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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.
GENERAL SITUATION AND TRENDS El Salvador is a democratic republic with three branches
of government: legislative, executive, and judicial. Its current political and
administrative entities are in the process of decentralization. In 1999, the
population in poverty was estimated at 47%; of which 38% lived in urban areas.
Demography:
As of 2000, the population was estimated at about 6 million, 58% living in urban
areas, and 50.7% male. It is a young population, with a mean age under 20 years.
The annual population growth rate was 20.2 per 1,000 population, the crude birth
rate was 27.7 and the crude mortality rate 6.1 - 5.6 for urban residents,
and 6.7 for rural residents. Life expectancy at birth was 69.4 years, urban
areas 71.3 years and rural areas 66 years, in 2000. For the same year, the general
fertility rate in women aged 15-49 years was 3.6 children per woman.
Economy:
In 1999, the GDP in constant prices was US$ 1,029.4 million increased to US$
1,044.6 million in 2000. Public general spending, as percentage of GDP, was
15.8 % in 1999. Public spending in the social sector increased from 5.4% in
1998 to 5.7% in 1999. In 2000, inflation was 4.3%; the constant GDP was US$
1,641,834, and the nominal GDP was US$ 3,347,729. The open unemployment rate
reached 7%. A total of 268,780 households were receiving support from families
abroad, and the annual flow of remittances to families amounted to approximately
US$ 1,700 million.
Mortality:
According to the Office of Statistics and Censuses in 1999 there were 28,078
reported deaths, 12% (3,380) were classified as ill-defined causes. In 1999,
the leading causes of death per 100,000 population were: diseases of the circulatory
system (88.3), external causes (82.3), and communicable diseases (59.4). The
1998 Family Health Survey (FESAL-98) estimated a maternal mortality rate of
120 per 100,000 live births.
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years):The
FESAL-98 survey found an infant mortality rate of 35 per 1,000 live births,
postneonatal mortality in rural areas was 41 per 1,000 lb and 27 in urban areas.
In 1999 children under one year of age one presented a total of 1,318 deaths;
46.7% were due to communicable diseases and 44.5% to certain conditions originating
in the perinatal period. In 1999, among children 1-4 years of age, 232 deaths
occurred: communicable diseases (33.6%); external causes (26.7%); and other
diseases (30.2%).
Schoolchildren: (5-9 years): Among
schoolchildren 5-9 years of age 228 deaths were reported: external causes (43.9%);
communicable diseases (20.7%) and tumors (5.3%). Among the leading causes of
morbidity were: acute respiratory infections (ARI) (34.3%) (% of all initial
consultations), followed by intestinal parasitism (10.2%). The most frequent
causes of hospital mortality were: hemorrhagic dengue (20.7%); pneumonia and
bronchopneumonia (12.1%) and head trauma (10.3%).
Adolescents (10-19 years): It
is estimated that adolescents constituted 21.4% of the total population in 2000;
50.7% male and 52.8% of adolescents resided in urban areas. The specific fertility
rate among women aged 15-19 years was 116 live births per 1,000 women, 1993-1998.
In 1999, the adolescent population accounted for 16% of all office visits at
MSPAS (Ministry of Health). 17% of all hospitals discharges recorded by the
MSPAS in 1999 corresponded to the adolescent population; 76% of discharges were
females. Adolescents deliveries increased from 21% in 1997 to 34% in 1999.
Adults (20-59 years): There
were 7,883 deaths among adults 20-59 years: external causes 32.4% (41.5 per
100,000), diseases of the circulatory system 12.5% (16.0 per 100,000), and tumors
11.8%. The most frequent reasons for consultations in 1999 by those 15-44 years
of age were: ARI (12%); urinary tract infections (6.7%); headache due to tension
(2.5%); and diarrhea (2%).
Elderly (60 years and older): In
1999, a total of 10,573 deaths were registered in this age group, 42.8% of all
deaths; of these 37.2 % were due to diseases of the circulatory system; communicable
diseases (14.1%); neoplasms (13.4%) and external causes (5.1%).
