Works for Taxes: A Bet to Reduce Anemia in Peru

What to expect from the new government?

This past July 28, Keiko Fujimori was sworn in as President of Peru, and while the central banner of her government plan has been to restore “an orderly Peru,” built on three fronts—citizen security, economic order, and legal order, with proposals highlighting investment in technology to combat insecurity, reducing the fiscal deficit to 1% by 2031, and a deregulatory shock, as well as modernizing the justice system—it’s worth taking a closer look at the social axis of her plan, where, in her own words, she will “prioritize attention to education, health, housing, water and sanitation, food security, social programs, pensions, and sports, ensuring equal opportunities and universal access to quality services.”

On this point, I will focus on reviewing, within the social axis, Keiko Fujimori’s health proposals—specifically, those aimed at reducing anemia in Peru. My argument is the need to continue along the path laid out by the Multisectoral Plan for the Prevention and Reduction of Maternal-Infant Anemia in Peru (2024-2030 period) and the Guidelines for the management of health investments issued by MINSA (approved under Resolution No. 132-2025/MINSA), whose emphasis is on promoting private investment through the Works for Taxes mechanism, without neglecting the need for a comprehensive solution to combat this problem from other angles, including access to clean water and sanitation, investment in technology, and expanding the reach of this tool.

Anemia: A Multidimensional Problem

According to figures from the National Institute of Statistics and Informatics, as of 2025 the country recorded a childhood anemia rate of between 34.9% and 43.4%. Historically, anemia has been addressed primarily through iron supplementation programs and/or medical care. However, this issue stems from multiple causes, such as lack of access to clean water and sanitation, food insecurity, and insufficient control of infectious diseases.

While the Multisectoral Plan for the Prevention and Reduction of Maternal-Infant Anemia in Peru (2024-2030 period) includes investments for the prevention, diagnosis, treatment, and monitoring of anemia—through the provision of medical infrastructure and equipping of clinical and mobile laboratories, complemented by investments in information systems and connectivity to ensure the integration of medical services—reducing anemia requires rethinking the preventive approach of iron supplementation in favor of one oriented toward achieving access to clean water and sanitation, which also requires reducing bureaucratic barriers to this type of investment.

Works for Taxes: Private Enterprise Building Value

In 2008, Peru became a pioneer in creating a mechanism to close infrastructure and service gaps, known as “Works for Taxes” (Obras por Impuestos, OxI), which facilitates private sector participation in developing investments, operation and/or maintenance activities, services, and rural housing construction activities, driven by public entities at the national, regional, and local government levels, as well as public universities.

This instrument takes shape through the signing of an Investment Agreement between the public entity and the private company, under which the latter directly finances and executes these interventions. Upon completion, the company receives a Public Investment Certificate—National Government or Regional and Local Government–Public Treasury, a document that grants it the right to deduct up to 80% of third-category income tax, the temporary tax on net assets, income tax under the special regime, income tax under the MYPE tax regime, the special mining tax, the general sales tax, and the selective consumption tax, with any remaining balance usable in the following fiscal year.

According to data from Peru’s Ministry of Economy and Finance, in 2025 Works for Taxes made possible the awarding of 498 investments worth S/ 5.182 billion, and for 2026, another 127 investments worth S/ 3 billion are expected to be awarded. However, the executive director of Proinversión stated that an authorized ceiling of S/ 60 billion is in place.

Keiko Fujimori’s Proposals to Reduce Anemia

The Fuerza Popular Government Plan 2026-2031, “Peru with Order,” proposes reducing childhood anemia to 20% through universal vaccination coverage, preventive checkups, and maternal-infant services. To this end, Keiko Fujimori translates that reduction into a series of proposals that appear to maintain the preventive logic of supplementation, while also including diagnosis and monitoring of this condition. Notable among these are:

Strengthening the implementation of the Multisectoral Plan to Combat Maternal-Infant Anemia with a specific budget allocation for the timely provision of supplements and medications, along with the consolidation of preventive and therapeutic supplementation for pregnant women and children aged 6 to 35 months, together with monthly monitoring of coverage and adherence in coordination with regional and local governments.

Launch of the social program “Babies Born Strong,” focused on:

• Implementation of the “First Thousand Days” package (pregnant women–children 0-24 months) with supplementation and fortification (iron and folic acid), reinforced prenatal care, and home visits.
• Quarterly hemoglobin testing in priority areas and monitoring through the Electronic Health Record (HCE).
• Development of a National Nominal Information System for Child and Maternal Health, interoperable with RENIEC, SIS, and EsSalud, with early warning alerts for anemia and malnutrition risks.

Although Keiko Fujimori has not explicitly mentioned, either in her Government Plan or in her “Message to the Nation,” that these proposals will be channeled through Works for Taxes, her programmatic proposal does reference the Multisectoral Plan to Combat Maternal-Infant Anemia, which centers on deploying prevention, diagnosis, treatment, and monitoring measures through Works for Taxes—which, in my view, is the path these initiatives should follow.

Additionally, within the social axis, her Government Plan acknowledges that lack of access to adequate clean water and sanitation is linked to high rates of childhood anemia and malnutrition, and that 30% of acute diarrheal diseases in children under 5 are associated with unsafe water consumption or inadequate excreta disposal—which is why it promises to finance strategic water and sanitation projects under this scheme.

The Potential of Works for Taxes for a Comprehensive Solution to Reducing Anemia in Peru

Having reviewed the anemia landscape in Peru, beyond the approach proposed by the incoming government to address this problem, it’s worth noting that although the new administration’s proposals offer a path to reducing anemia based on executing investments (Works for Taxes) in prevention, diagnosis, treatment, and monitoring of this condition, the potential impact of this tool increases considerably when combined with other investments.

In that sense, a comprehensive solution must involve prioritizing, in parallel, projects aimed at expanding access to clean water and sanitation, as well as investment in technology to achieve interoperability in health systems that helps reduce the bureaucratic burden of care in hospitals.

Finally, it’s worth exploring the expansion of Works for Taxes to incorporate components for providing specialized medical personnel services in areas where the shortage of human resources limits the functioning of built infrastructure. In such cases, it could even be worth extending this tax benefit to the specialized professionals providing the service, allowing them to deduct fourth- or fifth-category taxes, as applicable.

Originally published in Spanish by El Insubordinado.