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COVID-19 Vaccination in Dominica

COVID-19 Vaccination in Dominica
In the Caribbean island nation of Dominica, many people are now receiving COVID-19 vaccinations. Through the combined efforts of several world organizations, including the World Health Organization (WHO), the Coalition for Epidemic Preparedness Innovations and the Pan American Health Organization (PAHO), Dominica has received a steady supply of vaccines to help combat COVID-19.

Vaccines from COVAX

As of July 2021, the island of Dominica had seen 194 coronavirus cases and no deaths since the outbreak back in March 2020. As of April 2021, Dominica has received 28,800 doses of the vaccine through the COVAX Mechanism, which it will distribute throughout the country. Dominica is one of the 10 countries in the Americas that have received doses of COVID-19 vaccinations at no cost through COVAX.

“We will continue to work with the country to support vaccination along with the entire package of known public health and social measures that we know can help stop the spread of [COVID-19], protect health services and save lives,” said Dr. Yitades Gebre of the PAHO and WHO in an interview with those organizations.

Campaign for COVID-19 Vaccination in Dominica

As of early July 2021, Dominica has administered nearly 40,000 doses to its population. More than 20,000 people, or around 29% of the population, have received at least one shot, and nearly 20,000 more have received both doses of the vaccine. However, even though the COVID-19 vaccination in Dominica is underway, it will still take some time. Recently, the government has been able to give about 25 doses per day and it is on track to have another 10% of the population fully vaccinated in the next 585 days.

People are still contracting the virus as vaccination levels increase, but the U.S. has deemed Dominica a low-risk country. However, the Dominican government has declared that travelers must submit a negative COVID-19 test 24-72 hours before entering the island. People traveling from Dominica must also submit another negative test before reentering the United States, and the Centers for Disease Control advises that they self-quarantine for seven days upon their arrival.

With the majority of Dominicans still not fully vaccinated, the country’s basic COVID-19 prevention tactics are still in full effect. All residents must continue to socially distance themselves from one another, wear masks at all times in public areas, keep up personal hygiene and self-quarantine if they have contracted the virus or been in contact with someone who has. However, the Dominican government and organizations like the U.N. and PAHO remain hopeful that the pandemic will be under control soon enough on the island.

Economic Support for Pandemic Recovery

Not only have WHO and PAHO helped more Dominican citizens receive COVID-19 vaccination in Dominica, but the World Bank Group has also offered support to help Dominica recover from the pandemic. It has given the Dominican government $25 million in COVID-19 relief to help lay the foundation for long-term economic recovery. As of 2009, Dominica’s poverty rate was about 30%. Funding from the World Bank Group will improve the island’s economy by helping restore stability and jobs as the government works to combat the coronavirus.

– Demetrous Nobles
Photo: Flickr

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The Impact of COVID-19 on Poverty in Argentina 

Impact of COVID-19 on Poverty in Argentina Lionel Messi, captain of the Argentina national football team and one of the highest-paid athletes in the world, fears contracting the coronavirus. His comment comes on the heels of Argentina’s withdrawal from Copa America because of a spike in COVID-19 cases. But, the pandemic has caused more than just football safety concerns. The impact of COVID-19 on poverty in Argentina has been harsh but the country is working to address these effects.

Spiking Cases

As Europe and the United States see a decline in COVID-19 infections, the virus’s new hot spot has become Latin America and the Caribbean. According to the Pan American Health Organization (PAHO), 89% of total COVID-19 deaths in those regions have occurred in Argentina, Brazil, Mexico, Colombia and Peru. As of July 2021, Johns Hopkins University reported that Argentina had seen more than 4.4 million COVID-19 cases and 94,000 deaths. Although lockdown measures remain in place, Argentina’s low vaccination rate presents an obstacle in battling COVID-19. As of July 2021, only around 9% of Argentina’s population is fully vaccinated.

COVID-19 and Poverty Rates

In the late 1990s, Argentina experienced an economic crash that pushed many people into poverty. From 1999 to 2002, the percentage of the population living on less than $5.50 per day rate rose from 28.5% to 49.9%. Over the next few decades, however, this trend saw improvements. Through social programs such as the Universal Child Allowance, a monthly stipend for unemployed parents of children younger than 18, the poverty rate decreased to 12.2% by 2018. However, the pandemic has driven poverty up again. By June 2020, the poverty rate rose to 40.9%, the highest since 2004, shortly after Argentina’s economic crisis.

