Barriers to primary care in Lima, Peru

July 11, 2017 | Press Releases & Announcements

Dr. Sean Haley

Dr. Sean Haley and Dr. Jennifer Wisdom, professors at the CUNY Graduate School of Public Health and Health Policy, and colleagues examined the role of primary care within Lima, Peru’s medical system. The findings were published in the journal World Medical and Health Policy.

Peru has taken an incremental approach to expanding its health care system. In recent years it has expanded coverage to the poor through its public system and persons working in medium to large organizations are covered through a mandatory employer contribution, leaving those working in small organizations and the self-employed least able to access medical care insurance. As Peru engages in health care expansion, this study sought to identify barriers to primary care utilization including perceptions of the role of primary care, workforce training alignment, and costs, through an analysis of medical stakeholders’ perceptions of the need for and barriers to the delivery of primary care services in Lima, Peru. 

The research team members instituted semi-structured qualitative interviews with key stakeholders in Peru to understand the factors that influence the availability and quality of primary care. The team targeted five areas for inquiry: financing, the training of primary care providers, access to services, patients’ first contact with the health-care system, and treatment coordination. Interviewees described primary health-care services as having a lack of treatment continuity, inconsistent record keeping, and often staffed by recent medical graduates with little primary care training, which can result in reduction in the use of primary care services. Despite identifying numerous barriers to quality primary care services, interviewees remained committed to principles of universal access espoused by Peruvian legislation and offered recommendations related to metrics, financing, technology and workforce development to improve both primary care access and quality.

Dr. Jennifer Wisdom

The research team concluded with recommendations to improve primary care in all five areas, including establishing national health goals, adopting accreditation standards, increasing physician salaries to improve commitment and quality, improving physician education, and adopting a countrywide electronic health record system. Peru’s health-care infrastructure remains focused on acute medical services when the country’s disease burden suggests that it needs to transition to a primary health-care system capable of managing chronic conditions.

“The epidemiological transition in Peru has forced the country to quickly re-orient from a medical care system focused on acute infectious disease to one capable of managing both infectious and chronic conditions,” explains Dr. Haley.


Haley, S. J., Ponce Terashima, J., Hoffman, K. A., Cuba Fuentes, M. S. and Wisdom, J. P. (2017), Barriers to Primary Care in Lima, Peru. World Medical & Health Policy, 9: 164–185. doi:10.1002/wmh3.227