The Gift of Hearing by way of an ID card: Pierina’s Story

Every ID has a Story, a series by the Identification for Development (ID4D) initiative

By Ana Coyne

Also in: Español | العربية |Français

© Daniel Silva Yoshisato

Miluska Perez knew something was wrong when her baby, Pierina, exhibited signs of hearing impairment at a young age. “I started to wonder whether she could hear me,” Miluska said.

After rounds of tests, Miluska learned that her daughter had “deep hearing loss” and that a simple hearing aid would not fix the situation. The solution could only come in the form of an expensive cochlear implant, doctors told her. For Miluska, who works night shifts as a custodian in an upscale restaurant in Lima, Peru’s capital, the news was devastating. “It felt like a bucket of cold water,” she said. “I didn’t know what to say or do.”

© Daniel Silva Yoshisato

She sought help through organizations and hospitals. During her search, Miluska met another mother who had been able to get a cochlear implant for her child through SIS, the Peruvian health insurance program like Medicaid. Fortunately, Pierina, who is now six, already had a birth certificate and a national identity card, called a DNI, which allows participants to take advantage of a number of government services, including health benefits provided by SIS. Suddenly, Miluska’s goal of getting a cochlear implant for her daughter didn’t seem so distant.

Peru experienced tremendous economic growth in the past fifteen years. To help the economic gains to trickle down to the poor, the government started an array of social programs in the early 2000s, from education to health to pensions, targeting those living on the lower rungs of the economic ladder.

Since the government passed a law in 2009 aimed at providing universal health care, development indicators have improved dramatically in parts of Peru. Chronic malnutrition fell from 28% to 13% between 2008 and 2016, due in large part to an intersectoral governmental strategy that included Early Childhood Development, nutrition supplements, and conditional cash transfers, among other initiatives. Infant and maternal mortality rates have also dropped.

Part of the success of this push to provide better health services relies on making sure that newborns are registered at birth. In decades past, most babies were undocumented, especially in rural outposts. But today, every newborn born at an urban hospital or health center is given a Certificate of Live Birth and a DNI card right after delivery. The mother’s thumbprint is linked to her child and an 8-digit identification number is digitally assigned. Newborns born into families whose parents qualify for assistance are automatically registered with SIS.

Now, 80 percent of Peru’s population of about 31 million people have health insurance and the country’s Ministry of Health expects the country to reach universal coverage by 2021. To administer an efficient insurance program, a robust identification system is key. Official IDs help ensure that those receiving the medical care are those for whom premiums have been paid.

For Miluska, the last couple of years have changed her life. After getting health insurance from SIS, Miluska took her daughter to a local hospital last January for the operation. Two months later, the implant was activated. Miluska recalled a flurry of emotions as she watched her daughter turn her head from side to side when the implant was turned on. Initially, she said, Pierina was spooked by even the smallest of noises, but when Miluska spoke to her daughter something suddenly changed.

© Daniel Silva Yoshisato

“She looked at me,” Miluska said. “I knew she had heard my voice. I knew in her eyes that she had heard.”

Since the procedure, life has changed dramatically for Pierina as well. Before, Miluska said her daughter used to lie in the fetal position, her eyes vacant. She wore diapers and seemed lost and scared. “I couldn’t understand her and she would get so frustrated,” Miluska said. “I felt bad that I could not communicate with my own child.”

© Daniel Silva Yoshisato

The routine is now vastly different. Every morning, Pierina goes to the local school in a classroom with other Peruvian schoolchildren. Twice weekly, she works one on one with a specialist at the Peruvian Center for Hearing, Language and Learning. Miluska says her daughter never misses a lesson, and that her entire demeanor has been transformed. “The implant has been a blessing,” she said.

“She is happy and excited,” Miluska said about her daughter. “She loves her school. She loves learning. She is a totally different girl.”


Some 1.1 billion people in the world don’t have an official proof of identity, which greatly limits their ability to access services and benefits, such as education or health. With digital technologies, countries now have the power to efficiently change that. The World Bank’s Identification for Development (ID4D) initiative is documenting — through the #EveryID has a story campaign — how official IDs have a transformative effect on people’s lives.

Read more World Bank blogs.

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