Perhaps because Argentina was already in a recession when the pandemic began, the impact of COVID-19 on poverty in Argentina has been especially severe. The country’s unemployment rate rose from 9.8% in 2019 to 11.7% in 2020. The International Labour Organization (ILO) predicted that young women would face the highest unemployment rate. Therefore, industries with a large proportion of women workers, such as the tourism, hotel and restaurant industries, will have the most challenging recovery from the pandemic. Because of an already unstable economy, even the nearly $24 billion the Argentinian government spent on COVID-19 welfare programs was unable to pull citizens completely out of poverty.

Alleviating the Impact of COVID-19 on Poverty in Argentina

On June 11, 2021, Argentina approved the distribution of a single-dose vaccine that Cansino Biologics Inc. created. Cansino’s vaccine joins Argentina’s arsenal of approved vaccines, including the Sputnik V vaccine, the Sinopharm vaccine and the Oxford/AstraZeneca vaccine. Inoculating a majority of Argentina’s population is not only the greatest weapon against COVID-19, but also reduces the burden of medical care and helps the recovery of a struggling economy.

Argentina is also making progress in improving its public healthcare system. In early 2021, the World Bank Board of Directors approved a $250 million U.S. loan that will aid 17 million Argentinians through a Supporting Effective Health Care Coverage project to optimize medical care access, improve the treatment of chronic diseases and offer maternal and child health support.

Argentina is a global leader in livestock production with approximately 700,000 square miles of pasture land and the United States engaged in nearly $24 billion worth of trade with the country in 2019. If wealthy countries like the United States invest in poverty reduction in Argentina, not only will Argentina’s economy improve but more business opportunities will open to the United States and the rest of the world.

– Madeline Murphy
Photo: Wikimedia Commons

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Self-Testing for HIV/AIDS In The Dominican Republic

HIV/AIDS in The Dominican Republic
HIV/AIDS in the Dominican Republic is on the agenda of the Pan American Health Organization (PAHO) and HIV/AIDS has been the focus of the Plan of Action for the Prevention and Control of HIV and Sexually Transmitted Infections 2016-2021. The goal of the plan is to end HIV/AIDS in many regions of the Americas, including the Dominican Republic, by 2030.

From 2010 to 2019, HIV cases have reduced to 13 a year and the number of deaths has gone down by 4,000 over the years. Female sex workers are a portion of the population the epidemic affects; they accounted for 37% of new infections in 2019. Less than 30% of individuals do not know they have an infection and about one-third receive a late diagnosis. Over 200,000 were getting antiretroviral treatment in 2019.

HIV Diagnosis Decline

HIV/AIDS in the Dominican Republic has seen an advancement in health through more testing and the option of antiretroviral treatments. The options of PrEP, pre-exposure prophylaxis, and PEP, post-exposure prophylaxis, have contributed to the decline of infections. The COVID-19 pandemic has put a dent in the success of the decline of HIV/AIDS.

The pandemic is changing the social landscape and interaction of people through social distancing measures. Access to medical personnel has also experienced strain because of rising and new COVID-19 infections. When comparing 2019 to the current pandemic, the diagnosis of HIV has reduced by the thousands in the Dominican Republic. According to PAHO, “Self-testing is a key strategy for reaching the U.N. goal of having 90% of people with HIV know their status.”

PrEP and PEP

PrEP and PEP are two types of antiretroviral treatments that people can use to prevent HIV transmission. Individuals can take the antiretroviral treatment PrEP before HIV infection and it is available through two brands. Meanwhile, one can take PEP after an HIV infection and must take more than one medication. The CDC suggests that individuals consult with a doctor for more information. While both treatments are important, PEP offers more because sexual assault victims can use PEP or those who had a workplace accident. Advisories state that one should take PEP within three days of a dire situation and complete treatment within a month. Both treatments are highly effective with PrEP reducing HIV transmission from sex by 90% and PEP reducing risk by 80%.

HIV Self-Testing Market

The HIV self-testing market looks promising on a global scale especially with  HIV/AIDS in the Dominican Republic. Globally, there is a necessity and high demand for rapid diagnosis of HIV in many regions including Latin America. Self-testing is a better alternative because one can do it privately and it is less risky because it will prevent exposure to the COVID-19 pandemic. The self-testing market will grow more between 2020 and 2025. Self-testing will experience a great impact through government investments in healthcare worldwide. The HIV self-testing kit collects samples through blood, saliva and urine. In HIV testing, blood samples provide the most accurate read. According to MarketWatch, “The self-testing market in Latin America is anticipated to reach a value of 51.24 million USD in the year 2025.”

The COVID-19 pandemic has undoubtedly impacted the fight against HIV/AIDS in the Dominican Republic. However, despite HIV/AIDS’ prevalence, antiretroviral treatments and opportunities to self-test should result in improvements.

