Risk management is the process of identifying, analysing, accepting, mitigating or transferring uncertainty in investment decisions. Fund managers apply risk management by analysing and attempting to quantify the potential loss of an investment and then acting accordingly.

Institutions are being transformed thanks to the integration of new technologies. This vision represents a corporate change with a social impact, reducing costs, simplifying processes and procedures, and raising awareness of the importance and benefits of this transformation.

The good clinical practice of Hospital II Lima Norte Callao Luis Negreiros Vega – part of the Sabogal service network of Peru’s EsSalud - Social Health Insurance Institute (EsSalud - Seguro Social de Salud) – aimed to prevent respiratory and gastrointestinal diseases in hospitalized newborns.

To this end, we established an innovative model of care that disrupted the traditional neonatal-care model. Health professionals working in the neonatal unit were trained to promote exclusive breastfeeding and to ensure that colostrum was expressed within an hour of childbirth.

Peru’s Derrama Magisterial (DM) was created to provide social benefits to teachers in Peru. Teachers are at the core of everything the DM does, and since it was founded, the organization has aspired to provide ongoing excellent services to teachers, in compliance with its mission and vision.

Teachers are constantly looking for streamlined services that can be accessed wherever they are and whenever they need them. The COVID-19 pandemic prompted the DM to deploy a set of initiatives that would enable it to meet teachers’ needs with the support of new technology.

Article 12 of Law No. 5508 on the Promotion, Protection of Maternity and Support for Breastfeeding establishes that maternity allowance should be paid to employed women by the social security scheme of Paraguay’s Social Insurance Institute (Instituto de Previsión Social – IPS). This amount is equivalent to 100 per cent of her salary at the time of delivery, and is paid for the prescribed months of rest. This used to be given to women in a single payment.

Teachers associated with Derrama Magisterial (DM) in Peru can benefit from a number of different services, including a credit service.

This credit service offers loans to teachers. In the past, to secure a loan, the contractual process required teachers to sign documents by hand to create a credit file. As a result of the COVID-19 pandemic, we had to find innovative ways to digitalize these contractual documents, which is why the digital file service was launched.

The issue of population growth and social security planning is one of the biggest challenges facing governments today, and is a key part of a good social security system that instils confidence in its members.

The Retirement and Pension Fund for Employees of Banks and Related Institutions (Caja de Jubilaciones y Pensiones de Empleados de Bancos y Afines) (Bank Fund, hereinafter) is in constant communication with its members. It therefore continuously updates its databases, in order to have a better understanding of members’ current realities, experiences and needs.

In line with its mission and vision, Peru’s Derrama Magisterial (DM) is constantly striving to be the primary source of support for teachers in both their personal and professional lives.

Associated teachers make a monthly contribution that is deducted from their salary. This allows them to accumulate a pension pot that they will receive at the end of their working life. It also gives them access to monetary benefits in the event of retirement, total disability, or death.

Digital transformation is happening in institutions through the integration of new technologies. This vision represents an institutional and social change, optimizing available resources, reducing costs, shortening processes and procedures, and raising awareness of the importance and benefits of this transformation.

The good clinical practice implemented at the Edgardo Rebagliati Martins National Hospital (Hospital Nacional Edgardo Rebagliati Martins – HNERM), part of Peru’s EsSalud - Social Health Insurance Institute (EsSalud - Seguro Social de Salud), looked to prevent complications of infections in paediatric patients with onco-haematological diseases and febrile neutropenia.

As a result of the COVID-19 pandemic, Peru’s EsSalud - Social Health Insurance Institute (EsSalud - Seguro Social de Salud) was not able to provide patients with a single diagnosis of arterial hypertension with adequate check-ups due to the suspension of some services and the health regulations in place at the time. This led to an increase in hypertensive patients with diabetes mellitus (in 2020, there were 15 per cent more hypertensive patients with diabetes mellitus).

The Derrama Magisterial Digital Library – CRISOL is a service that Peru’s Derrama Magisterial (DM) has made available to associated teachers, in collaboration with Librerías CRISOL
(a distinguished and recognized bookstore chain that offers a wide and varied range of cultural entertainment and the best level of service in the Peruvian market at national level). This is part of the ongoing efforts to improve the focus on teachers and identify and satisfy their needs.

