Venezuela's Health Sector: Current Crisis and Opportunities for International Engagement

International assistance, along with the implementation of health and social sector reforms developed by Venezuelans, themselves, will be required to alleviate the shortages of medicines and medical supplies, failing public health infrastructure, and chronic food insecurity currently afflicting the Venezuelan population, according to two speakers at a December 14 event hosted by the CSIS Global Health Policy Center and Americas Program. The situation is driven in large part by the government's dependency on unstable oil revenues to fund social programs; highly centralized and politicized administrative practices; poor training for health care providers serving low-income areas; protracted political stalemate between President Nicolás Maduro and the Venezuelan opposition; and the failure of the Maduro regime to acknowledge worsening health and nutrition indicators.

Hermes Florez, professor of medical and public health sciences at the University of Miami and visiting professor at the Universidad del Zulia, in Venezuela, and Marianella Herrera-Cuenca, director of the Venezuelan Health Observatory (OVS) and associate professor at the Universidad Central de Venezuela, provided an overview of the origins, development and likely trajectory of the current health crisis.  

Florez, a physician and expert on aging and chronic diseases, noted that prior to the assumption of the presidency by Hugo Chávez in 1999, Venezuela was making progress on reducing maternal and child mortality, preventing and controlling infectious diseases, and improving equitable access to health care. The 1999 Constitution's provision that it is the right of the people to access health care and the responsibility of the government to provide it inspired Venezuelans across the social spectrum. But the efforts of Chávez's Bolivarian Revolution to improve the access of the poorest populations to health services through the Misión Barrio Adentro (MBA) program created a parallel, and sometimes inferior, program, according to Florez.  Under Barrio Adentro, the government established clinics in rural and impoverished urban areas and frequently staffed them with Cuban doctors, who provided health care in exchange for Cuba's access to Venezuela's oil. Florez noted that the Barrio Adentro clinics not only diverted public funds from other public clinics run by the health ministry, the Ministerio del Poder Popular para la Salud (MPPS), but also created a new category of provider, the médico integral comunitario. Florez observed that these providers offer important primary care services but are frequently not as well trained as médicos-cirujanos, who have traditionally staffed Venezuela's health care facilities. Thus, the poorest Venezuelans may actually be receiving a lower quality of health care than those in the wealthier quintiles. 

With the drop in oil prices over the last two years and renewed commitment to the Bolivarian Revolution under Maduro, who assumed power in 2013, following Chávez's death, government expenditures for health care for the poor, who receive care through MBA and MPPS, now average about $6 per person, compared to $30 for those who have insurance and receive care in the private system, where they benefit from better services. The government has ceased publishing epidemiological data, but, according to Florez, unofficial surveys and field reports indicate a worsening of maternal and child health indicators, rising mortality associated with cancer, diabetes, and cardiovascular disease, some of which can be attributed to the facts that there is a severe shortage of available beds in hospitals at all levels and many essential medicines are not available. 

Several factors help explain the crisis in food security and under-nutrition in Venezuela today, according to Marianella Herrera-Cuenca, a physician and development expert. Herrera-Cuenca noted that until relatively recently, o il-rich Venezuela was a prosperous country, where health experts worried more about obesity than about under-nutrition. But since 1999 the cancellation of school lunch programs, cessation of public programs promoting breastfeeding, and expropriation of private lands for public management have led to diminished food supply for citizens at all ages. Reflecting critically on the Food and Agriculture Organization's recognition of Venezuela's military-run food distribution program, the Comités Locales de Abastecimiento (CLAP), Herrera-Cuenca observed that frequently the distributed food, including corn flour, pasta, and fats, is of low nutritional value and that meat, such as chicken, is spoiled and inedible by the time it actually reaches families in need. Surveys carried out by the OVS, in cooperation with other organizations, show that the number of people reporting they do not earn enough income to feed their families increased from 80.1% in 2014 to 87% in 2015; those who are hospitalized cannot count on receiving three meals a day and must depend on family members to bring them something to eat. 

With no official government statistics upon which to rely, the OVS, Herrera-Cuenca noted, has made its own calculations of infant mortality in Venezuela, and recent assessments indicate an upward trend following a period of relative stability in the mid-2000s.  The group's calculations show an increase in maternal mortality, as well.  Herrera-Cuenca noted that triple threat of poverty, under-nutrition and poor access to health care has negative long-term implications for infants who survive the first few years -- they may be more likely to present with cardiovascular diseases and metabolic disorders later in life.  The reported increase in malaria transmission in a country long recognized for its vector-control and prevention efforts is also cause for concern. 

During the discussion comments focused on the potential role of the Pan American Health Organization and other multilateral agencies in supporting Venezuela, should the government request external assistance, something it has not yet done.  In the meantime, families spend several hours each week waiting in lines to secure access to needed drugs for a relative or to receive an inadequate ration of food, with regular reports of violence associated with food distribution and procurement. Ensuring Venezuelans are informed about their constitutional right to health, understand that the government has ceased to publish epidemiological data, and are aware that the international community is anxious to provide assistance may help generate demand for change and the generation of local solutions. Yet with the International Monetary Fund predicting that inflation will surpass 1600% in 2017, and the ongoing failure of Maduro and his administration to both recognize the challenges and accept external support to facilitate the population's access to essential commodities, the situation is likely to continue to deteriorate for the foreseeable future. 
Katherine E. Bliss
Senior Fellow and Director, Immunizations and Health Systems Resilience, Global Health Policy Center