65 years received revenues below the average during
this whole period, increasing the difference notably starting from 1997; on the other hand
the group of 50 to 65 years, having been the first one in terms of perceived revenues, was
seen in second place starting from 1992.
According to the information of the National Home Survey (ENAHO) of the year
2002, the employed population of Lima city elder than 55 years perceived more incomes
that the ones of 14 to 24 years and that of 25 to 44 years. This pattern doesn't repeat in other
coastal cities; this way for example in Ica, the 55 year-old population is the age group that
perceives the highest incomes, while in Tacna this group only had higher incomes than one
of 14 to 24 years; similar pattern to the one presented in the cities of the sierra (mountain)
and the forest. Chart 3.10
Chart 3.10 Metropolitan Lima and other cities: monthly labour according to age group,
2002 (in soles of the 2002)
Coast
Sierra (Mountain)
Forest
Lima
Ica
Tacna
Ayacucho
Huanuco
Huaraz
Tarapoto
14 to 24 years
495,65
358,71
408,51
338,18
271,09
263,66
341,97
25 to 44 years
985,33
674,27
639,99
681,77
649,36
714,00
717,79
45 to 54 years
1353,91
856,42
608,07
746,87
716,81
743,00
867,79
55 years or more
1157,93
874,70
462,79
497,18
577,00
470,00
512,44
Source: Elaboración propia en base a las Encuestas de Hogares del Ministerio de Trabajo y el INEI.
In Lima City, for all the age groups, the males perceive more income that the
females. This difference that is minimum in the group of 14 to 24 years increases
progressively with the age, being observed that in the 55 or more years-old group the men
almost triplicate the incomes of the women. In other cities the difference of income for this
group is similar or smaller than the one registered in Lima, but always favouring the group
of the males. Chart 3.11
Chart 3.11 Lima City: Labour monthly income according to age group and gender, 2002 (in
Soles of the 2002)
14 to 24 years
25 to 44 years
45 to 54 years
55 or more years
Men
497,5
1159,8
1716,6
1482,6
Source: ENAHO, October 2002
Women
493,3
756,5
868,6
508,5
Although a great percentage of the elderly adult’s counts with a family, mainly sons
or daughters that can most of times offer their economic support; it is one of the main
concerns of people that have passed the first half of their existence, to assure some form of
income.
However, the back of a small capital, the own housing, the investment carried out in
the education of the sons and daughters that is translated then like family help; don't always
attenuate the lacks that elder people can suffer.
3.2.2 Pensions and jubilation
Aging in Peru also means an economic deterioration, since the pensions have not
increased together with the economic inflation and is a fact that the pensioner cannot
exclusively live only with his/her pension. Most of the elderly adults appeal to the support
of their families, but that help cannot be constant in a context where the general population
income is low and with so much unemployment and poverty.
Also the labour market, hardly accepts the 60 or more years old population's
participation, being more negative for the elderly adult feminine population, many times
with the excuse that they are retired people.
The pensions constitute one of the first means to consider, when assuring a source
of income. However the establishment of social politics guided to give the benefits of the
jubilation without having the necessary sustenance, has determined an imbalance,
overloading the national systems of pensions; making the pensions insufficient for the
elderly adult’s necessities.
At the present time, Peru is in a transition stage between an allotment system
administered by the State and a system of individual capitalization of private property
(AFPs). The number of pensioners outside the economically active population has
increased from 67,700 in 1972 to 97,599 in 1981 and to 312,000 in 1993. Lima
concentrates approximately half of these people.
There is a significant increase of the minimum age of retirement in 1995. The
jubilation age in women was increased in ten years, from 55 to 65 years, and in the case of
men, increased from 60 to 65 years.
In the year 2002, 41.66% of the adult's elder than 65 years (pension beneficiaries for
jubilation) were affiliated to a pensions system. The 97% of this last group were affiliated
to the National System of Pensions (SNP) and the rest to Private pensions systems. Chart
3.12
Chart 3.12 Peru: Adults elder than 65 years, according to pension system affiliation
condition: 2002
Affiliation condition
Non affiliated
Affiliated
2002
58.33%
41.67%
National Pensions System
Private Pensions System
97.72%
2.28%
Source: INEI y ONP
A. National Pensions System
The number of affiliated pensioners to the national pensions system and other
entities whose pensioner population is administered by the Office of Previsional
Normalization (State System) can be found in chart 3.13.
Chart 3.13 Pensioner population administered by the Office of Previsional Normalization,
2002
Funds
Pensions National system - SNP
Education ministry - MINEDU
Workers Work accidents Insurance
Acquired Rights Funds - FODASA
Electricity Enterprise of Lima - ELECTROLIMA
Others
Total
Source: Oficina de Normalización Previsional (ONP)
Pensioner population
383737
145044
11964
2460
1125
1987
546317
In Lima, the group of pensioners presents strong differences between men and
women. For the year 2002, 30.2% of men elder than 65 years were retired or financiers,
while only 19.38% of women of this age group perceived this rent type.
The jubilation income varies according to the legislative ordinance to which the
pensioners are under. At the moment the jubilation incomes are determined by the Law
Ordinances 19990 and 20530. The last one is no longer valid for new insured and its
restructuring is under evaluation.
Chart 3.14 Peru: Jubilation Incomes of the Population 60 or more years old, 2003
Region
Average income in soles according to law
D.L 19990
D.L 20530
411.9
896.08
466.16
78.93
474.5
1006.30
585.76
1191.27
447.09
385.55
423.14
904.53
549.85
527.36
419.09
No Dete.
Huancavelica
Huánuco
lca
Junín
485.19
1014.75
502.29
773.19
556.76
529.10
565.90
793.7
La Libertad
524.72
649.67
Lambayeque
Lima
Loreto
501.57
859.77
422.44
345.49
394.45
No Dete.
Madre de Dios
625.72
141.96
Moquegua
Pasco
Piura
Puno
624.01
No Dete.
423.40
548.33
534.05
No Dete.
456.29
683.83
San Martín
Tacna
Tumbes
Ucayali
404.97
521.68
548.98
529.70
412.83
1021.79
Amazonas
Ancash
Apurímac
Arequipa
Ayacucho
Cajamarca
Callao
Cusco
426.80
843.35
Source: ONP (oficina nacional de pensiones) al año 2003
B. Pensions Private System
Aside to the previous state system, the Peru has also private models of attention and
social security, in the form of Pensions Fund Administrators (AFP's). These systems are
flexible and are applied in other countries of the world. In our country this system is
institutionalized in 1995. At the moment in the Peru four AFP's works: HORIZONTE,
PROFUTURO, INTEGRA and UNION VIDA, among all had a total of 2 millions 551
thousand 503 affiliated workers for the 2001. The number of affiliated elder than 50 years
can be observed in the Chart 3.15.
Chart 3.15 Affiliation to the Pensions Private System, according to age group at
December 31, 2002
Age Groups
AFP Affiliated number
From 50 to 65 years
253138
More than 65 years
11567
Total
264705
Source: Superintendencia de Administradoras Privadas de Fondos de Pensiones
3.2.3 Levels of Poverty
According to ENAHO 2001, the population in a situation of poverty reached 49.8%
of the total population of the country; and 19.5% lived in extreme poverty. The elderly
adults that live in a state of poverty were 41.7%, a little less than the national average;
however this number is still alarming. Chart 3.16
Chart 3.16 Peru: Population of 60 or more years old according to condition of poverty,
2001
Poverty
Poverty
Non
Extreme
Non extreme
Poverty
National total
49.80%
19.50%
30.30%
50.20%
Elderly adults
41.70%
17.50%
24.20%
58.30%
60 to 69 years
41.66%
17.58%
24.08%
58.34%
70 to 79 years
41.50%
16.74%
24.76%
58.50%
80 or more
42.50%
19.30%
23.20%
57.50%
Source: Condición de vida en el Perú evolución, ENAHO 1997 - 2001
3.3 GRADE OF INSTRUCTION
3.3.1 Illiteracy for age and for residence area
According to the National Home Survey (ENAHO) of the 2001; the illiteracy at
national level was of 12.1%. Adults of 60 or more years old have a rate of illiteracy of
35.4%; this is the highest rate between all the age groups. From this age group 29.3% of
illiterates are men and 70.7% are women, being most of them from the rural environment
(57.9%).
According to the census of 1993 the regions that present the highest rates of
illiteracy are Apurimac (73.9%), Ayacucho (69.2%), Cusco (61.3%), Huancavelica
(68.9%), Puno (63.9%), Pasco (52.8), Cajamarca (56.6%) and Huánuco (52.5%). These
regions concentrate 46.6% of the total of illiterate elder than 60 years. These regions also
maintain an important presence of rural population; this would evidence deficiencies as
much in covering as in educational quality in this area.
3.3.2 Average of years of study
The average of years of study reached by the population of 60 and more years,
according to data taken from ENAHO 2001, is of 4.0 years, very below the national
average that reaches 7.7 years. The year of studies average is superior in the urban area that
in the rural one (5.3 vs. 1.3). The masculine population reached an average of 4.9 years of
studies while the feminine population only achieved an average of 3.2 years.
3.3.3 Reached instruction level
The instruction level reached according to projections of the 2003 is shown In the
Chart 3.17
3.17 Peru: Reached Instruction levels, 2003
3.17
Instruction level reached
Non Level
Kindergarten
Elementary school
High school
Superior non University
n
705438
9073
861486
266933
49193
%
34.99%
0.45%
42.73%
13.24%
2.44%
University
90322
4.48%
Non specified
Total
33669
2016114
1.67%
100.00%
Spurce: INEI
For 1999, only 15.9% of the elderly adult men had achieved university education,
while only 5.2% of the women of the same age group had achieved the same level. The
gender inequity has marked the differentiated access of men and women to a superior
education, this fact also determines the different participation from both genders in the
labour market and in the decisions making.
3.4 HOUSING AND COMFORT
In 1997, the 87.7% of people elder than 60 years inhabited a house of their own and
10% had additional properties to the housing that they inhabited. In the rural area of the
country, 92.2% had their own housing and 76.3% agricultural properties. Although this
population's had the security of having housing where to inhabit, there are evidences of
situations in which other members of the family make use of the property that belongs to
their parents or grandparents.
The housings of the elderly adults are in a precarious situation. According to the
ENAHO 1998, 48% of the housings inhabited by this age group only have public net
hygienic services. Equally, 25% of these housings don’t have services of water and 33% it
doesn't have electricity.
Also, only 18.8% of the elderly adult population have phone service. 10% only has
car for its particular use, 67.6% possesses television and only 35.4% have a refrigerator.
4. HEALTH INDICATORS OF THE ELDERLY ADULT POPULATION
4.1 MORTALITY
For the year 1966 the mortality gross rate was 15.6 per thousand habitants; the main
causes of death were the transmittable diseases. Almost 60.07% of all the deaths happened
to those younger than 15 years of age. (Chart 4.1)
Chart 4.1 Peru: Registered deaths by age groups and causes, 1966
Death causes
Cardio
Population Transmittable
Tumours vascular
diseases
diseases
0 to 14 years
15 to 49 years
50 to 59 years
60 or more years
5062504
5101919
667095
635707
11467225
Source: OPS/OMS - MINSA
61411
9556
2587
9407
82961
689
2650
1992
6289
11620
288
1600
1231
8332
11451
Perinatal death External
causes
causes
24820
0
0
0
24820
2573
492
4729
1181
8975
Others
17520
7507
2917
10732
38676
Total
107241
21865
13456
35941
178503
The elder adults represented 5.54% of the peruvian population's for the year 1966,
this group had 20.13% of the deaths happened in that year; however their mortality gross
rate was of 56.54 per thousand habitants elder than 60 years. The main causes of mortality
for this age group were the transmittable diseases with 26.17%, followed by the
cardiovascular system diseases with 23.18%.
The mortality gross rate for the year 2000 was 6.15 per thousand habitants for the
general population; while for the elder adult population was 39.49 per thousand habitants.
This age group had 46.41% of the deaths happened in that year. The main cause of
mortality for the elderly adult group were the cardio-vascular diseases with 25.87%,
followed by tumours with 23.30% and in third place the transmittable diseases with 18.84%
(Chart 4.2).
Chart 4.2 Peru: Registered deaths by age and causes, 2000
Death causes
Population
0 to 14 years
15 to 49 years
50 to 59 years
60 or more years
Cardio
Transmittable
Tumours Vascular
diseases
diseases
8567257
11292
13572989 6110
1664975
1969
1856469
13811
25661690 33182
Source: OPS/OMS - MINSA
1307
5022
4067
17078
27474
985
2911
2541
18967
25404
Perinatal
causes
10721
0
0
0
10721
death External
Causes
5723
7288
1531
2560
17102
Others Total
11458
7301
4409
20892
44060
41486
28632
14517
73308
157943
There is a major change of the patterns of mortality from year 1966 to 2000; the
most significant changes are the reduction of mortality for transmittable diseases in the
general population as in the elder adult one. Chart 4.3
Chart 4.3 Peru: Indexes of mortality in elderly adult and general populations, 1966-2000
Transmittable
diseases
>= 60 years
14.80
General Pop. 7.23
>= 60 years
7.44
2000
General Pop
1.29
Mortality rate per 1000 habitants
Source: OPS/OMS - MINSA
1966
Tumours
Cardio
Vascular
diseases
Perinatal
External
death causes Causes
Others
Total
9.89
1.01
9.20
1.07
13.11
1.00
10.22
0.99
0.00
2.16
0.00
0.42
16.88
3.37
11.25
1.72
56.54
15.57
39.49
6.15
1.86
0.78
1.38
0.67
4.2 MAIN DEATH CAUSES
For 1986, the transmittable diseases and certain infections originated in the perinatal
period occupied the first places among the mortality causes; also by this year some
degenerative chronic illnesses were characteristic as main causes of death, most of all in the
aging population. The acute respiratory infections occupied the first place among the
causes of death in the general population; they were followed by the intestinal infectious
diseases and tuberculosis.