Workers: In
1999, 19,266 work related injuries were registered, of which 39.1% occurred
in the manufacturing industries; 16.6% in the sector of community, social, and
personal services; 15.6% in retail and wholesale businesses, hotels and restaurants;
12.2% in the construction industry; 9.1% in real estate and services rendered
to business.
Disabled:
In 2000, the overall prevalence of disability was 8.5 per 1,000 population.
Indigenous population: In
1999, the indigenous population was estimated at 11.3% of the population. The
majority of indigenous population were Pipil (Nahuat), 94.4%, Lenca (4.1%) and
Cacaopera (1.5%). The last group experienced the lowest levels of health and
quality of life.
Analysis by type of health problem Natural disasters: In
1997 and 1998, the effects of El Niño led to an unpredictable rainy season and
extremely arid dry season. In October 1998, Hurricane Mitch caused flooding
resulting in 239 deaths and 57,777 people suffered were affected. In 1998, the
environment was contaminated by the mishandling of liquid organochlorine pesticides.
In 2000, a mass poisoning through ingestion of sugar cane liquor adulterated
with methanol affected 167 people and caused 93 deaths. In 2001, two earthquakes
one of 7.6 magnitude on the Richter scale and a second earthquake of 6.6 magnitude
struck within months. As a result of the first earthquake were 827 deaths, 4,520
injured and 1,160,316 persons affected and in the second there were 315 deaths,
3,399 injured, and 252,622 victims reported.
Vector borne diseases:In
1997, Malaria cases from Plasmodium vivax , accounted for 2,714 cases (45.9
per 100,000); 1,171 cases (19.4) in 1998; 1,221 cases (9.5), in 1999 and 599
cases (9.0) in 2000. Dengue has been showing endemic characteristics with epidemics
in the last four years. In 1997, a total of 396 cases of classical dengue (6.7
per 100,000 population) were recorded. In 1998, there were 1,686 cases of classical
dengue (27.9) and 2 of dengue hemorrhagic fever, and in 1999, 556 cases of classical
dengue (9.0) and 70 cases of dengue hemorrhagic fever were reported. In 2000,
a new dengue epidemic occurred, with 16,697 clinical cases or 266.0 per 100,000.
Vaccine-preventable diseases:In 1999, there
were 233 cases of febrile eruptive diseases recorded and 633 in 2000. During
the months from February to March of 2001 a follow-up campaign was carried out
to eradicate measles, reaching a coverage of 98%. The country continues to be
free of polio and the coverage of vaccination of children under one is over
95%. There were 4 cases of whooping cough in 1999, 3 in 1999, and 8 in 2000.
Neonatal tetanus has virtually ceased to be a public health problem.
Intestinal infectious diseases:
Between December 1999 and April 2000, a cholera outbreak occurred with 788 cases,
157 in 1999 and 631 in 2000. The outbreak mainly affected the departments of
San Salvador, La Libertad, La Paz, and Santa Ana. In 1999, 3 deaths were registered
with a case fatality rate of 1.9% while the incidence rate was of 2.6 per 100,000.
In 2000, the overall incidence rate was 9.4. In weeks 50 to 52 of 2000, an increase
of diarrhea in children by rotavirus, was virus type 1.
Communicable chronic diseases:Between 1997
and 2000, the number of cases of all forms of tuberculosis ranged between 1,600
to 1,700 a year, with an annual incidence of between 27 and 28 per 100,000.
The vaccination coverage with BCG ranges around 95%-99 % in children under 5.
There have been 1-4 cases of tubercular meningitis every year, with an incidence
of between 0.025 and 0.2 per 100,000 in this age group. Activities in leprosy
diagnosis and early multidrug therapy have been stepped up over the last three
years. In 2000, there were 56 cases, with 7 new cases in the northern area of
the country.
Acute respiratory infections: Acute
respiratory diseases constituted one of the leading causes of morbidity and
mortality. In 2000, the incidence rate was 252 per 1000 population, affecting
52% of the population under the age 5. The incidence of pneumonia and bronchopneumonia
(44.7 by 1,000 pop.) affected 38.3% of children under the age of 1.
