Photo: New York Times retrieved

Public health in Venezuela is built on three pilars: the social security institute (IVSS), the Health Ministry’s hospitals and the mostly Cuban-ran Barrio Adentro outpatient clinic network. Together, they accounted for about 82% of all medical care in Venezuela in 2011. Today, all are in a state of near-total disrepair: yet faced with official denial, it’s falling to private NGOs to call a Complex Humanitarian Emergency a spade.

Even as far back 2015, the public network had lost around 40% of its hospitalization capacity and patient consultations had fallen almost 60%. The mind reels at what the numbers would look like if we had more recent data.

More narrowly, some newer data is available. The Barrio Adentro Network, consistently cited as one of the biggest achievements of the chavista regime, only received little more than 200,000 patients in 2017, compared to the 5,5 millions of 2011, a staggering 96% drop.

Public hospitals can’t guarantee the minimum hygiene conditions needed to prevent, or treat, nosocomial infections, as evidenced by how, between 2016 and 2018, 112 children died in Caracas’ Maternidad Santa Ana, with other 147 deaths in Barquisimeto’s Agustin Zubliaga Pediatric Hospital. Since 2017, 12 other kids died in Caracas’ JM de los Ríos Children’s Hospital.

All of them from hospital-acquired infections.

It’s even worse for especially vulnerable groups: The number of psychiatric patients treated in public hospitals dropped from 23,000 in 2013, to just 3,500 in 2018. By 2016, 63% of all psychiatric patients couldn’t find their medication in pharmacies. This data coincides with the rise of suicides in the country.

One of the most shocking aspects of the crisis is the Health Ministry’s determination to hide all data needed to measure its real impact.

Other groups of neglected patients include those with chronic and genetic conditions, like hemophilia, Parkinson’s disease and different forms of sclerosis. This group used to get their high-cost medicines for free through pharmacies in public hospitals, but since imports were cut in 2016, most stopped receiving treatment altogether and many have already died. Only four public radiotherapy units remain functional in the country and chemotherapy is increasingly hard to find in private centers (they’re completely gone from public ones), leaving over 140,000 cancer patients with no options of treatment. Death tolls among HIV+ patients rose from 1,800 in 2014, to some 5,000 in 2017 and 2018, after antiretroviral therapy became extremely rare. Patients receiving dialysis therapy have also been hit, with 2,500 out of 15,000 dying between 2017 and 2018.

Still, one of the most shocking aspects of the crisis is the Health Ministry’s determination to hide all data needed to measure its real impact.

That’s why a group of Venezuelan NGOs decided to create the National Report on the Right to Health Emergency, a detailed account on the destruction of healthcare in Venezuela, and the causes behind it.

The report is unprecedented for the wide range of activists involved (jointly elaborated by 12 NGOs helping patients with many different diseases, from HIV/AIDS to breast cancer) and, second, because it’s the first to label the Venezuelan condition as a Complex Humanitarian Emergency (CHE).

The United Nations defines a CHE as “a humanitarian crisis in a country, region, or society where there is total or considerable breakdown of authority resulting from internal or external conflict and which requires an international response that goes beyond the mandate or capacity of any single and/or ongoing UN country program.” One key aspect here is that, although CHEs can be triggered by natural disasters, their real cause is human, usually political, and can’t be addressed by humanitarian aid alone.

Venezuela may not be suffering a civil war, but the economic mayhem has destroyed the country’s health network to such a great extent, that it makes no difference.

The Venezuelan health system can’t even deal with heart attacks, the first cause of death in Venezuela and the world. While most countries take leaps reducing mortality there, 92% of Venezuelan hospitals lack medicines as common as aspirin, and 39% can’t even diagnose an infarction without ECG devices.

Infectious diseases have re-emerged in never seen numbers, becoming the worst public health problem in the country: 406,000 cases of malaria in 2017 and over 700,000 expected this year, 1,217 confirmed cases of diphtheria, 5,332 cases of measles until this August and a 67% increase in tuberculosis cases between 2011 and 2017, when the diseases affected 10,952 patients, all highlight the destruction of vaccination and epidemiologic vigilance programs.

Venezuela may not be suffering a civil war, but the economic mayhem has destroyed the country’s health network to such a great extent, that it makes no difference.

The Right to Health Emergency report is remarkable because, unlike most documents from the World Health Organization, the Pan-American Health Organization (WHO/PAHO) and other previous works by Venezuelan NGOs, it not only shows how bad the numbers are, it also paints a detailed portrait of the collapsed system behind them.

It details, for instance, how Venezuela’s health expenditure is just 1,5% of the GDP, the lowest in the continent and well below the regional average of 3,7%. That’s less than half the expense of 2000 when, according to the World Bank, it was a 4,4%. Reduction has been possible by increasing out-of-pocket expenses to a record-high 64%, easily confirmed by visiting any hospital and seeing how all medicine is bought by patients or their families, something increasingly harder as hyperinflation accelerates.

Talk about a caring government.