For the year 2000, the acute respiratory infections were still the first cause of
mortality for the general population. The other main causes belonged to a constellation of
damages corresponding to diverse stages of the life cycle, including the stroke and the
ischemic heart diseases on one side, and the intestinal infectious diseases, the perinatal
respiratory affections and nutritional deficiencies for another. Chart 4.4
Chart 4.4 General population’s main causes of mortality in Peru, 2000 (List 6/61 OPS
-CIE 10)
Mortality causes
Acute respiratory infections
Stroke
Ischemic heart diseases
Urinary system diseases (chronic renal insufficiency and others non specified)
Cirrhosis and others chronic liver diseases
Perinatal respiratory affections
Others accidents
Stomach malignant tumour
Septicaemia, except neonatal
Congenital malformations, deformities and cromosomal anomalies
Tuberculosis
Nutritional deficiencies y nutritional anaemia
Mortality rate
70.36
26.60
24.16
23.20
21.36
21.05
19.51
18.48
17.48
17.01
15.83
15.74
Terrestrial vehicle accidents
Cardiac insufficiency
Diabetes mellitus
Mortality rate per 100000 habitants
Source: OPS/OMS Ministerio de salud
15.01
13.72
13.39
In the group of adults elder than 50 years the acute respiratory infections still are the
main cause of mortality, followed by the stroke, ischemic heart disease and the urinary
system diseases; however cancer and chronic illnesses as the diabetes mellitus have more
importance today than past ages. Chart 4.5
Chart 4.5 Peru: Adults elder than 50 years main causes of mortality, 2000 year (List
6/61 OPS -CIE 10)
Mortality Causes
Acute Respiratory Infections
Stroke
Ischemic heart diseases
Urinary system diseases (chronic renal insufficiency and others non specified)
Cirrhosis and others chronic liver diseases
Stomach malignant tumour
Diabetes mellitus
Cardiac Insufficiency
Hypertensive diseases
Septicaemia
Thraquea, bronchus and lung malignant tumours
Tuberculosis
Malignant Prostate tumour
Nutritional Deficiencies and Nutritional Anaemia
Chronic respiratory tract diseases
Mortality rate per 100000 habitants
Source: OPS/OMS Ministerio de salud
Mortality
Rate
294.96
163.23
159.39
127.53
120.8
115.86
88.96
85.96
85.79
62.62
54.84
53.25
45.75
45.63
41.57
In Peru, like in other countries, the tumours have been acquiring more importance as
morbidity and mortality causes in the last decades. While the mortality gross rate has
decreased in the country, the mortality rate for this group of illnesses has stayed without
significant changes; this situation has increased their relative importance as mortality cause.
The neoplasic illnesses represented 17.5% of the elderly adults mortality causes in 1966,
while for the year 2000 were 23.29%.
The stomach malignant tumour is and has been from the second half of the 20th century
the main type of malignant neoplasia among the peruvian population. The bronchus’s and
lung tumours have displaced the malignant tumour of other parts of the uterus. Chart 4.6
Chart 4.6 Peru: Mortality Main Causes for Tumours, 2000
Main causes of mortality for tumors
Stomach malignant tumour
Lung and bronchus malignant tumours
Liver and biliary tract malignant tumours
Prostate malignant tumour
Uterus Neck malignant tumour
Breast malignant tumour
Non Hodgkin Lymphoma or other non specified type
Colon malignant tumour
Uterus malignant tumour; non specified part
Pancreas malignant tumour
Brain malignant tumour
Kidney malignant
Mortality Rate per 100000 habitants
Source: OPS/OMS Ministerio de salud
Mortality rate
19.27
8.50
7.38
7.18
6.46
5.33
4.15
3.85
3.50
3.32
3.01
1.58
There is not an important difference between the mortality rate by tumours in men and
women, but there are significant differences among the neoplasia types that affect these two
population groups. Charts 4.7 and 4.8
Chart 4.7 Peruvian male elder than 50 years mortality rate for tumours, 2000
Mortality main causes
Stomach malignant tumour
Prostate malignant tumour
Lung and bronchus malignant tumour
Liver and biliary tract malignant tumour
Non Hodgkin Linfoma of non specified type
Colon malignant tumour
Pancreas malignant tumour
Kidney malignant tumour, except from renal pelvis
Mortality rate
2174
1748
1132
655
403
367
358
220
Esophagus malignant tumour
Brain malignant tumour
Bladder malignant tumour
Multiple Myeloma and plasmatic cells tumours
Mortality rate per 100000 habitants
Source: OPS/OMS Ministerio de salud
201
193
192
177
Chart 4.8 Peruvian female elder than 50 years mortality rate for tumours, 2000
Mortality main causes
Stomach malignant tumour
Uterus Cervix malignant tumour
Breast malignant tumour
Liver and biliary tract malignant tumour
Lung and bronchus malignant tumours
Uterus malignant tumour, non specified parts
Colon malignant tumours
Pancreas malignant tumours
Biliary tract malign tumour of others non specified parts
Ovary malignant tumour
Non specified Hodgkin Lymphoma and of other parts
Gallbladder malignant tumour
Mortality rate per 100000 habitantes
Source: OPS/OMS Ministerio de salud
Mortality rate
2010
1020
921
817
732
648
468
395
325
319
303
292
Although the mortality profile shows the differences between men and women; there
are also differences between the different levels of poverty. In the less poor population (YI) the diabetes mellitus and the lung and bronchus malignant tumours acquire higher
importance like main cause of death. Of another side, in the poorest stratum (Y-V) acquire
higher importance, the nutrition deficiencies, the appendicitis and intestinal obstruction.
Chart 4.9
Chart 4.9 Peru: Elder Adults Mortality Main Causes for Socioeconomic level, 1997
Order
1
2
3
4
5
6
7
Mortality causes
Estrata I
Respiratory acute infections
Ischemic heart diseases
Stroke
Circulatory Lung diseases
Urinary tract diseases
Digestive tract diseases
Stomach malignant tumour
MR
376.8
239.3
218.5
200.5
165.7
150.7
Estrata V
Respiratory acute infections
MR
895.4
Ischemic Heart disease
546.6
Urinary tract diseases
401.1
Stomach malignant tumour
311.8
Stroke
304.9
Nutrition deficiencies
274.2
149.8
Intestinal Obstruction and
Appendicitis
257.4
8
Diabetes Mellitus
114
Cirrhosis
251.6
9
Cirrhosis
106.4
Septicaemia
190.9
100.8
Hypertensive diseases
179.4
10
Lung malignant tumour
Mortality rate per 100000
Source: Cálculos por OPS a partir de los certificados de defunción, 1996 – 1998
The social security health system counts with more recent statistical information of
intra-hospital deaths; In the year 2003, the main death causes of EsSalud adults elder than
65 were the low respiratory tract infections (12.68%), followed by the hypertensive
diseases with 9.48% and stroke with 5.57%. Chart 4.10
Chart 4.10 Peru: Adults elder than 65 years main causes of intra-hospital mortality, EsSalud
2003
Death causes
Low respiratory tract infections
Hypertensive diseases
Stroke
Diabetes mellitus
Cirrhosis
65 or
years
1137
850
500
480
328
+
12.68%
9.48%
5.58%
5.35%
3.66%
75
+years
921
550
352
283
153
or
15.78%
9.42%
6.03%
4.85%
2.62%
Chronic Obstructive Lung Disease
263
2.93%
205
3.51%
Nephritis, nephrosis
256
2.85%
125
2.14%
Stomach malignant tumour
253
2.82%
131
2.24%
Accidents
238
2.65%
165
2.83%
Ischemic heart diseases
235
2.62%
151
2.59%
Trachea, bronchus’s and lung malignant tumour
229
2.55%
122
2.09%
Other causes
4200
46.83%
2679
45.90%
Total
8969
100.00%
5837
100.00%
Source: Sistemas de Información y vigilancia epidemiológica, Gerencia de prestaciones-EsSalud
Although the main cause of death for those elder than 65 years that assisted to
Social Security Services are the low respiratory tract infections, as a group the transmittable
diseases occupy the third place (17.2%) in this age group, behind the cardiovascular
illnesses (21.34%) and the malignant tumours (20.5%). Chart 4.11
Chart 4.11 Peru: Social Security Adults elder than 65 years old, Mortality Main Causes by
groups of diseases, 2003
65 or + years %
Cardiovascular diseases
Malignant Tumours
Transmittable diseases
Digestive System diseases
Respiratory diseases
Genital-urinary diseases
Others
Total
1914
1839
1542
793
780
436
1665
8969
21.34%
20.50%
17.20%
8.84%
8.70%
4.86%
18.56%
100.00%
Source: Sistemas de Información y vigilancia epidemiológica, Gerencia de prestaciones-EsSalud
4.3 HEALTHY LIFE EXPECTANCY
A highest life expectancy doesn't necessarily mean that it lapses in a good health
state. The high frequency of functional limitations in the elderly adult population
deteriorates their quality of life; this makes indispensable to invest the maximum effort in
decreasing the morbidity and their disability. It is clear that the life expectancy is not
enough as a good health indicator, it is necessary to have an indicator that allows to plan
that proportion of life expectancy that corresponds at the time lived with disability.
In the WHO reports about the year 2001 World Health, the calculation of a healthy
life expectancy is included as an indicator of health level reached by the populations.
The healthy life expectancy at birth is equivalent to the numbers of years in
complete health that a newly born wait to live based on the current levels of bad health and
mortality in his/her country.
v
The measure of the time spent in bad health is based on a combination of the
estimates made for different health states by age and sex made by the study of various
diseases. The estimates for the peruvian population are in the chart 4.12
Chart 4.12 Peru: Healthy life expectancy, 2001
Total
population
Men
Women
Healthy
Healthy
years
expectancy
lost at birth
(percentage)
When born When born At 60 years When born At 60 years Men
61
59.6
12.7
62.4
14.4
7.9
Source: Informe sobre salud del mundo 2001, OMS
women men
9.6
11.70%
women
13.30%
4. 4 SECONDARY AND THIRD CARE
At Health Ministry institutions a defined geriatrics attention is almost not existent;
some few hospitals have geriatrics services whose functions are limited to the outpatient
practice and the answer of the inter-consults of the specialty. The geriatric patient that
requires hospitalization passes to internal medicine services. It is considered that the 30% to
40% of the beds of these services are occupied by this group of patients.
About rehabilitation, most of hospitals of the Health Ministry have this type of
service. There are rehabilitation centers that offer attention to the general population,
including the elderly adult population; the most important of these centers is the Peruvian
National Institute of Rehabilitation. In the year 1999 assisted 1743 elderly adults, the
67.1% were women. Chart 4.13
Chart 4.13 Elderly Adult Population with problems of the locomotive apparatus, consult
and attentions in the National Institute of Rehabilitation, 1999
Gender
Total
Men
Women
Source: INEI
Number ofr Attentions
N
%
1743
100%
573
32.90%
1170
67.10%
Number of Consults
N
%
4493
100%
1385
30.80%
3108
69.20%
life
lost
On the other hand, the Social Security (EsSalud) and the health services of the
Army Forces have been creating diverse geriatrics assistance levels with the purpose of
satisfying the necessities of their users, they have Domiciliary Attention Programs; as well
as Geriatrics Attention Units, Outpatient consults, Day Hospital and Acute Cases Attention
Units in their hospitals of higher levels.
The Social Security (EsSalud) assistance levels can be seen in the Chart 4.14, some
of these levels are exclusive of the Hospital Guillermo Almenara Irigoyen.
Chart 4.14 Assistance Geriatrics Levels, EsSalud
Assistance level
Centros de Salud
Acute Hospitalization Unit
Hospitalization Unit
Day Hospital
Medium care hospitalization unit
Long care hospitalization unit
Geriatrics outpatient office
Health attention program
Domiciliary attention program
Basic attention unit
Complementary medicine
Source: EsSalud
Guillermo Almenara Irigoyen Hospital
Assistance Health Center
Guillermo Almenara Irigoyen Hospital
San Isidro Labrador Clinic
Level IV Clinic
Assistance Health Center
Assistance Health Center
PADOMI
Elderly adult health center
Assistance Health Center
EsSalud and the Armed forces also have rehabilitation services in their main
assistance centers, their programs of domiciliary visits also offer these services. In the chart
4.15 is a report of the activities and resources of the Visits of EsSalud Domiciliary Program
for March, 2004.
Chart 4.15 Social Security (EsSalud), Domiciliary Program Activities and Resources,
March 2004
Activities and resources
Visits
Consults
(N+R)
Continued
attentions
Number
of
professionals
Domiciliary program
General Domiciliary Medic Visit
Specialized Domiciliary Medic Visit
Domiciliary Nurse Visit
Domiciliary Rehabilitation Visit
Domiciliary Psychology Visit
Domiciliary Social Service Visit
Source: Padomi
22970
4580
7928
13484
783
437
881
2105
381
435
267
426
20604
1539
1618
3127
467
9
122
31
48
69
5
5
4.5 MORBILITY RATES
Health Ministry Morbidity
The highest causes of morbidity registered by the peruvian health ministry system
are the respiratory system diseases, followed by the osteum muscular and connective tissue
diseases and the nervous and senses system diseases. Chart 4.16
Chart 4.16 Elderly adult population's morbidity diagnosis by programmatic damage,
MINSA 1998
Diagnosis
TOTAL
MEN
WOMEN
Respiratory System Diseases
169,904
69,296
100,608
Osteum muscular and connective tissues diseases
136,180
48,236
87,944
Nervous and senses system diseases
83,979
36,072
47,907
Trauma and poisoning
69,923
36,384
33,539
Dysentery and gastroenteritis
Oral cavity diseases
66,778
53,838
28,072
25,334
38,706
28,504
Skin diseases
39,289
17,088
22,201
Mental illnesses
28,133
8,808
19,325
Diabetes mellitus
12,172
3,649
8,523
Cancer
9,805
4,460
5,345
Mycosis
8,557
3,391
5,166
Helmintiasis
8,418
3,345
5,073
Tuberculosis
7,757
4,109
3,648
Ischemic Heart Diseases
4,168
1,676
2,492
Nutrition deficiencies
2,854
1,077
1,777
Typhoid Fever
1,265
495
770
Congenital anomalies
735
300
435
Cholera
628
342
286
Sexual transmittion diseases
461
304
157
Virus Hepatitis
331
174
157
Other diseases of the circulatory system
94,550
35,348
59,202
Other diseases of the gastrointestinal apparatus
88,677
33,727
54,950
PROGRAMMATIC DAMAGE
Diseases of the genital urinary apparatus
83,624
34,099
49,525
Non defined symptoms and signs
46,265
18,303
27,962
Other parasites
Blood and other haematopoietic organ diseases
23,933
17,591
11,115
6,055
12,818
11,536
Other external causes
10,486
6,109
4,377
Other metabolism and endocrine diseases
9,550
1,744
7,806
Tetanus, Sarampion
11
8
3
TOTAL
1,079,862
439,120
640,742
Source: INEI
The elderly adult outpatient attention causes by illness groups for the year 2002 are
in the Chart 4.17, the first cause of consults were the respiratory system diseases, followed
by the osteum muscular system diseases.
