The collapse of the Venezuelan health system

The Lancet
Apr 07, 2018 Volume 391 Number 10128 p1331-1454
http://www.thelancet.com/journals/lancet/issue/current

Editorial
The collapse of the Venezuelan health system
The Lancet
When Hugo Chavez became Venezuela’s new president in 1998, he promised to provide free health care to all and enshrined this right within Venezuela’s new constitution, rewritten in 1999. Progress was rapid and initial results were promising: according to the World Bank, life expectancy at birth rose from 71·8 to 74·1 years for both genders and infant mortality fell from 26·7 to 14·6 deaths per 1000 live births between 1998 and 2013, the period of Chavez’s rule. Success was recognised on the international stage and Venezuela achieved most of the UN’s Millennium Development Goals set for 2010. This initial success came on a backdrop of high oil prices providing the necessary government funding for public health-care spending and food imports. At the same time, a strong relationship with Cuba saw an agreement in 2003 that, in exchange for low-cost oil, Cuba would provide doctors, medical training, and medical supplies free of charge to Venezuela.

However, when the oil price began to fall in 2008 and Chavez’s revolutionary politics alienated foreign investors, the tide turned. The largest oil reserves in the world could not stave off economic collapse as lower demand for oil, excessive government spending, US sanctions, and price controls led to rocketing inflation and falling gross domestic product. The impact on the health-care system was exacerbated by exchange rate controls, which led to a shortage of the foreign currency needed to import equipment, food, and medicines.

Official government data are hard to come by. The last official report from the Venezuelan Ministry of Health was published in 2016 (Boletin Epidemiologico) and the then Health Minister, Antonieta Corporale, was rewarded by being sacked immediately thereafter by Nicolas Maduro, who has been leading the country since 2013 (Venezuela has had 17 different ministers of health in the past 20 years). The results of this report were highlighted in a Lancet World Report in August, 2017, which noted the untenable situation in Venezuela. This government report revealed a 65% increase in maternal mortality and a 30% increase in infant mortality, with 11 466 infants dying during 2016. It also revealed that while Venezuela had been the first country in the world to eliminate malaria in populated areas, this and other diseases such as diphtheria, which had previously been controlled, had returned in several outbreaks.

Health-care outcomes have continued to deteriorate rapidly. The Venezuelan Government has steadily reduced the share of its annual expenditure dedicated to public health-care spending from a high of 9·1% in 2010 to 5·8% in 2014. Medical supplies have been reported as going missing or getting embargoed and sitting in ports, with some media alleging corruption hindering distribution. Some of these are for treating heart disease and diabetes—the leading causes of death in Venezuela, according to WHO. As a result, patients have resorted to bringing their own surgical instruments, drugs, and food to hospital. In private practice, medical professionals charge in US dollars, which makes health care unaffordable to most of the population.

A recent national survey—Encuesta Nacional de Hospitales 2018 from the political opposition, the National Assembly, and the Venezuelan non-govermental organisation Médicos por la Salud—revealed that Venezuela’s health crisis is worse than anticipated. The survey, conducted between March 1–10, 2018, assessed the performance of 104 public and 33 private hospitals in Venezuela. According to the figures, most laboratory services and hospital nutrition services are only available intermittently or are completely inoperative. Shortages of items such as basic medicines, catheters, surgical supplies, and infant formula are highlighted in the survey; 14% of intensive care units have been shut down because they are unable to operate and 79% of the facilities analysed have no water at all.

Venezuela’s Government has allowed the country’s infrastructure to crumble, with fatal consequences for ordinary Venezuelans. Without regular reports on basic health indicators, assessment of the impact of the crisis is difficult. However, the Encuesta Nacional de Hospitales 2018 survey shows a shocking decline in health-care performance and a failure of the system. Aware of this humanitarian crisis, as declared by the political opposition in 2017, worldwide humanitarian aid has been offered by multiple countries and the UN. Yet Venezuela’s Government has refused this humanitarian aid, denying the existence of a crisis. It is time to end the abuse of power by the Venezuelan Government, and take immediate steps to address the heavy toll on the wellbeing of Venezuelans.