non-communicable diseases in El SalvadorEl Salvador has experienced rampant public health problems for generations and has recently made commendable successes in addressing these problems. However, non-communicable diseases in El Salvador continue to be stubborn roadblocks that cost many citizens their health and their lives.

Non-Communicable Diseases (NCDs) in El Salvador

Non-communicable diseases are those that cannot be directly spread from one person to another such as Alzheimer’s, cancer and diabetes. Like the rest of the world, NCDs are a leading cause of early death among the adult population in El Salvador. Estimates show about 71% of all global deaths result from NCDs, the majority of which come from low-and middle-income countries. During the 2011–2015 period, in El Salvador, one of the most impoverished and most dangerous countries in Latin America, cardiovascular disease accounted for some 12% of deaths. Chronic kidney disease followed at 6.3% and cancer at 5.4%.

Many of the factors leading to high death rates from non-communicable diseases in El Salvador are lifestyle-related. Sedentary lifestyles, smoking and poor nutritional choices all contribute to NCDs such as diabetes and cardiovascular disease. Poor nutrition is common in many low-and middle-income countries. A health survey among El Salvadorians found almost 94% of citizens consumed too few fruits and vegetables and almost as many consumed an excess of sugary beverages. With this information, it is no surprise the survey also found relatively high rates of overweight and obese adults. Obesity is synonymous with NCDs. Furthermore, chronic kidney disease is particularly prevalent among El Salvadorian adults. This results from excessive use of anti-inflammatory medication, inadequate hydration and exposure to agrochemicals in the workplace.

Previous Healthcare Efforts

Public health problems are nothing new to El Salvador. The Ministry of Health has been ramping up efforts to address these problems since 2009. Some of the main concerns in the past have been the fragmentation of the health sector and high rates of uninsured citizens. In 2009, the Ministry of Health implemented a National Health Strategy to correct these issues. Throughout this program, increasing equity of access to health services, improving the quality of these services and strengthening the monitoring and oversight capacity of the Ministry of Health have been top priorities. In order to accomplish these goals, El Salvador increased its public health expenditure by 33.7% from 2009 to 2019. The country also increased the amount of these expenditures allocated to the public health sector by 8%.

Many of these efforts have paid off, albeit modestly. Because of the National Health Strategy, more public health services have reached impoverished and remote citizens in El Salvador. Expanding access to healthcare has had a positive effect on the country’s economic outlook. The income-poverty rate decreased from 46.4% in 2008 to less than 34.8% in 2013 and extreme poverty dropped from 15.4% to 9.1% in the same period. Furthermore, El Salvador’s Gini coefficient (measure of income inequality) decreased from 0.47 in 2009 to 0.41 in 2013, in large part due to public service equity efforts such as those executed by the Ministry of Health.

Non-Communicable Disease Efforts

Even with all this progress, the problem of non-communicable diseases in El Salvador remains. Non-communicable diseases account for more than 65% of all deaths in the country. Therefore, the Ministry of Health teamed up with the World Bank and Access Accelerated in 2018. The two wanted to specifically fight NCDs through the project El Salvador Addressing Non-Communicable Diseases. This project focuses specifically on improving the prevention, detection and treatment of cervical cancer as well as the prevention of common NCD risk factors. In fighting cervical cancer, El Salvador received more than 86,000 HPV screening tests and almost 30,000 doses of HPV vaccines. Both prevent cervical cancer by taking early action.

Besides cervical cancer, the program works to fight other non-communicable diseases in El Salvador. It accomplishes this by training healthcare workers, providing workshops on nutrition and expanding access to mental health resources. The arrival of COVID-19 has disrupted some of these programs. However, it also forced organizers to rethink how to properly deliver care in continuation of their public health efforts. New methods have included providing health education through social networks, improving the delivery of medication, increasing the use of telehealth and making home dialysis available for chronic kidney disease patients. These approaches to healthcare spurred by COVID-19 will likely live on in the post-pandemic world. Many changes like switching to telehealth are increasingly popular, both in El Salvador and around the world.

The Road Ahead

As in most other nations, non-communicable diseases in El Salvador weigh heavily on the population. However, El Salvador has proven during the past decade that improving access to healthcare for impoverished citizens, treating NCDs proactively through preventative measures and championing new flexible ways of delivering healthcare are positive steps any country can take to make an impact on national public health. Though researchers will not know the full effects of recent programs for some time, early results are promising. Physicians are administering more HPV tests and vaccines, more public health services are reaching low-income citizens and pandemic-era practicalities are proving so popular that they will likely be hallmarks of global healthcare in the years to come.

Calvin Melloh
Photo: Flickr

Healthcare in Gabon
Gabon, a country of around 2 million people located in western Central Africa, shows how a universal healthcare system can succeed. The relatively recent improvement in healthcare in Gabon provides a roadmap for other countries. Furthermore, Gabon highlights which areas of healthcare could use improvement and how best to go about enhancing it.

The Good

Gabon’s national healthcare system, Caisse Nationale d’Assurance Maladie et de Garantie Sociale (CNAMGS), emerged in 2008. In its infancy, the program provided healthcare coverage to students, the poor and the elderly. Since then, it has extended coverage to public-sector workers in 2011 and private-sector workers in 2013. As early as 2011, 417,118 of the 546,125 eligible poor residents of Gabon signed up for the program.

Many typically consider healthcare in Gabon above-average for West Africa in both access and effectiveness. For instance, Gabon has a high healthcare center density and a below-average adult mortality rate from non-communicable diseases.

Gabon employs a novel and effective system to help finance its expansive healthcare coverage: levies on mobile phone companies and on money transfers outside of the country. This system is an incredible success, according to Dr. Inoua Aboubacar, a World Health Organization public health specialist located in Gabon. Overall resources for CNAMGS quadrupled from 2008 to 2011, increasing from 12.5 billion CFA to over 47 billion CFA (nearly $8.5 million). Around 17.5 billion CFA came from these levies.

Launched in 2010, the National Health Strategy now provides 100% covered maternal healthcare in Gabon. The program covers approximately 85% of healthcare costs in other areas as well. Out-of-pocket copays cover any additional costs. Nevertheless, maternal mortality rates remain worrisome, with 261 deaths per 100,000 live births as of 2015.

Universal healthcare was achieved in Gabon in only 10 years, quicker than developed countries such as South Korea, where it took 12 years.

What Needs Improvement

Healthcare in Gabon, while successful in many ways, lacks the national spending that it deserves. Healthcare spending only accounts for 3.44% of the country’s total GDP, which is the lower than Gabon’s neighbors of Cameroon, Equatorial Guinea, the Democratic Republic of the Congo, Republic of Congo and Chad. Although Gabon has the classification of an upper-middle-income country, it still spends less on healthcare than many comparable countries.

HIV/AIDS is a major problem in Gabon. An estimated 3.8% of adults live with the disease in Gabon, which makes it the 14th worst affected country in the world. However, the effects of the disease are diminishing. In 2017, the Gabon Ministry of Health launched a program to raise awareness and understanding of HIV through various campaigns and events in high schools.

Out-of-pocket spending for the people of Gabon is still higher than ideal. In the country, one can attribute 21.87% of healthcare expenditures to out-of-pocket spending, which is higher than in most economically similar countries in the region.

Healthcare in Gabon is a success by most standards, especially in comparison with other countries in Africa. It is far from perfect, though, and improvements must continue in the future. Still, Gabon’s quick and targeted approach should be a model for other countries seeking to improve healthcare programs of their own.

– Evan Kuo
Photo: Department of Defense