Chart 4.17 Elderly adult outpatient attention causes of attention, MINSA 2002
Group diseases
Total
Respiratory system diseases
15.14%
Osteum muscular diseases
13.50%
Circulatory system diseases
8.79%
Digestive apparatus diseases
7.88%
Genital urinary system diseases
7.70%
Rest of Diseases
46.99%
Source: Oficina de Estadística e Informática - MINSA
Men
40.00%
37.00%
36.00%
37.00%
42.30%
41.75%
Women
60.00%
63.00%
64.00%
63.00%
57.70%
58.25%
Social Security (EsSalud) Morbility
EsSalud registered a total of 4650035 outpatient attentions for the general
populations in the year 2003, of these 33.15% belonged to adults elder than 65 years. The
first morbidity cause was the primary arterial hypertension, followed by the arthrosis and
other dorsopathies. 55,9% of the Primary Hypertension cases belong to this age group.
Chart 4.18
Chart 4.18 EsSalud Outpatient Office Attentions Profile, 2003
General
%of cases that affect
Population
the population elder
65 years
or more %
Total
than 65 year old
Essential Hypertension (primary)
123387
8,00%
220735
55,90%
Arthrosis
82738
5,37%
167514
49,39%
Other dorsopathies
53681
3,48%
278668
19,26%
Other skin and connective tissues diseases
47977
3,11%
283680
16,91%
Acute pharyngitis and amygdalitis
46729
3,03%
596464
7,83%
Prostatic Hyperplasia
46085
2,99%
75624
60,94%
Diabetes mellitus
44653
2,90%
105083
42,49%
Gastritis y duodenitis
41842
2,71%
200202
20,90%
Glaucoma
39991
2,59%
62690
63,79%
Cataract and other crystalline problems
31915
2,07%
40455
78,89%
Soft tissue problems
31484
2,04%
132922
23,69%
Others
951201
61,70%
2637813
43,28%
Total
1541683 100,00% 4650035
33,15%
Source: Sistemas de Información y vigilancia epidemiológica, Gerencia de prestaciones-EsSalud
EsSalud registered a total of 2699672 attentions in the emergency services in the
year 2003. Of these, 14.62% belonged to adults elder than 65 years. The Primary Arterial
Hypertension was the elderly adult’s first cause of consultation. Chart 4.19
Chart 4.19 EsSalud Emergency Services Attentions Profile, 2003
Essential Hypertension (primary)
Other trauma
Abdominal and pelvic pain
Diarrheic and gastroenteritis of infectious origin
Acute Pharyngitis and Amygdalitis
Others dorsopathies
Asthma
Acute Bronchitis
Other urinary system diseases
Fever of unknown origin
Other ear and mastoid apophysis diseases
65 years
or more
32694
26766
22393
18675
17697
14874
12638
10357
10017
9176
7463
%
8,28%
6,78%
5,67%
4,73%
4,48%
3,77%
3,20%
2,62%
2,54%
2,33%
1,89%
General
Population
Total
66535
186823
150884
144351
274656
85496
121466
82158
65196
146605
30819
%of cases that affect the
population elder than 65
year old
49,14%
14,33%
14,84%
12,94%
6,44%
17,40%
10,40%
12,61%
15,36%
6,26%
24,22%
Other acute respiratory infectious diseases
6880
1,74%
115606
5,95%
Other
205004 51,95%
1229077
16,68%
Total
394634 100,00% 2699672
14,62%
Source:Sistemas de Información y vigilancia epidemiológica,Gerencia de prestaciones-EsSalud
EsSalud Hospitalization Services registered a total of 352332 users in the year 2003;
of them 20.49% were adults elder than 65 years. Pneumonia was their first cause of
hospitalization, followed by the cholecistitis, cholelitiasis and the prostatic hyperplasia.
Chart 4.20
Chart 4.20 EsSalud Hospitalization Services Attentions Profile, 2003
65 years or
more
%
3669
5,08%
3291
4,56%
3095
4,29%
2647
3,67%
2070
2,87%
2066
2,86%
Pneumonia
Cholelitiasis and cholecistitis
Prostatic Hyperplasia
Other urinary system diseases
Other respiratory system diseases
Septicaemia
Others symptoms, signs y abnormal clinical
findings
1963
Cardiac Failure
1953
Inguinal Hernia
1911
Diabetes mellitus
1836
Others digestive apparatus diseases
1716
Femur Fracture
1570
Others ischemic heart diseases
1542
Others
42869
Total
72198
2,72%
2,71%
2,65%
2,54%
2,38%
2,17%
2,14%
59,38%
100,00%
General
Population
Total
9799
15254
4385
7371
3808
3030
%of cases that affect the
population elder than 65
year old
37,44%
21,57%
70,58%
35,91%
54,36%
68,18%
5255
2883
5182
3761
3370
2322
2607
283305
352332
37,35%
67,74%
36,88%
48,82%
50,92%
67,61%
59,15%
15,13%
20,49%
Source:Sistemas de Información y vigilancia epidemiológica,Gerencia de prestaciones-EsSalud
EsSalud domiciliary attention program (PADOMI), presents as first morbidity cause
essential hypertension (18.97%), followed by osteoarthrosis and urinary tract infections.
Chart 4.21
Chart 4.21 PADOMI Morbility Causes, March - 2003
Causes
Essential Hypertension (primary)
Generalized Primary Osteoathrosis
Urinary tract infections
Parkinson Disease
Chronic Gastritis, non specified
Number. Of
attentions
5249
1048
634
513
423
%
18,97%
3,79%
2,29%
1,85%
1,53%
Chronic Bronchitis, non specified
Dementia, non specified
Stroke Sequels
Acute Pharyngitis, non specified
Cardiovascular diseases sequels
Pressure Ulcers
Other general controls
Others
Source EsSalud: Padomi, 2003
361
327
321
304
275
272
6079
11867
1,30%
1,18%
1,16%
1,10%
0,99%
0,98%
21,97%
42,88%
4.6 CHRONIC DISABILITY
For the year 2003, 1.3% of the total population had some type of disability, while
the elderly adult population had almost quadrupled the general population's value. Chart
4.22
Chart 4.22 Peru: Disability type distribution. 2003
Total population
60 to 64 years old
Elder than 65 years
%of population
with disability
1,30%
5,30%
23,10%
6,70%
Mental
Retard
12,40%
Mental
Problems
9,80%
2,00%
3,10%
5,60%
Blindness
Deafness
Mutest
20,90%
14,40%
17,10%
32,10%
Invalid
Othes
28,00%
7,90%
30,60%
9,60%
Source: INEI Censo de población 1993
CONADIS is a public organism of the Woman and Social Development Ministry
that has as function to promote the execution of the law of people with disability, as well as
the establishing of national multisector politics for the people with disability in order to
contribute to their social, economic and cultural integration process. This organism
registered for the year 2003, 2263 elderly adults with some type of disability, the
distribution by gender and type of disability can be seen in the chart 4.23
Chart 4.23 CONADIS: Registered Elderly Adults distribution according to disability type.
2003
Population Behaviour Communication Self-care Locomotion
Registered
l
Men
1693
44
186
180
517
Women
570
13
74
53
159
Total
2263
57
260
233
676
Source: Gerencia de Sistemas, Identificación y estadística – CONADIS
4.7 FUNCTIONAL CAPACITY; basic activities of daily life (ADLs)
Body
Dexterity Situation
248
89
337
313
96
409
205
86
291
Few peruvian works evaluate the activities related to the daily life in the
community. Recently Varela and collaborators carried out a national hospitalary study that
evaluates this indicator as part of a integral geriatric assessment. This study found that 53%
of the elderly adults were independent two weeks before their hospitalization ( 0 score in
the scale of Katz), 30% were partial dependent (score between 1 at 5) and 17% were
dependent total ( 6 score in the scale of Katz). Graph 4.1
Graph 4.1 Functionality in patients two weeks before their hospitalization, 2003
Functionality by KATZ
17%
Autonomy
53%
Partial
Dependence
30%
n = 400
Total
Dependence
Source: Valoración Geriátrica Integral en Adultos Mayores Hospitalizados a Nivel Nacional, 2003; Diagnostico Vol
43, Num 2, Marzo-Abril 2004
Another important work was the Trujillo county Elderly Adults Profile carried out
by Leiton, Villanueva, and collaborators among the years 1999 and 2000; the study had a
sample of 681 elderly adults and the instrument for gathering information was a survey
elaborated by the PAHO/WHO (1990) adapted to the Peruvian reality. It evaluates
economic characteristic, health risks and problems; among them the levels of independence
to carry out activities of daily life.
According to the results of this study, the elderly adults present levels of
independence in basic activities of the daily life of 82% for men and 76.4% for women.
Also found that in this population there is a decrease in independence as the age increase.
However, the dependence in the men began at 85 years, while in women started at 75 years.
Chart 4.24
Chart 4.24 Trujillo, Basic Activities of the Daily Life by age and gender, 1999 -2000
60 - 74 years 75 - 79 years 80 - 84 years 85 or + years
Men
0.00%
0.00%
0.00%
16.70%
Women
0.00%
8.00%
3.00%
14.00%
Source: Perfil del adulto mayor en la provincia de Trujillo, 1999-2000
Besides the previous studies, there are other smaller studies in hospitalized patients,
national health clinics and localized communities; most of these studies used as instrument
the Katz Test . Chart 4.25
Chart 4.25 Elderly Adults Functionality Studies, Peru
Year Researcher
1990 Chu, M
1998
Sandoval, L
Varela, L
1999 Hardy,G
Varela, P
Sillicani, A
Villar, D
2000
Varela, L
2000
2001 Ruiz, W
2002
Place
Lima
Cusco
N
Age group
913
+ 65 years
Lima
168
+ 60 years
Lima
168
+ 60 years
Lima
130
+ 60 years
Lima
60
+ 60 years
Lima
100
+ 60 years
Lisigurski,M
Barranca 90
Varela, L
+ 60 years
Origin
Outpatient with
Social Insurance
Outpatient and
Hospitalized
Outpatient and
Hospitalized
Hospitalized
Results
50% Lima were independent
25% Cusco were independent
77.3% Outpatient independent
59.5% Hospitalizes independent
22.4% ADLs dependent
40.3% ADLs dependent
77% functional dependence
Outpatient and
Hospitalized
13.4% Outpatient dependent
50% Hospitalized dependent
Higher levels of dependence in the
asylums patients
Elderly adult club
Asylums
Health campaign
40% functional dependence
4.8 INSTRUMENTAL ACTIVITIES OF THE DAILY LIFE
In Peru there are only a few studies about the instrumental activities of the daily life.
In the elderly adult’s profile of Trujillo county, the levels of independence in instrumental
activities of the daily life are also found in a high frequency, although in smaller proportion
than the dependence levels in basic activities. Chart 4.26
Chart 4.26 Trujillo, Instrumental Daily Life Activities by age and gender, 1999 - 2000
60 - 64 years 65 - 74 years 75 – 79 years 80 - 84 years
Men
0.00%
0.00%
8.00%
3.00%
Women
0.00%
4.00%
4.00%
23.00%
Source: Perfil del adulto mayor en la provincia de Trujillo, 1999-2000
85 or + years
33.00%
53.00%
4.9 RISK FACTORS FOR NON TRANSMISIBLES CHRONIC ILLNESSES
Although a few national studies about risk factors for chronic illnesses exist for the
general population, few make emphasis in the elderly adult population and generally take
this age group like part of the one of all the adults.
Noxious habits
Smoking
According to the Pan American Health Organization the smoking prevalence in
Peru in the population between 12 and 50 years is 41.5% for males and 15.7% for women.
According to the 2002 Lima City Epidemiology Study of the National Institute of Mental
Health Hideyo Noguchi, the life prevalence of tobacco use is 69.5% (84.1% males and
56.2% women) and the annual prevalence of tobacco dependence is 1.9% (3.3% males and
0.5% women) for the general population.
According to the national survey of prevention and use of drugs of 1999, the
tobacco dependence in the age group between 17 and 40 years was 9.3% to 10.4%, and
3.9% for the adults among 60 to 64 years. This study doesn't make reference to the
population elder than 65 years but it is considered that the prevalence should be smaller
than the one of the last group. The results can be observed in the Chart 4.27
Chart 4.27 Peru: Tobacco Dependence, Contradrogas, 1999
12 to 13
Total
0.80%
Men
0.30%
Women
1.40%
Source. Contradrogas, 1999
14 to 16
1.60%
2.30%
0.90%
17 to 19
9.30%
16.60%
2.80%
20 to 40
10.40%
15.90%
5.80%
41 to 59
6.20%
9.10%
4.20%
60 to 64
3.90%
5.60%
2.90%
Alcoholism
In Peru, it is considered that the percentage of alcoholism is higher than 10% in the
adult population, especially in the males and in the rural area. According to Contradrogas,
in Peru the age group with more alcoholic dependence is the one between 20 to 40 years,
however the groups among 41 to 64 years present an important prevalence, in males
mostly. Chart 4.28
Chart 4.28 Peru: Alcohol Dependence, Contradrogas, 1999
Total
Men
Women
12 to 13
1.00%
1.60%
0.00%
14 to 16
3.00%
4.30%
1.60%
17 to 19
11.50%
19.00%
4.70%
20 to 40
13.50%
21.60%
7.00%
41 to 59
7.30%
12.50%
3.50%
60 to 64
7.20%
18.80%
0.00%
Source. Contradrogas, 1999
Other noxious habits
In the Trujillo County Elderly Adult profile a 56.2% of the elderly adult population
consumed coffee, a 44.9% fat and 20.6% salt; it is also appreciated that although this
consumption is high in the elderly adults, it becomes smaller as the age increases. Chart
4.27
Chart 4.27 Trujillo, Presence of noxious habits: coffee, fat and salt in the elderly adult by
age and gender, 1999 - 2000
60 - 64 years 65 - 69 years 70 - 74 years
75 - 79 years
Coffe
53.00%
47.00%
45.00%
39.00%
Fat
50.00%
45.00%
41.00%
48.00%
Salt
23.40%
17.00%
25.00%
21.00%
Source: Perfil del adulto mayor en la provincia de Trujillo, 1999-2000
80- 84 years 85 + years
19.00%
37.00%
17.00%
36.00%
37.00%
12.00%
Physical Activity
According to Seclen-Palacin and Jacobi study, that was based on the information of
the National Home Survey of the year 1997. Only 11.6% of the population elder than 18
years old had physical activity in a daily or inter-daily frequency, a higher proportion was
found in men that in women; 53.7% of the population didn't practice sports. The age group
that practiced more regular sport activities (daily or inter-daily) was the one of men
between 50 to 55 years (20%) and for women the group of 40 to 45 years (18%).
