CIPR | Center For Inter-American Policy & Research

Tulane University

Mary Clark researches FMLN health care reform in El Salvador

October 1st, 2013

By: Mary Clark, Associate Professor in Political Science

After a decade of civil war and 20 years of conservative single-party rule, El Salvador‘€™s leftist Farabundo Martí National Liberation Front (FMLN) won its first presidential election in 2009. What concrete difference did this make for people? How did public policy change under this New Left government? My research seeks to answer this question in the area of medical care, specifically for the 70 percent of the population dependent on the services of the Ministry of Health.

On the eve of the election in 2009, the state of public health care had gotten so bad that up to 40 percent of the population had no access to medical services at all. Ravaged by war and decades of underinvestment, the Ministry of Health‘€™s capacity was particularly low in the poorest, rural areas of El Salvador. The FMLN‘€™s Minister of Health, Dr. María Isabel Rodríguez, and her team have attacked this situation by implementing reforms meant to carry out the Pan-American Health Organization‘€™s (PAHO) call for a renewed emphasis on primary care. While in San Salvador, I was invited to two health care forums where the PAHO country director and top ministry officials presented data about the recent reforms. I got to meet Dr. Rodríguez, interview the primary health care team and the director of hospitals, and tour the largest hospital. El Salvador‘€™s health care reforms have an interesting intellectual history. Dr. Rodríguez had worked with PAHO before returning from exile and so was well-versed on international strategies for universalizing health care. Under her guidance, the ministry studied primary care models in Brazil, Paraguay, Cuba, and Spain. The Salvadoran reform combined the best elements of these models along with the FMLN‘€™s own experience in popular health care within its ‘€œliberated‘€ territories during the war. Launched in 2010, the new model sent 481 community health care teams to permanent placements throughout the country starting with the poorest municipalities first.

The ministry hopes that most health problems can be managed and resolved on the primary level. But it has also worked to improve the organization of the hospital referral and counter-referral systems as well as using World Bank loans to renovate and re-equip these facilities. Finally, the most popular measure the ministry has taken was to abolish all required ‘€œvoluntary‘€ charges for using public medical services.

But there is still much to be done. Like most developing countries, El Salvador must continue to fight infant diarrhea and infectious diseases but also treat the chronic conditions associated with modern living: diabetes, cardio-vascular diseases, and cancers. For these non-communicable diseases (NCDs), diagnostics and therapies are often expensive and take place in grossly under-funded hospitals. In the area of cancer care, for example, the Ministry of Health employs a grand total of three medical oncologists, operates a single chemotherapy infusion center, and offers no radiation therapy whatsoever.

The article I am writing based on this summer‘€™s experience compares Salvadoran health care reform to what is written about the social policies of New Left governments. If the FMLN wins the February 2014 presidential elections, I would like to continue to follow the health reforms and gather more information about the management of NCDs.

I want to thank the Stone Center for making this trip possible as well as Colin Crawford and Ludovico Feoli for advice and logistical help.

For Mary Clark’s website, click here

Photograph taken by Arielle Pentes