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Governments globally deployed various non-pharmacological public health measures to respond to the COVID-19 pandemic (i.e. lockdowns and suspension of transportation, amongst others); some of these measures had an influence on society's mental health. Specific mental health policies were therefore implemented to mitigate the potential mental health impact of the pandemic. We aimed to explore the implementation of mental health regulations adopted by the Peruvian health system by focusing on the care services at Community Mental Health Centres (CMHCs), based on the experiences of health workers. We conducted a phenomenological qualitative study to understand the implementation of mental health policies launched in Peru during the COVID-19 pandemic. Data were obtained from a document review of 15 national policy measures implemented during the pandemic (March 2020 to September 2021), and 20 interviews with health workers from CMHCs (September 2021 to February 2022). The analysis was conducted using thematic content analysis. Most implemented policies adapted CMHC care services to a virtual modality during the COVID-19 pandemic; however, various challenges and barriers were evidenced in the process, which prevented effective adaptation of services. Workers perceived that ineffective telemedicine use was attributed to a gap in access to technology at the CMHCs and also by users, ranging from limited access to technological devices to a lack of technological skills. Further, although mental health promotion and prevention policies targeting the community were proposed, CMHC staff reported temporary interruption of these services during the first wave. The disparity between what is stated in the regulations and the experiences of health workers is evident. Policies that focus on mental health need to provide practical and flexible methods taking into consideration both the needs of CMHCs and socio-cultural characteristics that may affect their implementation. [ABSTRACT FROM AUTHOR]

The spread of COVID-19 in Peru resulted in the declaration of a national health emergency, in which Indigenous peoples were identified as being particularly vulnerable due to their pre-existing poor health indicators and disadvantaged social conditions. The aim of this paper is to examine how the Peruvian government responded to the health and food needs of the Shawi and Ashaninka Indigenous peoples of Peru during the first 18 months of the pandemic (March 2020–August 2021). This study uses both official policy documents and real-world experiences to evaluate policy responses in terms of their immediate impact and their longer-term sustainability and contribution to the improvement of health, well-being and justice for Indigenous communities. Four health and food security responses were evaluated: the Amazon Health Plan and Indigenous Command; food aid; cash aid; and COVID-19 vaccination. We employed the Multidimensional Injustice Framework to analyse the justice implications of the design and implementation of responses. Data collection included 71 interviews with government officials (n  = 7), Indigenous leaders (n  = 31) and community members (n  = 33). The results show how national and regional governments released policies to address the health and food needs of Indigenous peoples directly or indirectly, as part of a broader focus on vulnerable people. However, justice implications were not sufficiently addressed in the design or implementation of the responses. On the distributive dimension, Indigenous communities were prioritized to receive health goods and services, nevertheless, the distribution had shortcomings that impeded their collection and Indigenous food systems and livelihoods were largely overlooked. On the procedural dimension, Indigenous representatives were included to provide culturally sensitive feedback on health interventions, but without funding, and furthermore, the community members had only passive participation. This paper points out the importance of considering and addressing justice implications for more effective and fairer health and food policy responses to current and future health crises. [ABSTRACT FROM AUTHOR]

This paper discusses the dialectic tension between the top-down and bottom-up processes that led to the establishment of the first public deaf education programme in Iquitos, Peru in 2016. This dialectic was initiated by the Peruvian Ministry's adoption and implementation of the policy of inclusive education, an internationally supported education initiative to educate all students, including those with special educational needs, in general education classrooms. The implementation of inclusive education in Iquitos led to an entire generation of deaf youth attending school without gaining opportunities to acquire the linguistic resources of Lengua de Señas Peruana (LSP). Parents of deaf children, dissatisfied with the inclusive education system, formed together to create a parents' association, Asociación Iquitos Unidos en Señas (AIUS). Two years later, AIUS signed an agreement with an existing school to establish a sign-based public deaf education programme, CEBA MORB - Periférico AIUS. We discuss what it took to bring Perféirco AIUS into being from the bottom-up and the top-down processes that both sparked the community effort and then facilitated it. [ABSTRACT FROM AUTHOR]

