Peer-graded Assignment: Responding to a Humanitarian Public Health Crisis

Prompt 1: Provide a link to at least one news story or article about the country and the crisis
you have selected.

The COVID-19 Pandemic in Peru: What Went Wrong?

https://www.ajtmh.org/view/journals/tpmd/104/4/article-p1176.xml

Improving Maternal and Child Health and Nutrition in Peru

https://www.worldbank.org/en/results/2017/04/07/improving-maternal-child-health-nutrition-
peru

Country case-study: sexual and reproductive rights in Peru

https://privacyinternational.org/long-read/3791/country-case-study-sexual-and-reproductive-
rights-peru

Prompt 2: Identify three course modules from which you will be using in your response.
Here’s a list of modules for reference:

Disease Outbreak Management:

- The first confirmed COVID-19 case was reported on March 6, 2020, and a week later, a
strict lockdown was imposed by the government. Although Peru was the first country in
Latin America to implement such a severe measure, further spread throughout the
country was inevitable. A rapid increase of reported deaths reached a temporary
plateau by June; however, a slow, albeit progressive ease of restrictions has been
associated with a rise in mortality in the midst of a second wave, reaching a milestone of
more than 1,200 deaths per one million inhabitants. What went wrong?
- One of the most important things that happened was that the healthcare system had
been working at its limit for decades and was not prepared to handle any additional
burden. Peru has one of the lowest investment rates in healthcare compared with other
countries in the region. As a result, only some hospitals and primary care facilities were
built to compensate for the population growth. Peru also has a low number of intensive
care unit beds (5/100,000 inhabitants) compared with Colombia (7/100,000) and
Argentina (26/100,000), of which 80% of these beds are clustered in Lima. Moreover,
the healthcare system is fragmented into a public system that covers approximately
60% of the population, whereas the rest are cared with the social security (health
insurance for workers), the armed forces, and the private sector, with all of them
operating independently. Lack of oxygen, hospitalization, and ICU beds continue to be
shortcomings; more importantly, there is a scarcity of trained health professionals to
work in ICUs.

Maternal and Newborn Health:

- Peru had advanced on some health-related Millennium Development Goals outcome
indicators, but improvements were not uniform and revealed persistent inequalities
 across socioeconomic groups and regions and between rural and urban settings. In
2006, the infant mortality rate varied from 5 per 1,000 live births in the richest quintile
to 45 per 1,000 live births in the poorest. Furthermore, perinatal mortality, linked to
maternal malnutrition and anemia, affected more than a quarter of pregnant women.
The maternal mortality ratio (164 deaths per 100,000 live births) was double the Latin
American average, and pregnant women in rural areas were less than half as likely to
have an institutional delivery than were their urban counterparts (44 percent and 92
percent, respectively). Statistics for children were no more positive: one-quarter of
children under the age of five suffered from chronic malnutrition, and 69 percent of
children under the age of two were diagnosed with anemia. Stunting occurred in 40
percent of children in Huancavelica, Huánuco, and Ayacucho. Financial obstacles still
represented one of the most significant barriers to equal access (34 percent for
individuals in the poorest quintile as compared to 6 percent in the richest).

Sexual and Reproductive Health:

- There is no universal right to abortion in Peru, and women seeking abortion outside the
legally established exceptions are liable to prosecution
- Anti-abortion organizations and their representatives are embedded in political parties
and legislative bodies
- Some anti-abortion online platforms are designed to collect user data, but fail to provide
a privacy policy

Prompt 3: Describe your plan for assessing the crisis. Be sure to apply the principles from at
least 2 of the 3 modules you’ve identified in Prompt 2.

Disease Outbreak Management:

- Increase the budget for the healthcare system
- Provide universal free vaccination
- Campaigns to promote vaccination among the whole population to achieve herd
immunity

Maternal and Newborn Health:

- Supporting the governance functions of the Ministry of Health in regulation, quality,
efficiency, and equity for an improved, decentralized healthcare delivery model for
promoting maternal and child health.
- Increase in the proportion of institutional deliveries in rural areas
- Increase in the share of children exclusively breastfed until six months of age

Sexual and Reproductive Health:

- Offer age-appropriate comprehensive sex education.
- Use mass media
- Provide adolescent-friendly contraceptive services.
- Expand access to and promotion of the use of condoms and other contraceptives.
- Implement programs for out-of-school and married adolescents.
Prompt 4: Describe your planned intervention. Be sure to apply the principles from at least 2
of the 3 modules you’ve identified in Prompt 2.

