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.

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