Peru - Public investment program 1966-1967 (Vol. 4 of 7) : Water supply and public health

RETURN 1TO REPORTS DESK RESTRICTED 'WITHIN ONE WEEK WH155 Vol. 4 This report wos prepared for use within the Bank and its affiliated organizations. They do not accept responsibility for its accuracy or completeness. The report may not be published nor moy it be quoted as representing their views. INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT INTERNATIONAL DEVELOPMENT ASSOCIATION AN APPRAISAL OF THE 1966-1967 PUBLIC; INVESTMENT PROGRAM OF PERU (in seven volumes) VOLUME IV WATER SUPPLY AND PUBLIC HEALTH December 28, 1965 Western Hemisphere Department  CURRENCY EQUIVALENTS 1 US $ = 26.82 Soles I Sol (S/.) = 3.7 US cents 1 million Soles = US $37, 286  TABLE OF CONTENTS Page No. Prefatory Note SUID4ARY ..........1............. 1 INTRODUCTION ..............*...... ...... 3 WATER SUPPLY AND SEWAGE ..................4h Urban Sanitary Works 7. ....... 7 Rural Community Sanitary Works ..................... 9 National Economic Development Fund ................. Needs and Construction Levels ...................... 12 HOSPITALS D*vvese@*v**@4^@*@@@15 MALARIA * . . .... o ... 17 STATISTICAL APPENDIX  PREFATORY MOTE The focal point of reference in this report is the investment program prepared in early 1905 by the National Planning Institute (INP) as a proposed basis for the Government's investment outlays for 1966. Subsequently, the Government's Budget proposals of August 1965 intro- duced changes in the INP prepared program. VJhile it has not been pos- sible to revise this report to take account of these changes and conment on them, certain cornments are made and some new information included in the main report (particularly Chapter II and supporting tables). The main aspects of the analysis and policy conclusions in the present report are still applicable in broad terms, and many of the details provide useful reference materiaL.  WkTER SUPPLY AlD PUBLIC HEALTH SUMMARY 1. Vigorous construction investment programs have been initiated toward satisfying a great need in Peru for community water supply and sewerage facilities and for medical facilities such as hospitals and health, medical and sanitary centers. Rates of planning and construc- tion are sufficient to meet the rapid rate of community growth and make substantial progress towa,^d satisfying the backlog of accumulated needs. There is evidence that the rate of progress in the future will be limited by financing available for construction and for operation of the completed works rather than by capacity, in Peru, for planning and construction. 2. Most of the projects in water supply and sewerage have been financed, in part, by international lending institutions. The lending institutions, through their review, have contributed to the technical soundness of the projects. Recent policy trends requiring water service charges sufficient to pay at least operating and maintenance cost on rural projects and to pay all costs, plus a reserve for expansion on urban projects have contributed to the financial soundness of the pro- gram. Foreign and domestic supplier credits have also been used for financing, particularly in the hospital and equipment fiesld. Such credits may not be subjected to a critical review and may rosult in reduced competition. 3. There are three main multi-project water supply and sewerage construction programs in Peru conducted by three different agencies: a. the Sub-Direction of Sanitary Works of the Ministry of Development and Public Works, b. a Special Health Service of the Ministry of Health and Social Assistance, and c. the National Economic Development Fund. To avert a tendency to overlap, a single agency is proposed which would assume responsibility for all three programs. Legis'ation creating such an agency, to be known as the National Sanitation In3tiLtute, is now pro- gressing through the Congress. The mission supports the fix',atioa of this Institute with the suggestion that local authorities be encollraged to participate in planning and financing and to assume operation respon- sibility for local facilities with supervision from a central agency as necessary until adequate local competency is developed. 4. A review of the community water and sewerage needs and programs of Peru indicates that these facilities can be provided to 70 percent of the urban population (excluding Lima and Arequipa) and 50 percent of rural commtuity (under 2,000 population) population by the end of 1970 with average annual investment of S/. 180 million for urban facilities and S. 50 million for rural community facilities.  - 2 - 5. The present hospital program of Peru is guided by a National Health Policy, stressing full utilization of existing facilities through adding equipment and reitiodelirng and expanding existing hospitals. Despite this stated policy, construction of eleven new hospitals wras initiated during 1964 and 1965. To place these hospitals in operation, key medical and technical personnel, plus a substantial operating budget will be re- quired. The mission recommends that the construction of these hospitals be extended over an additional year. WSith this change, the hospitals will be ready for operation one year later. This extra year can be devoted to solving the operating personnel and budget problems. 6. As new areas are developed in Peru, small but important invest- ments in public health become necessary. It is necessary that the malaria eradication program be expanded to these areas. The influix of population from the limited active malarious areas remaining in Peru to new develop- ment areas can introduce the disease. This hazard has been recognized through agreements whereby the development agencies provide the National NIalaria Eradication Service with cooperation and relatively minor financial support. Tle agreements cover an interim period until the regular miralaria eradication activity can be otherwwise financed for the new area. Such agreements are essential to the success of new highway, irrigation and similar developmients. Because of yellow fever in thie monkeys of the jungle and the plague in the rodents, it is important that appropriate protective measures be taken against these diseases in new development areas. 7. The Public Health and Sanitation 196