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PAHO Basic Health Indicator Data Base
This is a multidimensional query tool that offers a collection of 108 indicators from 1995 to 2005. The system presents data and indicators on:
- demography
- socioeconomic
- mortality by cause indicators
- morbidity and risk factors
- access, resources and health services coverage.
Selected indicators are disaggregated into age groups, sex and/or urban/rural region. Generated tables can be exported and printed.
The data presented is updated annually with the latest country information.
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- GENERAL SITUATION AND TRENDS
Demography: Colombia
has a land area of 1,141,748 km2, with a topography dominated by
three branches of the Andean mountain range. The population is estimated at
42,299,000 people living in the country's 32 departments, which are divided
into 1,076 municipalities. Colombia is experiencing demographic changes as well
as changes to its epidemiological profile typical of transitional societies.
Examples of demographic changes include population aging, decreasing fertility,
rapid urbanization, while the change in the epidemiological profile emphasizes
the persistence of communicable diseases with a concomitant increase of noncommunicable
diseases. Life expectancy at birth had increased to 70.6 years, fertility dropped
to 2.8 children per woman, and 71% of the total population lived in urban areas.
Economy:
In 1999, Colombia faced its most serious economic recession in 60 years, with
GDP declining by 4.3% and unemployment rising. The low price of coffee on the
world market and the extensive damage inflicted in coffee-producing areas by
an earthquake added to Colombia 's economic problems. Although the economy grew
by 2.8% in 2000, unemployment reached 19.7%. The number of persons living in
poverty increased from 19.7 million in 1997 to 22.7 million in 1999. Between
1995 and 1999, Colombia 's total indebtedness rose from 19.1% to 34% of its
GDP. In 2000, public expenditure was reduced, the tax base was broadened, a
special tax on financial transactions was established, and measures were taken
to control tax evasion. In addition, the salaries of government employees were
frozen and an attempt was made to reduce bureaucracy and noninvestment spending.
Although these actions halted the economy's downward trend, no progress was
made in solving the problems of unemployment, poverty, or the steadily worsening
situation of the most vulnerable sectors of the population. The country's development
is seriously hindered by inefficient social expenditures. Spending on education
is more than 4% of the GDP, but national coverage is only 88%. Health spending,
in turn, was 3.9% of the GDP and the national Gini coefficient of 0.56 remained
unchanged between 1997 and 1999, but the inequality of income distribution decreased
in some departments. According to estimates, about 25% of the municipalities
fell within the two strata with the highest proportion of unmet basic needs;
another 25% were in the two strata with better living conditions. Social inequality
can also be seen in the negative impact economic liberalization had on the agricultural
sector in the 1990s. Some of Colombia 's grains and basic products were not
competitive on the world market, and by the end of the decade, 700,000 hm2
of agricultural production had been lost, while planting of illegal crops doubled
from 57,500 hm2 in 1994 to 112,000 in 1999. These changes exacerbated
the armed conflict and societal deterioration, and contributed to the increase
in all forms of violence. The situation is marked by the highest levels of violence
in Colombia 's recent history. The Commission on Human Rights calculated that
between 1985 and 1999, 1,700,000 persons were displaced due to violence. To
address these serious problems, the government has initiated negotiations for
a peace agreement among the conflicting participants. Another major problem
is drug trafficking and the high levels of crime associated with it. Colombia
has become the world leader in cocaine and heroin production.
- SPECIFIC HEALTH PROBLEMS|
Analysis by population group
Children (0-4 years):In
2000, Colombia had 4.8 million children under 5 years old. The infant mortality
rate was 21 deaths per 1,000 live births and ranged from 17 in Bogotá to 29
in the coastal area. In this age group, the prevalence of chronic undernutrition
was 13.5%; diarrhea, 13.9%; and acute respiratory infections, 12.6%.
Schoolchildren (5-9 years): In
the age group 5-9 years, there were 1,537 deaths in 1998 (36.9 per 100,000 males
and 26.7 per 100,000 females); more than 65% were due to external causes.
