For rural indigenous women in Peru, health care is inadequate and hard to reach

Albina Núñez Ponciano is a leader of the indigenous Ashaninka community of Capitiri in Junin, Peru. Photo: Rafael Polar/Oxfam

People in the central forest of Junin province struggle to get health care for serious diseases, and the barriers are particularly steep for indigenous Asháninka women.

In Peru’s central forest area of Junin, Albina Núñez Ponciano is worried about the health of the indigenous Asháninka people in her community, Capitiri. “Super worried” is in fact the phrase she uses, as there are no hospitals in the area, only “health outposts,” as she calls them, which she says are “not equipped.” “We don’t have enough medicine to treat patients,” she says. “Because of that, we are worried.”

She says the nearest decent hospital is in Satipo, a small city that is far enough away that people in Capitiri struggle to find the 80 soles (US$25) it takes to travel to the city and back.

Asháninka women, she says, are particularly vulnerable. “We are worried about cervical cancer, we don’t have the means to treat it,” she says. And if indigenous women make it to a hospital, she says that even patients with state-sponsored health insurance sometimes do not get good care. “The hospital does not treat us as it should,” she says. “’Asháninka, they don’t know anything,’” she says is the attitude.

Dr. Marishel Carraso Quispe is an obstetrician who works in Satipo, one of the only areas in Junin where rural women can get tested for cervical cancer, but she says lack of resources has made it difficult to get the results to patients. Photo by Rafael Polar/Oxfam

Lack of resources for health

Peru spends less than three percent of its GDP on public health care, according to Jorge Rodriguez of the Foro Salud, Peru’s largest health care advocacy network, less than the seven percent average across the region. He says the country has undergone a “systematic defunding of health care” in recent years, after a decade of economic growth led by exporting oil and minerals led to a slumping economy. Peru has one of the highest levels of income per capita in South America, but spends far less on health care than other countries with similar economies.

Critics of the health care system in Peru also say the country fails to get good value for the medications it buys for its citizens. Oxfam's new report Prescription for Poverty shows one example: In 2014 Peru was paying $10.50 per pill for the antiretroviral drug atazanavir (Reyataz), “…while the same pill cost $3.60 in Brazil and as little as 50 cents on the international market. To look at it another way, a year’s treatment was costing Peru $3,832 per patient, while the Pan American Health Organization’s Strategic Fund was obtaining generics for only $182 per patient.”

Javier Llamoza studies health care in Peru. “There’s a gap in health spending generally—less money for hospitals, which affects patients directly. Patients don’t get the resources they need.” Photo by Rafael Polar/Oxfam

Paying high prices for medication has an effect Peru’s health care budget, according to Javier Llamoza, a researcher at Health Action International Peru. “There’s a gap in health spending generally–less money for hospitals, which affects patients directly. Patients don’t get the resources they need.”

Health care challenges

Lack of resources across the health system tend to affect indigenous women in places like Junin in particular. And even when indigenous Asháninka women can get to a doctor, there are still challenges, according to Dr. Marishel Carraso Quispe, an obstetrician who works at the hospital in Satipo. Prevention of cervical cancer requires testing, she says, and lack of resources and working in remote areas make it hard to handle that efficiently. She says if they could convince a woman to be tested, “It took three or four months to get the results back, and sometimes they did not come back because the samples were lost. So, for a while that was the problem, it was hard to convince the patient, once you convinced her, she wanted her results, and the results never arrived, and we lost a little of the patient’s trust,” she says.

And if diagnosed with cancer, indigenous women in remote areas must travel to Lima to get proper treatment, Dr. Carraso says, as there is no oncologist at the hospital in Satipo. “The problem for them is one, the distance, and two, the cost,” she says.

The government of Peru is failing to provide basic health care in a cost-effective manner. Part of the problem is that major drug companies do not pay their fair share of taxes, and charge high prices for their products—it makes it difficult for poor indigenous women to access the life-saving health care they need. But you can help: act now to tell Johnson & Johnson to pay its fair share of taxes.

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