This book presents findings of systematic research into the contested meanings of development and wellbeing from a country, Peru, which has recently experienced both rapid economic growth and deep social conflict.

The health sector development in Peru, experienced a quick recovery after collapsing in the late 1980s and early 1990s, as a result of hyperinflation and terrorism. A marked improvement in child malnutrition and infant mortality has also been experienced recently. But in spite of input and outcome improvements, policy makers are facing challenges, such as: a) reducing the health status gap between the poor and that of the non-poor; b) increasing resources for the provision of health care to the poor; and, c) increasing the efficiency in the use of these resources. The report reviews the health sector financing and delivery systems, the progress made thus far in health outcomes, and health reforms, both in financing of services and the provision of health. It further recommends best practices for strengthening management, planning, and information systems within the Ministry of Health. Conclusions and recommendations emerge from this report, conveying that much can be gained by sustaining and deepening those reforms directed at health improvements for the poor.

This book examines an important aspect of health care in Peru in considerable depth, based on intensive analysis of data from Peruvian sources. It offers a number of recommendations that can help bring the allocation of health sector resources into line with the country's health care policy. .

Using the accountability framework developed by the World Development Report 2004: Making Services Work for Poor People, this book analyzes the low-level equilibrium and the numerous reforms attempted in recent decades in Peru, and, based on this analysis, proposes interventions that would facilitate the creation of a new social contract for Peru.

"The Peruvian health sector has recovered rapidly after collapsing in the late 1980s and early 1990s as a result of hyperinflation and terrorism. Total public and private spending on health rose by over 50% in real terms in the three years after 1994. The supply of health services increased sharply,... Health outcomes have also improved rapidly in recent years..."Several reforms were attempted during the health sector's recuperative years. Some were successful, others failed. To increase the chances for success in the future, policymakers in Peru must face three key challenges: • continue to reduce the large gap between the health status of the poor and that of the nonpoor; • increase the resources assigned to provide care for the poor; • increase the efficiency in the use of these resources. This report is meant to help the Government continue to develop its agenda to improve health care for the poor. Its focus is on poverty, and particularly on ways to improve the Ministry of Health's primary health subprogram, rather than on sector-wide reforms, to increase efficiency. The report emphasizes that there is much to be gained by sustaining and deepening the reforms directed toward improving health care for the poor while using the shift in focus and responding to the key challenges. The executive summary and introduction are provided in both English and Spanish.

Peru is an upper middle-income country that has experienced fast economic growth (average of 6.9 percent per year from 2004 to 2013, according World Developing Indicators, WDI) combined with a reduction in poverty and inequality over the past decade. Economic growth was led by exports and domestic demand, generating an increase in private investment, attracting foreign capital, and strengthening public finances. The population living in poverty and extreme poverty fell from 58.7 percent and 16.4 percent in 2004 to 25.8 percent and 6 percent in 2012, respectively (INEI 2014a). Inequality has also decreased, with the Gini index declining from 0.503 in 2004 to 0.48.1 in 2010 (WDI).