Union leaders have ended a 14-day “indefinite” strike involving 60,000 workers of EsSalud, Peru’s public healthcare agency, after reaching an agreement with the Ministry of Labor and Employment Promotion (MTPE). The agreement includes improvements in working conditions, budget increases, and provisions for collective bargaining, according to La República. However, the business newspaper Gestión highlighted concerns raised during the protests, such as shortages of medicines, non-functional medical equipment, and poor infrastructure, which are not adequately addressed.

The language used promises anti-corruption measures. Still, it lacks substance, raising concerns about the credibility of President Dina Boluarte’s government and the right-wing political parties, especially Alianza Para el Progreso (APP), which support her in Congress, of fulfilling the signed agreement.

Since the strike began on September 9, doctors, nurses and technicians have denounced the prevailing corruption within the administrative body of EsSalud. Notably, without consulting the membership, the agreement omitted the major call for the resignation of EsSalud President Segundo Acho, which was considered a “non-negotiable” demand for ending the strike. Amid allegations of mismanagement and corruption, Acho has faced criticism for his lack of qualifications and his connections to César Acuña, a right-wing populist multimillionaire and founding leader of APP.

Recent reports indicate that Health Minister César Vásquez, also a member of APP and subordinate to Acuña, awarded lucrative hospital construction contracts to companies that appear to be mere fronts. Union representatives have also accused Segundo Acho of appointing officials without relevant healthcare experience and of favoring individuals based on their connections to APP. Acuña had previously fought state regulation of private universities and is now targeting the health sector.

Throughout the strike, union leaders expressed concerns over potential privatization of certain services linked to corruption in management.  The strikers demanded action against problematic agreements with private companies totaling over 4 billion soles (approximately US$1.15 billion), but the agreement with the MTPE leaves this demand unanswered.

The end of the strike brings relief to tens of thousands of EsSalud affiliates where medical appointments, including surgeries, were delayed. Union leaders had emphasized the fight for better services for the 13 million members of the public health system, but this critical issue receives little attention in the signed agreement.

The EsSalud strike and the resurgence of class struggle in Peru

The EsSalud strike is part of a resurgence of class struggle in Peru, particularly among public sector workers who are demanding that previously made promises be fulfilled. Additionally, university students have started street protests—resulting in clashes with police—against the recently passed Law No. 32123, which requires students over the age of 18 to join and pay into a pension system. Many students, already unable to meet expenses due to the ongoing economic crisis, oppose this mandate.

The majority of the 13 million Peruvians served by EsSalud are from the working and middle classes—both professionals and non-professionals—who rely on EsSalud for their families’ healthcare. In contrast, wealthier families tend to opt for more expensive private health insurance.

EsSalud has become a significant target for corrupt politicians and entrepreneurs seeking to enrich themselves. With annual funding of about 17.477 billion soles (approximately US$5 billion) from member contributions, many exploit the system by diverting these funds to private contracts instead of investing in necessary medical equipment.

The origins of the recent strike can be traced to the actions of current and past governments that uphold the neoliberal principles of the 1993 Constitution, which was imposed after the coup by then-President Alberto Fujimori in April 1992. The Fujimori Constitution was designed to favor both national and international capital by establishing a free-market economy, neglecting to provide adequate funding for institutions like EsSalud. It also promoted privatization and limited collective bargaining.

While Fujimori claimed to respect labor rights, the Constitution introduced the concept of “labor flexibility,” leading to labor outsourcing and a fragmented workforce. Currently, around 7 million informal workers in Micro and Small Enterprises (MYPES) earn an average wage that is only 76 percent of the Minimum Living Wage (1,130 soles per month, US$3,875 per year), which is barely sufficient for survival. Why is this important? Recent struggles are raising the demand for collective negotiations, which may bring them into conflict with the 1993 Constitution. For the ruling class, the Fujimori Constitution is the “holy grail.” Any attempt to change it would detonate a fierce class war.

Clashes with police

During the 14-day strike, confrontations occurred between police and EsSalud workers on Salaverry Avenue, in front of the Ministries of Labor and Health (Minsa). Police used teargas to disperse workers who broke through barricades, and multiple arrests were reported.

The “indefinite” strike saw other government employees and Lima Municipality workers staging marches to voice their demands, highlighting a rising struggle against the bourgeois state.

• There has been growing conflict over a collective agreement for 9,500 workers that was signed in early 2025 following mediation by the Ministry of Labor and Fentramip. Implementation of a new salary scale for Public Ministry workers has been postponed since March.
• On September 16, tens of thousands of CAS (Administrative Services Contract, a state labor regime for contract workers in the public sector) workers occupied Abancay Avenue, demanding collective bargaining. One protester stated, “The state is abusing municipal workers. We need materials to perform our jobs effectively.” The worker emphasized the necessity for unity among global workers.
• Minsa healthcare workers are also demanding benefits. With over 18,000 members and plans for 23,000 CAS employees by 2026, both Minsa and EsSalud are facing mismanagement and shortages. Protests are tied to earlier agreements from 2018 regarding bonuses and administrative staff reevaluation.

Union leaders feared an escalation in the class struggle

The union leadership shut down the strike as it became apparent that its continuation would lead to a confrontation with the bourgeois state. The Ministry of Labor declared the strike unlawful, warning of potential dismissals for those who failed to return to work. Although emergency services were operational, securing appointments became increasingly challenging, causing public anxiety.

The dictatorial government of President Dina Boluarte signaled its aim of exploiting delays in medical treatment as a pretext to declare a state of emergency and deploy the military against healthcare workers and silence their demands for an end to corruption and theft at EsSalud.

Boluarte’s government, along with its corrupt allies in Congress, attempted to blame and intimidate strikers. Boluarte’s disapproval rating exceeds 80 percent nationwide. Known as “Dina Asesina [Murderer],” her order to shoot protesters after she took power in December 2022—following a CIA-supported coup against democratically elected President Pedro Castillo—resulted in 49 deaths, including eight youth.

The lifting of the EsSalud healthcare workers’ strike coincided with Boluarte’s speech at the UN General Assembly, where her remarks echoed the reactionary views of fascistic US President Donald Trump. She claimed her government was “stable,” while defending the recently passed amnesty for military personnel who carried out massive human rights violations during Peru’s “dirty war.”

Boluarte’s alignment with Trump signals an escalation of the attacks on the working class. Over the past year, public transportation organizations staged 10 successful one-day strikes against citizen insecurity caused by extortionist mafias. These actions revealed a growing militancy among workers, peasants and youth to fight against the hated Boluarte regime. Their main demand was the repeal of Law 32108, which protects these corrupt entities and their political allies, but Congress ignored their calls.

The growing movement of strikes and protests can advance only on the basis of a socialist program to overthrow the rule of the Peruvian bourgeoisie and its foreign partners in mining, petroleum, agribusiness and infrastructure. The parallels between Boluarte’s perspective and Trump’s show that the struggle confronting the working class is a global one. The EsSalud and transportation strikes are significant steps toward uniting the Peruvian working class and forging unity with the international working class to confront the common enemy—capitalism in crisis.