The 11.4% of those interviewed was 60 or more years old, of this group only 13.5%
of the males had regular sport activity and 47.7% didn't practice any sport, while in the
group of women 6.6% had a daily or inter-daily physical activity and a 61.4% didn't
practice any sport. Chart 4.28
Chart 4.28 Frequency of Regular Sport Activities in the urban population, by age group and
gender. Peru 1997
Frecuency
Daily
Age groups (years)
15 - 19
20 - 29
30 -44
45-49
%
%
%
%
Men ( n = 21798)
7,00
5,60
9,20
10,70
>=60
%
Total
9,90
8,20
Inter-daily
Weekly
Sometimes
Didn’t practice
3,30
3,50
5,50
6,80
3,60
21,20
24,20
38,50
44,00
28,20
2,60
6,70
14,30
15,30
10,60
65,90
60,00
32,50
23,20
47,70
Women ( n = 23521)
Daily
4,50
4,20
10,40
9,10
5,20
Inter-daily
2,20
2,10
5,40
4,20
2,60
Weekly
13,10
13,70
30,80
31,70
15,60
Sometimes
2,10
5,30
8,00
8,80
4,90
Didn’t practice
78,10
74,70
45,40
46,20
71,70
Source: Seclen – Palacin, cuadro elaborado en base a ENAHO –1997
4,60
31,70
10,20
45,30
7,00
3,50
21,90
6,20
61,40
The practice of sport activities was significantly higher in males in all the sociodemographic levels. There was not a relationship between socioeconomic level and sport
activity, but it was found that in men a higher educational level had a direct association
with a regular sport activity. Is also important to mention that men and women from Lima
had less sport activity than the population that lived in other urban areas outside the capital.
Being married, have an employment, access to modern communication technologies
(Internet or Cable TV) or to consume sport information are significant factors and are
directly associated with the regular practice of sport activities. Finally the practice of
regular sport activities by the family boss is associated with the family high levels of sport
activities.
Hypertensive Illnesses
The arterial hypertension is recognized as an important risk factor for the
presentation of other circulatory system diseases of the brain and the heart.
In Peru, there are two studies that had tried to measure the general population's
frequency of this condition: the one of Seclen in 1997 and the one of the Ministry of Health
General Office of Epidemiology of the 1998 -2000. These studies found frequencies from
15% to 33% in the Peruvian population. At the moment there is not information about the
prevalence of this pathology by age groups, but is considered that the frequency must be
higher in the elderly adult population. Chart 4.29
Chart 4.29 Arterial Hypertension Prevalence Studies
Place and population of Prevalence
study
Men
Women
Lima, Ingeniería
32,10% 34,70%
Piura, Castilla
35,10% 32,50%
San Martín, Tarapoto
33,30% 17,40%
Reference
Total
33,00% Seclen, Segundo y col.
33,00%
21,80%
Ancash, Huaraz
22,20%
18,00%
Lima, Comas
Lima, Magdalena del Mar
Huanuco, Huanuco
Ica, Parcona
Ucayali, Calleria
Arequipa, Yanahuara
11,00%
24,60%
16,40%
18,80%
16,70%
14,60%
7,10%
7,70%
9,10%
11,50%
10,70%
9,70%
19,55% 1997
Health Ministry, General
Office of Epidemiology
1998 –2000
Non published inform
Source: OPS/ OMS
Diabetes mellitus
There are a few studies that had measured the general population frequency of
Diabetes Mellitus. These studies are not necessarily comparable due to the different
methodologies for the population's selection, as well as for the techniques for the glycaemia
measurement; however they offer an idea on the prevalence of this problem in some
populations of the country. Chart 4.30
Chart 4.30 Diabetes Mellitus Studies
Place and population studies
Lima
Cusco
Pucallpa
Piura
Lima
Chiclayo
Lima
Piura
Tarapoto
Huaraz
Tumbes
Tacna
Cusco
Lima, Comas
Lima, Magdalena del Mar
Huanuco, Huanuco
Ica, Parcona
Ucayali, Calleria
Arequipa, Yanahuara
Source: OMS/OPS
Prevalence
Men
Women
0,00%
8,00%
33,20%
45, 4%
4,10%
9,90%
1,90%
2,60%
22,10%
51,00%
1,50%
4,60%
Total
1,60%
0,40%
1,80%
5,00%
7,50%
6,90%
7,60%
6,70%
4,40%
1,30%
2,90%
1,40%
1,30%
Reference
Zubiate, M y col
1987
Seclen, S
1996
Seclen, S y col.
1997
Sosa, J y col
1996
Health Ministry, General
Office of Epidemiology
1998 –2000
Non published inform
In a study carried out by the Endocrinology Service of the Hospital Guillermo
Almenara Irigoyen in workers of diverse labour centers of the cities of Lima, Cusco,
Pucallpa and Piura found that the frequency of Diabetes Mellitus was 8,3% in adults elder
than 50 years, while the ones below 40 years didn't reach the 0,5%. Chart 4.31
Chart 4.31 Diabetes Mellitus frequency in workers of some cities of the Peru
Age groups
Till 29 years
From 30 to 39 years
From 40 to 49 years
More than 50 years
Total
%
0,20%
0,50%
2,40%
8,30%
2,20%
Source: Calderon, R; Peñaloza, J. Diabetes Mellitus en el Perú. Lima 1996
Hyperlipidemia
For these conditions the series varies from 10% to 47% for the general population;
these great differences are probably due the same inconveniences of methodology found in
the cases of hypertension and diabetes, for this reason the results cannot be extrapolated for
the country. At the moment there are not information about he prevalence for these
conditions by age groups, but is considered that the frequency must be higher in the elderly
adult population. Chart 4.32 and 4.33
Chart 4.32 Peru: Hypercholesterolemia Studies
Place and population
Prevalence
Men
Women
Reference
Total
Lima, Urbanización Ingeniería
Piura, Castilla
San Martín, Tarapoto
22.70% Seclen, Segundo y col.
47.20%
20.40%
Ancash, Huaraz
10.60% 1997
Lima, Comas
14.70%
13.00%
Lima, Magdalena del Mar
Huanuco
Ica, Parcona
Ucyali Calleria
27.60%
17.30%
49.70%
32.50%
16.00%
13.00%
43.00%
28.00%
Arequipa, Yanahuara
Source: OMS/OPS
17.40%
16.20%
Health Ministry,
General Office of
Epidemiology
1998 –2000
Non published inform
Chart 4.33 Peru: Hypertrigliceridemia Studies
Place and Population
Prevalence
Men
Women
Lima, Comas
Lima, Magdalena del Mar
15.80%
46.00%
3.70%
22.80%
Health Ministry
Huanuco
Ica, Parcona
Ucyali Calleria
36.70%
26.50%
32.50%
26.50%
23.80%
22.70%
Epidemiology
Arequipa, Yanahuara
Source: OMS/OPS
39.90%
14.80%
Reference
General Office of
1998 –2000
Non published inform
Obesity
The frequency of Obesity varies from 10% to 36.7% for the general population.
Chart 4.34
Chart 4.34. Peru: Obesity Studies
Place and population
Lima,Urbanización
Ingeniería
Piura, Castilla
San Martín, Tarapoto
Ancash, Huaraz
Lima, Comas
Lima, Magdalena del Mar
Huanuco, Huanuco
Ica, Parcona
Ucayali, Calleria
Arequipa, Yanahuara
Source: OPS/OMS
Prevalence
Reference
Men
Women Total
24.50%
34.20%
29.10%
14.80%
17.50%
18%
10%
24.80%
10.40%
16.90%
21.70% 22.80%
38.00% 36.70%
12.50% 17.00%
20.40% 18.30%
28.00%
15.30%
23.70%
32.10%
25.30%
16.90%
Seclen, Segundo y col.
1997
Health Ministry
General Office of
Epidemiology
1998 -2000
Non Published
A recent study carried out by Varela and col. in the elderly adult hospitalizated
population found that the overweight frequency was 9.56%, for obesity, 4.13%; and for
malnutrition, 54.52%.
A study carried out by Rosas and col.. in workers of a state institution of Lima,
found that 25.4% of the adults elder than 50 years presented obesity; becoming the age
group with the highest frequency of this problem. Chart 4.35
Chart 4.35 Obesity frequencies in workers of a state institution of Lima - Peru
Proper
Over
Obesity
Weight
Weight
Less than 40 years
42.60%
42.60%
14.80%
From 40 to 50 years
36.30%
45.80%
17.90%
Elder than 50 years
14.30%
60.30%
25.40%
Source: Rosas, A;. Prevalencia de obesidad en trabajadores de una institución
estatal en Lima -Perú
Age
4.10 Integral Geriatric Assessment
In Varela and col. study the 82.5% of the hospitalized elderly adults, presented
some grade of auditory or visual loss, 54% of faecal or urinary incontinence; 52.75%, of
insomnia; 39.75% have had falls; 37.25%, acute confusion; 28.25%, moderate or severe
cognitive impairment; 22.11%, immobilization; 15.97%, depression; 14.25% pressure
ulcers and 12% syncope. Graph 4.2
Graph 4.2 Integral Geriatric Assessments in Hospitalized Elderly Adults at National Level,
2003
Integral Geriatric Assesment in the Hospitalized
Elderly Adults at National Level
90%
Sensorial impairment
80%
Incontinence
70%
Insomnia
60%
Falls
50%
Acute Confusion
40%
Cognitive Impairment
(moderate-severe)*
Inmobilization
30%
20%
Mayor depression**
10%
Pressure ulcers
0%
1
Geriatric syndromes
n = 400 n*=312 n**=288
Syncope
Source: Valoración Geriátrica Integral en Adultos Mayores Hospitalizados a Nivel Nacional, 2003;
Diagnostico Vol 43, Num 2, Marzo-Abril 2004
4.11 Mental State
According to the Lima City Mental Health Study carried out in the year 2002 by the
National Mental Health Institute Hideyo Noguchi, the 10.5% of the elderly adult population
(with more than 8 years of instruction) presents according to the Folstein Mini Mental an
abnormal cognitive function. This study also found that the adults elder than 75 years
present a frequency of abnormal cognitive states of 30.2%, while those who are between 60
and 74 years present a prevalence of 5.3%. Chart 4.36
Chart 4.36 Lima and Callao: Elderly Adult Cognitive Function Evaluation by Folstein Mini
Mental Scale, 2002
Cognitive Function
60 to 74 years
Normal
Doubtful
Abnormal
Total
34.70%
60.00%
5.30%
100.00%
More than 75
Total
years
23.40%
32.10%
46.40%
57.40%
30.20%
10.50%
100.00%
100.00%
Source: Estudio epidemiológico metropolitano de Salud Mental, 2002
According to the Trujillo County Elderly Adult Profile a 85.5% of the elderly adults
had a normal mental state.
The elderly group (85 or more years) had the highest frequency of mental state
severe deterioration (8.3%). Chart 4.38
4.38 Trujillo, Elderly Adult Cognitive Deterioration by Age, 1999 - 2000
60 - 64
65 - 69
70 - 74
75 - 79
Normal
95.90%
91.80%
85.80%
82.10%
Slight Impairment
3.50%
4.80%
7.10%
6.00%
Moderate Impairment 0.60%
2.70%
7.10%
7.10%
Severe Impairment
0%
0.70%
0%
4.80%
Source: Perfil del adulto mayor en la provincia de Trujillo, 1999-2000
80 - 84
85 o mas
74.60%
14.90%
27.10%
8.30%
50.00%
14.60%
27.10%
8.30%
Depression
Depression and aging have been associated in diverse ways. Formerly, it was
considered that the classic depressive symptoms were aging unavoidable consequence.
Now, it is believed that they are the result of diverse biological risk factors and psycho
socials characteristics of this stage of the life.
In the year 2002, the Mental Health National Institute Hideyo Noguchi, carried out
the Lima City Mental Health study; this research found that the current prevalence of
depression in the elderly adult population was of 9.8%, becoming the age group with the
highest prevalence of depression (young adults, 8.6% and adults, 6.6%). Chart 4.39
Chart 4.39 Lima City: Current Depressive Episode in Elderly Adult population; by gender
and age, 2002
Population Group
Total
Men
Women
Elderly Adults between 60-74 years
Elderly Adults more than 75 years
Population %
with depression
9.80%
7.00%
12.30%
8.00%
15.90%
Source: Estudio epidemiológico metropolitano de Salud Mental, 2002
Suicidal indicators
The frequency of suicidal thoughts according to the 2002, Lima City Mental Health
Study was of 12.2%; while 0.3% had at least one suicidal attempt. Chart 4.40 and 4.41
4.40.- Lima City considerations or suicidal thoughts month’s and year’s prevalence, 2002
Year Prevalence
Total
Men
Women
Month Prevalence
Total
Men
Women
Elderly Adult
12.20%
7.10%
16.70%
Adults
3.60%
1.50%
5.60%
6.20%
3.80%
8.30%
8.50%
4.90%
11.90%
Source: Estudio epidemiológico metropolitano de Salud Mental, 2002
4.41.- Lima City Suicidal Attempt, Month’s and Year’s Prevalence, 2002
Year Prevalence
Total
Men
Women
Month Prevalence
Total
Men
Elderly Adult
0.30%
0.30%
0.30%
Adult
1.00%
0.60%
1.50%
0.00%
0.00%
0.30%
0.20%
Women
0.00%
0.50%
Source: Estudio epidemiológico metropolitano de Salud Mental, 2002
5. SOCIAL LIFE OF THE POPULATION OF 50 OR MORE YEARS
In our country the elderly social group’s organization were most of the times limited
to labour aspects (pensions and jubilation). Only recently in the 90’s decade the elderly
adults organized for other reasons the access to income security, health, companionship
meetings and social interaction.
