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