Download CISPES 2012 Medical Brigade Report

CISPES 2012
Medical Brigade
Report Back
9/30/12 Democracy Center, Cambridge, MA
Historical and Political
Context
From Government Repression to
Government Led Universal Health Care
Presented by: Van Hardy
1st CISPES Medical Brigade- August 2012
The War: 1980-1992
State Terrorism
The Resistance
Rebuilding Community
Principles and Vision
of the 2010
Health Care Reform
Presented by Carly
2001
2006
● Ever since 2001, when their ● Almost half (47%) of the
attempt to privatize
healthcare was defeated,
the right-wing increased
their efforts to restrict, and
cut off, access to
healthcare…the
government had a
deliberate attitude to
restrict services to the
population.”
-Roger Blandino Nerio,
FMLN Political Commission
population was outside any
health system.
2009 – 2010
"Constructing Hope"
- At his inauguration in June 2009, Mauricio
Funes announced that all costs at the public
health clinics would be eliminated.
- The reform includes essential PUBLIC HEALTH
functions that will enhance the long-term health
of the Salvadoran population.
3 Pillars of Healthcare Reform
- Social Participation
- Inter-Institutional Work
- Equality/Equal Access
“…we’re really interested in organizing the population
to be participants in their own health outcomes.”
- Dra Violeta Menjivar, Vice-Minister of Health
Major Changes
● Based on the Cuban Model
● Community-oriented primary care
○ Epidemiology
○ Preventive medicine
○ Health promotion
● Systematized follow-up care
● No charges for visits or medications
8 Central Ideas of Healthcare
Reform
1. Comprehensive & Integrated Health Services
Networks
2. National Emergency Medical System
3. Medicine & Vaccines
4. National Health Institute
5. National Health Forum
6. Inter-/Intra-Institutional Work
7. Strategic Planning & Information System
8. Professional Development
1. Comprehensive & Integrated
Health Services Networks
3-Tier System
1st Level: primary care by community health teams
-460 ECOS in 153 municipalities
2nd Level: basic hospitals
-11 municipal, 14 departmental, 2 regional hospitals
3rd Level: specialized national hospitals
-Maternity Hospital, Pediatric Hospital, and Rosales
General Hospital in San Salvador
1st Level: Community Health Teams
ECOS - Equipo Communitario de Salud
(Familiares or Especializados)
- Basic & intermediate health services provided by local
teams of health workers
- 1 doctor, 1 nurse, 1 nurse assistant, 3 health promoters, 1
“jack of all trades”
- ECOS work in family health clinics and specialized clinics
- Rural community health clinics service about 600 families
(~3000 people)
- Each healthcare promoter is responsible for about 200 families
within a specific geographic region
- 9 clinics per rural area
st
1 Level: ECOS
- Patients can visit the clinic if they are having a
problem and have scheduled routine check-ups
according to a risk classification system
- When ECOS are launched, each promoter conducts a
“census” of their assigned families to assess risk factors
and current health status
- ECOS conduct house visits to assess conditions and
check on higher risk patients
- ECOS use family charts to assess risk levels,
describe protocol/treatment plans, and track
progress
Other Components of ECOS
Community Health Committees
- Community members working with the ECOS and MINSAL to
improve the services and overall health of their own communities
based on real needs
“To transform the reality of their communities”
Other Components of ECOS
Health Clubs
- Adolescents, pregnant women, chronically ill, elderly
- Healthcare promotion can be accomplished through these
groups with targeted messages
Health Care Reform
in Action
Touring the clinics, accompanying health
promoters, and presenting workshops
Presented by Rachel
San Salvador: Hospitals and
Unionized Hospital Workers
● Maternity Hospital
● SithBloom Workers
from the Children's
Hospital
● Community Mental
Health Presentation
SithBloom Workers
Fought against the privatization of health care, which still looms as
a threat.
Community Mental Health through
Art Therapy
● Community Mental Health Team comprised
of: social worker, psychologist, psychiatrist,
and visual artist
● Distrito Italia is North of San Salvador and
has serious gang problems
● Conducted needs assessment
○ Violence
○ Sale of liquor to underage kids
○ Waste treatment plant not processing
● Group therapy with art projects
● Community mental health work- murals
Health Promoters
Workshops:
Community Engagement
● Infant nutrition
● Healthy
Relationships for
teenagers
● Cervical Cancer
Prevention
● Family Planning for
Pregnant Women
● Healthy Aging for
Elders
Infant Nutrition Workshop
Healthy Relationship Workshop for Teens
Teenage pregnancy is identified as a major problem in the country.
The Vice-Minister of Health told us that a national sexual education
campaign will be kicking off this year.
Cervical Cancer Prevention Workshop
Talk emphasized the importance of getting a pap smear. The
presenters passed around a speculum!
Family Planning Workshop
Distributed free condoms. Eventually people discreetly took some.
Healthy Aging Workshop
House for Expectant Mothers
● Partnership
between Korean
and Salvadoran
Government
● Purpose: to reduce
maternal mortality
rate
● Policies outlawing
midwifery
Press Conference
Solidarity work in action to support El Salvador's self-determination.
Health Reform:
Accomplishments and
Challenges
Presented by Carol Pryor
El Salvador Faces
Tremendous Problems
●
●
●
●
More than 1/3 of population below poverty line
One of world's highest homicide rates
Lowest rate of tax collection in the world
Remittances from the US = 17% of GDP
● Which makes the effort to reform the health system
more inspiring!
ECOs
● Over 400 ECOs in 140 of 262 municipalities
● Increased primary care staffing by more than 2500
since 2009
Hospitals
● Constructed and equipped 4 new hospitals
● Increased hospital staffing by more than 1500
● Started construction of new National Maternity Hospital
○ Completion expected Q4 2013
Improvements in Maternal
and Child Health
● 2006-11: Reduction in maternal mortality from 71 to
50/100,000 births
● 2008-2011: Percentage of women receiving postnatal
checkup increased from
49% to 82%
Increased Resources Devoted to
Health Care and Public Health
● Share of GDP devoted to health increased from 1.9% of
GDP in 2008 to 2.4% in 2012
● Budget for medications and vaccinations in 2012
increased by more than 50% since 2008
Other Improvements
●
●
●
●
Coordination of networks
Coordination of national emergency system
Inter- and intrasectoral work
Professional development
What Remains to Be Done
● Expand primary care clinics throughout the country
● Continue improvements in maternal and child health
○ 30% of births to women between the ages of
12 and 19
What Remains to Be Done
● Educate doctors in new system, reduce staff turnover
● Increase available resources
The Future of Health Care
Reform in El Salvador
Presented by Carol Pryor
The 2014 Presidential Elections
in El Salvador
● ARENA gained seats in last legislative election
● FMLN lost seats in urban areas, where reforms not as
fully implemented
● FMLN will run its own candidate
● If FMLN loses, many of the health reforms may be rolled
back
The US in El Salvador
● Support for continuation of War on Drugs
● Pressed Funes government to make changes in the
Security Cabinet
The US in El Salvador
● Support for privatization initiatives
● Intervention of US senators in Salvadoran Constitutional
Crisis
Our Role
● Support fair elections in El Salvador
● Ensure that the US does not intervene
● Let Salvadorans decide their own future