Page 0131

Control Plan for Peru was implemented in 2011 for ten

regions based upon demographic, epidemiologic and

"readiness" criteria (3), through the assignment of 28 million

nuevo soles to INEN (13). The initial focus was on cancers of

the cervix, breast, lung, stomach and prostate. The budget

was increased to 75 million nuevo soles for 2012, with the

programme becoming the pilot for Plan Esperanza (28).

In this regard between 2011 and 2012, with the technical

support from INEN across the 25 regions, over 7,000

establishments in the country have the opportunity to

budget and allocate resources for cancer prevention and

health promotion, as well as for early detection of the five

most common cancers: stomach, breast, cervix, prostate and

lung, with outstanding implementation and execution (28).

Based upon performance, Supreme Decree No. 009-2012

declared comprehensive cancer care and improved access to

cancer services in Peru to be in the national interest and

approved the National Plan for Comprehensive Cancer Care

and Improving Access to Cancer Services in Peru, called the

"Plan Esperanza". The Ministry of Health (MINSA) and INEN

shared the designated authority for the plan for the entire

population of Peru. Comprehensive Health Insurance covers

comprehensive cancer care, palliative care and

complementary support for 12 million poor and vulnerable

Peruvians and for the decentralization of cancer control

services to reduce gaps in geographic and economic access

in the most remote regions (6, 16).

Plan Esperanza is a national plan for the prevention and

control of cancer that considers the social health

determinants of health, epidemiology and risk factors,

cancer biology and molecular genetics, treatment and

sociocultural phenomena with defined processes for ease of

implementation, measurement, evaluation and control.

Reducing the time of public policy dissemination and

increasing capacity for decentralized delivery of a greater

range of services for comprehensive prevention and control

of cancer in a contextually-appropriate manner are core

elements of the plan. Interventions include free access to

basic and/or specialized prevention for the whole

population; equitable access to comprehensive cancer care,

palliative care and complementary support; protecting the

poor and vulnerable with full health coverage; promoting

patient-focused quality services; technical development and

knowledge transfer through policy, research and specialized

teaching; shared and informed decision-making with

patients; responsible participation of civil society to

encourage the commitment of the whole society to promote

health and wellbeing; an effective model of comprehensive

health care with a focus on primary health care and universal

REGIONAL INITIATIVES

CANCER CONTROL 2015 133

is financed by the National Government through the

Ministry of Health (MINSA), public executing agencies,

regional and local governments. The remaining 20% is

provided by Social Health Insurance (ESSALUD), which

serves to fund public employees of the Ministry of Work (37).

Universal Health Insurance commenced in 1997, initially

through a subsidized programme called Free School

Insurance (SEG), which covered schoolchildren enrolled in

public schools nationwide (38). A further subsidized

programme covering pregnant women and children under

five years old (Maternal and Child Insurance) commenced

between 1998-2000. Both programmes were merged in

2002 to establish the Comprehensive Health Insurance

programme (SIS), with the creation of a decentralized public

executing agency with an independent administration and

financing to protect the health of Peruvians without health

insurance, prioritizing those vulnerable because of poverty

(38). Also, in 2002, law 27656 established the Intangible

Health Solidarity Fund (FISSAL) as a legal entity under

private law, attached to the Ministry of Health to promote

access to quality health services to marginalized populations

through the complete financing activities of SIS (39).

Between 2000 and 2011 the number of new cancer

patients increased from 7,746 to 10,497. With the

decentralization of cancer services and migration of more

affluent patients from INEN to private oncology services, a

greater proportion of patients referred to INEN were of

lower incomes. Accordingly, in 2009, the Law Assurance in

Health Act (law 29344) established that all residents in the

country must be affiliated with one of the three existing

insurance regimens: subsidized, semi-contributory and

contributory (40). Further, in 2009, the Plan of Universal

Health Insurance was approved giving financing conditions

for the treatment of cervical, breast, colon, stomach and

prostate cancers, with limited access coverage, but allowing

joint action towards universal cancer coverage between SIS

and INEN. The Law 325-2012/MINSA (April 2012),

determined that the list of high-cost diseases would be

financed by FISSAL (20).

Thus for the provision of cancer treatment since 2012,

Comprehensive Health Insurance has provided coverage

through the Intangible Health Solidarity Fund (FISSAL) to

finance services associated with the seven types cancer that

represent the greatest burden of disease and the treatment

of high-cost diseases, with a model of intangible and

specialized public funding.

Cancer in Peru: INEN and Plan Esperanza

The strategy and budget for the Cancer Prevention and

Index

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