Adolescents (10-14 and 15-19 years): In
1998, there were 7,864 deaths in the adolescent population (133.4 per 100,000
males and 47.9 per 100,000 females). In young men aged 15-19, violence accounted
for 69% of the deaths; there were 13 male deaths for each female death in this
age group. Data from a national survey on juvenile drug use showed that among
the population surveyed, alcohol and marijuana continued to be the most consumed
drugs; 15.2% of all persons who drank alcohol and 6.8 % of cigarette smokers
were under 18 years of age. The prevalence of cocaine consumption in the general
population is 3.8%. During the 1990s, the proportion of pregnant women aged
15-19 years almost doubled, from 10% in 1990 to 19% in 2000.
Adults (20-59 years): In
2000, the adult population in Colombia numbered 26 million. There were 78,820
deaths for this age group in 1998 (406.3 deaths per 100,000 males and 168.9
per 100,000 females). At the end of the 20th century, the adult population
aged 15-44 saw an increased burden, especially among males, attributable to
the rise in homicides and in AIDS as causes of death.
The elderly (60 years and older):
In 2000, 7% of Colombians (3 million people) were aged 60 years and over. In
1998, there were 73,121 deaths in this age group. The leading diseases for both
sexes were ischemic heart disease; chronic obstructive pulmonary disease; diabetes
mellitus; and malignant neoplasms of the trachea, bronchus, lung, prostate,
and uterine cervix.
Family health: Domestic
violence is a high-priority problem. Forty-one percent of women who ever lived
with a partner declared they had been physically abused by their partner (and
an additional 20% by another relative). An additional, thirty-four percent had
been threatened by their partner.
Worker's health: Every
year, there are thousands of cases of severe trauma and hundreds of deaths due
to exposure to physical and chemical hazards in the workplace. The artisanal
industries do not provide adequate health conditions for their employees.
The disabled:
Of the persons with disabilities, 12.1% are under 14 years old and 27.6% are
over 60, and most of them are males.
Indigenous groups: The
indigenous population of Colombia was estimated at 2% in the year 2000. In addition,
there is an ethnic population of African origin that numbers more than 10 million
and represents 25% of the nation's total. The most prevalent health problems
afflicting both sexes were acute respiratory infections, intestinal parasitosis
, and acute diarrheal disease.
Analysis by type of health problem
Vector-borne diseases :
Malaria poses a serious public health problem for Colombia . It is estimated
that 18 million people live in areas where malaria is transmitted. In 1998,
there was an epidemic with 240,000 confirmed cases. In 2000, there were 141,047
confirmed cases - a figure consistent with the endemic level observed over the
preceding decade - and 41 deaths. Another serious public health problem in Colombia
is dengue. Around 65% of the urban population faces a high probability of becoming
infected with dengue and dengue hemorrhagic fever (DHF). In 1998, a total of
57,985 cases were documented, including 5,171 cases of DHF. The dengue-2 and
dengue-4 serotypes were circulating simultaneously. In 2000, there were 22,772
reported cases of classic dengue and 1,819 cases of DHF, with 19 deaths. The
high index of Aedes aegypti infestation in many municipalities poses a serious
risk factor for the urban transmission of yellow fever, and jungle yellow fever
continues to be active in Colombia . In the 1990s, there were an average of
4 cases per year.
Diseases preventable by immunization: In
1993, Colombia joined a regional partnership for the elimination of measles
by the year 2000; successive national campaigns in 1993, 1995, and 1999 achieved
coverages of 97%, 95%, and 90%, respectively, in children under 5 years old.
Reports of suspected cases increased from 632 in 1997 to 1,267 in 2000, while
the number of laboratory-confirmed cases fell from 308 in 1995 to 0 in 2000,
and the number of clinically confirmed cases dropped from 473 in 1995 to 34
in 1999 and to 1 in 2000. Coverage with measles vaccine was 80% in 2000. Rubella
was added to the measles surveillance system in 2000, and that year, 679 suspected
cases were reported, 155 of them laboratory confirmed and 4 of them clinically
confirmed. The reports included outbreaks among military personnel and sanitation
workers. Vaccination against Haemophilus influenzae type b was introduced in
1998. There has been a decline in meningitis caused by H. influenzae type b
among children under 5 years, from 306 cases (6.4 per 100,000) in 1998 to 163
cases (3.4 per 100,000) in 1999 and 119 cases (2.8 per 100,000) in 2000. Most
of the reported cases of pertussis occurred in the department of Antioquia (181
in 1998, 255 in 1999, and 264 in 2000). Also, in 2000, there was an outbreak
of 46 cases with 7 deaths in indigenous population. Reported cases of hepatitis
B numbered 1,354 in 1998, 1,490 in 1999, and 1,283 in 2000; most of the cases
were in endemic areas ( Orinoquia , Amazonia , and Santa María ).