Since 2021, Peru’s Derrama Magisterial (DM) has been implementing a virtual legal advice service for teachers working in educational institutions nationwide, designed to be provided free of charge.

The need to care for older patients with chronic illnesses in a more human-centred and effective way inspired this good clinical practice at the Almanzor Aguinaga Asenjo National Hospital (Hospital Nacional Almanzor Aguinaga Asenjo), which is part of the Lambayeque Health Care Network (Red Prestacional Lambayeque) and Peru’s EsSalud - Social Health Insurance Institute (EsSalud - Seguro Social de Salud).

Good practice in health – service quality.

As health-care systems have evolved to become more complex and due to the resultant increase in patients coming to harm in health care settings, patient safety has emerged as a health-care discipline.

The Actuarial Advisory Office (Asesoría Actuarial) of the Social Insurance Institute (Instituto de Previsión Social – IPS) carried out an actuarial valuation of the Common Retirement and Pension Fund (Fondo Común de Jubilaciones y Pensiones). The valuation looks to comply with international best practices and observe the guidelines and standards of the International Standards of Actuarial Practice 2 (ISAP 2), and the ISSA-ILO Guidelines on Actuarial Work for Social Security, with technical support from the International Labour Organization (ILO).

The aim is to promote social security culture in Peru, with a comprehensive strategy to reach different target audiences, such as children, adolescents, young people and adults, through different content that is hosted on different sections of the ONP Cultura landing page, set up and managed by the Pension Standardization Office (Oficina de Normalización Previsional – ONP), seeking to help citizens internalize knowledge and behaviour related to social security.

In view of the declaration of the coronavirus pandemic by the World Health Organization (WHO) and the national emergency declared by Peru, the EsSalud - Social Health Insurance Institute (EsSalud - Seguro Social de Salud) proposed rapid responses to tackle the challenge of insufficient hospital infrastructure in order to protect lives and offer healthcare services during a health emergency.

The EsSalud - Social Health Insurance Institute (EsSalud - Seguro Social de Salud) of Peru is a critical actor with regard to the COVID-19 pandemic, as it watches over the well-being of nearly 12 million insured persons. The information produced by the recently created Business Intelligence and Data Analytics Unit (Unidad de Inteligencia y Análisis de Datos – UIAD) has underpinned the strategic, tactical and operational decisions of EsSalud’s senior management and other entities, as well as other aspects of the institutional response to the health emergency.

In line with its mission and vision, Peru’s Derrama Magisterial (DM) continuously aspires to be a central source of support for teachers, providing a variety of DM services and informing them about social security issues.

In order to achieve this, the organizational structure of the social security unit includes different staff members who offer associated teachers guidance, registration support, and advice from the moment they join the DM until the moment they leave.

Like most of the world’s countries, Paraguay has adopted lockdown measures to prevent the spread of COVID-19. These steps taken by the government have impacted the productive sector, leading to mass suspensions of employment contracts for persons insured with the Social Insurance Institute (Instituto de Previsión Social – IPS) of Paraguay.

In line with its mission and vision, Peru’s Derrama Magisterial (DM) is constantly striving to be the primary source of support for teachers, offering them a social welfare programme that gives them access to the institution’s various services, as well as support throughout their teaching career and a significant retirement fund at the end of their working life. Teachers have access to these benefits after voluntarily joining the DM.

Derrama Magisterial (DM), Peru’s welfare and social security institution for teachers in public education, offers online courses to ensure the continuity of training services for teachers after face-to-face events were suspended due to the COVID-19 pandemic.

In line with its mission and vision, Peru’s Derrama Magisterial (DM) is constantly striving to be the primary source of support for teachers, allowing them to build up a significant retirement fund for the end of their working life. This fund offers fundamental support for both teachers and their families in the event of their death.

The mission of Peru’s Derrama Magisterial (DM) is to support and guide teachers throughout the digital transformation of its processes. For this reason, we have defined our key strategy as having staff members who are trained to assist teachers in the use of the digital applications, as well as to raise awareness of the benefits of belonging to the digital era, through the use of modern and agile technological tools.

