The Government has promulgated, at the end of May, two regulations that have a direct impact on health. The first is Supreme Decree 013-2023-SA that declares a health emergency in 12 regions and the Constitutional Province of Callao due to the high risk of an outbreak of poliomyelitis and measles, with a budget of S/ 27.7 million. The second is Legislative Decree 1566 that authorizes the financing of volunteer initiatives through “executing nuclei” in vulnerable populations in humanitarian crisis areas, with a budget of S/ 349,000.
The norm that declares a health emergency due to a high risk of polio and measles outbreaks is a response to actions that were not carried out or health negligence and that now represent a serious danger to the health of populations, especially the most vulnerable. . The norm that finances the nuclei executing volunteering represents a form of its own kind and creative direct social intervention with the participation of local leaders.
Since March 22, 2023, when the Epidemiological Alert AE 006-2023 presented a case of vaccine-derived poliovirus in the macro-eastern zone of the country, in a one-year-old infant, and in which it also remarked that the coverage of the anti-polio vaccine has been low in the last four years, (2019 of 87.3%; 2020 of 71.6%; 2021 of 78.8% and 2022 of 81.4%) with figures far from 95%, that at least, the Ministry of Health (Minsa), should have reached. Funds have recently been transferred and an action plan approved by Supreme Decree 013-2023-SA has been carried out. More than two months to undertake the remediation of a detected failure is a long time. Something similar occurs with the measles, mumps and rubella (SPR) vaccine and the childhood vaccination scheme, which in 2022, according to the INEI, only 55.9% of children under 36 months received their vaccines according to their age. It is true that coverage has improved due to the campaign that was carried out during vaccination week, starting on April 22, 2022, called “Get up to date, each vaccine counts”, however, it has still been insufficient.
The goal that the Minsa has proposed, according to the Action Plan approved by Supreme Decree 013-2023-SA is to “vaccinate at least 1,373,999 children from 2 months to 5 years of age with an additional dose of inactivated polio vaccine. (IPV) and 1,133,485 children from 12 months to 5 years with a dose of vaccine against measles, mumps and rubella (SPR)”. The methodology that will be used is the “sweep” that implies, “a massive vaccination activity to develop a sanitary barrier in a certain territory.”
Likewise, a rapid monitoring of those vaccinated will be carried out, 300 biological samples will be processed for measles and rubella, as well as 250 biological samples for the diagnosis of polio virus. Differential diagnosis will also be carried out, with 100 biological samples, between poliovirus and Guillain Barré reported, in addition to 100 biological samples for “the differential diagnosis of measles in samples of discarded cases of dengue with rash.” Finally, “a sampling of water for human consumption will be carried out in 100% of the localities that present confirmed cases of poliomyelitis and their referral to an international laboratory. This activity is important due to the possibility that oral vaccine-derived polioviruses circulate.
A communication and dissemination campaign has also been programmed in each department, as well as loudspeaker sessions, distribution and publication of printed informative material, among others. This declaration of emergency, according to Legislative Decree 1156, “enables the health authority to hire personnel, to attend to the emergency that has arisen through special administrative contracting processes, as well as to provide complementary services. With this new emergency declaration, once again, simplified, abbreviated purchases continue and with little control due to the nature of the procedure.
The second norm, Legislative Decree 1566 “authorizes the financing of measures related to the implementation of volunteer initiatives aimed at vulnerable populations in humanitarian crisis areas in prioritized departments” that are implemented by “executing nuclei” constituted by volunteer organizations. To this end, the regulation authorizes the executing unit, Development Cooperation Fund, of the Ministry of Development and Social Inclusion (Midis) to finance these volunteer initiatives. This rule has introduced a new way of relating the State with voluntary organizations.
According to Law 28238 and its amendments, volunteering is the “work or activity carried out non-profit and free of charge and without contractual ties or responsibilities.” In addition, in practice, a new type of organization has been added to the classification of volunteer organizations, since the executing nuclei made up of volunteer organizations accredited by the Ministry of Women and Vulnerable Populations (MIMP) before Foncodes, they become a legal entity, which will then sign agreements with Foncodes for the transfer of resources. Therefore, they will manage resources, as established by the agreement.
This innovation in the process of direct intervention in vulnerable populations classified as humanitarian crisis areas, allows the population itself, especially those most closely linked to local problems, to participate in the solution with the transfer of public funds. In addition, the experience of the executing nuclei for local development works, through Foncodes, has had a great impact on the well-being of the population. This form of organization facilitates social control of the use of the transferred resources and that the activities carried out are the expression of the desires and needs of the people. As can be seen, this standard has broken paradigms. However, the amount that has been allocated is very small. It is likely that it is only the beginning of a new form of social intervention and that, depending on the results, the funds or resources would increase, although this does not indicate the norm. More and better relationships of trust between the State and community organizations!
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