Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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