OECD Reviews of Health Systems: Peru 2025

Over the past four decades, Peru has made remarkable progress in improving most population health indicators. The country has significantly increased life expectancy, reduced infant and maternal mortality rates, and expanded healthcare coverage. Life expectancy rose by approximately 13 years since 1980, reaching 72.4 years in 2022, while infant mortality declined from 83 deaths per 1 000 live births in 1980 to 11 in 2021. Maternal mortality also halved from 101.9 deaths per 100 000 live births in 2002 to 51.9 in 2023. These improvements have been largely driven by healthcare reforms, notably the introduction of the Universal Health Insurance Law in 2009. As a result, insurance coverage increased from 61% in 2009 to over 97% in 2023, with the Seguro Integral de Salud (SIS) playing a crucial role in covering poor and underserved populations.

However, Peru continues to grapple with a health system that remains both segmented and fragmented, with multiple public sub-systems serving different population groups, leading to inequality in access to care. In Puno – the Andean region with a high density of indigenous people, the proportion of people reporting unmet medical needs is almost double that of Metropolitan Lima areas (40% compared to 23%). Unmet medical needs are more often reported among women (33%) than men (29%), and women face longer waiting times for a medical consultation than men. Peru’s healthcare infrastructure also requires urgent improvements. Many public healthcare facilities are deemed inadequate, posing risks to patient safety and service delivery. Overall, the health system still lacks the integration and co‑ordination needed to ensure equitable access to high-quality care for all Peruvians. Addressing these challenges requires strengthening quality governance, investing in high-impact healthcare service improvements, and curbing inefficiencies. In this context, the Review identifies scope for Peru to build a stronger healthcare system, and to strengthen existing policies and practices to improve access, care quality, efficiency and resiliency.

The persistent fragmentation and segmentation of its health system affects its access, quality and efficiency. The system is divided into two main sub-systems: EsSalud, a contributory system covering salaried workers and their families, and SIS, a non-contributory system financed through general taxation for poor and vulnerable populations. These systems operate separate networks of providers with different governance and financing structures, leading to inefficiencies, service duplication in some areas, and gaps in access in others, particularly rural regions. To address these issues, Peru should enhance benefit exchange agreements (intercambios prestacionales), allowing SIS and EsSalud affiliates to access services across networks for a basic set of healthcare services. A more unified approach could also be achieved by harmonising the minimum benefit packages across both sub-systems, following examples from Chile, Colombia and Mexico. However, such reforms must balance expanding access with maintaining service quality to ensure public support.

Improving healthcare quality governance and establishing an interoperable health information infrastructure are also essential steps toward a more integrated health system. Peru’s healthcare data systems remain highly fragmented, preventing effective measurement of health outcomes and service quality. The development of a unified national health data system is a step in the right direction, but broader participation across all sub-systems is needed to ensure its effectiveness. Standardising and mandating the reporting of quality and outcomes indicators would facilitate better monitoring and comparison of care quality across providers. Policy makers should also enhance their utilisation of information systems and more effectively integrate data into the decision-making process. When it comes to quality governance, there is scope to further strengthen quality initiatives at system level as right now the scope and depth of initiatives depends on regional or local capacity to assume quality assurance mechanisms.

To bring improvement in health infrastructure and invest towards high-impact interventions, Peru will have to mobilise additional health resources. Although SIS funding has increased nearly fourfold in the past decade, Peru’s healthcare system remains underfunded compared to regional and international standards. In 2022, the country allocated only 6.2% of its GDP to health, less than Costa Rica (7.2%), Colombia (7.6%), and Chile (10.0%). In addition, public spending remains significantly below the OECD average, leading to high out-of-pocket expenditures (which accounted for 27% of total health spending in 2022). However, financial sustainability remains a concern in a context of tight fiscal space, and continuing to improve efficiency of health expenditure is needed. The budgeting process is highly restrictive, with funds allocated by line items, limiting flexibility in resource distribution. Transferring recurrent costs such as maintenance and labour expenses to the Ministry of Health could improve efficiency and enable better workforce planning. Beyond improving budgeting process, there is also huge potential for efficiency gains throughout the health system. Implementing risk-adjustment formulas to ensure adequate SIS funding based on population health needs, increasing accountability for public healthcare facilities, and adopting results-based budgeting for key health objectives are necessary steps. Strengthening primary healthcare is also crucial, particularly through the implementation of Integrated Health Networks and improved diagnostic capacity. Given the rising burden of non-communicable diseases such as obesity and the persistence of infectious diseases like dengue, investing in prevention and health promotion is another key step for consideration. Furthermore, optimising pharmaceutical procurement and expanding the availability of generic medicines could generate cost savings while improving treatment accessibility.

The COVID‑19 pandemic exposed Peru’s vulnerabilities in health crisis preparedness, with the country experiencing the highest excess mortality rates among Latin American and OECD countries in 2020 and 2021. While Peru has since improved its emergency response capabilities through national pandemic plans and strategic policies, effective regional implementation remains a challenge. Strengthening regional oversight and ensuring sufficient technical and organisational capacity at the local level will be critical to enhancing resilience against future health crises. But Peru should also address workforce shortages which further exacerbate Peru’s healthcare challenges. Strategies to retain healthcare workers, such as salary improvements and targeted incentive programmes, are necessary to close these gaps. Expanding nursing training and integrating community health workers into primary healthcare could also enhance service delivery and promote preventive healthcare efforts.

Peru’s near achievement of universal health coverage is a significant milestone. However, the country still faces challenges to ensure that high-quality services are accessible to all Peruvians. This means providing the right care, at the right time, responding to patient’s needs and preferences, while minimising waste of scarce resources. By implementing targeted reforms and learning from international best practices, Peru can build a more resilient and inclusive health system that meets the needs of its diverse population.