5.1 Organizations
5.1.1 Woman and Human Development Ministry (MIMDES)
In the social aspect, the Woman and Human Development Ministry is the organism
in charge of coordinating the multisectorial commission for the application of the Elderly
Adult National Plan. 2002 - 2006.
This public organism promotes some activities in the elderly adult’s population
social area, as the Handmade Fair "Micro-Enterprising Elderly Adult Women" that
summons the elderly women that come from diverse institutions, as Canevaro Housing,
Family Promotion Centres of the Well-Being Family National Institute (INABIF), Santiago
de Surco Municipality, the Impaired Persons National Council for Integration (CONADIS),
and Santa Anita's and Cercado de Lima market merchants. In this Fair they can offer their
products to the public, improving their qualification and insertion in the labour market.
This institution also tries to motivate and commit the representatives of local and
regional governments, government and not government organizations and the civil society
to develop activities directed to the elderly adult population, by means of realization of
forums, shops and conferences at national and regional level. It gives special emphasis to
self-esteem and self-care like facilitator’s elements for obtaining a better life quality, health
and social participation. It promotes the organization of meetings, showing other sectors,
the necessity to carry out actions in the elderly adult populations at all the levels of the
society (family, school, community, etc.).
5.1.2 Health Ministry
Except for the creation of elderly adult's clubs in some hospitals of the Health
Ministry, like in Archbishop Loayza or Cayetano Heredia Hospitals, this institution doesn't
exercise a lot of influence in the social area, concentrating mainly on the health assistance
area. These clubs offer promotional preventive chats, programs of exercises; carry out
tourist trips and promote companionship meetings.
5.1.3 Public Recreation Programs
In Peru the public programs directed to recreation are insufficient, fickle and don't
cover all the populational segments. The elderly adult population only has a few public
recreation programs that give marginal benefits.
The Sport Peruvian Institute is a public organism dedicated to the development and
promotion of the sport in Peru. It carries out only a few recreational sports programs
dedicated to the elderly adult population denominated “Elderly Adult Program”. In the year
1999, around 6000 elderly adult participated in these programs, insufficient number
considering that the elderly adult population that year it already had surpassed the
1'800,000 people.
5.1.4 Municipal programs
Lima Municipalities had the most important changes in relation to the elderly adult
population. Making programs specifically directed to them that include courses, meetings,
aerobics, dance, tai-chi, swimming, theatre; and chats about common elderly population
illnesses (arthritis, glaucoma, etc.), with the purpose to improve this population's health and
to increase their physical activity.
In Lima, Lince Municipality was the first one to organise an Elderly Adult club and
create a date for the elderly adults of the district. In a same way, municipalities like those of
Callao, Comas, Independence, Jesus María, Miraflores, Surco, San Borja, Villa El
Salvador, among others, have elderly adult's special programs. In some cases, this
population is assisted by Local Participation offices as in Cieneguilla and Breña
municipalities. It should be emphasized that not all the municipal town councils have
developed Programs for the elderly adult because they require constant financing that
cannot be covered by the activities because most of the courses and meetings are free or of
minimum cost.
The programs are guided to channel the elderly adult’s recreation and many of them
have been developed to form third age homes like in the cases of La Molina, San Miguel,
Chorrillos, Pachacámac and San Isidro districts.
At national level, the provincial municipalities also have elderly adults support
programs, but due to budget restrictions, they are not able to satisfy the demands of this
population sector.
5.1.5 Social Security (EsSalud)
Elderly Adults Centers (CAM)
The Elderly Adult's Centers (CAM) were conceived by EsSalud (social security) as
spaces of generational encounter, guided to promote an authentic interpersonal relationship,
by means of recreational development, productive social-cultural activities and of health
attention directed to improve the quality of the elderly adult's life.
In December of 2002, EsSalud had 107 of these centers at national level, 31 in Lima
city and 76 in the counties, with a total of 132895 members, 57% of women and 43% of
males (Graph 5.1).
Graph 5.1 Elderly Adult Centers Population by gender, December 2002
43%
57%
Male
Female
132895 members
This program is directed to retired elderly beneficiaries of the social security. The
services that gives are: Social dining room, games room, social-law orientation, medical
and preventive care (UBAAM), social tourism, cultural and artistic activities, family
encounters, physical culture (Thai Chi) and recreational events. They also give self-esteem,
memory, self-care, literacy, and others classes.
EsSalud with theirs CAMs is the organism that had developed more the topic of the
elderly adult's social integration, but some limitations still persist. For example, it centers
the attention in the young elderly adults (among 60 to 70 years) that conform their 47% of
population. Another important limitation is the covering, since most of affiliated (43%) are
in Lima City (Graphics 5.2 and 5.3).
Graph 5.2 Elderly Adult centers population's distribution by age group
16%
7%
47%
60 - 69
years
70 - 79
years
80 or +
years
30%
less than
60 years
Graph 5.3 Distribution of Elderly Adults affiliated to Elderly Adults Centers (CAMs) by
regions
Nº
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Region
Lima y Callao
Lambayeque
Arequipa
Cusco
La Libertad
Ica
Piura
Puno
Junín
San Martín
Amazonas
Huánuco
Ancash
Moquegua
Tacna
Ayacucho
Pasco
Ucayali
Apurímac
Cajamarca
Loreto
Tumbes
Madre de Dios
Huancavelica
TOTAL
Affiliated
57 260
11 336
10 143
10 106
7 993
6 386
5 392
4 886
2 854
1 829
1 714
1 686
1 676
1 670
1 244
1 059
1 017
829
702
691
682
666
560
514
132 895
%
43,09%
8,53%
7,63%
7,60%
6,01%
4,81%
4,06%
3,68%
2,15%
1,38%
1,29%
1,27%
1,26%
1,26%
0,94%
0,80%
0,77%
0,62%
0,53%
0,52%
0,51%
0,50%
0,42%
0,39%
100,00%
5.1.6 Pensioners Organizations
The pensioners of our country grouped initially according to the laws that
corresponded them, in reason of their labour rights, for pensions raise, reduction of
dismissal age, etc.
Some of these institutions have taken a turn in their activities, being guided more
toward the community, developing of local and regional work nets, as well as extending
their work toward non pensioners elderly adults organized sectors
These organizations are:
· Pensioners National Center of Peru – CEAJUPE, that initially contained the pensioners
under the law 1990; later on it incorporated affiliated of different regimens. It is the
organization of this type with most strength and affiliation in Peru, it has local, and regional
bases at national level.
· Pensioners Unified Central of Peru – CUPPER, that contains the pensioners and
pensioners under the law 20530.
Special law regimens have their respective groupings:
· National Association of Retired Fishermen of Peru - ANPJ (Box of Benefits and Social
security of the Fisherman, Law 27301)
· Regional Associations of Mining Pensioners (Law 25009)
· Association of Pensioners (Law 19846)
· Association of Pensioners of the Education Sector - ANCIJE and their departmental
dependences
· Association of Pensioners of the Nation Bank, of the Health Ministry, of the San Marcos
National University, of the Armed and Police Forces, of the Credit Bank of Peru, of the
Transport and Communications, etc.
Finally, we have the Mutual Associations that have been developed mainly by the
Armed and Police forces.
5.1.7 Elderly Adults Civil Organizations
The initial characteristic of these organizations was that they were referred to
activities of recreational type and of use of free time. However, because of the work of the
NGOs, these institutions have begun to develop a new role and they are propitiating the
elderly adult population's revaluation in relation with the development of their
communities.
Nets Development
The work developed in nets as: The Third Age Distrital Association of
Independence - ADITEI, the Elderly Adults National Association of Peru - ANAMPER, the
Net Horizons of Villa and the Net Wonderful Age of the Small North have as main
achievements the establishment of relationships with the local governments.
5.2 Abuse and violence against the elderly adult
Our country is not free of the violence against elderly; this could be because our
society has diverse factors that propitiate this type of behaviours. The poverty and
unemployment in that a big part of the population's live contribute to the generation of
behaviors and negative attitudes in front of the aging process. However, it is convenient to
keep in mind that in the rural area, particularly in the rural indigenous populations, the
respect to the elderly adults continues being a central value in the life of the communities.
The data and figures in this respect are scarce, in spite of constituting a relatively
daily problem. The Centers of Woman Emergency (CEM) of the National Program against
the Family and Sexual Violence (PNCVFS) of the MIMDES that work in the mark of the
Law of Protection against the Family and Sexual Violence, registered during the year 2002,
1120 cases of elderly adult victims of family and/or sexual violence. This represents 3.6%
of the total of cases assisted in the 38 CEM at national level during the 2002 (29,759 cases).
Of the total of cases of elderly adults, family and/or sexual violence registered by the CEM,
76% corresponds to females.
It is also important to mention that the 46% of the elderly adults, victims of
aggressions, had an educational elementary level and the 28.6% hadn’t any educational
level. Also, 70.4% didn’t make any activity that offered them revenues.
Most of aggressions are given in the family environment. According to the statistics
of the PNCVFS, the main elderly adult’s aggressors are their own mature children, with
44.4%; their spouses, 14.6%; their current couple, 9.7% or other relatives (daughter-in-law,
son-in-law, etc.), 17%. It is necessary to highlight that the ages of the mature children
aggressors fluctuate between 26 and 45 years and that 68% are male.
In the family environment, the type of violence that is exercised most against the
elderly adults it is the psychological abuse (95%). The most frequent aggressions are the
insults (85%), humiliation and devaluation (66.3%), threats of death (40%) and rejection
(48.8%). However, the elderly adults are not exempt of the physical violence that
represented 39% of the total of cases registered in the CEM in the 2002.
2% of the total of cases (22) pointed out to be victims of sexual violence, being
female elderly adults the mainly affected ones. Of this group, 8 denounced violation and 12
pursuit or sexual blackmail. Both crimes were only referred by women.
We should be kept in mind that the Law of Protection against Family Violence and
the Penal Code, aids the people in risk, being able to go to the extrajudicial reconciliation.
However, the elderly adult’s abuse don't have a defined space for its legal treatment, neither
instances with the qualified human resources for its attention, as well as an explicit
legislation that favors the attention and the elderly adult population's protection.
5.3 Studies about socio-gerontological aspects
In our country, the scientific works in the social area are scarce. According to the
social evaluation carried out in hospitalized patients (as a part of a Integral Geriatric
Assessment) at national level by Varela and collaborators, 23.25% of the hospitalized
elderly adults were in a situation of social problem, while 49.5% were in a situation of
social risk.
In the Trujillo's county Elderly Adult's Profile, the social activity carried out in the
free time was measured, either as singular activities: listening radio, see television, to read
newspaper, read magazines, make handiworks, go to the cinema; or activities in group, as
attendance to sport events, social and religious meetings, practice of sports, friends/family
visits, carry out walks and receive visits. The most of the elderly adults in this county had a
low social activity (63.4%) and 32.4%, had a moderate activity. Also, the social activity
diminish as the age increases, this is slightly more evident in the case of the women.
Chart 5.1 Trujillo: Elderly Adults Social Activity, 1999 – 2000
Gender
Male
Female
Total
Social Activity
Low
Moderate
54.70% 38.80%
69.00% 28.30%
63.40% 32.40%
High
6.50%
2.70%
4.20%
Total
100.00%
100.00%
100.00%
Source: Perfil del Adulto mayor en la provincia de Trujillo, 1999-2000.
In both genders the groups that still work is the one with a higher social activity, this
difference is higher in the case of the women.
Another aspect to consider is the desire to work in connection with the labor
activity. A 71.5% of the elderly adults of this county, referred not to be working at that
moment. In the group that didn't work, 57% manifested desires to carry out a labor activity.
In the chart 5.2 is a relationship of other scientific works carried out in the elderly
adult population's social area (Chart 5.2).
Chart 5.2 Social gerontological studies; Peru
Year
1986
Title
The third age: Retired
Worker Integration and
Health within the society
and family
Author
Arce, E
Place
Retired Pensioners
Club
IPSS (now
EsSalud)
Results
- Workers wish to reach retirement
age as lately as possible
- Health negative state due to lack of
income, sometimes explained also by
previously life and work conditions.
- Marginalization feelings due to lost of
economic power and decrease of the
home directing role.
- Lesser participation in organizations
and activities
1986
Family Attitudes Toward
the Elderly Adults (EA) in
two communities of
Condevilla –San Martin
de Porres
1987
Relative’s Biosocial
Chávez, G
Factors that affect the
isolation of the elderly
adult
Socio-cultural Factors that Cuellar, M
affect the integration of
Sáenz, I
the elderly adult to his/her
community and family
1989
Pérez, F
Community
- There is a positive attitude toward
the EA in the psychological and social
areas, but indifference toward the
biological area.
- The lesser the age of the family
member and the closer blood
relationship, more positive attitudes
are seen
- There is not association between
marital status and work of the relative
with the attitude toward the EA.
Isolation’s principal factor is the lack of
relatives that look for them
San Vicente de
Paul Asylum
Community
1991
Third age and elderly
adult care knowledge
Huapaya, L
Centromin
Workers
(Mining company)
1995
Socio-economical and
cultural factors influence
in the integration of the
retired military personnel
(more than 60 years old)
to their family and
community
Geriatric Navy Center
Huillca, D
Mori, C
Quijada, R
Outpatient Office
The majority of the EA are poorly
integrated to his/her family and
community, the most important factors
are age, gender, origin (Lima or
counties) and instruction level
The workers had wrong ideas and fear
about the aging process. The lack of
knowledge about preventive measures
for a healthy life determines incorrect
opinions about the elderly adult care. l
The workers don’t accept the idea of
being elderly adults
The 62.8% presents a low integration
level with his family and community.
The most important factors are:
marital status, origin, previously
occupation, age, retired years, socioeconomical level. Factors that not
have influence: religion, residence
place and military rank
5.4 Family Nets
A significant number of elderly adults lack of a proper economical support and, in
consequence, will depend on their families. The family support assumes diverse forms as:
direct monetary help, personal cares in the case of a sick relative or partially impaired or by
means of the emotional support.
In chart 5.3 is seen that in Peru the elderly adults co-residence with their families
continues being an extended practice.
Chart 5.3 Elderly Adults Proportion that live alone, Peru 1993
Year
1993
Total
8,70%
Men
8,70%
Women
8,80%
Source: Censo 93, INEI CELADE.
Approximately one of four peruvian homes have at least one elderly adult among
their members. The distribution of homes according to residence areas shows that in the
rural area the proportion of homes that counts among its members with at least one elderly
adult is a little higher than in the urban area.