Rabies: One
case of human rabies was recorded in 1999 and one in 2000.
AIDS: In 2000,
there were reported 3,482 cases of AIDS, (8.16 per 100,000), 80.5% of cases
were urban residents; 73.3% were males. Sexual transmission has accounted for
89.5% of the cases, 4.8% for vertical transmission and 0.5% for blood transfusions.
The most affected age group was that from age 15-39 with 67.4% of cases.
Nutritional diseases:
According to (FESAL-98) chronic malnutrition in children under the age 5 was
23.3%. The prevalence of anemia in mothers 15-49 years was 8.8%.
Cardiovascular diseases: In
terms of general mortality, information from DIGESTYC 1999, observed that 22%
all deaths were attributable to diseases of the circulatory system. The leading
three causes were: acute myocardium infarction (44.6%); congestive cardiac insufficiency
(25.5%), and cerebrovascular diseases (19%).
Malignant neoplasms:In 1999, DIGESTYC recorded
2,736 deaths from neoplasms, or 11% of all deaths in the country. The principal
malignant neoplasms were: stomach 16.7%; uterine cervix, the uterus, body, and
unspecified parts of the uterus 14.6%, and prostate 6%.
Accidents and violence: In
2000, minors under age 18 accounted for 5% of all recorded cases of kidnapping
in 1999 but increased to 27% in 2000. Between January-September of 2000, there
were 18,210 transport accidents, where 9 % were caused by alcohol abuse.
Oral health: In
1999, a survey showed that 12 year olds and 15 year olds had 43.6% prevalence
of caries. The average DMFT was 1.3 for those 12 years of age and 2.4 at 15
years of age.
Emerging and re-emerging: In
1999, 40 cases of leptospirosis were reported, 0.65 per 100,000 population.
RESPONSE OF THE HEALTH SYSTEM Policies and national plans: The
Government's Program for 1999-2004 "The New Partnership" sets out six strategic
areas of action: (i) Partnership for workers; (ii) Partnership for solidarity;
(iii) Partnership for security; (iv) Partnership for the future; (v) Effective
and participative government; (vi) Consolidation of Economic Stability. The
Partnership for Solidarity is intended to encourage local participation, decentralization
of government administration, and effective access to basic health services.
In the area of health, it envisages: initiating reform that is builds an equitable,
effective, and participatory national health system, decentralizing and introducing
market incentives into health services delivery, and providing incentives for
local projects in the areas of health promotion, disease prevention, and basic
sanitation and environmental health that will encourage organized and sustained
participation by the community and local governments.
Reform strategies: The
lines of action were aimed at consolidating the national health system, ensuring
implementation of a comprehensive care model characterized by joint delivery
of services, developing an administration model in which the Ministry of Health
plays a steering role, institutionalizing social participation and promoting
decentralization of the health system, strengthening the intersectoral approach
in an organized response to health challenges, and guaranteeing the provision
of essential health services for the entire population.. Leadership for reform
is provided by the National Council on Health Sector Reform, with guidance by
the MSPAS. The Integrated Basic Health Systems comprises the basic decentralized
structure of the national health system. The structure consists of a network
of integrated primary and secondary level services that rely on the conscious
and effective participation of citizens and on responsibility shared with other
sectors to improve the level of health of the target populations.
Institutional organization: The
Health Sector is composed of three subsectors: (i) the public subsector, consisting
of the Ministry of Public Health and Social Welfare, the Teaching Welfare and
Military Health; (ii) social security, consisting of the Salvadorian Institute
of Social Security (ISSR) and the Institute of Social Security of the Armed
Forces (ISSFA); (iii) the private subsector: including both profit and nonprofit
health services. The Plan for Modernization of the State was launched during
the period 1994-1999 and continues. The MSPAS introduced changes in its organization
and management model based on the decentralization of health service delivery
and administration. Health services were organized by levels of complexity,
with both curative and preventive approaches. The network of services at the
national level consisted of 610 establishments in 2000: 30 hospitals, with a
total of 4,677 hospital beds, 357 health units, 171 "health houses", 52 Rural
Nutrition Centers, and 1 clinic for its employees. The ISSS provided health
care to workers in public and private institutions. The network of services
comprises 10 hospitals, 35 medical units, and 24 community clinics.