Intestinal infectious diseases: In 1998, a
total of 445 cases and 7 deaths from cholera were reported for the entire country,
followed by 18 cases in 1999 (11 of them confirmed), and 1 case in 2000.
Chronic communicable diseases: The
incidence of chronic communicable diseases are thought to have fallen substantially
between 1970, when the group rate was 58.6 per 100,000 population (12,522 cases),
and 1999, when it was 26.5 (10,999 cases). Reported cases in 2000 totaled 11,590.
National policy called for eliminating leprosy as a public health problem. In
2000, the reported incidence was 0.5 per 10,000 population (2,124 cases). Although
the incidence has been reduced, the proportion of new cases with some degree
of disability has risen, which indicates a delayed diagnosis of the disease.
Acute respiratory infections:
Acute respiratory infections continued to be one of the leading causes of morbidity
and mortality in children under 5 years old, even though mortality from pneumonia
fell from 51.0 per 100,000 population in 1988 to 34.1 in 1998.
Zoonoses : Since
1994, 61.8 % of Colombia 's canine population, estimated at 3.4 million, has
been vaccinated against rabies. Cases of canine rabies decreased from 350 in
1990 to 67 in 2000. At the same time, human rabies dropped from 10 cases in
1990 to 1 case in 2000.
HIV/AIDS: There
were 17,163 cases of HIV/AIDS registered between 1983 and March 1999, of which
11,381 corresponded to carriers of HIV infection and 5,782 to patients with
AIDS; 85% were males. During the same period, 3,441 deaths were reported (90%
in males). In 2000, it was estimated that 67,000 persons were carriers of HIV.
Sexual transmission is predominant.
Nutritional and metabolic diseases: The
prevalence of chronic undernutrition was 13.5% in children under 5, with 2.8%
at risk for severe undernutrition . The prevalence of exclusive breastfeeding
through the fourth month of life was 23%, and through the sixth month, 12%.
The prevalence of anemia in children under 5 years old increased from 18% in
1997 to 23% in 1995, and it was higher in the 12-23-month-old group (36.7%)
and in rural areas (27.2%).
Diseases of the circulatory system: During
1995-1998, mortality due to diseases of the circulatory system accounted for
26% to 30% of all deaths. The highest rates are for ischemic heart disease,
cerebrovascular damage, and hypertension (44.0, 31.1, and 13.5 per 100,000 population
, respectively).
Malignant neoplasms: Stomach
cancer is the neoplasm with the highest incidence in Colombia , followed by
lung cancer, and leukemia and lymphoma. In men, the lung and prostate are the
most frequent sites; in women, cervical and breast cancer head the list. In
1998, the mortality rate from neoplasms was 62.7 per 100,000 in the population
as a whole.
Accidents and violence: The
last 25 years have seen an increase in accidents and violence. There were 36,947
violent deaths in 1999, of which 23,209 were homicides, 7,026 were due to traffic
accidents, and 2,089 were suicides. The group most affected were men aged 25-34
years (9,097 deaths) and 18-24 years (7,925 deaths).
- RESPONSE OF THE HEALTH SYSTEM
National health policies and plans: In
1990, the health sector gave impetus to Law 10 on Municipalization of Health,
which launched the process of strengthening national health system institutions
at all levels. This initiative, which sets forth the fundamental principles
of sectoral reform, was reflected in the new Constitution of 1991. These mandates,
in turn, were taken into account in Law 60, which defined the scope of responsibility
of the different territorial jurisdictions and stipulated the resources to be
made available to them. The legal framework was further refined by the enactment
of Law 100 (1993), which created the General Health and Social Security System
(SGSSS) and, under it, a comprehensive pension plan, coverage for work-related
risks, supplementary social services, and the health and social security system
itself.
