This opinion piece was written by Alexandra Winkler, the former deputy mayor of El Hatillo Municipality in Caracas.
The Venezuelan health system is undergoing a humanitarian crisis without precedent. The collapse is very visible, with endemic diseases reappearing, medicine shortages, a mass exodus of medical professionals and the demise of hundreds of clinics and abandoned hospitals that can’t attend a single patient due to poor conditions.
The most serious consequences of this situation are a dismantled care system and a lack of primary prevention policies. In our decentralised public health system, local municipalities are meant to focus on education, promotion and disease prevention. But this objective is utopian when regional and national governments have lost their ability to address and solve public health issues, forcing local governments to take on a larger load of primary medical assistance.
In the wake of this serious crisis, we decided to reinvent the way we managed public health in the Municipality of El Hatillo. We accepted the challenge of innovating our services, and clearly defined that our priority was providing attention to vulnerable groups such as kids, adolescents, pregnant women, women at a reproductive stage and patients with chronic diseases. Critical to all our innovations were strategic alliances with private sector organisations and NGOs.
Supporting an overburdened healthcare system
Due to the ongoing humanitarian crisis, demand for medical attention has increased substantially. One key challenge was increasing quality and coverage of healthcare to serve these needs, especially with our population stretched over a 114 square kilometre radius.
El Hatillo is the only municipality within the capital city of Caracas without hospitals or private clinics. Our urban health centre became a critical — but overburdened — emergency service, commonly dealing with asthma attacks, severe respiratory infections, heart attacks, women in labour, multiple-trauma injuries and convulsions.
We responded to this situation with several initiatives. In 2016, we launched Hatillo Health, a program offering in-home healthcare services, emergency response with ambulances and a 24-hour medical health line. An alliance with the private sector allowed us use of two ambulances, two motorbikes and 12 paramedics. Rapidly, this local effort became the city’s most popular health service, achieving over 100 consultations a month.
We also recuperated a Mobile Clinic Van, again thanks to an alliance with the private sector. This van expanded the municipality´s primary care network; medical aid was able to arrive on wheels to the communities farthest away.
Finally, we strengthened the capacity of four rural health centres so they could offer free medical consultations for services such as dentistry, paediatrics, gynaecology, obstetrics, traumatology, lab testing and emergencies.
Helping mothers stay healthy
Going against international standards, the Venezuelan government does not publish detailed health stats on a regular basis. However, in May 2017, the ministry of health did share two shocking figures: 1) child mortality had increased 30% in 2016, and 2) maternal mortality had increased 65% during that same year. This is particularly alarming given that teenage pregnancy in Venezuela is on the rise due to inadequate reproductive health provisions.
Our team acted fast and created the Healthy Pregnancy Initiative, a conditional transfer program which shared gift incentives with women who completed a nine month prenatal health control. Prenatal control increased to 300 appointments a year, and consultations within our Health Woman Program increased, reaching more adolescents and young adults to offer sexual education, gynaecological checkups and family planning support.
Partnering for child health
Kids are probably the most affected by this humanitarian calamity. As local government, we started to notice the impact of the crisis when student absenteeism began to rise to 25% in our public schools. The incapacity of parents to feed their children due to food scarcity and high costs was the most disturbing of the causes.
We decided to plan and execute a school health program for 1,100 kids over our four-year term. It demonstrates how local government, the corporate sector and communities can work together to reintegrate children in schools and promote the well-being of families.
Thanks to the Digisalud Foundation, we used an app to build a medical history on each child, registering data on nutrition, dental health, ophthalmology and parasitology, which allowed us to study their individual progress. One discovery was that 70% of the kids examined had cavities — so we partnered with a company to access treatment for all of them.
To combat the nutrition problem, we offered a daily nutritional supplement to all kids, made possible by establishing alliances with NGOs that had the capacity to prepare and distribute food to all schools.
Local government in humanitarian crisis
No one could ever imagine that a local government could guarantee continued public health services under the context of a national humanitarian crisis, let alone increase their impact. But we were able to offer a doctor at every doorstep, and keep our system running 365 days a year. All of this, thanks to the effort of a committed Health Department Team, volunteers and private allies who decided to keep investing in Venezuela.
El Hatillo not only became a positive reference for management of public health services at a municipal level, but also an example of true dedication to public service. — Alexandra Winkler
A version of this article is on LinkedIn.
(Picture credit: Communications Team, El Hatillo Municipality)