The pandemic, which began in 2019 with the spread of the infectious disease caused by the coronavirus (COVID-19) has proved a challenge for all the social security institutions in the world. The pandemic has required the establishment of social protection mechanisms for the whole population, particularly the most vulnerable groups – older adults, people with chronic diseases, etc.

The pandemic created significant social pressure in terms of access to pension and health services in Peru. Faced with this situation, 47 years after the creation of the National Pension System (Sistema Nacional de Pensiones – SNP), the Pension Standardization Office (Oficina de Normalización Previsional – ONP) has been pushing to change and improve regulations, in order to make the conditions more flexible and extend social security coverage.

Extra-hospital care is defined as care provided in a setting outside the health establishment, either via telephone medical assistance or at the patient’s home.

The COVID-19 pandemic marked a “before” and “after” regarding how public services are accessed. As an institution, Peru’s Pension Standardization Office (Oficina de Normalización Previsional – ONP) had to reinvent itself and take on the challenge of digital transformation, promoting an omnichannel approach, with new platforms and channels used to offer more and better services.

In accordance with its mission and vision, Derrama Magisterial (DM) of Peru constantly endeavours to become a mainstay for teachers, offering a social well-being programme that gives teaching staff access to the institution’s various services and guarantees them a large retirement fund at the end of their working life.

Paraguay’s Social Insurance Institute (Instituto de Previsión de Social – IPS) used to make sick leave payments at its administrative offices, which had associated administrative costs and meant beneficiaries had to visit the IPS service counter in person.

In March 2020, Peru declared a health emergency owing to the COVID-19 global pandemic and the Ministry of Health recommended suspending external consultations and diagnostic tests to avoid exposing the population to infection by the new coronavirus.

On 16 March 2020, a state of emergency was declared in Peru due to COVID-19 which also impacted the services for patients with chronic diseases, including diabetic and hypertensive patients.

The Yuyaq, Casa del Pensionista is a support programme that contributes to the healthy, productive and dignified ageing of older people at the national level; it is focused on pensioners and run by the Pension Standardization Office (Oficina de Normalización Previsional – ONP) of Peru. The programme is based on five strategies:

In accordance with its mission and vision, Derrama Magisterial (DM) of Peru constantly endeavours to become the mainstay for teachers, offering them a social well-being programme that gives teaching staff access to the institution’s various services and guarantees them a large retirement fund at the end of their working life. Teachers have access to these benefits once they voluntarily join DM.

Facility management and security (FMS) is part of offering timely, humanized, continuous and efficient care geared to ensuring the availability of facilities and equipment that is secure and functional and provides support for patients, family members, staff and visitors at the Instituto Nacional Cardiovascular Carlos Alberto Peschiera Carrillo (INCOR), of the EsSalud - Social Health Insurance Institute (EsSalud - Seguro Social de Salud) of Peru.

The Business Intelligence and Data Analytics Unit (Unidad de Inteligencia y Análisis de Datos – UIAD) is a functional body created by the EsSalud - Social Health Insurance Institute (EsSalud - Seguro Social de Salud) of Peru to generate critical information to underpin the decisions taken by the institution’s senior management and departments.

The virtual integrated platform for insured persons, (Ventanilla Integrada Virtual del Asegurado - VIVA) is a virtual platform set up by Peru’s EsSalud - Social Health Insurance Institute (EsSalud - Seguro Social de Salud). VIVA gives insured persons and employer representatives immediate access to their EsSalud insurance and benefit files, enabling them to carry out operations and consult their data while avoiding any delay linked to the need for a physical appointment.

In accordance with its mission and vision, Derrama Magisterial (DM) of Peru consistently endeavours to become the mainstay for teachers, guaranteeing them a large retirement fund at the end of their working life.

DM is constantly mindful of the need to guarantee financial sustainability, implementing the necessary initiatives or projects to enable the improvement of the operational processes associated with the collection of pension contributions, in line with the institution’s objectives.

In accordance with its vision, Derrama Magisterial (DM) of Peru is endeavouring to become a key ongoing support for its affiliates in both their family and professional lives. To do so, it has designed a functional, organizational structure for the delivery of pension services to teachers in very remote or hard-to-access parts of the country.

