A New Social Contract for Peru: An Agenda for Improving by Daniel Cotlear

By Daniel Cotlear

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Extra resources for A New Social Contract for Peru: An Agenda for Improving Education, Health Care, and the Social Safety Net

Example text

3 This is less than half the average for Latin America 3. These estimates are based on ENAHO 2003/2004. Among the population over 65 years of age, only 22 percent are pensioners. ESSALUD claims that the number of users of its system is twice as high as the estimate based on household surveys. 5. Stunting Rate in Peru and Latin America, 1975–2002 (Percent of children under age 5) 50 40 Peru 30 20 LAC 10 0 1975– 1979 1980– 1984 1985– 1989 1990– 1994 1995– 1999 2000– 2002 (Lindert, Skoufias, and Shapiro 2005).

Shocking the System through Partial Reforms The State Co mp a ice Vo Politicians Citizens A e oic st V i ctiv ct Policymakers Ci rcu mv en tin gt he C Corporation of Providers ora Administrators tio n orp Client Power Users Frontline Providers Users as Implementers Services implementers of services (empowerment of users); (b) reforms that establish a parallel system of frontline providers or that establish procedures to circumvent the rigidities of the existing corporations by reaching directly to the frontline providers; and (c) reforms that attempt to give citizens a stronger influence in the design and implementation of social programs (“Voice”).

For the services considered here—health, education, and social assistance— society has decided that the service will be financed not through a market transaction but through the government taking responsibility. 8 However, as the following sections will describe, a number of experiences are under way to empower users in relation to the frontline providers to create a “short route of accountability” to improve services. An example of this in the health sector consists of community leaders who have established nonprofit boards that direct the management of over 2,000 primary care clinics.

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