A family from Colon, Honduras traveled for eight hours by bus to arrive at the Ruth Paz hospital in San Pedro Sula, to have their five-year-old daughter examined for heart issues. The family is one of many who travel great distances to be seen by the staff at Ruth Paz Foundation Hospital. Photo: Francesca Volpi for Direct Relief Aid Organization
Carmen Madrid of the People’s Health Movement in Honduras talks about how the healthcare system was wrecked by the 12-year rule of the National Party and how it can be revived
Xiomara Castro will be sworn in as the first female president of Honduras on January 27. Her electoral victory on November 28 broke the 12-year rule of the conservative National Party, which came to power through a coup in 2009. The rule of the National Party was characterized by corruption, criminal activities, and the systematic erosion of the public sector. The result was an unprecedented rise in poverty and extreme poverty, the largest wave of migration out of the country, and the denial of basic human rights like healthcare, housing, and education.
The National Party’s rule hit Honduras’ public healthcare system particularly hard. In addition to massive budget cuts, the sector witnessed several massive corruption scandals, with millions of dollars siphoned into the pockets of elected officials and away from the Honduran people.
In order to understand the state of the Honduran healthcare system and the perspectives for change with the incoming government of the Libre Party, Peoples Health Dispatch spoke to Carmen Madrid of the Regional Committee of the People’s Health Movement and the Citizen Alliance for Health in Honduras. Madrid is also active in fighting for women’s rights on a regional and national level, which is an integral part of the fight for healthcare and dignity.
Peoples Health Dispatch: Can you talk about the healthcare system in Honduras? What is the reality of access to healthcare for the population?
Carmen Madrid: Well, first of all it is a weak system, mostly because of budgetary issues. Health has not been the priority of the last governments. For example, if we look at data from 2017, if I remember correctly, the health budget was more or less 14% of the budget and right now, it is about 10%. So, instead of an increase, we actually saw a decrease of the healthcare budget. The investment in infrastructure, personnel, and medicines is very low.
Then there is the issue of corruption, not only in the Ministry of Health, but also in the Honduran Institute of Social Security, where there was a mass embezzlement of the funds. This does not allow the population in general, whether they receive care from the National Health System or the Institute of Social Security, to receive the care they require.
There is also the fact that the national health policy pays little attention to primary care and prevention. For people with diseases like kidney ailments, cancer and HIV, there has always been systematic neglect, but now because of the COVID-19 pandemic, the whole population in need of continuous care is left much more unprotected and vulnerable. There has been almost no care for this section. Some health centers completely stopped treating other diseases during the pandemic and completely suspended other services needed by the population, and these patients did not receive the attention that was required.
For example, there are very few specialized dialysis centers in the country. This makes accessing treatment much more difficult for people who need this kind of care. In the western part of the country, there is only one center that can provide dialysis. Most people have to travel a significant distance to even receive care, and the clinic is not even free.
We have a system that is seriously lacking. It lacks human resources and necessary equipment to provide better care to patients, and training to healthcare workers. We also need more healthcare centers in order to be able to provide care and have prevention programs.
That is more or less the general evaluation of the system, but there are many expectations at this moment in light of the recent elections. We are lucky that Xiomara was elected and obviously the expectations are high on the part of the union movements, of the peasant and workers movements, of the whole population in general.
We also know that the new government is not going to have it easy. They will face many complex situations due to the composition of the Congress, particularly in the case of the repeal of some key laws, which will require a qualified majority. They are going to have to work very hard.
PHD: Beyond the slashing of the budget, what were some of the other ways the National Party rule weakened the healthcare sector?
CM: One of the initiatives of the National Party was the “Code Green” hiring program, wherein personnel were hired for public hospitals and health centers. In practice, it often resulted in their party activists being hired. This used to help them with elections, so political activists of the National Party would give people jobs in public healthcare institutions, but this wouldn’t boost the healthcare system’s capacities: it actually reduced the capacity of the hospitals and health centers to be able to provide care, even beyond the limitations already imposed by the budget.
These political activists were not hired in wards that needed staff and where people really needed care. So when the pandemic hit, workers in the wards that remained understaffed were already facing an overload, and then COVID-19 made everything even worse. On top of that, many healthcare workers have not been paid and are still fighting for their salaries.
