Venezuela also tried to implement one of the newer trends in the health care debate before the collapse, a preventive health program. This raises the question: "Was the fall of the Venezuelan health care system the result of its efforts to implement a health system based on preventive care?". I argue that the collapse of the Venezuelan health system was not caused by its decision to implement policies based on preventive medicine or simply the result of an economic crisis.
The economic crisis served as the catalyst that exposed the underlying problems that led to the epic decline of Venezuela's health care system. I argue that one of the primary reasons for Venezuela's inability to develop a more comprehensive health care system was due to its extreme dependence on oil. By combining the analysis of health before the Bolivarian revolution with the adjustments and developments in health after the revolution, I reveal many of the main factors that led to the vulnerability of Venezuela's health system.
The preventive health system I am referring to is primarily in the form of the Barrio Adentro program. The program served as an alternative to the neoliberal policies that were common throughout Latin America and provided an opportunity to test a health system that mirrored that of the Cuban anomaly. In studying the failures of the Venezuelan system, I hope to demonstrate the potential benefits of an increased emphasis on preventive health while uncovering some of the components that allowed the health system to deteriorate so quickly.
A History of Apathy
A key aspect to understanding why Venezuela failed to develop its health care system can be found in its relationship with oil. In the mid-1900s, economists believed that resource wealth would help countries develop quickly as they were able to invest in roads, schools, and other infrastructure (Ross, 2012). This created a series of booms and busts for these countries as they succumbed to the demands of the global economy.
Venezuela quickly became one of the richest countries in Latin America, building its economy around the oil industry. Oil exports allowed Venezuelans to become some of the wealthiest individuals in South America and allowed Venezuela to trade with a large number of countries to meet all of its needs. While this is a worrying trend, it is exacerbated by the policies implemented in Venezuela in the late 1900s and early 2000s.
Unfortunately, Venezuela failed to invest in the necessary institutions that would make these changes sustainable. It wasn't just health care systems and social programs that became fueled by oil. Those working within the Venezuelan healthcare system were also affected by oil dependence.
One of the most important exchanges of goods between the two countries was the exchange of Venezuelan oil for Cuban doctors. This reveals the irony in the joint statement made by Chavez and Castro, because this exchange multiplied the dependence of Venezuela's health care system on oil. The arrival of Cuban doctors provided a false sense of security that allowed the government to continue a low level of investment in the health care sector.
As is the case with many dependency situations, this has left many of the major issues facing the healthcare sector and other aspects of internal development hidden. Instead of trying to create the necessary infrastructure that would have allowed the healthcare sector to develop and become independent, the Venezuelan government has chosen not to implement any of the long-term changes necessary to move away from dependency experienced by the healthcare sector.
A Failed Transition
The revolution was considered a revolution for the people and was a movement against the neoliberal policies that were common throughout Latin America. She installed a new, left-wing government that tried to alleviate many of the problems faced by the poor and create a more equal society. The extreme polarity between the ideals of the Bolivarian Revolution and the previous government played a role in the development of new institutions and programs “developed outside the institutions of the ancien régime” (Gott, 2011).
One of the main reasons that preventive health measures have gained so much attention is that they recognize and work with non-biological factors that affect health. Not only is education a major factor in health outcomes, it is also one of the most accepted long-term pathways to combating poverty and inequality (Psacharopoulos & Woodhall, 1993). Many of these systems require full community participation, which becomes an unrealistic requirement when a large percentage of the population is uneducated.
Cuba has successfully implemented primary health care centers that rely on local involvement to increase community health. This is just another example of the empty rhetoric about health care that highlights the lack of importance placed on the health system. A stark example of the Chavez governments' empty rhetoric toward health care can be found in the percentage of Venezuela's GDP that was directed toward health care.
This is in stark contrast to what was indicated in the Chavez government's rhetoric. After the Bolivarian Revolution, government spending on health care as a percentage of GDP remained among the lowest in Latin America. This appears to be one of the most devastating mistakes that will lead to the future demise of the Venezuelan healthcare system.
Even President Maduro had to acknowledge the seriousness of the crisis and asked the United Nations for help (Brocchetto, 2017). This highlights the importance of studying the aspects of the Bolivarian Revolution that triggered one of the most dramatic breakdowns of the health care system in history.
Misión Barrio Adentro
Allowing individuals to fulfill this role gives a community a sense that they can identify with the members of the health care system. These community health workers were local people who could identify with the problems many community members faced. Compared to the state of the health care system less than a decade earlier, this is an incredible achievement.
However, in July 2007, Douglas León Natera, president of The Venezuela Medical Federation, reported that up to 70% of Barrio Adentro clinics had either been abandoned or left unfinished (Matheus, 2007). Their absence has exposed many of the underlying flaws that have permeated the entire Venezuelan healthcare system. Does the failure of the health system as a whole serve as proof that the early promise of Barrio Adentro was too good to be true.
Once a source of pride for the Bolivarian Revolution, Barrio Adentro serves as an anecdote of the many failures that went into the collapse of Venezuela's health care system. From the beginning Barrio Adentro was created as a system outside the established health systems. Instead of finding a solution to bring together the potential of the new Barrio Adentro program and the medical facility, Chávez used the country's oil wealth to provide a new workforce to run Barrio Adentro.
As the flow of Venezuelan physicians out of the country developed, it went somewhat unnoticed and did not receive much attention (Herriman, 2016). As more Venezuelans left the country and fewer Cuban doctors came to Venezuela, the severity of the situation became increasingly apparent. The initial excitement about Barrio Adentro's potential eventually faded as government support for the expanded program quickly disappeared, causing it to slowly crumble.
In 2006, an unused office building was designated to be converted into a Barrio Adentro clinic that would provide rehabilitation services; however, three years later, the building of the clinic was still unfinished (Cooper, 2015). Barrio Adentro also provides a concrete example of the effects the brain drain has had on various health service programs across the country.
Immunization, DPT (% of children ages 12-23 months)
However, it is also important to understand that the framework emphasizes the importance of the interdependence of each part of the health system. One of the key characteristics identified by WHO for a productive health system is a well-performing health workforce. This is a complicated aspect of Venezuela's health system that has experienced large amounts of turnover.
We affirm total responsibility.” This allowed the government to brand any criticism of the health care system as fake news and made it difficult to make any progress in the health care system. The effects of Venezuela's failure to provide a well-functioning health information system have been compounded by its failure to finance health, another of the six building blocks of a successful health system. People die from preventable causes due to the lack of medical supplies needed to save their lives (Forero, 2015).
The effects of these deficiencies are some of the most visible indicators of health system failure. As previously mentioned, healthcare services require a multidisciplinary approach, and when one aspect of the healthcare system fails, it greatly affects other aspects of the system. A doctor described the work in one of the hospitals in Venezuela as monitoring the death of patients (Dr. Fernández, 2017).
The sum of these failures reveals a disgusting amount of mismanagement and negligence on behalf of the Venezuelan government. Stubborn denial of any flaws in government practices has led to the instability and destruction of the health care system (Garcia-Navarro, 2016). Dramatic government failures to provide health leadership and guidance serve as the source of Venezuela's failure to put nearly all six building blocks in place for a.
Many of the problems plaguing the system had continued to grow and be covered by temporary solutions until the health system reached the point of collapse. This study merely serves to reveal the nature of the collapse and what aspects of Venezuela's health care system are worth maintaining. Barrio Adentro and the reduction of health inequalities in Venezuela: an assessment of the first years.
Journalist's notebook: How a look inside Venezuela's crumbling health care system took me abroad.