– Amanda Ortiz
Photo: Flickr

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Japan’s Response to COVID-19

COVID-19Japan has handled the COVID-19 pandemic much better compared to other nations. For example, the death rate for COVID-19 in Japan is one death per 100,000 people. This number is much lower than other countries, with the United States death rate at 59 deaths per 100,000 people and the United Kingdom rate at 62 deaths per 100,000. Japan also has a lower rate of infection than other nations. Japan had less than 101 per 1,000,000 new cases of  COVID-19 reported while the US has between 501-1000 per 1,000,000. What is Japan doing differently to make the mortality infection rates so much lower than other high-income nations?

Culture of the Japanese

One reason Japan has so few coronavirus cases is built into the culture of the Japanese. Japanese people have worn face masks since the flu pandemic in 1919. Masks are also common to wear in Japan when it is cold and flu season. So, when the COVID-19 pandemic hit, wearing masks as a protective measure was widely accepted and used by the Japanese population. Also, the Japanese culture is more socially distant. For instance, Japanese do not hug or shake hands when making acquaintances like Americans do. Social distancing and mask-wearing came naturally to the people of Japan, so the infection rate is very low for them.

Japan’s Healthcare System

Japan has a highly regionalized healthcare system that has helped them minimize the impact of COVID-19. Japanese healthcare institutions, called Public Health Centers (PHCs), are similar to the Center for Disease Control but at a much more local level. However, when COVID-19 hit its peak in Japan, the PHCs struggled to keep up with the surge of patients. So, the PHCs reacted quickly and would send patients to available PHCs and resources to the PHCs that had shortages. Japan’s quick actions and regionalized healthcare system allowed the COVID-19 death rates to stay low and spread to be minimum.

Negatives Impacts of the Virus in Japan

Though Japan has a relatively small infection and the death rate for COVID-19, the Japanese people’s lives have been greatly affected. Japan’s suicide rate has risen considerably since the pandemic hit. There have been 13,000 suicide deaths in Japan this year; a number much higher than the 2,000 COVID-19 deaths. The suicide rates for August were 15.4% higher than those of last year. Economic hardship, unemployment and isolation from society as a result of COVID-19

Japanese women have been disproportionately affected by the secondary effects of COVID-19. The suicide rate for women specifically has risen 40%. Also, 66% of people in Japan who have lost their jobs because of the pandemic were women. In response, Japan has increased its funding towards suicide prevention resources by 3.7 billion yen ($35,520,000).

The Future of Japan Amid COVID

Looking into the future, vaccine security looks very good for all Japanese citizens regardless of economic status. The Japanese government recently approved a bill to provide all of the citizens of Japan with COVID-19 vaccines free of charge. Providing a free vaccine will ensure everyone will have the opportunity to receive one. Since the vaccine cost is covered, the vast population of Japan can be protected from COVID-19 in the future.

Not only is Japan thriving in the fight against COVID-19, the country is also providing aid to help other nations overcome this disease. Recently, Japan recently donated $2.7 million to the Pan American Health Organization (PAHO) to help Latin American countries with the fight against the coronavirus. Specifically, this aid will provide Pan-American nations with slowing the spread by implementing preventative measures and providing information for citizens about the disease.

Overall, Japan has handled the pandemic really well. Their unique approach to regionalized healthcare along with their willingness to wear masks have greatly decreased the COVID-19 damage in Japan. Other countries should use the Japanese response to COVID-19 as an example. Japan’s quick and regionalized response to COVID-19 attributed to the small death and infection rate. Countries should also consider providing their citizens with vaccines to ensure everyone is protected from COVID-19. The wealthy nations should take into account the countries that cannot afford to provide vaccines for their citizens. To ensure our world overcomes this pandemic, resources like vaccines, masks and ventilators will need to be allocated to lower-income nations.

– Hannah Drzewiecki
Photo: Flickr

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Healthcare in the Dominican Republic

Healthcare in the Dominican Republic
Healthcare in the Dominican Republic is among the most advanced in the Caribbean. Despite noteworthy recent progress, it still requires work to improve.

The Pan American Health Organization (PAHO) defines the healthcare system in the Dominican Republic as a social security model with guidance from the principles of universal coverage, compulsory enrollment, solidarity, comprehensiveness of care, a unified system, free choice and gradual implementation. In 2014, the Dominican Republic adopted a model of care based on the Primary Healthcare (PHC) strategy and the Integrated Health Service Delivery Network.

What is Primary Healthcare?

In 1978, the World Health Organization (WHO) defined the PHC strategy as, “Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community by means acceptable to them at a cost that the community and the country can afford to maintain at every stage of their development in a spirit of self-reliance and self-determination. It forms an integral part of both countries’ health system of which it is the central function and the main focus of the overall social and economic development of the community. It is the first level of contact of individuals, the family and the community with the national health system, bringing health care as close as possible to where people live and work and constitutes the first element of continuing health care process.”