Regulatory Actions: The
delivery of health services by private providers, the practice of health-related
professions, and the licensing of pharmacies and other regulated services were
overseen by the Public Health Council of the MSPAS through Surveillance Boards.
The licensing, regulation, and control of medications and cosmetics is overseen
by the Public Health Council. The growing degradation of the environment is
noticeable, especially as seen in the contamination of most of the surface water
sources, the deforestation of hydographic basins, erosion and frequent washouts
caused by rains, air pollution in the metropolitan area of San Salvador, and
the poor quality of housing in the country's rural areas. The National Toxicology
Information Center, based at San Rafael Hospital, assists in the handling of
problems related to chemical poisoning.
Delivery of services:The
MSPAS has defined its integrated programming along three matrices, programs
by population groups (care of children, adolescents, and adults, women's health
and health of older adults); by health problem or damage (oral health, tuberculosis,
vector control, AIDS/HIV, immunization, environmental health); and by focus
on attention (individual, family, community and environment). Emphasis is placed
on preventive health and during 2000 mental health care has received special
attention. At the end of 2000 a program was implemented to reduce cervical cancer.
The water supply and sanitation sector consists primarily of the National Aqueduct
and Water Supply Administration. In 1998, the Salvadorian Compulsory Standard
for Drinking Water Quality went into effect. Access to potable water services
covered 93.5% of the urban population, and 86.4% of urban residents had benefit
of some form of sanitation service. On the other hand, only 26.2% of the rural
population had access to any water supply service, while 49.6 % have adequate
sanitary excreta disposal. It has been estimated that 82.6% of the water supply
systems provide intermittent service. Most municipal seats in the interior do
not have any formal arrangements for the final disposal of solid waste. In 1998,
it was estimated that 64.2% of the urban dwellings in the country had trash
collection service.
Individual health care services:The MSPAS
covers 80.0% of the population; the ISSS, 15% and private providers, 5%. El
Salvador formed a Committee on the National Blood Bank Network that includes
representation from various sectors and disciplines. The Central Laboratory
has a section devoted to blood banks as well as budgetary allocation for clinical
laboratory studies and blood banks. Health promotion is one of the five themes
for action that run through the current model of comprehensive care for individuals.
Health supply: The
per capita expenditure on medications was about US$ 8 in 1998. There is a basic
list of compulsory drugs that were to be used in MSPAS facilities. 63% of the
public hospitals in El Salvador were over 30 years old, and need to replace
their equipment, renovate their infrastructure, and update their technology.
Natural disasters have wreaked havoc with their infrastructure and equipment.
Human resources:
El Salvador has 7,298 registered physicians; the ratio of physicians per 10.000
population increased in the last 5 years from 9.1 to 12.1.
Research and technology: There
were no policies for the evaluation technology in the health sector, nor was
there any governmental agency in charge of this area. "Quality circles" have
been created, especially in hospitals, to assess the utilization of resources,
and steps have been taken to promote the establishment of treatment protocols,
external processes to determine the extent to which users'needs were met, and
internal procedures to evaluate performance of the services and other areas.
Expenditure and financing: In
general, health sector spending in 1998, was US$ 1,041.5 million, equivalent
to 8.3 % of GDP, and the corresponding expenditures per capita was US$ 166.
Public health spending represented 41,8% of the total, and private spending,
58,2%, with households contributing 97,0 % of the latter.
Technical cooperation: In
1997, external cooperation accounted for 18.8% of the financial flows. The main
donors were the United States of America, Sweden, the Netherlands, Germany,
Spain, the European Union, and multilateral organisms as PAHO/WHO, UNFPA, UNICEF,
and the systems of international development such as the IDB and the Central
American Bank for Economic Integration.
