18 oct. 2018

Once upon a time there was health in Honduras!

In the middle of the last century several international declarations arose that defended the fundamental rights of the human being, among these basic and fundamental rights, health was indisputable, since this allows us to access more complex rights such as social and political. Health is a social benefit, it behaves as an index of the welfare and balance of the community and the individual. Society must aspire to continuously improve this level of health through energetic actions without distinctions between its individuals and the relationship with the environment; Therefore, this transformation should not be limited only to health or government institutions, since it excludes a large part of the social context. A health reform would require an absolute intromission that seeks to implement health protocols and doctrines according to our social needs, renovation of any obsolete or precarious physical-virtual structure and finally the establishment of new managerial models with funding that guarantees its optimal performance. [Rev Med Hond2004; 72: 110-113]  

In Honduras, a physical, financial and organizational deterioration of the entire national network of health has been observed since the last several decades. In addition, some sectors demand a rapid privatization of the health care service, without evaluating first all the possible edges and scenarios of a national chaotic reality. The rudimentary health network in Honduras does have some competent programs, among these and perhaps my favorite, the Expanded Immunization Program or EPI, which has enormous results, greater national scope and sustainability sponsored by governmental and non-governmental organizations. With a deficient infrastructure in hospitals and health centers, medical-health care that does not offer the quality and coverage required, the imperative need for equitable investment in structure-equipment and the almost null maintenance of these infrastructures since decades are some of the variants that characterize our health network.

The Honduran Ministry of Health has 1,635 public health facilities: 7 national hospitals, 6 regional hospitals, 16 area hospitals, 436 CESAMO (health center with general practitioner and dentist), 1,078 CESAR (rural health center, served by a doctor or a nurse), 74 maternal and child clinics, 3 peripheral emergency clinics (CLIPER) and 15 CEO (dental schools). The IHSS (Honduran Institute of Social Security) has 2 hospitals, 7 peripheral clinics, 1 dental center, 2 medicine and rehabilitation centers and 1 center for elderly care. This represents 10.1 doctors / 10,000 inhabitants, 9.5 hospital beds / 10,000 inhabitants, 0.4 hospital / 100,000 inhabitants, 2.1 units of computerized tomography / 1 million inhabitants and 0.7 radiotherapy units / 1 million inhabitants. Total health expenditure as a percentage of the Gross Domestic Product-GDP is only 8.5% and represents only 11.5% of the Honduran annual budget. The private sector has 1,131 health facilities. [taken from article]  
The Honduran government recently published a legislative decree with the purpose of intervening the national system of health, through the creation of an intervening board subject to submit a quarterly report and focused primarily on correcting the entire health network. 
Every day in the health care centers, a large part of the population is obliged to buy all the supplies and medicines that have been repeatedly depleted [ for example: acetaminophen, antihypertensives, oral hypoglycemic agents, anti-inflammatories, insulin, antibiotics, iodine, cotton, syringes, sheets, set for minor or major surgeries, etc. ], in addition to relying on interns and doctors who are doing their professional practice with goverment, both of them subjected to an enormous work and administrative load [ Where is the professional staff hired for doing this and who actually earn a salary? ] To face constant strikes by doctors, nurses, administrative-care personnel, suffer in the flesh the fruitless protocolization of procedures and standards in hospitals and healthcare centers [ at the emergency room infants killed by diarrhea because they did not get rehydrated inmediately by the student or intern without supervision by the doctor on duty, a complex case in under 5 years old child with complicated pneumonia not full recovered after brief stay at public hospital, too soon discharge and who died in her home 3 days after discharge due to complications, overcrowding in waiting rooms without triage, referrals to another hospital level without meeting the requirements or minimum considerations for transfer, etc. ] and to continue prostrate and hesitant, longing for a better Honduras. 

I applaud all those doctors, nurses and care personnel who with temper and conscience have assimilated this reality without decaying, surpassing themselves by serving with candor, efficiency and humanism to our Honduran population. Together, a better world is possible!

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