Chart 5.4 Percentage of family homes with at least one elderly adult, by residence area,
Peru 1993
Year
% of homes with elderly adults
Total
Urban Area
1993
24,70% 23,90%
Source: Censo 93, INEI CELADE.
Rural Area
26,80%
The proportion of homes headed by elderly adults in our country is of 18.9%. The
homes leaded by a female elderly adult overcome the ones leaded by male elderly adults as
a result of the differential mortality for sexes.
Chart 5.5 Percentage of homes leaded by an elderly adult, by gender and residence area,
Peru 1993
Total
18,90%
Total
17,20%
Male Boss
24,80%
Female Boss
Source: Censo 93, INEI CELADE.
Urban Area
17,70%
17,20%
24,80%
Rural Area
21,70%
19,20%
31,80%
Most of homes with elderly adults; also have other younger members (children,
grandsons, other kindred ones and non relatives), constituting multi-generational homes
where, in general, they live in dependence relationship. The cohabitation is in this way a
form very common form of intergenerational solidarity that reduces the expenses for person
housing and the purchase and preparation of meals and facilitates the direct support to
relatives with special necessities.
Chart 5.6 Distribution of homes that includes Elderly Adults, by residence with other non
elderly adults members, Peru 1993
Total
Year
Total
Only
with
Elderly
adults
another
with
other
elderly
members
adults
80,80%
19,20%
Urban Area 84,20%
15,80%
Rural Area
73,60%
26,40%
Source: Censo 93, INEI CELADE.
Regarding the marital status, is observed that there is a higher proportion of
divorced, single and widower women than men.
Chart 5.7 Elderly Adults Marital Status, by gender, Urban Peru 2003
Marital Status
Partner (non married)
Married
Widower
Divorced
Single
Don’t tell
185,801
1’088,800
501,349
58,883
157,244
24,038
TOTAL
2’016,115
Source: INEI - MIMDES, 2003.
Men
Women
9.22%
54.00%
24.87%
2.92%
7.80%
1.19%
10.5%
66.7%
14.4%
5.4%
3.0%
----
6.0%
40.4%
38.7%
9.3%
5.6%
----
100.00%
100.0%
100.0%
6.
HEALTH SYSTEM DESCRIPTION
6.1 PANORAMIC VISION OF THE PERUVIAN HEALTH SYSTEM
The peruvian health system had have an inadequate global acting for decades.
According to the World Health Organization (WHO) evaluation published in the World
Health Report of the year 2000, our country is located in the position 129 for health system
global acting, among the 191 studied countries. In what concerns to achievement goals, it
occupies the penultimate place (Graphics 6.1 and 6.2).
Graphics 6.1 and 6.2: Acting and global achievements of the peruvian health system, 2000
Health system global acting
Colombia
22
Chile
33
Costa Rica
36
Venezuela
54
Paraguay
57
Uruguay
65
Ecuador
111
Bolivia
126
Peru
129
00000
Health system position
00050
00100
00150
Health system global achievement
Chile
33
Colombia
41
Costa Rica
46
50
Uruguay
Venezuela
65
73
Paraguay
Ecuador
107
115
Peru
Bolivia
117
0
50
100
150
Health system position
Source: Informe sobre la salud en el mundo 2000, OMS
The most important factors that have contributed to this faulty acting are the
administrative disorder and lack of leadership of the Health Ministry.
During last decade the Health Ministry didn't reach enough leadership, taking place
an intra-sectorial fragmentation with the presence of programs and projects financed with
external co-operation that acted parallel to planning and administration of the central and
regional formal health structures. There was also a scarce investment in health promotion
and illnesses prevention.
6.1.1 Health sector segmentation
In Peru, several instances take charge of health attention. Approximately 20% of the
country population have access to the Social Security Services (EsSalud). 12% are assisted
to private services (health lender entities, private clinics, medical clinics and other
institutions) and 3% have access as to the Armed Forces (FFAA) and of the Peruvian
National Police (PNP) Sanities. The 65% remaining depends on the health public services
that offers the Health Ministry; but is considered that inside this sector, 25% doesn't have
possibilities to access any type of attention (Graph 5.3).
Graph 6.3 Health Sector Segmentation, Peru 2002
12%
3%
Health Ministry
Social Security
Army and Police
Private system
20%
65%
Source: Lineamientos dela politica sectorial para el periodo 2002-2012, MINSA
This segmentation of services prevents the articulation of efficiently health actions.
It is also the cause of duplicities and hinders the Health Ministry directing role. Also, it
doesn't facilitate the country’s process of decentralisation that requires an efficient coordination of the attention and organisation, for an appropriate articulation among the local,
regional and national levels.
It is also observed a separation and duplicity of functions between diverse state
organs like the Woman's and Social Development Ministry, the Ministry of the Presidency,
the Defence Ministry, the Interior Ministry, the Health Ministry and the Work Ministry.
EsSalud (Social Security) belongs to this last Ministry, and does not have the co-ordination
instances and necessary intersector planning. In this mark, the Health Ministry has not been
able to reach a leadership role in the formulation of health inter-sector politics.
There is also a disproportion in the distribution of resources and the responsibilities
that have the different subsectors. The Health Ministry has an expense per capita 4 times
minor that EsSalud (Social security); however it administers more health establishments
and carries out a higher number of attentions (Graph 5.4).
Graph 5.4 Resources and responsibilities proportion by expense per layer
90
80
70
81
Hospitalization
65
60
Outpatient
office
60
50
44
40
30
23
Rural
hospitalization
18
12
20
5
10
Rural
outpatient
0
Health Ministry US$
28 annual
Social Security
US$105 annual
Source: Lineamientos de la política sectorial para el periodo 2002-2012, MINSA
The Armed Forced and Police health system assumes 2% of the hospitalizations, 2%
of the outpatient attentions at national level and 1% of the total outpatient attentions. They
don’t assume hospitalisations in rural areas.
The private sector assumes 9% of the hospitalizations, 36% of the outpatient
attentions at national level, 7% of the hospitalizations and 34% of the outpatient attentions
in the rural areas. It should be kept in mind that at least 50% of the outpatient attentions of
the private subsector corresponds to pharmacies (mainly in urban areas), to faith healers
and community agents of health (mainly in rural areas). The participation of the private
sector of social and humanitarian projection (NGOs, churches) is not appropriately valued
neither systematized.
In 1994, the Health Ministry assisted the13% of the insured population of EsSalud
(Social Security) and 10% of the population with private insurance.
Although the expense per layer in health at national level is of US$100, the subsector Health Ministry has much lower and very more variable figures of region to region,
constituting the subsector that assumes the highest number of attentions in spite of the
scarce assigned resources. The access to the services of health is shown in the Graph 6.5.
Graph 6.5 Medical Services Population Access, Perú 2000
18%
Population:
with
access
without
access
82%
Source: Lineamientos de la política sectorial para el periodo 2002-2012, MINSA
6.1.2 Financing
According to the WHO Report, Peru is one of the countries of the region that invest
less in health; only 4.7% of its national gross product (Chart 6.1). The public expense in
health in the 90s by millions of dollars is shown in the Graph 6.6.
Chart 6.1 National Expense Health Indicator, Peru 1997 - 2001
1997
% NGP Health Total Expense
4,4
Government General Health Expense, % of 11,6
the goverments total expense
Social Security Health Expenses, % the
43,0
government general health expense
Source: World Health Report 2003, Annex 5.
1998
1999
2000
2001
4,6
12,9
4,9
13,0
4,7
12,7
4,7
12,1
43,1
48,3
47,2
51,9
Graph 6.6 Health Public Expense, Perú 1990-1999
600
500
400
300
200
100
0
1990
1992
1995
1998
1999
Source: Lineamientos de Política Sectorial para el periodo 2002 – 2012, MINSA.
In 1997, 13% of the average expense was dedicated to the administrative units, 54%
to the hospitals (that only assisted 30% of the demand), and 33% to the primary health care
centers (that assisted 70% of the daily demand) (Graph 6.7).
Graph 6.7 Average Health Expense Distributions, Peru 1997
100%
33%
80%
70%
60%
54%
40%
30%
20%
13%
0
0%
Current expences%
Administrative units
Hospitals
Demand%
Primary health care centers
Source: Lineamientos de Política Sectorial para el periodo 2002 – 2012, MINSA.
6.1.3 COVERING
Barriers of diverse nature limit health service cover, some of which affect the
elderly adult population.
Economic barriers
According to the National Home Survey (ENAHO), the lack of economic resources
was an important barrier to the health services access. 40% of people that didn't have access
to health services in the year 1998 didn't make it purely for economic reasons; in 1999, the
percentage ascended to 49.4%.
Geographical barriers
It is still not possible to cover the demand of the whole national territory, in spite of
the increment of services. The existence of many areas of the country in those that the
pattern of dispersed populational establishment prevails is an important factor in the
geographical inaccessibility to the services. This situation is increased with relationship to
the health centers and local hospitals of more resolutory capacity that in general are at a
considerable distance of some rural towns or communities. The communication difficulties
and public transportation are additional factors to the geographical problem, especially in
the rural areas.
However, in the big coastal cities as Lima, Arequipa and Trujillo, although public
transportation means exist, these are not the appropriate ones for the population's sectors
that have great demand for health services, as the elderly adult and impaired people.
In 1999, approximately 8% of the sick people that had not access to the health
services didn't make it up due to geographical reasons.
Cultural barriers
Our country is characterized by its great cultural diversity, one that manifests with
great vigor in the different perceptions of the health-illness process and the relationship
between life and death.
Qualitative studies developed in some of the poorest regions in the country show,
that the residents and health personnel of the communities have very different ideas on
what normal is and in what cases is required a qualified health personal intervention.
Distrust exists toward the primary health care personnel, as well as toward the
diagnosis and treatment techniques employed. To this we must add that the public services
of health have little acceptance for traditional medicine; that is very used by the general
population, especially by the ones that live in rural areas.
Health care professional’s behaviour barriers
The main causes for service dissatisfaction referred by the users were abuse and/or
inadequate treatment (55% of the total complaints).
Medications Access
The most expense that a person makes when using health services to recover of
some illness corresponds to medications. According to the ENAHO 1998, the total cost of
an average medical consult is composed in 12% by personnel fee (physician, nurse,
secretary etc.), 13% by auxiliary exams and the 75% by medications.
The access reduction of the Peruvian population to the medications is appreciated in
Graphics 6.8 and 6.9. The main reason of this contraction in medications consumption is
the cost, which implies a higher marginalization of the population's poorer sectors.
Graphics 6.8 and 6.9 Peruvian population to medications access, 1988-2000
Drugs units quantity selled (by millions)
160
160
140
120
100
80
60
40
20
0
58
1988
2000
Drug units selled by habitant
7,75
8
7
6
5
4
2,26
3
2
1
0
1988
2000
Source: Lineamientos de Política Sectorial para el periodo 2002 – 2012, MINSA.
6.1.4 HUMAN RESOURCES
Between 1994 and 1997 were incorporated in the “Basic Health Program for All”,
10,806 workers (physicians, professionals non physicians and technicians) to work in the
first level establishments (primary health care centers) for renewable contracts of 90 days,
without rights for vacations neither for social benefits. This means that approximately the
sixth part of the human resources of the Health Ministry is working with extreme labour
flexibility that generates labour uncertainty, a precarious work situation and inadequate
conditions for the good performance.
The Health Ministry is the main employer of the Health sector; however, the highest
growth of labour positions has taken place in the Sanity of the Armed and Police forces
(156%) and in the private subsector (139%) (Graph 6.10).
Graph 6.10 Growth of labour positions by subsectors, 1999
156
139
160
140
120
100
68
80
60
30
40
20
0
MINSA
ESSALUD
SANIDADES
PRIVADOS
Source: Ricse 2000, World Bank 1999.
The labour positions are concentrated in the hospitals; however, an increment of
positions has been given in the first level attention services (primary health care centers).
This way, in 1996 these increased in 200% and in 1999, in 314%.
In the year 2001 the most important problems for the development of the human
resources of the administration were:
•
•
•
•
The not planned growth of the health personnel formation. The sector lacks an unit
specialized in the planning and development of human resources.
A weak regulation and accreditation of the medical professional, observed in an
excessive growth of medicine faculties. Also, the sector has not had the proper
participation in the qualification of the medical professionals in activity
(professional certification).
Exists a tendency to the over-specialization of the medical professionals, but
specialties like anaesthesiology and other necessary to assist regional pathologies,
are not promoted. Little interest also exists in forming integral general doctors and
general nurses that are required in the first and second level of attention.
The Marginal Rural and Urban Service of Health doesn’t have enough resources
and doesn't fulfil the appropriately the function of linking the practice of the young
professionals with the necessities of the population's health.
•
A limited formation and training of distance health teams
For the year 2000, Peru had 11.7 medical professionals per each 10000 inhabitants
most of them were concentrated in the cities of the coast, being Lima and Callao the cities
with more concentration (Graph 6.11).
22
20
18
16
14
12
10
8
6
4
2
0
LI
M
C
A
A L
Q
M P
O
Q
IC
A
TA
M C
D
D
LA
A L
N
C
LA
M
PI
U
PA
S
JU
N
TU
M
C
U
S
A
YA
H
N
C
H
U
A
LO
R
SM
U T
C
A
PU
N
A
M
A A
PU
C
A
J
Tasa x 10.000 Hb.
Graph 6.11 Number of physicians by region, Peru 2000
6.1.5 Health System New Reforms
It is prominent the recent impulse of the primary health care attention as a central
function of the Coordinated and Decentralized National System of Health (SNCDS). This
new system looks for the construction of health equity and its fundamental strategy is the
public and solidary health insurance, with tendency to the universalization, through the
invigoration of the Health’s Social Security (EsSalud) and of the Health’s Integral
Insurance (SIS) of the Health Ministry, this last one created in the year 2001 and guided
fundamentally to insurance of the most vulnerable population in extreme poverty.
6.2 HEALTH MINISTRY
History
In 1568, when Peru was a colony of Spain, was created the Royal Tribunal of the
Protomedicato with the purpose to guarantee the correct exercise of the medicine, the
operation of drugstores, to combat the empiricism, to classify plants and medicinal herbs, to
write the Peru’s natural history and to acquit the government's consultations on the climate,
existent illnesses, hygiene and public health in general. The physician who works most in
this period was Hipólito Unanue, also an eminent person of the independence process.