The features of PHC include:

  • Accessibility
  • Person-focused preventive and curative care over time
  • Patient-oriented comprehension and coordination
  • Focus on the community, especially when addressing social determinates of health

The Integrated Health Service Delivery Network

The purpose of the Integrated Health Service Delivery Networks (IHSDNs) is to help in the development of PHC-based health systems, by making a health services delivery that is more accessible, equitable, efficient, of higher technical quality and better fulfills the needs of the citizens.

Integrated health systems networks are the principal operational mechanism of the PHC system. It helps make some of the essential elements of PHC a reality. These elements include universal coverage and access, first contact, comprehensive, integrated and continuing care, appropriate care, optimal organization and management and intersectional care.

In 2015, 65% of the population enrolled in the Family Health Insurance program. Of this group, the subsidized system covered 47.5% and the contributory system covered 52.5%. However, a major gap in the system still exists for a significant portion of the population. According to WHO, 17.6% of the population spend more than 10% of their income on healthcare. It also reported that 4.9% of the population spends more than 25% of their income on healthcare.

In 2011, the PAHO estimated that there were 21.2 doctors and 3.8 nurses per 10,000 people in the Dominican Republic. The National Health Service has 1,450 primary care centers, 1,774 primary care units, 189 specialized health centers including, 13 regional hospitals, 35 provincial hospitals, 122 municipal hospitals and 19 referral hospitals.

Pharmacies’ Role in Healthcare in the Dominican Republic

Pharmacies are abundant in the Dominican Republic with even a small town having as many as 20 pharmacies. Most of these pharmacies will prescribe medications simply by hearing about or seeing the individual’s medical problem.

In 2015, the basic list of essential medications received updates based on WHO’s Model List of Essential Medications. Almost all medications are available over the counter including pain killers, antibiotics, steroids, anti-inflammatory medications and sleeping pills. The only medications that require a prescription are narcotics like morphine. However, some pharmacies will dispense these medications without a prescription even though it is illegal.

The Progress the Dominican Republic Still Needs

The government has implemented a 911 emergency call system. As of right now, it is available from Santo Domingo, east to Boca Chica and west to San Cristobal. It is also available in Santigo and Puerto Plata. It will eventually be available throughout the country.

There is a maternal mortality rate of 92 deaths per 100,000 live births in 2015 in the Dominican Republic, which is alarming in comparison to the 18 deaths per 100,000 live births in the United States. The Dominican Republic also has a mortality rate of 22.9 deaths per 1,000 live births in children under 1 year of age in comparison to a rate of 5.901 deaths per 1,000 live births in the United States.

Other data also shows the need for improvement in healthcare in the Dominican Republic. This includes:

  • In 2012, 65% of deaths in children under 1 were due to disorders beginning after birth. Sepsis was one of the top five leading causes of death in children less than 5-years-old. Children under 1-year-old were at even higher risk.
  • Even though vaccination rates for children under 1 year of age range from 82% to 95%, reports determined that the Dominican Republic had cases of diphtheria and whooping cough in 2015.
  • There was a cholera outbreak in 2011-2012.
  • In 2013, estimates determined that the chikungunya virus would infect 539,000 people.
  • In 2015, the rate of malaria infection was 1.9 per 100,000.

Even though the Dominican Republic has made an effort to improve its healthcare system, there is still more that it needs to accomplish to improve the system. Moreover, it needs to instigate methods to bring down the mortality rates and lower the incidence of diseases like cholera and malaria.

– Lynn DeJarnette
Photo: Flickr

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3 Initiatives to Improve Healthcare in Belize

Healthcare in Belize
Belize is a small Central American country with fewer citizens than many major American cities. Though the population is so small, Belize has struggled to provide adequate health care services in the past. Lately, however, public and private services have been working in tandem to better healthcare in Belize. Since the creation of the Health Care Strategic Plan in 2014, Belize has made a committed effort to improving healthcare policies and systems to best serve its population. The three initiatives below highlight recent successes in the effort to improve healthcare in Belize.

Health Sector Strategic Plan 2014-2024

In 2014, the World Health Organization in conjunction with the government of Belize created the Health Sector Strategic Plan. The plan created a framework and targets to be reached by 2024 focused around developing a more sustainable and people-centered healthcare system. The approach includes six key pillars of healthcare: governance and leadership, service delivery, financing, human resource in health, informational systems and medicines and technology.