Derrama Magisterial (DM) of Peru, in its desire to continue strengthening a culture geared to the quality and good performance of the staff, teachers and other stakeholders of the institution, is implementing the Modelo de Excelencia en la Gestión (MEG), a Model for Excellence in Management based on the Malcolm Baldrige National Quality Award, which is used by many organizations to improve their results and raise their management levels.

Derrama Magisterial (DM) of Peru set up a programme of face-to-face relations with teachers with a view to broadening and strengthening its institutional presence nationwide in hard-to-reach places, generating assistance, credibility, trust, visibility, recognition and long-term relationships with teachers, their families and the institution.

In Peru, 10.4 per cent of the population has a disability. It is estimated that only 33 per cent of persons with disabilities of working age participate in the labour market, given that educational level and job training are key factors for access to employment. With this in mind, the EsSalud - Social Health Insurance Institute (EsSalud - Seguro Social de Salud) of Peru established the Vocational Rehabilitation Centres (Centros de Rehabilitación Profesional – CERPS) for persons with disabilities over 14 years of age.

India has a federal structure of governance, where health is a provincial subject and social security and labour are in the concurrent list. Healthcare and cash compensation for employment injury in the formal sector are provided by the Employees’ State Insurance Corporation (ESIC) while the pension and provident fund are provided by the Employees Provident Fund. The employees of factories and establishments in the formal sector are entitled to social security benefits through the ESIC scheme.

Mindful of the importance of corporate governance practices, Derrama Magisterial (DM) of Peru has taken the initiative to deploy a series of activities leading to the implementation of good corporate governance practices, as part of its process of continuous improvement.

The Derrama Magisterial (DM) has begun offering a number of services in accordance with the terms of its Statutes, and one noteworthy scheme involves providing credit to member teachers at a preferential rate of interest. Such credit, along with other types of investment, helps support the organization, and contributes above all to providing pension-related benefits to member teachers and their dependents. 

The good clinical practice implemented at the Guillermo Almenara Irigoyen National Hospital (Hospital Nacional Guillermo Almenara Irigoyen – HNGAI), which is part of Peru’s EsSalud - Social Health Insurance Institute (EsSalud - Seguro Social de Salud), looked to improve the difficult experiences of patients with rheumatoid arthritis.

The “pension benefit service” that Derrama Magisterial (DM) provides to its members must be accompanied with sufficient ongoing support, including giving information and guidance to teachers. This is the role of the pensions advisory service.

The pensions advisory service aims to promote and raise awareness about the social security system among members through constant outreach, thus forging close and lasting links.

This good practice relates to the formalization and standardization of the improvement of our main services, based on the integration into a quality management system of a series of efforts which Derrama Magisterial (DM) of Peru has been developing for some time that will enable its consolidation as a pension body committed to achieving excellence in its services offered to the country’s teachers.

Most patients requiring Unrelated Bone Marrow Transplantation – UBMT (trasplante de médula ósea no emparentado – TMO-NE) through Peru’s Social Health Insurance Institute (Seguro Social de Salud – EsSalud) are being treated for leukaemia, and the majority of these are children.

The Social Health Insurance Institute (Seguro Social de Salud – EsSalud) consists of 10,978,635 members (one third of the Peruvian population), 30 highly and medium specialized assistance networks, various specialized institutions and others. With an annual budget of 411,401,032.93 US Dollars (USD), it carries out 28,079,260 hospital interventions annually.

The Process of managing pregnancy and post-pregnancy (Gestion de la Embarazada y Puérpera – GEyP) standardizes care for pregnant women in the Red Asistencial Juliaca (RAJUL) healthcare network of the EsSalud - Social Health Insurance Institute (EsSalud - Seguro Social de Salud). It judiciously incorporates institutional standards for pregnancy with medical advances as of December 2019 and adds a dynamic administrative process. Everything is contained in a graphic presentation that lays out tasks and functions in accordance with the pregnancy timeline.

June 2015: after taking up the post of Director of Foreign Travel at the Social Health Insurance Institute (Seguro Social de Salud – EsSalud), I had the following experience: a patient had come back from a foreign country after spending a month there and I decided to go with him to his first check-up in Peru. The attending doctor looked at me and asked “What do you want me to do with this patient? He has had a type of treatment that we don’t use in this country and I’m not familiar with it.