The health system:
Inspection, monitoring and regulation of the system (basically in terms of its
juridical, contractual, administrative, and financial aspects) were delegated
to the National Health Superintendency in 1993 after Law 100 was created. The
new scenario also encompasses public health programs, and the present system
has been designed to ensure equitable coverage, improve the quality of services,
and actively advance promotional and preventive plans for improving the health
conditions of all Colombian citizens. According to the Ministry of Health, the
hospitals under its authority managed to improve their productivity by 5% between
1996 and 1997, while at the same time lowering their costs by the same percentage
(since there was no increase in resources), but they experienced a moderate
decline in overall production between 1997 and 1998; total hospital discharges,
outpatient consultations, surgeries and deliveries fell. Nonetheless, visits
for emergency care rose.
Developments in health legislation:
Article 22 of this law sets basic priorities for municipal
investment: 25% to health; 30% to education; 20% to potable water; 5 % to physical
education, recreation, culture, and sports; and the remaining 20% left to the
discretion of the mayor or the community. In 1999, the National Congress received
the draft of Law 156 for consideration that will fill in some of the gaps in
public health law that created the SGSSS.
Organization of regulatory actions: In
the course of implementing the institutional reform of health services, it has
been observed that institutions tend to operate in isolation, which makes it
difficult to coordinate strategies against community health problems. The decentralization
of local and intermediate-level health systems has been taken to mean that these
regional and local systems were autonomous and self-sufficient, and it has not
been accompanied by an adequate transfer of authority and technological and
financial resources.
Certification and professional health practice:
The certification required to practice the various
health care professions is conferred, in principle, by the educational institutions
that grant degrees attesting to the specific professional or technical competency
of their graduates.
Environmental quality: One
of the most serious effects of economic development has been the deterioration
of natural resources, especially water, soil, and air. Poor water quality and
variations in the water cycle are having a negative effect on health. The pollution
of groundwater by domestic and industrial effluents and solid waste of all kinds
is threatening not only the supply of water available for human consumption
and production but also the nation's flora and fauna. One of the worst pollutants
is oil, which has leaked into the soil and water sources as a result of attacks
on the country's petroleum infrastructure. In 1998, the Ministry of Health and
other sources estimated that leakage of 2 million barrels of oil had affected
70 municipalities in 13 departments, including 2,600 km of rivers and streams,
6,000 ha of land with agricultural potential, 1,600 hm2 of marshes
and wetlands, and transnational catchment areas such as the Catatumbo and Arauca
river basins. On average, Colombian households are made up of 4.2 persons. Almost
four of five people (79%) live in houses and 19% live in apartments. Inadequate
housing conditions, especially poor ventilation, provide favorable environments
for diseases like tuberculosis, which is found especially in settlements with
precarious infrastructures. Overcrowding in the large city centers also contributes
to transmission of this disease.
Food quality:
In Colombia , the program for epidemiological surveillance of foodborne diseases
and the corresponding information system initially met with certain difficulties
in connection with decentralization standards and the division of responsibilities
between the Ministry of Health and its decentralized agencies. Colombia has
begun to set policies on food protection and to coordinate activities with international
cooperation agencies, particularly with regard to the Codex Alimentarius .
Organization of public health care services:
In each municipality, the mayor is responsible for
overseeing the management of health, guaranteeing the effective operation of
the PAB, regulating health insurance, and monitoring health and health services.
The program of the PAB calls for the development of health promotion activities
and mandatory interventions to be carried out for and by communities in the
various territorial jurisdictions. The health promotion initiatives of the PAB
are healthy municipalities; promotion of peaceful coexistence and prevention
of domestic violence; healthy schools; information, education, and communication
strategies; promotion of sexual and reproductive health; prevention of the use
of psychoactive substances that are harmful to health; promotion of healthy
eating habits; and prevention of problems stemming from malnutrition.