The strategic plan includes a vast range of healthcare subcategories so that it can address healthcare inequity from multiple fronts. Some of the specific challenges faced by healthcare in Belize that the initiative has made plans to overcome include:

  • Unequal distribution of healthcare: This includes shortages of specialty providers and creates an imbalanced system. Belize often has to import healthcare workers, especially in certain specialties and to specific geographic locations.
  • Unequal healthcare financing: Access to care is limited and financial coverage is highly dependent on region.
  • Fragmentation: Belizean’s often don’t experience continuity of care. This system of receiving medical care only when necessary and not from the same provider leads to a higher risk of non-communicable diseases such as chronic illnesses, mental health disorders, and violence-related injuries.

The Health Sector Strategic Plan has also created the framework and put into practice viable solutions to address these issues.

  • National Health Insurance (NHI): Belize has initiated a system to expand national health insurance to more regions in order to address healthcare inequity and improve the financing system. The NHI system provides many primary care services to Belizean’s without cost.
  • Integrated primary health care approach: This approach specifically addresses fragmentation by implementing programs that assist with lifestyle-related health and wellness by a primary care physician.
  • Expanding the workforce: Expanded training programs both domestically and in conjunction with outside programs are helping to bolster the workforce.

Wisconsin Medical School’s Partnership with Belize Hospitals

Significant hurdle healthcare in Belize has faced is a shortage of medical professionals. To combat this issue, Belize has repeatedly had to import healthcare workers, which is often only a temporary solution. In order to strengthen the system from within, partnering programs with foreign medical schools help decrease provider shortages and better prepare hospital management and healthcare workers for best treating patients.

Beginning in 2010, The Global Health Department of the Medical College of Wisconsin (MCW) created a collaborative partnership with the Belize Ministry of Health to improve emergency medicine. Leaders from hospitals in Belize have met with MCW faculty to plan specific training goals in order to best address concerns specific to Belize.

The collective efforts of the initiative have produced goals for improving both emergency care and disaster preparedness and relief. They have also produced a tangible change in the form of training partnerships that work to standardize education and patient care. Rather than function as short term outreach, the partnership is committed to long-term collaboration and seeks to create a sustainable education model to improve healthcare in Belize.

Pan American Health Organization

One of the primary reasons that Belizean’s face unstable access to care is due to regional inconsistencies and shortages of healthcare workers. In addition to the Health Sector Strategic Plan, in 2019 the Pan American Health Organization together with the Ministry of Health produced The Strategic Plan on Human Resources for Universal Health 2019-2024.

One of the core goals of the Health Care Strategic Plan is to improve healthcare in Belize by addressing unequal access to care. The plan created a targeted approach for combatting inequities in health care by focusing on training personnel, creating improved working conditions, and developing a standard system for education and professional practices. The plan does more than just train workers, it gives them an incentive for providing quality care.

This focused strategy in combination with the longer term Health Sector Strategic Plan aims to improve both conditions for providers and access to enhanced health care for millions of Belizeans. Improving conditions for providers in addition to providing practical competency training in all geographic regions motivates providers to issue high-quality care and remain longer in the same area. The goal of the health workforce expansion plan is to improve healthcare in Belize through promoting quality and reliable care in all areas by empowering the professionals that provide it.

Conclusion

These three initiatives have been working with the Belizean government to best adapt to the health care needs of the population. Approaching improvements from a variety of angles, together they are working towards a wholistic betterment of healthcare in Belize.

– Jazmin Johnson
Photo: Flickr

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International Response to COVID-19 in Belize

COVID-19 in Belize
While the global community has certainly experienced unprecedented hardship in the wake of COVID-19, many organizations worldwide have stepped up to offer help where it is needed. Belize has been a recipient of such aid, having recently experienced a medical supply shortage in all geographic regions. In response to these limitations, as well as shortages of trained response teams, donations of medical equipment, testing kits and training programs have been offered by various countries and international groups. Below are four ways the international community has responded to COVID-19 in Belize.

