The International Health Regulations (IHR) 2005 oblige all WHO Member States to have ‘core capacities’ to detect, report, and respond to public health emergencies, especially those posing international risks.[1] However, the COVID-19 pandemic revealed significant inequities and inadequacies in these capacities globally, including in Peru. The country grappled with a fragmented information system affecting the consolidation of emergency response data, under-resourced situation rooms, poorly equipped laboratories and medical facilities, a health workforce unprepared for major emergencies, and incomplete territorial coverage of national capacity building efforts.[2] In response, PAHO/WHO teamed up with Peru's Ministry of Health (MoH) and sub-national health authorities. They identified and, using a sustainable system’s approach, addressed critical gaps in key areas including epidemiological surveillance, laboratory capacity, local-level data-driven decision-making, and effective risk communication. The collaboration resulted in enhanced situation rooms, data platforms, and regional laboratories which rapidly strengthened IHR core capacities in 12 of the country's 25 regions, increasing the country's resilience to health emergencies. The technical cooperation provided through this project aimed to contribute to the fulfilment of the 2030 Agenda for Sustainable Development, as well as the Sustainable Health Agenda for the Americas 2018-2030. It is aligned with the immediate and intermediate outcomes proposed in PAHO's Strategic Plan 2020-2025 and the United Nations Cooperation Framework for Sustainable Development Peru 2022-2026.

How did Peru, with the support PAHO/WHO, achieve this?

Peru's response to health challenges received a significant boost through a collaboration with PAHO/WHO, backed financially by the USAID Bureau of Humanitarian Affairs (BHA) and the American Rescue Plan (ARP). This joint effort, spanning 12 regions, was in line with the key pillars of WHO’s Strategic Preparedness and Response Plan for COVID-19. It emphasized risk communication, epidemiological surveillance, laboratory capacity, and the enhancement of key healthcare services and systems. In these efforts, approximately 5.6 million USD was allocated for supplies and equipment to strengthen the pandemic response in the twelve prioritized regions.

^{Community Health Agents were trained in basic risk communication strategies and prevention of noncommunicable diseases, such as diabetes and hypertension}
Photo credit: PAHO/WHO Peru

The training component of the collaboration was meticulously aligned with WHO/PAHO standards, with PAHO/WHO providing facilitators and organizing sessions. Key personnel, including nearly 1500 health professionals, community health agents, and journalists, underwent comprehensive training in outbreak detection, rapid response, laboratory confirmation, patient care, infection prevention and control (IPC), oxygen plant management, and self-care for mental health and chronic diseases like diabetes and hypertension. The program also tackled infodemic management and misinformation countermeasures.

In terms of data management, the collaboration led to the consolidation of data systems and the establishment of modernized situation rooms in five regions. These rooms, equipped and staffed using agile project-management strategies, significantly improved decision-making capabilities at local levels, overcoming the previous challenges of fragmented data and non-functional situation rooms.

Laboratory diagnostic capacities were also notably improved and decentralized in these regions, adopting WHO-recommended methods that enabled immediate sample processing and faster result dissemination. Before, samples were sent to the capital causing delays in response. PAHO/WHO's procurement of essential laboratory equipment, such as thermal cyclers, refrigerators, centrifuges, and biosafety cabinets, and focused staff training, particularly for COVID-19 and Mpox testing, enabled these laboratories to test for a wider range of public health diseases, reducing reliance on centralized testing.

“When we started the molecular biology laboratory, we started with the basics; we even borrowed equipment from other areas. We had to adapt to be able to respond to the pandemic. With the implementation (of the project), the laboratory has improved. We now have two thermal cyclers, which have allowed us to test for other etiologies as well. In addition to COVID-19 we are testing for mpox and influenza, and are considering expanding to cover many more diseases, because we now have the capacity.” 

-Claudia Ramos, Biologist in the molecular area of DIRESA Arequipa's reference laboratory

Furthermore, robust IPC systems were established in 74 health facilities across 12 regions. This entailed acquiring computer equipment, Personal Protective Equipment (PPE), and other IPC supplies, enhancing respiratory pathogen and Healthcare Associated Infection Surveillance (HAI) analysis, and strengthening adherence to standard precautions to minimize in-facility contagion.

Additionally, 31 health facilities in seven regions received training, medical equipment, and supplies to better manage COVID-19 cases and associated noncommunicable diseases. Eight community mental health centers were also equipped with IT tools and educational materials, including WHO-recommended mhGAP intervention guides, to enhance mental health care at the primary level.

“PAHO helped us in two important ways for us. The first was the resources provided to the Community Mental Health Centre, which allowed us to provide continuity of services. The second was training of personnel, both health professionals and community health agents. And therefore, it is a lesson learned that when an emergency arises, mental health services should not be neglected or closed, but on the contrary, reinforced because there are people who are afraid and fearful, in this case because of COVID-19, of contagion and death.”

-Merly Leiva, Responsible of the Mental Health Strategy, DIRESA Ucayali

The collaboration between PAHO/WHO and Peru has not only addressed immediate needs but also established a foundation for more resilient health systems for future emergencies.[3][4] This includes developing a health service model responsive to pandemic challenges and bolstering mental health and noncommunicable disease interventions. The ongoing goal is to sustain and expand these improved capacities to the remaining 13 regions of Peru, ensuring nationwide preparedness and resilience.