Disease Outbreak Management:

- Increase the budget for the healthcare system, and make sure the money reaches its
intended destination
- Provide universal free vaccination for everyone in the country
- Make campaigns to promote vaccination among the whole population to achieve herd
immunity, in order to reduce the risk of infection and the risk of serious disease

Maternal and Newborn Health:

- Improving family healthcare practices for women (during pregnancy, delivery, and
breast-feeding) and for children under the age of three.
- Strengthening the capacity of health services networks to solve obstetric, neonatal, and
infant emergencies and to provide comprehensive healthcare services to women and
children under the age of three.
- Supporting the governance functions of the Ministry of Health in regulation, quality,
efficiency, and equity for an improved, decentralized healthcare delivery model for
promoting maternal and child health.

Sexual and Reproductive Health:

- Offer age-appropriate comprehensive sex education. Ensuring that young people have
the appropriate information to plan to protect themselves—before their first sexual
experience—is vitally important.
- Use mass media. Multiple mass media approaches have been used to inform
adolescents about sexual and reproductive health issues, particularly AIDS and HIV.
Evaluated media approaches include entertainment-education, social marketing, and
media channels (television, radio, magazines, and the Internet)
- Provide adolescent-friendly contraceptive services. The importance of providing
adolescents and youth with services that are tailored to their special needs has long
been recognized. Rather than standalone youth-friendly services or separate spaces
within services for adolescents, current programming is focusing on mainstreaming
adolescent-friendly contraceptive services with existing family planning services. Four
components of adolescent-friendly contraceptive services are important to reducing the
common barriers adolescents face in accessing services
- Expand access to and promotion of the use of condoms and other contraceptives.
Ensuring access to and regular use of condoms and other contraceptives is an essential
element in programs to protect youth from unintended pregnancies and STIs. The use of
condoms to guard against STIs can provide the added benefit of safeguarding fertility.
Promoting condoms for pregnancy prevention, as well as for prevention of HIV and
other STIs, could increase condom use for safe sex among young people
- Implement programs for out-of-school and married adolescents.
Prompt 5: Describe your plan for evaluating the effectiveness of your intervention. Be sure to
apply the principles from at least 2 of the 3 modules you’ve identified in Prompt 2.

Disease Outbreak Management:

- Using epidemiological measures of risk, such as incidence and prevalence of covid
infection, mortality rate, hospitalization rates, how many infected people require care in
an intensive care unit
- Measure how many people have been vaccinated and the doses they have
- Measure the relationship between vaccination and disease

Maternal and Newborn Health:

- Key demographic indicators such as under-five mortality rate, Newborn mortality rate,
Annual reduction in newborn mortality rate, Stillbirth rate, Early initiation of
breastfeeding, Preterm birth rate, maternal mortality

Sexual and Reproductive Health:

- Total fertility rate, Contraceptive prevalence, Maternal mortality ratio, Proportion of
women attended, at least once during pregnancy, by skilled health personnel for
reasons related to pregnancy, Proportion of births attended by skilled health personnel,
Number of facilities with functioning basic essential obstetric care per 500 000
population, Number of facilities with functioning comprehensive essential obstetric care
per 500 000 population, Perinatal mortality rate, Proportion of live births of low birth
weight, Positive syphilis serology prevalence in pregnant women attending for antenatal
care, Percentage of women of reproductive age screened for haemoglobin levels who
are anaemic, Percentage of obstetric and gynaecological admissions owing to abortion,
Reported prevalence of women with female genital mutilation, Percentage of women of
reproductive age at risk of pregnancy who report trying for a pregnancy for two years or
more, Reported incidence of urethritis in men, HIV prevalence in pregnant women,
Knowledge of HIV related prevention practices