SES Site Background

Peru, with a population of approximately 28 million inhabitants, is located on the Pacific coast of South America, bordering Chile on the south, Ecuador and Colombia on the north, and Brazil and Bolivia on the west.

Although the terrain of Peru is dominated by the towering Andes mountains, most of the people live in the coastal lowlands. Nearly one third of them are crowded into the capital city, Lima, whose population has almost doubled over the past 25 years.

Lima is also where Socios En Salud does most of its work, in the three districts of Carabayllo, Comas, and Independencia, located at the northern tip of metropolitan Lima. These districts consist, as does much of the area surrounding the capital, of urban shantytowns and settlements in the desert hills. The population of these districts is estimated at over 700,000 inhabitants, many of whom have emigrated from Peru’s countryside, fleeing from poverty and political violence.

Carabayllo, where SES began and has its headquarters, is home to more than 120,000 people, including some of the region's poorest and most uprooted urban populations. Immigrants arrive daily in search of jobs and education – anything to earn a living. They settle in the dry, dusty hills, building unheated shacks in a swelling community served by only two roads and almost completely lacking in basic public utilities, such as water, electricity and sewage.

Peru has long had a heavy burden of TB, and also a long history of TB-control efforts. Only in the last decade, however, have the efforts been successful. In the 1960s, Peru was estimated to have one of the highest case rates in Latin America at 400 active cases for every 100,000 people. National legislation enacted to fight the epidemic made little progress. In 1980, only less than half of patients receiving treatment were successfully cured, largely as a result of failure to complete therapy, which also fosters the emergence of drug-resistant strains of TB.

Since 1990, when Peru instituted a national program based on the DOTS (Directly Observed Therapy, Short-term) approach prescribed by the World Health Organization, the effectiveness of TB control improved markedly. By 1995, with 92 percent of hospitals and 60 percent of health centers providing DOTS, Peru had earned recognition as an international success story. Even more impressive were cure rates that recently topped 90 percent, placing Peru among the best performing programs in the world.

But the problems that had plagued the program in the past – especially failure to complete therapy and low cure rates – had left a deadly legacy: endemic resistance to several antituberculosis drugs, also known as multidrug-resistant tuberculosis (MDR-TB). Patients with MDR-TB often cannot be treated successfully with short-course chemotherapy.