HEALTH-COLOMBIA:
Public Hospitals Need Intensive Care

Yadira Ferrer


BOGOTA, (IPS) - Delayed paycheques, ongoing strikes, lack of supplies and patients left waiting for treatment are just some of the elements of the crisis afflicting Colombia's public hospitals, where charges of corruption and poor management are increasingly the norm.

Hospital San Pablo, in the Caribbean coastal city of Cartagena, owes its employees 40 months in back-wages. In that same city, Hospital Universitario began the liquidation process last July, and will ultimately be shut down.

Another university hospital, this time in Barranquilla, also on the northern coast, owes its workers two months' pay. Several of the hospital units, including nuclear medicine, have practically shut their doors.

These public hospitals are supposed to attend to the lower-income segments of the population. In this country of 44 million people, 23 million live on less than two dollars a day, according to the government's National Department of Statistics (DANE).

”The public hospitals don't have the resources to operate because the money (from the government) is left in the hands of the financial intermediaries in the private sector,” union activist Angel Salas, secretary of the National Association of Hospital Workers (ANTHOC), said in comments to IPS.

A source from the National Academy of Medicine, speaking on condition of anonymity, agreed with Salas, and said the intermediaries appropriate resources that are earmarked for treating patients, medical research, and hospital staff wages.

The problematic situation of the hospitals ”is structural, and began in December 1994 with the enactment of Law 100, which created the Integrated Social Security System,” says Salas.

The intent of the law was to make medical coverage universal. Just 24 percent of Colombians had access to medical services, and most of them were workers affiliated with the social security agency run by the state and financed by worker and employer contributions.

Diego Palacio, minister of social protection, admits that the goal of that legislation has not been achieved. According to the most optimistic estimates, the system covers 57 percent of the Colombian population.

But Palacio argues that progress has been made. ”Before the reform, 57 percent of the population did not have access to health services because they had no way to pay for it.”

The unionists say their numbers in this regard are quite different.

ANTHOC calculates that 68 percent of Colombians do not have medical coverage, despite the fact that the government spends 11 percent of gross domestic product (GDP) on health, one of the highest proportions in Latin America, according to the World Health Organisation.

Nonetheless, the people using the health system see some improvements. In remote villages, for example, a mother can take her children to a local health centre for basic medical treatment and obtain medications at a minimal cost.

But when a patient requires attention at a public hospital, the situation is a bit more complicated. In some cases, only emergency patients are treated, because the hospital workers are on strike, demanding their delayed paycheques.

In other cases, the basic materials -- syringes, gauze, sutures etc. -- are not available, there is a shortage of beds, or the medical equipment does not work due to lack of maintenance.

With the 1994 law, the government cut back the funds that were to go to the hospitals, and designated private firms -- known as ”health providers” and ”risk management” companies -- to handle the public health budget resources.

These intermediary financial companies owe the hospitals nearly 367 million dollars, a trade union source told IPS.

One result of the crisis is that public health programmes, such as vaccination and illness prevention initiatives, have been weakened, resulting in greater spread of diseases that were previously under control.

Minister Palacio admits the state needs a better oversight system to ensure that the health budget resources (around 1.4 billion dollars a year) are reaching their destination.

And an effort to resolve the problem has begun, but it, too, has its costs.

On Dec. 23, a bidding process was approved to select a company to conduct an audit of the intermediary firms in the health sector. The study will cost an estimated 3.5 million dollars.

According to the Colombian People's Defender (Ombudsman), the problems troubling the hospital sector are not just financial. People who use the system lack adequate information about their rights as patients, says this government agency.