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Peru: A Country Overview 109

programs. The reason for this slowing of progress in rates of detection is that some
national programs that were making rapid strides during the last five years have
been unable to continue at the same pace in 2006 (WHO, 2008a).
The Global Tuberculosis Control report highlights two aspects of the epidemic
that could further slow progress on TB. The first is the increase in multi-drug-
resistant tuberculosis (MDR-TB), reported by WHO in March 2008 to have reached
the highest levels ever recorded. To date, however, the response to this epidemic has
been inadequate. Given limited laboratory and treatment capacity, countries were
projecting they will provide treatment only to an estimated 10% of people with
MDR-TB worldwide in 2008 (WHO, 2008b). The second threat is the lethal combi-
nation of TB and HIV, with slow progress toward testing TB patients for HIV. In
2006, although 700,000 were tested, the target goal was 1.6 million (WHO, 2008a).
The main constraints to achieving the global targets appear to be lack of polit-
ical commitment, poor health systems, an irregular supply of anti-TB drugs, and
weak communication components in TB control programs (Llanos-Zavalaga,
Poppe, Tawfik, & Church-Balin, 2004). The WHO report also documents a short-
age in funding. Despite an increase in resources, especially from The Global Fund
and some middle-income countries, TB budgets are projected to remain flat in
2008 in almost all of the countries most heavily burdened by the disease. Ninety
countries in which 91% of the world’s TB cases occur provided complete financial
data for the report. To meet the 2008 targets of the Global Plan to Stop TB, the
funding shortfall for these 90 countries is about US$1 billion.
Peru is internationally recognized for its success in reducing the incidence of
tuberculosis by an estimated 7% per year between 1990 and 2000, from about 190
per 100,000 to 140 per 100,000 (The Global Fund, 2003). Its story, which follows,
illustrates the role social marketing efforts played in this success and should inspire
those working to achieve the 2015 Millennium Development Goal #6 to reduce TB
prevalence and death rates by 50% relative to 1990 (WHO, 2007).
A vast majority of the information for this highlighted case was provided by
Fernandez Llanos-Zavalaga, Patricia Poppe, Youssef Tawfik, and Cathleen Church-
Balin in a report they wrote in September 2004 for Communications Insights: “The
Role of Communication in Peru’s Fight Against Tuberculosis.” Communication
Insights is published by the Health Communication Partnership based at Johns
Hopkins Bloomberg School of Public Health/Center for Communications Programs.

PE R U: A C O U NTRY OVE RVI EW

With a population of 27.9 million, Peru is the 41st most populated country in the
world (Census, 2007) and 4th most populated in South America. Almost the size of