Something to understand here is the country’s dependence on imports: by 2010, 95% of all drugs sold in the Venezuelan market were imported and funded through government debt. The few companies producing drugs in Venezuela imported about 98% of the raw materials needed; between 2012 and 2016, long before U.S. individual sanctions were a thing, Venezuela reduced health-related imports in almost 70%, designing no backup plan and leaving a millionaire debt to both domestic and international pharmaceutical companies. The sudden cut on imports not only affected pharmaceutical companies, it virtually stopped the arrival of reagents for laboratories and critical equipment such as medical monitors, X-ray machines and CAT or MRI scans, as well as the spare parts needed to repair those already here.

Tellingly, Venezuela increased its military imports by 19% in 2017.

The collapse of health in Venezuela is not casual and could’ve been avoided, if the government had wanted to. Instead, it decided to ignore it and let it escalate to a point where it can no longer be tackled without help from the international community. The fact that it still minimizes its scale and keeps hiding epidemiologic data only proves its little interest in changing the current situation, making this kind of reports even more valuable.

The full report is available in Spanish and English.

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  1. The report is comprehensive and detailed as to the failure of our govt to meet even the minimal health care demands of the population , before the health care system was semifunctioal but now we are experiencing a total collapse one which results in the unecessary loss of thousands of lives each year , the cause is clear , the government has failed to manage the health care system because it relied not on any organizational capacity or expertise to handle the area and simply dealt with it by flooding it with resources which our oil income provided , once the latter started to fall , the resources werent there to meet the demand and now we have the sorry situation described above. Moreover the deficiencies of the health system cant even be addressed in any rational manner because the regime must deny their very existence so as not to lose face politically ……., if the health system was run professionally by professional managers and the govt had only to provide the funds that a public health insure system could not provide then giving the management of the system to incompetent and corrupt political appointees would be avoided and the public health system even if flawed would be able to function much more effectively , many lives would be saved . Why is it that we have to give the running of the public health system to the govt , why not create an independent authority made up of people with proben expertise in the matter to run the system without the corruption skewed interests and clientelism which is rampant in systems where authority is granted to political headman usually totally ignorant of the systems they are appointed to run ……Couldnt we create a metapolitical system of functions where the political element of governance was taken out of the equation and left only with a general funding function (to the extent they could not be provided with their own income streams) and the monitoring of the proffesionals performance from a public perception perspective ??

  2. That’s the crowning accomplishment of chavismo, what Mr. Gabaldon has vividly and accurately described. Death for the weakest, least fortunate, and least connected.

  3. My understanding is that Maduro and co. keep calling the health care debacle fake news, refuse to acknowledge a humanitarian crisis and refuse outside assistance unless they can administrate same (pillaging the medicines and dolling them out as political favors – evil work to be sure). So the question remains, as it seems to with all things Chavista: What to do? By what means can ANYONE force or ever influence change, with healthcare or anything else? My sense of it is that without direct action, which few want, change is basically impossible, which basically saps all discussion save political analysis which itself changes nothing.

    Tis puzzlement, and no wonder why so many Venezuelans either flee for the lack of solutions, or are resigned and depressed.

  4. If you take oil from our economy and just leave what private business is able to contribute there would be no roads no electricity no water supply , no health system practically no higher education nothing to make life livable , you just saw what happened in Puerto Rico , when a big hurricane struck the island , the whole place just broke down and if hadnt been for the help from the continental US (whatever its failings) things would have been much worse looking into the future ……, Now venezuelas oil industry has been crushed by the inefficiency and corruption of the people chavez appointed to run it after he threw out the organization of professionals that the foreign company formed and left as a kind of silent gift for the country. I am close to certain that if Pdvsa had continued to be run the way it was run before Chavez destroyed its professional base ,our situation would not be great but we would be in a much better situation than that we are in now ……. just as the US did at the start of the XX century we have to proffesionalize and depolitize those areas of not for profit public activity which private business interets cannot by themselves alone handle !! and the way to do it is to sever that part of public activity which political appointees are not qualified to handle because their sole credential to running those activities is the political loyalty to those that rose politically to a posiition of maximum authority , why cant many public activities be entrusted to professionally apolitical run institutions that do their job quite separate from those who rise to office thru a partisan political process , Im thinking of the prestigious universities in brittain and the US which are run not to make a profit for those who form part of their life , of the BBC, of the US Army , public opinion is essential to tell those professionals when they are not doing a good job but they dont have to be commercial in order to succesfully accomplish their designated tasks , why cant we depolitize those areas of public life which quite simply are better run by traines career professional elites rathe than by political appointees ??

    • There is a problem with political accountability in petrostates because these governments do not need to rely on taxation of individuals for their existence. Having said that, Venezuela has had a well trained civil service – including people in health at the highest level- but authoritarian demands for political loyalty above all else has set it back.

  5. In different countries non partisan autonomous professionally run funds are created using tax monies (among others) to supply the resources needed by different not for profit institutions to operate and serve certain public functions……, this means that legally the govt puts up the money and some monitoring but its politics cant interfere with the way those puhlic functions are run ……., this is a way of preventing corrupt partisan or political considerations to distort and ruin the performance of not for profit organizations serving the public interest . This is the way offord and cambridge universities operate , in Venezuela until quite recently most of the Catholic Church organizations was run using a fixed contribution from the Venezuelan govt (including church run popular schools and healt care facilities. If you create a system where most public functions are run along these lines you can de politize many public functions and allow them to be run rationally and effectively .


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