4 Ways the International Community Has Responded to COVID-19 in Belize

  1. International COVID-19 Relief Donations. In response to shortages of testing kits and medical supplies, the Pan American Health Organization, together with the World Health Organization, made multiple donations to both the Belize Ministry of Health and the Central Medical Laboratory in April and May 2020. These donations included personal protective equipment necessary to keep health providers safe as well as supplies needed to conduct testing. These organizations were able to donate 100 gowns, 420 N-95 masks, 1,500 boxes of gloves, 750 reaction kits and 130 testing swabs to support the fight against COVID-19 in Belize.
  2. Taiwanese Donation of COVID-19 Supplies. Not only has Belize has been receiving donations of medical equipment from international relief organizations, but also from individual countries working to make a difference. Taiwan has made multiple donations to Belize in June and July of 2020. The donations included; thousands of testing kits, thermometers, ventilators, and protective equipment including over 270,000 masks, together totaling more than $1 million in supplies. A large hurdle in slowing the spread of COVID-19 in Belize is accurate and fast testing: to aid with this obstacle, Taiwan developed rapid antibody tests able to deliver results in just 15 minutes with 95% specificity, and included 5,000 of these tests, along with accompanying analyzers, in their donation to Belize. These donations are just a single example of the long-standing friendship between the two countries.
  3. Community Volunteer Training for COVID-19 Centers. The Pan American Health Organization, along with the World Health Organization and the Belize Ministry of Health, held training sessions in April and May 2020 to provide volunteer medical staff with life-saving information regarding the prevention and control of COVID-19. The training included instruction on proper management of quarantine centers as well as practical infection prevention education. These training sessions have been provided on an ongoing basis by the Ministry of Health, and have been successful in preparing Red Cross volunteers for as-needed deployment to quarantine centers across Belize, as regions have been experiencing varying needs for additional resources as case numbers fluctuate. Another way these training sessions have prepared volunteers to face COVID-19 in Belize is through psychosocial support and training, helping to produce volunteers that are prepared to fight COVID-19 on all fronts.
  4. World Bank COVID-19 Assistance Program. In addition to the clear health implications of COVID-19 in Belize, the country’s most vulnerable populations have also experienced severe social and economic challenges in the wake of the pandemic. In response, the World Bank donated 12.4 million in July 2020 to support Belize’s social protection programs. The funds will be managed by the Ministry of Human Development, Social Transformation and Poverty Alleviation, and will provide support for those most affected by COVID-19. Support will specifically be used to further aid those already receiving government assistance as well as those who don’t normally qualify, under a temporary COVID-19 relief program. Funds will be allocated to those experiencing poverty, with priority going to households containing children, pregnant women, elderly or persons with disabilities. The donation is expected to affect as many as 13,000 households affected by COVID-19 in Belize.

Efforts such as these are making progress against the spread of COVID-19 in Belize, and demonstrate the benefits of global cooperation amid a devastating pandemic.

– Jazmin Johnson
Photo: Unsplash

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The Regional Disparities of Healthcare in Paraguay

Healthcare in Paraguai
Healthcare in Paraguay has improved tremendously over the past decades. The life expectancy of both males and females has increased by about 10 years since 1990. In the same period of time, the mortality rate of children under 5 years old decreased from 34.6 deaths to 14 deaths per 1,000 live births. Still, many communities remain underserved and face the repercussions of limited access to healthcare.

The Rural-Urban Divide

The improvements in Paraguay’s healthcare system have occurred mostly in urban areas. This makes sense considering that more than 60% of Paraguay’s population lives in the urban perimeters of Asunción and Ciudad del Este. In fact, about 70% of healthcare workers operate within the Greater Asunción area.

In contrast, rural populations do not receive the same access to healthcare. While the more rural regions located to the West of Asunción represent 61% of the national territory, only about 31% of the national paved road network reaches these regions. As a result, transportation from isolated rural communities to urban areas with better access to healthcare is not an easy feat.

The Family Health Units and Coverage

In 2008, the Ministry of Public Health and Social Welfare created family health teams to carry out healthcare in a coordinated, comprehensive and continuous manner. Each team is organized in Family Health Units (USF in the Spanish acronym) and serves the populations to which they are assigned. These teams must provide consultation, home care and ongoing medical evaluation to their communities.

While USFs have successfully improved the health of urban populations, they have largely left behind those who live outside of urban centers. For example, only about 50% of the Alto Paraguay residents have USF coverage.

The following reasons help explain this disparity in USF coverage between city and country areas:

  • Rural areas generally have low population density and exist between small towns. Therefore, providing USF coverage to many rural communities can be inefficient and challenging.
  • Many healthcare workers who are originally from rural areas often decide to either move to urban areas or leave Paraguay completely due to the poor working conditions and precarious employment contracts.
  • There are few incentives for healthcare workers to practice in rural areas.

As a result, rural areas, where poverty rates are the highest, are also most susceptible to experiencing USF shortages.

The maternal mortality rates (MMRs) by region reflects the disparity in USF coverage. In 2015, the rural areas of Boquerón, Amambay and Canindeyú recorded MMRs of 347, 190 and 167 per 100,000 live births, respectively. This data stands in stark contrast to the average MMR of the entire nation which is 132 per 100,000 live births. Clearly a significant imbalance in healthcare access exists between geographic locations in Paraguay.

Addressing MMR in Rural Communities

Several initiatives emerged to address this problem, although some deemed some of them unsuccessful. The Maternal Health and Child Development Project, which operated from 1996 to 2004, aimed to improve the health of mothers and their children in underserved areas. As the World Bank notes, the outcomes of this project were unsatisfactory.

