Healthcare in El Salvador

El Salvador’s healthcare system is a dual system: 1) private, for-profit practice and hospitals that have state-of-the-art technology, no wait times, and easy access to medicines.  Only the wealthy can afford this system (less than 20% of the population); and, 2) the public system – characterized by highly-centralized, ageing, poorly-run facilities, overworked medical staff, and death-inducing wait times.  This is the system that attends to the majority of the population.

 

After its election in 2009, the FMLN government, the first non-military or right wing government in El Salvador’s history, started a series of healthcare reforms to bring medical care closer to communities who need it most.  However, implementation is slow due to the lack of resources and a prior history of low government investment in social prorams.  The first reform was to increase healthcare spending from $299 million to its current level of $600 million.  The Ministry also hired 2,500 new healthcare professionals.  Next, the new government eliminated the not-so-voluntary “voluntary” payment made by patients to access healthcare at public hospitals.  The Ministry of Health then began a series of reforms to focus on primary healthcare, particularly in rural areas where 40% of the population lives.  The flagship of the new integrated health system are the ECCOS (Community-based Family Health Teams), which aim to bring healthcare to communities, rather than require that they seek it out elsewhere.  Teams consist of a doctor, nurse, nursing assistant, health promoter and utility person.  The team serves approximately 200 families, and there are currently 450 ECCOS, serving 1,600,000 in 535 communities.  The teams concentrate on clinic visits in the morning, and house visits by foot or on motorbike in the afternoons.  The program has now run out of money to expand.  To date, there is no ECCO anywhere near Chicuma.

Earlier this year, the legislature finally passed a bill to regulate the cost of medicine.  Salvadoreans currently pay some of the highest costs in the world for prescription medicines – in a country where nearly half of the population lives below the poverty line.  For many years, reform of the system was blocked vehemently by pharmaceutical companies and their political patrons – the ARENA party.

The Vice Presidential Commission for Social Action, which operates with no funds and 100% volunteers, holds Medical Days in several, high risk communities – on average, about two times per year.  A team of up to 22 medical professionals (general medicine, cardiologist, gynecologist, psychologist, dentist, internalist, etc) volunteer in a community, such as Chicuma, for the day and see as many patients as possible – sometimes up to 400 consultations.  The patients are tended in school classrooms.  If needed, patients get a prescription which they can fill, for free, at the makeshift pharmacy. The Commission also works with the community to establish a local health committee to assist with education and minor incidents when no doctor is present.  While laudable, these are stop-gap measures that demonstrate a huge vacuum in the healthcare system, particularly in poor, rural areas.