Peru seemed well placed to respond to the COVID-19 pandemic as a country that had achieved sustained economic growth and moved towards achieving universal health coverage. However, Peru has one of the highest rates of transmission and mortality worldwide. This article analyses what the pandemic has unveiled with regards to the health system, arguing that a focus on meeting global development targets, including by promoting public-private partnerships in health, has distracted attention from the underlying structural causes of inequalities and enabled the continuation of a highly fragmented system, with access determined by income, gender, ethnicity and geography.

Costa Rica and Colombia, two of the earliest Latin American countries to protect many LGBT rights, attempted to amplify those rights and litigate same-sex marriage (SSM) in mid-2000s; however, these attempts sparked a major anti-LGBT backlash by religious and conservative organizations. Yet a decade later, Colombia legalized SSM while Costa Rica still lacks the right to SSM. Using a most-similar systems comparative case study, this study engages the judicial politics literature to explain this divergent outcome. It details how courts, while staying receptive to many individual LGBT rights claims, deferred SSM legalization to popularly elected branches. In spite of the lack of legislative success in both countries, in Colombia a new litigation strategy harnessed that deference to craft a litigated route to legalized SSM. In Costa Rica, the courts’ lack of conditions or deadlines has left SSM foundering in the congress.

Los que trabajamos en salud indígena sabemos que es muy común que los pobladores indígenas o campesinos sean representados como culpables de sus problemas de salud, desconociendo que los pobres indicadores de salud en los lugares con mayor porcentaje de población indígena son, en gran medida, consecuencia de un Estado negligente incapaz de garantizar acceso y disponibilidad de servicios de salud de calidad a las comunidades indígenas del país. En el marco de la pandemia del COVID-19 que viene afectando intensamente a la población indígena amazónica del Perú, los pueblos indígenas están mostrando que sus prácticas culturales, ignoradas y discriminadas por el sector salud pueden contribuir en el cuidado de aquellos afectados por el COVID-19. A partir del análisis de la iniciativa del Comando Matico en la Amazonía peruana mostramos la capacidad de los pueblos indígenas para implementar iniciativas interculturales autónomas al Estado central. Este artículo muestra que en el Perú no nos faltan normativas detallando el enfoque intercultural en la atención de salud. Lo que hace falta es reconocer la importancia de pensar que los conocimientos ancestrales de los pueblos indígenas pueden ser claves para atender sus necesidades y las de otros sectores de la población.

In 2014 the World Health Organization (WHO) launched the “End TB Strategy”, setting new ambitious goals for elimination of tuberculosis (TB). In contrast with previous efforts to control TB, the new strategy adopted the protection and promotion of human rights in TB prevention and care as a core pillar. This mandated the development of national programmes that are sensitive to the characteristics of populations and responsive to structural factors that put people at increased risk of exposure to TB, limit access to good quality health services and make people more vulnerable to TB infection. Indigenous people living in the Peruvian Amazon have been identified as a TB vulnerable group by Peruvian health authorities. This article examines the barriers faced by indigenous people and rural settlers from the Peruvian Amazon in obtaining a TB diagnosis and appropriate TB treatment, through the principles of the human rights based approach of accessibility, availability, affordability, adaptability and quality, and thus provides evidence of the utility of such approach in Peru. This is a qualitative study. We combined information from policy documents and legal regulations and in-depth interviews with health workers and health authorities. We used Atlas-ti to conduct a thematic analysis and identify interviewees responses to pre-defined topics. Despite having a strong legal framework to protect the right to health of indigenous people and people affected by TB, there are underlying structural factors contributing to delays in detection, diagnosis and TB treatment, which are mostly related to having a health system poorly prepared to provide care for people living in dispersed rural communities. This article shows the limited level of integration of the “End TB Strategy” principles in the Peruvian National TB Programme and identifies the weakness of the health system to improve health care provision for indigenous people and rural settlers from the Peruvian Amazon. Our study shows the need to go beyond developing a strong legal framework to ensure vulnerable populations such as indigenous people are able to realize their right to health. Governments need to allocate funds, improve training and adapt healthcare provision to the cultural, geographical, and social context of indigenous people.