A joint project between the Pan American Health Organization (PAHO) and the World Health Organization (WHO) is currently in effect with the goal of strengthening the care of mothers and children and improving responses to obstetric emergencies. PAHO and the WHO implemented this project in 19 municipalities across Bolivia, Argentina and Paraguay, reaching approximately 400,000 people. It is too early to discern the impact of this project as it only emerged in 2017. Nevertheless, since it only serves a few municipalities in Paraguay, many rural, underserved Paraguayan communities have not received the assistance necessary to improve their MMR.

The COVID-19 Pandemic

In spite of the challenges Paraguay faces in terms of its healthcare system, the country has kept COVID-19 under control in rural and urban communities alike. As of July 19, 2020, there have been confirmations of 3,721 cases and 31 deaths in a country with over 7 million people. One can attribute this successful containment of the virus to the government’s quick and effective response. The first COVID-19 case in Paraguay received confirmation on March 7, 2020, and the country went into full lockdown on March 20, 2020. While the country is not in the clear yet, Paraguay is among the most healthy South American countries with regards to COVID-19.

Bringing Healthcare to Rural Areas

The situation for rural regions, however, is not hopeless. Since urban areas observed significant successes in healthcare through the implementation of the USFs, one could reasonably apply similar tactics to rural areas. Having said that, the biggest hurdle in bringing healthcare access to rural areas will be providing incentives for healthcare workers to settle in areas with low population density.

Luckily, in 2010 the Ministry of Public Health and Social Welfare launched a rural internship program that incentivizes doctors to work in rural areas. As a result, the concentration of healthcare workers in rural areas should increase as more doctors graduate from medical school.

Nevertheless, the Ministry must continue to pay special attention to rural areas, especially those where impoverished and indigenous people reside. The healthcare system has historically underserved these communities while urban, wealthier communities continue to experience improvements in healthcare. In order to provide healthcare for all residents of Paraguay in an equitable manner, the government must ensure that all Paraguayans can receive the same basic healthcare regardless of geographic location.

There are certain challenges that should receive special attention as Paraguay continues to improve its healthcare system for residents. Many regions still struggle with maternal mortality, especially in rural areas. In addition, viruses that mosquitoes transmit, such as Zika, chikungunya and dengue, cause intermittent regional epidemics. Lastly, about 18,000 people in Paraguay live with HIV or AIDS. However, given the government’s swift and effective response to COVID-19 as well as the success of USFs across the country, these challenges certainly are not insurmountable. If USFs expand significantly into underserved areas, Paraguay should be better able to effectively handle these health challenges.

– Alanna Jaffee
Photo: Flickr

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10 Facts About Slums in Latin America

Slums in Latin AmericaCurrently, one in seven people worldwide lives in a slum. By some estimates, this number will rise to one in four people by the year 2030. A slum can be defined as housing with no land permits, inadequate access to basic services (water, toilets and electricity), unsafe components (broken windows, dirt floors and leaks) and an overcrowded population. These 10 facts about slums in Latin America explain how people are affected by these poor living conditions.

