By Anibal VelásquezPeru’s first National Health Plan was conducted for the 1966 - 1970 period. It was prepared by the National Planning Institute, through a sectorial office. The plan was carried out using a regulatory methodology, and it was not coordinated with the Ministry of Health, and therefore, it was not put into practice.
During the 1973 - 1974 period, there was a migration to bi-annual planning; however, bi-annual plans did not work very well. Action Plan 2000 was prepared in 1983, with definitions of policy guidelines to achieve the goals set forth for the Salud para Todos [Health for Everyone] initiative (OPS/OMS, 1982)[1]. In 1985, with a new government, there were new basic guidelines prepared for the national health policy. In 1993, there was a specific proposal as to the need to pay attention to local planning by development zones, to a large extent, due to the disappointment of the results of the planning performed at the national level. But this did not succeed either, as government remained centralized.
In the year 2001, the national planning process was re-started to make up for the lack of planning. This is how the national health policy guidelines for the 2002-2012 period were prepared. This effort sought to set the basis for the definition of the national plan, but it could not be continued.
In any case, the characteristics of the efforts made for sectorial planning haven been known for the high level of irregularity in their production, intensive temporary and political non-continuity, as the plans were basically a formal requirement and they did not provide a direction to action, planning efforts ended up becoming policy guidelines and strategies, but they were not real plans with explicit priorities or goals, and the planning efforts have been sub-sectorial (Ministry of Health) and centralized without public participation of any type.
Starting in 2004, this form of planning has changed, due to a political decision to decentralize government’s branches and to make wealth distribution more equitable. Regional plans have characterized themselves for being more participative, and in most cases they have explicit priorities, and some plans have allowed citizens to decide on health priorities and for civil society to validate strategies and goals. In addition to being participative, many of these regional plans are territorial, not only for health services, in such way that the chosen priorities refer not only to damages and problems in the health services, but also to problems in certain determining aspects of health, such as water, sanitation, citizens security and environmental pollution, which are the competence of other sectors and municipalities.
After the regional experience, during the early months of 2007, the Ministry of Health developed the Concerted National Health Plan (PNCS). The initial design took into account that citizens would bet involved in the definition process, particularly in decision making with regard to sanitary priorities and priority changes in the health system, based on an already defined technical proposal. This dimension, however, only went half way. The participation of organized and non-organized citizens centered around the regional PNCS consultation meetings or assemblies, where an election took place of the representatives who would attend a National Assembly where the right to determine the plan’s priorities would be exercised (over 1000 representatives were expected). The participation of organized and non-organized citizens centered around the regional PNCS consultation meetings or assemblies, where an election took place of the representatives who would attend a National Assembly. The Ministry of Health sought political backing at the highest level of the National Executive branch for the holding of the Assembly, and tin the end, the Assembly was cancelled (PRAES, 2007)[2].
Thus, this plan, reviewed in the regions and approved by civil society’s representatives at the National Health Council was published in Ministerial Resolution on July 21, 2007, becoming a plan without explicit priorities to guide the health sector’s actions between 2007 and 2011. It is expected that its implementation will require new participative processes to resolve with the other sectors, local governments and civil society where to start and to define who does what. For this reason, it will be necessary to better document the advantages and effects of public participation in planning, especially in the definition of priorities.
[1] OPS/OMS. Salud para Todos en el año 2000. Plan de Acción para la instrumentación de las Estrategia Regionales. Washington: OPS/OMS, 1982 (D.O. 179).
[2] PRAES, José Calderón Yberico, Viceministro de Salud. Entrevista sobre el Plan Nacional Concertado de Salud. Lima: Boletín PRAES. Abril-Junio 2007, p: 16-19. Available in: http://www.praes.org/sistema/docs_boletin/BoletinPRAESJunio2007.pdf, access September 3, 2007
Source: Velásquez A, Granados A. Plan Nacional Concertado de Salud. Perspectiva de un proceso. Lima: Boletín PRAES. Abril-Junio 2007, p: 3-15. Available in: http://www.praes.org/sistema/docs_boletin/BoletinPRAESJunio2007.pdf, access September 3, 2007