The extension of the ESI scheme was not progressing at the desired pace. In 2010 the threshold coverage level was reduced from 20 to 10 employees through an amendment to the Act. Moreover, in sparsely populated areas many establishments could not be covered even with the threshold of 10 employees.

Article 10 of the Constitution of Peru acknowledges and entitles the progressive and universal right of every person to social security. Within this scope, the Act Nº 26790 Modernizing Social Security for Health was enacted, based on the constitutional principles that acknowledge the right to welfare and entitles people to the free access to the services provided by public, private or mixed entities.

State Governments are instrumental in delivering healthcare services under the ESI Act. An enabling provision was inserted in the Act to establish a body at the State level to address certain operational issues.

A committee, entitled Medical Services and Medical Education (MSME), was constituted to explore various options to improve operational efficiency.

The Employees  Provident Fund Organisation (EPFO), under the Ministry of Labour & Employment, Government of India provides social security benefits to its members in terms of provident fund and old age pensions under the Employees' Provident Funds & Miscellaneous Provisions Act, 1952 (referred to as the Act hereafter), enacted by the Parliament of India, which extends to the whole of India except the state of Jammu and Kashmir.

The inefficiency and complexity of various processes involving a multitude of forms and returns and the resulting difficulty in delivery of online services to over 60 million contributory subscribers and over 200 million accounts, was a big challenge for the Employees’ Provident Fund Organisation (EPFO) of India since some time back. The sheer size of stakeholders heightened the need of digitization.

To ensure adequacy and improve the quality of social security benefits the following actions have been taken:
 

The ESIC has taken the following measures to proactively improve the scheme:
 

Planning errors affecting the handling of strategic goods, lack of awareness among end users and the lack of ongoing training on planning have been recognized as a major management problem which leads among other things to large stocks of out-of-date goods and constitutes a challenge in terms of quality at all stages of the goods handling processes involved in the direct provision of health care.

For this purpose, line managers have formed multidisciplinary work teams responsible for designing the roadmap for the process, developing and updating procedures that standardise the criteria for the services we provide, and streamlining the procedures in the insurance agencies.

• The minimum amount of monthly dependants' benefit payable to dependants of a deceased insured person has been prescribed as 1,200 Indian Rupees (INR) a month.
• Long-term benefits (permanent disablement benefit and dependant's benefit) have been linked to the cost of living index.

The Institution has thus adopted an approach based on procedures, constant improvement and ensuring conformity with the requirements of our clients and with applicable norms.

To date we have achieved significant results in terms of:

The Employees' State Insurance Corporation (ESIC) undertook a number of actions which led to the following measures being introduced to extend coverage:

ICT has been used to improve compliance, and to implement on-line registration of employers and employees, and make benefit payments.
Forms and the procedure for benefit rate calculations have been simplified.

The new systems and procedures resulted in savings of about 25 per cent of Branch Office staff which could be utilized in other information and communication technology (ICT) related work during its transition phase.

Their activities are carried out under a primary care management model that involves the provision of outpatient type services which are accessible to a population of insured persons residing in a specific geographical area, with comprehensive care being provided where appropriate.

It also entails three phases: firstly, awareness-raising and motivation; secondly, training on how to change unhealthy habits; and thirdly, training for company leaders to make sure that the change lasts. The level of information, the changes in lifestyle and the number of leaders trained has been evaluated.

This situation led to the establishment of the Integrated Policyholder Service System (SIAS) as a support platform for claims and requests for mediation from EsSalud policyholders in response to an infringement of their rights. The SIAS comprises 128 Policyholder Service Offices - OAS at national level, in 25 of the country's regions.

A pilot project was implemented to address this issue using complementary medicine (holistic view of the patient and the use of acupuncture, medicinal plants, manual therapy and mind & body therapies). The results were evaluated by the Pan American Health Organisation through a cost-effectiveness analysis on nine diseases, with complementary medicine proving 60% more cost-effective than conventional medicine. For this reason, 51 complementary medicine units and centres were implemented nationally in the country's 24 care networks.