In the republic, this institution was conserved along the XIX century, under the
name of General Protomedicato of the State. In 1903, the Peruvian government created the
Public Health Direction dependant of the Development Ministry, later acquiring autonomy
as a ministry thanks to the1920’s Republic Constitution.
In 1935 was promulgated the legislation decree 8124 that creates the Public Health,
Work and Social Forecast Ministry. In 1942 it adopted the name of Ministry of Public
Health and Social Attendance and from 1968 the name that maintains until the present time:
Health Ministry.
Mission and Objectives
The Ministry of Health has the mission of protecting the personal dignity,
promoting the health, preventing the illnesses and guaranteeing the integral health attention
of all the inhabitants' of the country; proposing and driving the limits of sanitary politics in
agreement with all the public and social sectors.
Organization
With the purpose of fulfilling their functions, the Peruvian Health Ministry is
composed by seven organs:
1. High Direction
• ·Health Minister
• ·Health Vice minister
• ·General Secretary
2. Advisory organ
• ·Health National Council
3. Control Organ
• ·General Inspectors Office
4. Judicial Defence Organ
• Public Attorney's office of the Health Ministry
5. Consultantship Organs
• · General Office of Strategic Planning
• · Cabinet of Advisory of the High Direction
• · General Office of International Cooperation
• · General Office of Epidemiology
• · General Office of Artificial Consultantship
6. Support Organs
• · General Office of Statistic and Computer Science
• · General Office of National Defense
• · General Office of Administration of Human resources
• · General Office of Administration
• · General Office of Communications
7. Line Organs
• · General Direction of Environmental Health
• · General Direction of People’s Health
•
•
· General Direction of Health Promotion
· General Direction of Medications, Inputs and Drugs
Among the Line Organs, it is necessary to mention some of the functions that
performs the General Address of People’s Health, as the establishing of the norms,
supervision and evaluation of the attention of the people’s health from their conception
until their natural death, as well as the categorization, and operation of the health services
and the sanitary administration in the health sector. This Direction is composed in turn of
the following executive’s directions:
· Executive Direction of Health Integral Attention
· Executive Direction of Health Services
· Executive Direction of Health Quality
· Executive Direction of Sanitary Administration
· Direction of Health Basic Services
· Direction of Health Specialized Services
The Executive Address of Integral Attention of Health (DEAIS) is in charge of the
formulation and diffusion of the attention politics, of the identification of priorities and of
the proposition of national sanitary strategies, as well as their pursuit and evaluation. This
direction is responsible for the implementation of the Health Integral Attention Model
(MAIS), according to the Political Linings of the Sector 2002 - 2012. This model
contemplates the integral attention of people's health by Life Stages, including the elderly
adult’s stage. It constitutes the reference mark for the health attention in the country, based
on the development of health promotion actions of, illness prevention, recovery and
rehabilitation.
Decentralized organs
1. Specialized institutes
2. Health Directions (Lima)
3. Regional Health Directions (counties)
4. Lima and Callao Communicators
The Assistance Levels, are determined in function of the users affluence, the
installed capacity and the modernization of the infrastructure and equipment, they are the
following ones:
1. First level: health posts and centers
2. Second level: Small hospitals
3. Third level: General hospitals
4. Fourth level: Specialized Institutes (for example: Neoplasic Diseases National Institute
or Mental Illness National Institute)
HEALTH ESTABLISHMENTS
The Health Ministry has 6874 health establishments in the whole country. 80.48%
are health posts; 17.43%, health centers and only 1.99%, hospitals. 97% of the
infrastructure of the Health Ministry of Health is dedicated to offer primary health care
(Chart 6.2).
Chart 6.2 Health Ministry Establishments by region, 2004
Region
TOTAL
Hospital
Health Center
Health Post
TOTAL
6,874
137
1,198
5,532
100.00%
1.99%
17.43%
80.48%
%
289
2
30
257
AMAZONAS
414
12
50
352
ANCASH
237
6
33
198
APURÍMAC
246
4
51
191
AREQUIPA
383
8
45
330
AYACUCHO
600
8
98
494
CAJAMARCA
57
2
50
4
CALLAO
268
4
47
217
CUSCO
286
1
44
241
HUANCAVELICA
233
4
21
208
HUÁNUCO
138
6
34
98
ICA
454
7
56
391
JUNÍN
208
8
44
156
LA LIBERTAD
154
2
43
109
LAMBAYEQUE
677
24
205
442
LIMA
327
3
53
271
LORETO
114
2
13
99
MADRE DE DIOS
60
1
26
33
MOQUEGUA
254
3
15
236
PASCO
385
4
73
308
PIURA
439
11
80
348
PUNO
350
11
43
296
SAN MARTÍN
72
1
17
54
TACNA
44
1
13
30
TUMBES
185
2
14
169
UCAYALI
Source: Oficina General de Estadística e Informática MINSA. Base de Datos de Infraestructura.
The Chart 6.3 presents the Health Ministry physicians distribution by Regional
Health Directions.
Chart 6.3 Health Ministry physicians distribution by Regional Health Directions.
, Peru 2002
Health Ministry physicians by Regional Health Directions and type of
establishment
Health
Center
Health
Post
Health Direction
Total
Hospital
AMAZONAS
ANCASH
APURÍMAC I (APURÍMAC)
APURÍMAC II (ANDAHUAYLAS)
AREQUIPA
AYACUCHO
BAGUA
CAJAMARCA I (CAJAMARCA)
CAJAMARCA II (CHOTA)
CAJAMARCA III (CUTERVO)
CALLAO
CUSCO
HUANCAVELICA
HUÁNUCO
ICA
JAÉN
JUNÍN
LA LIBERTAD
LAMBAYEQUE
LIMA II - (LIMA SUR)
LIMA III - (LIMA NORTE
LIMA IV - (LIMA ESTE)
LIMA V - (LIMA CIUDAD)
LORETO
MADRE DE DIOS
MOQUEGUA
PASCO
PIURA I (PIURA)
PIURA II (LUCIANO CASTILLO)
PUNO
11,388
100%
89
313
82
45
642
217
43
120
54
27
663
287
79
186
312
67
332
562
204
768
1,338
631
2,764
156
58
91
74
190
166
295
7,244
63,61%
22
226
30
19
369
132
12
58
16
SAN MARTÍN
180
66
87
27
TACNA
133
60
53
20
74
27
35
12
TOTAL
TUMBES
480
157
13
75
215
20
164
347
128
318
811
429
2,554
99
28
19
26
10
75
154
2,822
1,322
36,39%
34
33
48
39
31
21
15
11
170
103
65
20
25
6
34
28
34
4
22
5
181
2
78
52
60
6
57
54
53
44
30
17
106
62
115
100
50
26
303
147
305
222
149
53
201
9
46
11
21
9
62
10
22
26
121
59
67
24
105
36
UCAYALI
146
85
37
24
Source: Ministerio de Salud - Oficina General de Estadística e Informática. Bases de datos de
Recursos de Salud.
Most Health Ministry physicians are in the hospitals (64%); only in Lima and
Callao were working 6,164 physicians that represent 54% of the total of these professionals
in the sector (Graphics 6.12 and 6.13).
Graphics 6.12 and 6.13 Health Ministry physician’s concentration for establishment,
MINSA 2002
Health establishment distribution,
Perú 2002
90
80
80
70
60
50
40
30
17
20
2
1
Hospital
Hospitales
Institute
Institutos
10
0
PHC
center
Centros
PHC post
Puestos
Health Ministry: Physician distribution by
health establishment
70
64
60
50
40
25
30
20
11
10
0
Hospitales
Hospitals
Centros
PHC
center
Puestos
PHC
post
Source: Lineamientos de Política Sectorial para el periodo 2002 – 2012, MINSA.
Access
Chart 6.4 Elderly Adults Health Assisted and Attentions, Ministry of Health, 2003
Region
Assisted
%
Attentions
%
Total
781,314
100,00 2’010,706
100,00
Lima and Callao
306,641
39,25
845,797
42,06
Rest of the country
474,673
60,75 1,164,909
57,94
Source: Informe de registro Diario HIS Ministerio de Salud – OEI, cifras preliminares.
The Health Ministry offers attention to all people that requires its services, without
restriction and at a lower cost than most of private health centers. Also offers the Health
Integral Insurance (SIS) guided fundamentally to the vulnerable population in extreme
poverty. The ministry also have other free programs, as the Tuberculosis Control Program
and of other pathologies, of which the elderly adult benefits, together with the general
population.
Health Integral Insurance (SIS)
The Health Integral Insurance-SIS is a free attention system directed to the less
economically favoured. This insurance that was directed initially to the children and
pregnant mothers, now involves also some people considered in extreme poverty:
Plan A, 0 to 4 years infants
Plan B, 5 to 17 years children and adolescents of
Plan C, Pregnant mothers
Plan D, Adult in Emergency situation
Plan E, Focalized Adult
Plan F, a monthly payment whose value is not calculated yet
Some health authorities say that the SIS is on the process of constitute the institution
that contributes to the universal insurance and guarantee the full exercise of the population's
health right in our country. The Benefits Plan is appreciated in the Chart 6.5.
Chart 6.5 Integral Health Insurance Benefits Plan, Peru 2002
Consult Emergency Medicines
Plan A
Plan B
Plan C
x
x
x
Plan D
Plan E
Plan F
x
x
x
x
x
x
x
x
x
x
x
x
x
x
X ray
x
x
x
x
x
x
Laboratory
Hospitalization
x
x
x
x
x
x
x
x
x
x
x
x
Surgery
x
x
x
x
x
x
Odontology
x
x
x
x
Mobility to
Death
other
institution
x
x
x
x
x
x
x
x
x
x
x
x
The SIS also has incorporated, for political decision and without another approach,
the following populational groups:
Popular Dining Rooms Directors
Mothers of the milk glass program
Administration committee’s integrants and wawa wasi mothers caretakers
Hospitals
The national hospitals of more complexity level are generally in Lima. They have a
specialist doctor in Geriatrics or a Internist qualified in the elderly adults attention:
Archbishop Loayza Hospital, 2 de Mayo Hospital, National Cayetano Heredia Hospital,
María Auxiliadora Hospital, Hipólito Unanue Hospital and Sergio E. Bernales National
Hospital. However, some of these hospitals, with Geriatrics Services don't have the enough
human resources and lack of infrastructure; therefore, they don't really operate as properly
conformed Geriatrics Units, being limited, in most of the cases, to the Outpatient
consultation and in giving answer to the specialty inter-consults. In counties this situation is
even more dramatic, especially in the rural areas.
6.3 THE SOCIAL SECURITY (ESSALUD)
History
In July of 1980 by Legislative decree #23161 was created the Peruvian Institute of
Social Security (IPSS), among its functions were: the cover of the insured and their
relatives against the illness, maternity, disability, accidents, age and death risks; also
pointed out as objective the insured's and their family social realization.
Until 1994 the Peruvian Institute of Social Security took charge of the Health
Services Benefits for the insured population and their family and of the grant of pensions
for the population in pension age. At the present time, the Previsional Normalization Office
(ONP), as autonomous entity, is the one in charge of administering the resources dedicated
to cover the jubilation pensions.
In 1999, on the base of the Peruvian Institute of Social security (IPSS) was created
the Health Social Security (EsSalud) as decentralized public organism, attributed to the
Sector Work and Social Promotion, with technical, administrative, economic, financial and
accountant autonomy.
Mission and objectives
EsSalud has for purpose to give cover to the insured through the grant of prevention,
promotion, recovery, rehabilitation, economic and social benefits that correspond to the
Health Social Security contributive regime, as well as other human risks insurance.
Organization
EsSalud attention levels present a similar distribution to that of the Health Ministry,
although it has a Domiciliary Attention Program (PADOMI) and Elderly Adults Centers
(CAM), this last one already described in the previous section.
Program of Domiciliary Attention (PADOMI)
Through this program EsSalud provides home health services to patients elder than
80 years and with physical limitations. This program intends to achieve the patient and
family participation in the health attention, fomenting self care and prevention, and
contribute to the effective use of the Medical Consultation and of EsSalud Hospital Bed
Services, as well as the rational use of the hired clinics.
Access
Social security health service offers attention to the workers, pensioners and their
family (spouses and children) that are in the system. The beneficiaries constitute a minority
group, in which the elderly adults represent 13% of the total of insureds. These age group
use EsSalud health services in an important way because they have the 25% of the
outpatient office consults it, 29% of the hospitalizations, and 22% of the emergency
attentions. On the average they use 25% of the total of attentions, without counting the
special programs for chronic non communicable diseases as hypertension, diabetes,
osteoartrosis, asthma and other exclusive services as the Domiciliary Attention Program
(PADOMI), the Elderly Adults Centers (CAM) and the Elderly Adult Basic Units of
Attention (UBAAM) that elevate the use from the services to 30% in relation to the other
populational groups.
The elderly adults represent an increment of 1.6% annual inside this institution. In
absolute numbers the population of elderly adults, regular pensioners ascends in EsSalud,
to 600123; if we include the spouses we must add another 294,060 people, reaching a total
of 894,193 insured. Although all the spouses are not necessarily elderly adults, is assumed
that in their majority they are contemporary.
Making an approximate calculation, the elderly adult’s contribution is of 84 million
annual suns, while the costs of their attention rise to near 390 millions in the same period,
being the expense subsidized in 78.46%.
The new contributors cannot cover the expense breach made by the benefits given to
the elderly adults, the problem becomes worse because of others factors resultant from the
economic crisis. The qualitative change of being retired elderly adults goes accompanied by
a decrease of their contributions.
It is important to mention that 5 EsSalud hospitals spend 60% of this institution
general budget; of this it is deduced that in this institution the expense in recuperative
medicine is higher than the investment in health prevention and promotion. In the Chart 6.6
is a list of EsSalud establishments and their distribution by regions.