10 Facts About Slums in Latin America

  1. Rapid Urbanization: South America has historically been dominated by rural living. However, in more recent years, the cities of South America have seen a rapid rate of urbanization. Urban living now supports 82 percent of the population. When people move from the countryside to the city in large numbers, there are often not enough resources to support everyone. As a result, people resort to constructing illegal housing to survive.
  2. Millions Affected: In Latin America, approximately 117 million people survive in poverty. Most of these people survive in slums just outside major metropolitan areas. These cities include Mexico City, São Paulo, Bogota, Rio de Janeiro and Lima.
  3. Neza-Chalco-Itiza: On the cusp of Mexico City rests Neza-Chalco-Itiza, one of the largest slums in South America and the fourth largest in the world. With a population of 1.1 million people, the slum is filled to the brim. People flooded to the city after World War II in hopes of work, but they found poverty instead. Today, the slum has developed a systematic way of living that mimics life inside the major city.
  4. Favelas: Some of the most infamous slums can be found in Brazil. In Portuguese, slums are called favelas. Most favelas in Brazil can be found in the areas surrounding Rio de Janeiro. More than 11 million people live in this type of housing.
  5. Entrepreneurship: While slums can be a source of hardship and poverty, they can also be the birthplace for many entrepreneurs. With so many people struggling to survive, some take it upon themselves to create businesses out of the little resources that they have. For example, Bistrô Estação R&R is a bar inside a garage in Rio de Janeiro. These small businesses bring people together in their communities and can help boost the economy.
  6. Widespread disease: Slums are often a breeding ground for disease. With a lack of proper sanitation and people living in such close proximity, illness develops fast and spreads even quicker. Tuberculosis is just one example of a disease that has spread in slums. In Peru, 60 percent of tuberculosis cases in 2011 were reported from the slums surrounding Lima. Luckily, organizations such as the Pan American Health Organization (PAHO) have hosted several government interventions to advocate for development plans.
  7. Drugs, gangs and violence: With a lack of central authority, slums are more susceptible to drugs, gangs and violence. Many of the world’s most infamous drug lords originate from these areas and threaten the local community. While police intervention sometimes occurs, often these communities are ignored. In 2015, 47 of the 50 most murderous cities were found in Latin America.
  8. Upgrading housing: With the aim of improving housing for communities living in slums, several nonprofits, such as TECHO, have advocated for the improvement of infrastructure. TECHO’s policy is that slums of 10 or more families who lack one or more necessities, such as water or sewage, qualify for aid. In several of TECHOs projects, houses have been reconstructed using pinewood and tin. Families who received this assistance have stated that their quality of life has effectively improved after the refurbishments.
  9. Pride: While slums can be riddled with poverty and crime, they are also filled with pride. In a 2013 study, 85 percent of favela residents said that they like where they are from. This could largely be attributed to the communities formed within these tight housing situations and the entrepreneurship that binds people together.
  10. Slum tourism: Slum tourism is when travelers visit impoverished populations in order to see the areas. The practice began in the 1800s when wealthy Londoners would pay to see a lifestyle that was so drastically different from their own. Slum tourism can have negative effects on a community for multiple reasons. For one, it promotes the wealth gap by separating the wealthy from the poor. In addition, poverty tourism does not necessarily benefit local areas. If tourists pay larger organizations to conduct the visit rather than community members, the money will not reach the slums. On the other hand, poverty tourism that challenges negative stereotypes and is led by slum residents can aid in the growth of the local economy.

By looking at these 10 facts about slums in Latin America, it easy to see how these living conditions can damage a person’s health and wellbeing as well as how the residents of these slums are struggling to survive. However, by upgrading communities and being conscious tourists, these areas can be uplifted and improved, helping the one-seventh of the world that lives in slums.

Photo: Flickr

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Free PrEP in Cuba Combats HIV

Free PrEP in Cuba

In April 2019, news broke that Cuba passed a bill making pre-exposure prophylaxis (PrEP) free. PrEP is a drug that significantly reduces the chances of contracting HIV/Aids. Free PrEP in Cuba could reduce the number of those infected and improve the lives of those most susceptible to the virus. Cuba’s history with HIV is extensive and controversial, with practices considered inhumane, yet Cuba’s desire to “better study” to eliminate the virus has always been prevalent.

Cuba’s History of HIV

In 1988, The Los Angeles Times published an article detailing the quarantine that occurred in Cuba. The article states that “one-third of the nation’s 10.2 million people” were tested for HIV, and 270 Cubans had the virus. Cuban officials supported the quarantine, though many found this tactic controversial.

In 2015, Cuba became the first country in the world to be certified by the World Health Organization for the elimination of mother-to-child transmission of HIV and syphilis — elimination defined as only 50 babies per 100,000 live births having HIV. This milestone is a precursor to eradicating the virus for generations to come.

There are currently 234 cases of HIV in Cuba and 30 cases being presented each year. Sixty percent of all HIV cases are derived from Cardenas and the capital city, Matanzas.

What is PrEP?

Pre-exposure prophylaxis (PrEP) is medication for people who are at very high risk for HIV. If taken daily, the medication could reduce the risk of contracting HIV by 90 percent; for those injecting drugs, the treatment could reduce their risk by 70 percent. Although PrEP reduces the risk of acquiring HIV, it does not erase the need to practice safe sex.

The pill has been 99-percent effective against the virus. In the U.S., there have only been two cases in which people contracted the virus while taking the pill, and the strain of HIV that they had was resistant to treatment.

Present Day Cuba

Free PrEP in Cuba became possible through the Pan-American Health Organization (PAHO), an agency of the United Nation, partnered with Niura Pérez Castro, who is head of the municipal program for preventions of STDs, HIV, AIDS and hepatitis.

The prevention medication has already been supplied to 28 people in Cardenas and is available to whoever needs it. For those who are HIV negative and wish to partake in the program, the Center for Prevention and Control of STIs, HIV and AIDS in Cárdenas evaluates people’s HIV status to make sure they could take the prevention medication.

Cuba’s battle with HIV has been extensive and controversial, but with strong determination, they have made strides. Free PrEP in Cuba and the end of mother-to-child transmissions promise a brighter future for generations to come.

– Andrew Valdovinos
Photo: Flickr