Disease prevention and control programs: The
PAB component of SGSSS enables the mayor in each municipality to carry out his
or her primary duty, which is to ensure the community's health. They encompass
all the disease prevention and control programs. Health Analysis,
Epidemiological surveillance, and public health laboratory systems:
The enactment of Law 100 (1993) created a unified social security system that
incorporates the private sector. The law also provides for the development of
a single national public health information and surveillance system, encompassing
both the public and private sectors. However, the surveillance system has remained
unchanged since it was set up for the 1996-2000 period .
Potable water, excreta disposal, and sewerage
services: According to the Ministry of Development,
barely 5% of Colombia 's 1,076 municipalities treat their wastewater before
they dispose of it. This situation has turned the Cauca and Magdalena river
basins essentially into sewers, as they receive more than 80% of the nation's
wastewater. According to the Ministry of Health, 60% of the inhabitants in the
municipal seats run a medium to high risk of contracting diseases because of
the poor quality of the water. In 2000, 76% of municipalities did not have potable
water. Solid Waste Services Very few urban areas in Colombia have adequate facilities
for the disposal of solid waste. In rural areas, this waste is usually dumped
in open fields or burned or buried on household property. The use of organic
solid waste for productive purposes has not been sufficiently studied, and recycling
programs lack continuity.
Health supplies: The
General Social Security and Health System guarantees access to essential drugs
(from a list of some 350 medicines) through the Mandatory Health Plan (POS)
for those insured under the contributory regime, with certain restrictions for
those under the subsidized regime, and with no clearly defined criteria for
those not affiliated with the system, although this last group receives prescribed
medications for basic care. As a consequence of decentralization and health
system reform, there have been some noteworthy advances in the area of biomedical
technology. (1) The provision of maintenance services in public sector health
institutions has been regulated. (2) A detailed inventory of infrastructure
resources in second- and third-level hospitals (170 institutions) was conducted.
(3) The procurement of medical equipment increased in both the public and the
private sectors.
Human resources: In
Colombia, the inequitable distribution of human resources is more pronounced
for professionals and, among physicians, specialists. Colombia has 43,166 physicians,
for a rate of 10.4 per 10,000 population .
Health research and technology: In
Colombia , no agency does a thorough compilation of national data on health
research. Until two years ago, the former Science and Technology Office in the
Ministry of Health gathered partial information on research topics and teams
working in the health sector. The Colombian Institute for Science and Technology
Development (COLCIENCIAS) has various programs that are responsible for strategic
planning within the national science and technology system. One of these programs
corresponds to the health sector and follows up on research conducted with official
funds made available through the Institute.
Health sector expenditure and financing: Under
Law 100 (1993), in 1996, an estimated US$ 300,482,310 was spent on health in
Colombia , or the equivalent of 10.1% of the GDP (estimated for that year at
US$ 4,400 million); 4.1% corresponded to the public sector and 5.9% to private
sources. Of the total amount, spending on health promotion and disease prevention
came to about 5% of all health expenditure. In 1997, health promotion enterprises
were assessed and it was learned that 5 of the 11 mandatory programs used 86.3%
of the resources. The largest amount (30.2%) was spent on the oral health program,
followed by the prevention of diseases related to pregnancy, childbirth, and
the puerperium (18.5%); the Expanded Program on Immunization ranked seventh,
with a 2% investment; and the smallest expenditure reported was for the prevention
of sexually transmitted diseases and HIV/AIDS infection.
External technical cooperation and financing: The
international cooperation received by the Ministry of Health in 2000 was reflected
in the execution of 13 agreements for multilateral cooperation, entered into
with the following agencies and international programs: JICA; GTZ; the Hipólito
Unanue Agreement; Partners in Population; the Andean Development Community;
the Organization of Iberoamerican States for Education, Science, and Culture;
the World Bank; the IDB; the IOM; and the Andrés Bello Agreement. Ten provided
technical cooperation in the following areas: strengthening health systems,
sexual and reproductive health, hospital consortia, a meeting of the health
ministers of the Andean area, and health sector reforms and financing. Bilateral
cooperation agreements were undertaken with various agencies and governments.
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