And then the fact that the healthcare system was overwhelmed has been used as an excuse to outsource some of the services to private companies. This is where the contentious Social Protection Framework Law came in and offered the possibility for third party contractors to provide the service because the Health Secretary of Honduras does not have the capacity to do so. But the reality is not that it does not have the capacity to do so, but rather that the budget is not allocated according to the needs.
And in this subcontracting process, there were many responsibilities and services contracts given to companies that did not have experience in healthcare management and administration, which further contributed to weakening the system and the care deficit.
PHD: What has happened regarding corruption in the healthcare system?
CM: In 2015, several serious corruption cases came to light in the sector which saw not only the criminal embezzlement of funds that should have been used for the health of the people, but also caused deaths.
The case of the flour pills is one of the most emblematic examples. The Ministry of Health had purchased overpriced adulterated pills from a company owned by the family of Congresswoman and vice-president of the National Congress Lena Gutiérrez (National Party). Despite the fact that people died due to these pills, Gutiérrez was only made to pay a fine and was released. She did not even lose her position in the National Congress.
This is only one of the examples where crimes against the Honduran population have gone unpunished. We saw the same thing in the case of the embezzlement at the Honduran Institute of Social Security (IHSS) during the government of Porfirio Lobo Sosa of the National Party. At least USD$200 million was embezzled from this institute, which is supposed to guarantee health care to the Honduran population. In this case, there was also no real justice process. Two or three people were arrested and they are allegedly still being investigated.
PHD: What has been the impact of the last 12 years on women in Honduras and their right to healthcare and a dignified life?
CM: Women are often denied proper care. Especially when we look at the last two years, due to the pandemic, women were confronted with the issue of violence in their homes even more than before, and they often could not even go to a health center or elsewhere, for example, to receive care or file a complaint.
However, even in the event that a complaint is filed, many times, there is no response or there is a negative response. In Honduras, around 94% of cases go unpunished. So the response of women in general has been to say, “why am I going to report if I am not going to receive a response to my complaint or, worse, why am I going to report if tomorrow the man walks free and I can even die [at his hands].” The situation is quite complicated in this sense, because there is little financial or training support for those that are in charge of the justice process and in the end, women do not feel supported to file a complaint.
Beyond the situation of the pandemic, the reality is that we do not have sufficient specialized courts to address all the complaints. Those that do exist often do not know either the national nor the international legislation that could be applied in some cases. It is a pressing task for the government to train competent personnel to do this work. As civil society organizations, we also provide support with this training.
As feminist organizations, we also stood up to the implementation of the new Penal Code, which came into force in May 2020, because it contemplates a reduction of penalties. The Code actually pursues a reduction of penalties by almost a half or a third in cases of harassment, rape or violence against children.
There are also few women’s organizations in the country. At the national level, there are only 10 shelters for women who suffer from gender violence, and none of them are financed 100% by the government. They are mostly organized by civil society organizations that seek funding through other sources, and therefore they have very little support from the state.
PD: What proposals have been put forth by movements to improve healthcare in the country?
CM: Some civil society organizations and unions at the national level launched an initiative for the framing of a national health law. There is already a first draft, which proposes elements such as a better budget and expanding care capacities so that both the urban and rural populations have access. Today over 70% of the Honduran population lives below the poverty line, and that obviously has repercussions on their health and their ability to handle any out-of-pocket expenses, including transportation.
During the last 12 years, as social movements, we have had significant challenges in getting our demands heard in Honduras, not least because of the formal limitations on popular mobilization. For example, the new Penal Code effectively limited participation in mass struggle. Through this and other measures, fear has been induced among the population when it comes to participating in organizations and protests, even if most people do not agree with the laws and with the measures that are being taken.
PD: What is at stake with the new government taking office?
CM: We had 12 years of a government with a high level of corruption and a high level of impunity because they had control of all three sectors of power: the judiciary, the legislature and the executive. With this absolute control, they believed that nothing could happen to them, whatever they did.
This has translated to very poor quality health services for the Honduran people. As I said, there have been deaths as a result of corruption and to this day, those guilty in these cases have gone unpunished. Even when we look at the embezzlement that happened during the pandemic in the case of mobile hospitals, it is not clear how many millions were stolen.
I believe that several years will go by in which we will be talking about all the rottenness caused by the National Party government. And these years are not going to be easy. The new government wants to dismantle everything, the whole network of corruption, everything that has been part of the corruption of this government, and that is not easy at all.
But we have hope that as different sectors, we are going to support this. We are going to work and we are going to try out best with the new government so that some of these issues can be resolved.
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