Chart 6.6 EsSalud Establishments by level and regions, Peru
Hosp IV Hosp III Hosp II Hosp I Policlin PHCCenter PHC post TOTAL
Amazonas
1
Ancash
Apurímac
Arequipa
1
Ayacucho
Cajamarca
Callao
Cusco
1
1
1
1
1
La Libertad
Lambayeque
Lima
1
1
1
2
Loreto
1
1
1
1
4
1
1
4
1
3
3
3
2
5
6
2
1
1
1
1
4
15
1
4
2
3
1
1
Madre de Dios
Moquegua
Pasco
1
2
Piura
Puno
2
1
2
1
San Martín
1
Tacna
Tumbes
2
2
2
3
1
1
2
4
1
1
Ucayali
TOTAL
2
2
Huánuco
Ica
7
5
Huancavelica
Junín
1
1
2
1
2
3
1
1
1
8
8
22
40
30
36
6
9
4
19
8
10
1
3
5
6
9
9
23
7
12
4
3
1
14
11
7
6
2
3
4
9
19
6
26
10
16
4
15
8
9
14
16
33
16
42
6
4
3
17
18
15
11
4
4
5
186
330
6.4 THE ARMED FORCES AND POLICE SANITIES
As was mentioned previously, the Armed forces sanity offers health services to the
military or police personnel, and their spouses and children, according to the institution to
which the person belongs.
4 sanities exist:
· Military Sanity
· Navy Sanity
· Air Force Sanity
· Police Forces Sanity
In the Peru, the sanities were the first institutions that created specialized services of
attention for the elderly adults and have very differentiated attention levels for the attention
of this age group.
6.5 PRIVATE INSURANCE, PRIVATE CLINICS, PARTICULAR CLINICS AND
OTHERS
PRIVATE INSURANCE (Health lenders entities (EPS))
In 1997, the Health Social Security Modernization Law N° 26790 was approved,
that is based in the constitutional principles that recognize the right to the well-being and
that guarantee the free access to benefits in charge of public, private or mixed entities.
The health plans and programs of the Health Lenders Entities properly credited
supplement the covering of the Health Social Security, financing the benefits by means of
contributions and other payments according to law.
The Health Lenders Entities that function at the moment are two;
· INTERNATIONAL RÍMAC EPS
· PEACEFUL HEALTH EPS
Nova Salud EPS has been fused to Pacifico Salud EPS. (Graph 6.14).
Graph 6.14 Insured Population's Distribution by EPS, 2003
46%
54%
Rimac
Novasalud/Pacificosalud
Source: Reportes mensures de aplicación de las EPS
EPS DEFINITION
According to the regulation of the Health Social Security Modernization Law, EPS
is defined as the companies and public or private institutions different to ESSALUD whose
only end is to lend health attention services, with an own infrastructure, held to the controls
of the Health Lenders Entities Superintendence (SEPS) that is the decentralized public
organism of the Health sector that authorizes, regulates and supervises the operation of the
EPS and caution the correct use of the administered funds.
CONTRIBUTIONS
Regarding the contributions, at the moment the Health Lenders Entities affiliated to
the system contribute the 6.75% of the remuneration from their workers to EsSalud and
2.25% to an EPS.
BENEFITS
In what refers to the benefits, these include the preventive, promotional, and
recovery activities, benefits of well-being and social promotion (Social help projection
activities and of rehabilitation for work, guided to the promotion of people and protection
of their health) and economic benefits, as subsidies for temporary inability, maternity,
nursing or benefits for burial.
ATTENTION PLANS
Simple Plan:
Group of health interventions of more frequency and smaller complexity, they can be lent
by the EPS or for EsSalud.
Complex Plan:
Group of interventions of smaller frequency and higher complexity. They are in charge of
EsSalud.
AFFILIATION
The affiliations are classified according to the insurance type: Regular, Optional and Risk
Work Complementary Insurance (SCTR).
Regular insureds
People that work in dependence relationship and their claimants (spouse, children
smaller than 18 years and work impaired elder children). Additionally they could be
included the principal affiliated children elder than 18 years, the parents and the parents inlaws.
Optional insureds
Workers and independent professionals and other people that don't qualify for the
regular affiliation.
Assured for Sure Complementary of Work of Risk (SCTR)
The SCTR gives cover to the professional diseases and the workers' labor accidents
(for those who carry out high risk activities, defined in the Technical Norms of the Risk
Work Complementary Insurance, D.S. 003-98-INC).
The total number of affiliations at the end of the year 2003 was of 417,293, the
highest since the creation of the system. This number of affiliations doesn't indicate the
total number of insureds, because some duplicity is given due to 211 companies that have
workers insureds under the regular insurance and the SCTR modalities.
6.15 Population assured to EPS by affiliation type, 2003
3%
37%
60%
SCTR
Regulars
Potestatives
Source: Resportes mensuales de afiliacion de las EPS
GEOGRAPHICAL ENVIRONMENT
The geographical environment in which the EPS operates is composed by 17
regions of the country. In some regions of the mountain, such as Apurímac, Huánuco,
Huancavelica and Pasco this system has not still been implemented.
LINKED ENTITIES TO THE EPS SYSTEM
When concluding the year 2003, were registered 528 entities linked to the EPS
system, with a total of 932 establishments or health services in the whole country. This
number includes the branches of the linked entities and health establishments that form the
net of services of the Health Services Administrators given by third persons. Of the total of
establishments, 497 are located in Lima and Callao (53%) and 435 (47%) in other counties
of the country (Chart 6.7).
Chart 6.7 Entities linked to EPS Health Plans, 2003
Entity type
Hospitals and clinics
Institutes
Medical Centers
Odontological Centers
Medical Poli-Clinics
Odontological Poli-Clinics
Private Physician Outpatiant office
Dentist Outpatient office
Psychological Outpatient office
Diagnostic and Therapeutic services
Medical Support Center
Domiciliary attention services
Patients movement services
Other establishments
Total
Lima and Callao
Nro
%
38
37%
4
80%
25
64%
0
0%
26
68%
70
89%
139
48%
101
46%
9
100%
59
65%
8
100%
9
75%
6
100%
3
100%
497
53%
Countryside
Nro
%
65
63%
1
20%
14
36%
28
100%
12
32%
9
11%
153
52%
118
54%
0
0%
32
35%
0
0%
3
25%
0
0%
0
0%
435
47%
Total
Nro
%
103
11%
5
1%
39
4%
28
3%
38
4%
79
8%
292
31%
219
23%
9
1%
91
10%
8
1%
12
1%
6
1%
3
1%
932 100%
CLINICAL AND PRIVATE HOSPITALS
The private sector faces diverse problems, among those more important are its non
used infrastructure capacity that oscillates between the 40 and 50%. The private health
services possess near 7,300 beds and constitute the second subsector, after the Health
Ministry in hospital beds capacity of the country. The other great problem in the private
sector is that in the last years it has registered a significant descent in the margins of utility,
which doesn't allow it to be developed appropriately.
Nursing Homes
For the economic sectors with more income, elderly adult’s private centers of
attention are being established.
In the year 2001, in Lima officially existed 20 nursing homes. At the moment the
number should be higher and it is very probable that some of them are not properly
accredited. The lodgings can vary from 60 to 600 dollars monthly. These nursing homes are
generally dedicated to the care, lodging and attention of the elderly adult with health
problems that cannot be assisted by their relatives by some reason. Almost all the nursing
homes are located in middle class neighborhoods.
6.6 ELDERLY ADULT POPULATION PUBLIC ATTENTION PROGRAMS
In the Peru exist public programs for the attention of the elderly adult of scarce
resources, however, these, in most of cases, are inscribed inside integral programs of
attention to the poor population that are developed by Woman's Ministry and Human
Development (MINDES) and the Health Ministry (MINSA) dependent organisms, as well
as for programs developed by provincial municipalities and districts of the country. Maybe
the only exceptions constitute those denominated housings or homes that depend on the
Charity Societies whose activity almost exclusively is concentrated in the needy elderly
adult's attention.
6.6.1 Family Well-being National institute (INABIF)
The Family Well-being National Institute is a decentralized public organism that
belongs to the Woman's and Human Development Ministry that carries out promotional
preventive actions directed to the population in social risk. The elderly adult population
attention is in charge of the Family Promotion Direction that also assists adolescents,
women and adults in poverty situation, through family promotion centers. The service
offered to the elderly adult population is made through Elderly Adult's Clubs, by means of
biohuertos productive courses, labour-therapy courses, literacy promotion, health
prevention; motivation and cultural courses, and alimentary support.
The Population in Risk Development Direction is responsible for (asylums,
housings) distributed at national level. They assist the population that doesn't have family,
or that for diverse reasons (generally economic or of incompatibilities that affect the
coexistence) doesn't have a housing or minimum comfort or attention.
The main housings or asylums for the elderly adult of Lima city depend on the
Public Charity Society, a decentralized organism of the Woman and Human Development
Ministry that have been experiencing an increment in the demand of services. In 1998 the
elderly adult population residents ascended at 673; in 1999, to 794 people and in the 2000,
802 elderly adult already resided in the group of housings administered by Lima Public
Charity (Canevaro, San Vicente of Paul Geriatric Home and outlying housings).
6.6.2 Feeding programs
The feeding and nutrition programs in our country are in their majority in charge of
five institutions that belong to the MIMDES; these programs are not directed specifically to
the elderly adult population:
•
•
•
•
•
PRONAA National Alimentary Support Programs
PRO MARN Nutrition and Feeding Program for the Minor
PREDEMI School breakfasts and Micro-nutrients Deficiencies
PANFAR Family in Risk Feeding and Nutrition
PACFO Alimentary Complementation for Groups of more Risk
The MINSA is in charge of the TBC Patient and Family Feeding and Nutrition
Program, while the local governments are in charge of the Milk Glass Program. The
proliferation of programs seems an administration problem, for the quantity of operators for
a similar objective population, creating in this way overlapping in the action of alimentary
support.
The Elderly Adult Population of scarce resources benefits from the PRONAA
alimentary attendance programs in popular dining rooms. When they suffer tuberculosis,
they benefit from the Feeding and Nutrition Program for TBC Patient and Family; when
they reside in rural areas of extreme poverty through the program of the Milk Glass,
although this last program prioritizes the attention to children from 0 to 6 years and
pregnant mothers.
6.6.3 Development Compensation Fund (FONCODES)
The Development Compensation Fund (FONCODES) is a decentralized
autonomous organism dependant of the Woman's and Human Development Ministry. The
different work areas and projects that FONCODES supports, are those linked to the
construction and equipment of health centers and the health campaigns specially those
directed to the elderly adult population. These programs must be executed by base
organizations, rural or native communities, religious organisms seated in popular areas, non
government organisms (ONG), municipalities and public organisms. FONCODES, the
same as the PRONAA, carry out its activities generally by channel resources coming from
international cooperation organisms.
6.6.4 Health Centers or municipal clinics
Other establishments that offer services of public health nature are the Health
Centers or Municipal Clinics. However, due the limited resources of this Centers and
Clinics; in most of the cases they only services offered are of ambulatory consultation and
of smaller surgery. They don't have implemented departments or programs for the attention
for the elderly adult population, except for sporadic campaigns for some special
circumstance.
6.7 CIVIL SOCIETY AND INTERNATIONAL COOPERATION
The civil society in our country has been working in regard of the elderly adult
population.
6.7.1 NON GOVERNMENT ORGANIZATIONS - ONG
Unofficially it is known that for the year 2001 in Peru existed more than 3,000 non
government organizations (NGO), without ends of economical profits, inscribed in the
juridical people register. However, the Technical Secretary of International Cooperation,
SECTI (now APCI) has registered officially only 2,000 NGOs.
In the VI National Conference on Social Development (CONADES) was
incorporated the aging dimension in the formulation of the civic strategies for the
democracy, decentralization and development. Also it was developed the First National
Forum on Aging.
For the year 2001, the 5 non government organizations considered as the most
important operators of the social attendance and of development at national level programs,
programmed a social programs investment of 166'470,592 New Soles (US $48 millions 392
thousand American dollars). The available information of these organizations doesn't
specify differentiation for age group programs, but it is known that they prioritize the
attention to children, women and families in risk situation.
The NGOs universe that works with and in favor of the elderly adults is not very
wide yet. These institutions began their work, supporting people of lower resources
initially; but with the pass of the time this NGOs had specialized in elderly adults.
Among the main NGOs that work with elderly adults, there are those associated to
the Peru Consortium and the NGOs work table of elderly adults integrated by IPEMIN,
Center Social Process, ACECO and Auquis of Ollantay, in which other institutions like the
Vigencia Group are attributed.
The Aging Rural Net is integrated by CEPROM Huancayo, KAUSAY
Huancavelica, CICCA AYLLU, National University of San Cristóbal of Huamanga and
Agrarian National University of the Molina.
Institutions like PROVIDA PERU, the Consultant Labor Center of Peru - CEDAL
are specialized in labor topics and of gender, urban and rural Services for women of low
incomes - SURUMBI of Trujillo and organizations like the Young Christian Association
(elderly Adult Programs), the Cantares Voluntary Association, Caritas of Peru (Lima’s
elderly adult Program of Attention) and Christ's Home are developing an important work in
particular in association to the churches, specially the Catholic Church.
Finally, other NGOs that work with elderly adults are APROUTED, APROMUC,
CCCUNSCH, CEDINCO, Forging Identity, the Institute San Bartolomé, the Integral
Health Table, SISAY and Voluntary Vicentinas.
The fundamental achievements are:
- The development of certain specialization areas, as the jubilation, rights, ecology,
environment and health programs.
- The influence in the emergence and development of elderly adult’s organizations.
- The recognition of this age group in the local organizations, as well as a higher
sensitization toward the problem on the part of the members of the community.
- The influence in the formation of elderly adults' nets at regional and district level, in Lima
as in counties.
6.7.2 International cooperation
The international cooperation agencies are grouped in the International Cooperation
Foreign Entities Coordinator - COEECI, constituted as civil association that acts as
organized speaker of the foreign international cooperation entities before the Peruvian
government.
Of 74 affiliated institutions to the COEECI, only 8 include among their objective
population the elderly adult:
1. Cooperations and Sviluppo - CESVI Italy
2. Pharmacists without Frontiers - Spain
3. Health Unlimited - England
4. International Center for the Biological Control of Pest and Pathogens - it USES
5. Physicians of the World - France
6. Counselling Service Project - Denmark
7. Summer Institute of Linguistics - it USES
8. Terra Nuova, Voluntary Center - Italy
It is necessary also, to mention Help Age International that is a global net of
organizations without ends of economical profits with presence in more than 70 countries.
Their mission is to work with and for the elderly adults in disadvantage in the entire world
so that they can achieve a lasting improvement in their life quality. In Latin America this
organization works actively in Argentina, Chile, Bolivia, Peru, Colombia, Ecuador,
Dominican Republic and Costa Rica. From the work of this net the elderly adult
organizations and the NGOs that work in her, have been able to take important steps in the
improvement of the life quality of this population sector.