INTRODUCTION TO THE PERUVIAN HEALTHCARE SECTOR AND BUSINESS OPPORTUNITIES. Jorge Fernández Gates, Senior Advisor Peru, Colombia, Bolivia and Ecuador

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1 PERU:

2 INTRODUCTION TO THE PERUVIAN HEALTHCARE SECTOR AND BUSINESS OPPORTUNITIES Jorge Fernández Gates, Senior Advisor Peru, Colombia, Bolivia and Ecuador

3 Health: a high priority for the Peruvian Government Government allocates 5.5% of the GDP to the health sector. Latin American average is 7%. Sector is fragmented in different Ministries. MoH is responsable for defining the general policies. Current Government has prioritized this sector and promised to increase the sector s GDP share.

4 Main causes of death in Peru (2014) Cause Total % of Total % of Men % of Women 1 Malignant Tumors (Neoplasms) % 18% 23% 2 Influenza (flu), pneumonia % 13% 15% 3 Other bacterial diseases % 7% 8% 4 Other external causes from accidental traumas % 8% 4% 5 Other heart diseases % 5% 5% 6 Ischemic heart diseases % 5% 4% 7 Cerebrovascular diseases % 4% 5% 8 Other respiratory diseases affecting the interstice % 4% 4% 9 Hypertensive diseases % 4% 4% 10 Diabetes Mellitus % 4% 4% Source: MINSA 2014 Other % 28% 24% Total % 100% 100%

5 There are new cancer cases registered yearly in Peru Cancer Cases in 2016 Men Wome n 1 Cervical % 100% 2 Stomach % 51% 3 Breast % 100% 4 Prostate % 0% 5 Colorectal % 57% 10 Leukemia % 46% Source: El Comercio 2016

6 Peru s fight against cancer has strenghtend but Peruvian National Cancer Institute Peruvian National Cancer Institute (INEN) implemented a initiative called Plan Esperanza in order to improve cancer comprehensive care and the accesibility of the low-income population by providing free cancer treatment. INEN is the largest and most modern hospital specialized in cancer treatment in Peru. The are always investing in the latest technology regarding their sector.

7 still the prevention work has lots to improve Population is still not aware of the prevention work. In Latam only 5 out 10 cases detected survive cáncer. The number of INEN s hospitals across the country is still not sufficient. Telemedicine a good tool for faster diagnosis.

8 Main sector s challenges Big gap in infrastructure. Especially among public hospitals located outside Lima. Doctors salaries are still low compared to the region. Only 4% of all doctors earn more than USD per month. Inequality in attention on public and private hospitals Use of telemedicine in rural areas in order to facilitate the access to proper healthcare for poor populations. Insufficient number of proper medical equipment in strategic areas and lack of trained employees to use them.

9 Health System in Peru Public sector Ministry of Health Ministry of Labour (EsSalud) Ministry of Defence Ministry of Internal Affairs

10 Upcoming investments in the Peruvian public health sector Investments in new high-complexity hospitals for the period are around USD 450 million.

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13 Upcoming investments in the Peruvian private health sector Since the private healthcare market has become extremelly competitive, in the last two years large insurance companies together with the private clinics are investing considerable amounts of funds to improve their infrastructure to provide a high quality client service.

14 Digital era entering recently but rapidly into Peruvian hospitals The infrastructure gap in Peru is big challenge for the healthcare sector. The hard geography hampers people to access to proper attention and care. Telemedicine has become a boom in the private healthcare sector since Most of the companies are developing their own apps.

15 Clínica Internacional will go for telephone consultations Clínica Internacional is one of the biggest chain of private clinics in Peru. It was bought by the Insurance Company Rimac. They launched their own app for arrange medical appointments. These have already over downloads. In 2018 they are going to launch telephone consulations. They expected to reach over 400 during the first period. They plan to launch also a remote monitoring platform for patients with chronic diseases such as diabetes, hypetension, asma, etc. For these purposes, the company will invest USD 14 million

16 Clínica Delgado: One of the most modern clinics in Latin America Belongs to the Spanish Peruvian Investment Group Auna inaugurated in The investment for this clinic was 120 million. In 2017 announced they will invest in telephone consultations. They will have specific medical staff for this purpose. This will also permit that doctors from other clinics can follow online medical procedures such as surgeries. 20% of their annual budget will be allocated for these purposes.

17 Grupo San Pablo Currently developing their own app to book medical appointments and online payment for their three clinics. Their ambition is to apply this in all their clinics. They have also expressed the necessity of implementing an app to have the results of imaging and labs. They have invested so in USD 1,5 million in developing their ICT capacities and planning to increase this.

18 Grupo Sanna By the end of 2017 announced they will focus in telephone consultations and other apps to strenghten their relation with their clients.

19 Health fair TECNOSALUD 2018 Tecnosalud is the biggest health fair all over Peru. It is arranged by Lima Chamber of Commerce. It takes place between 13-15th of September in the city of Arequipa There are more tan 400 national and international providers present.

20 Peru Area: km2 Inhabitants: 32 million Language: Spanish, Quechua and Aimara Urban population: 77% Currency: Sol Constitution: Democratic Republic President: Pedro Pablo Kuzcynski GDP: 219 billion USD (2016) GDP per capita: USD (2016) Inflation: 1.36% (2016) Main exports: Mining ores, vegetables, fish meal, textiles Main Imports: Machinery & equipment, vehicles

21 Peru Political and economic stability since 2000 Stable legal framework for investments Lowest average inflation in the last ten years 3rd best in the region according to Doing Business Free Trade Agreements in force (FTA with the EU since March 2013) Member of the Pacific Alliance together with Mexico, Colombia and Chile Exports mainly based on raw materials (mining ores and natural gas) China and USA are the most important trade partners.

22 Peru: Leading GDP growth among the PA members

23 Finland in Peru Finnish embassy was re-opened in Lima in Over 40 Finnish companies present in Peru: 9 established subsidiaries and around 35 with local representation or distribution. Most of them providing to the mining and energy sector. The subsidiaries are: Konecranes, Lamor, Metso, Nokia Network Solutions, Normet, Outotec, Pöyry, Robit and Wärtsilä. Most of these cover the Colombian market from Peru. They employ 477 people and had a turnover of USD million by Finnish healthcare brands locally represented: Planmeca, Merivaara, Instrumentarium and Wallac

24 Peru s population is relatively young Life expectancy in Peru has augmented 15 years since the last four decades. For men is 72 and for women is 77,3 years of age. In average, Peruvians live up to 74,6.

25 Things to consider! FTA between EU and Peru is working smoothly. However Peruvian Customs Authority sometimes is highly bureaucratic with some medical devices Average time to get permissions 6-8 months. Big presence of Asian brands. Price is sensible in the market but, if the solution has a clear differiantior, the chances are good. Private clinics are less bureacratic and open to new technologies. Sales cycle in Peru is years.

26 Next steps Business Opportunity on Digital Hosipitals in Peru will be published on Start discussions with potential local distributors/agents. Visit the region and meet face-toface potential clients Visit to the biggest fair on medical equipment and related solutions. Tecnosalud September 13-15th.

27 Tervetuola Peruun! Jorge Fernández Gates Senior Advisor Peru, Colombia, Bolivia and Ecuador