Migrant access to sexual and reproductive health (SRH) services has been highlighted as an urgent priority for the 800,000+ Venezuelans who have arrived in Peru in recent years due to political and economic crisis. Venezuelan migrants in Peru, however, negotiate their access to SRH services in what anthropologists term a 'geography of blame', and are accused and stigmatised for having imported sexually transmitted infections to the local population. Alongside this blame, female migrants are highly sexualised and face stigma, resulting in real and perceived threats to their safety, wellbeing, and integration. By juxtaposing ethnographic research and 50 interviews conducted with female migrants living in Lima, their Limeño neighbours, and with local NGOs, the paper argues how stigma is itself a neglected public health issue. Addressing SRH needs for Venezuelan migrants is not only a question of rolling out health campaigns or providing pills, but that underlying social issues such as sexualisation and stigma need to also be recognised and incorporated into policy. [ABSTRACT FROM AUTHOR]

Objectives: To describe the HIV treatment cascade and care continuum in regions of highest HIV prevalence in Peru. Methods: An observational longitudinal study was carried out in 14 tertiary hospitals in Peru. These are the main hospitals that administer antiretroviral treatment (ART) in the regions that represent approximately 95% of reports of HIV/AIDS cases in Peru in 2013. We included individuals older than 18 years newly diagnosed with HIV from 1 January 2011 to 31 December 2012. Medical records were reviewed until 2015. Results: A total of 2119 people living with HIV (PLHIV) were identified in the selected health facilities (mean age = 35.26 years, 78% male). 97.25% [1845/1897; 95% confidence interval (CI): 96.4–97.9%] of the patients attended the consultation at least once during the follow‐up, but only 64.84% (885/1365; 95% CI: 62.2–67.4%) attended within a month after the diagnosis. After starting ART, 74.63% (95% CI: 71.9–77.2%) of PLHIV remained in healthcare. Regardless of the time after diagnosis, 88.40% (1837/2078; 95% CI: 86.9–89.7%) of PLHIV started ART during the observation time. However, 78.68% (95% CI: 76.8–80.4%) did so during the first post‐treatment year and only 28.88% (95% CI: 27.9–31.9%) after 1 month. After starting treatment, it was observed that 51.60% (95% CI: 49.2–54%) of PLHIV reached viral suppression during the follow‐up period. Conclusions: Further analysis and improvements in the definition of indicators are required to achieve conclusive results; however, these data will give us a general understanding of the progress of Peruvian health policies in achieving the goal established by the WHO. [ABSTRACT FROM AUTHOR]

Aims: To describe and compare the health system responses for type 1 diabetes in Kyrgyzstan, Mali, Peru and Tanzania. Methods: The Rapid Assessment Protocol for Insulin Access, a multi‐level assessment of the health system, was implemented in Kyrgyzstan, Mali, Peru and Tanzania using document reviews, site visits and interviews to assess the delivery of care and access to insulin. Results: Despite the existence of noncommunicable or diabetes strategies and Universal Health Coverage policies including diabetes‐related supplies, this has not necessarily translated into access to insulin or diabetes care for all. Insulin and related supplies were often unavailable and unaffordable. Across the four countries test strips and insulin, when paid for by the individual, represented respectively 48–82% and 25–36% of total costs. Care was mainly delivered at tertiary‐level hospitals by specialists. Only Kyrgyzstan had data collection systems integrated into the Ministry of Health structure. In addition, issues with healthcare worker training and education and empowerment of people with diabetes were present in these health systems. Conclusions: People with type 1 diabetes in these countries face different barriers, including the cost of insulin and care. Given the renewed attention to diabetes on the global health agenda tailored health system responses for type 1 diabetes are needed. Insulin should be prioritized as it is the foundation of type 1 diabetes care, but other elements of care and support need to be fostered by different actors. [ABSTRACT FROM AUTHOR]