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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 Demography:Honduras
has an area of 112,492 km2 and it is divided administratively into
18 departments and 298 municipalities, over 3,000 towns. In 2000, it had an
estimated total population of 6,194,926 inhabitants, with a density of 55 inhabitants
per km2; the annual growth rate was 2.8%; 44% of the population was
urban and 49.6% were women. Forty-three percent were under 15 years old and
6% were 60 years and over. Indigenous groups represented 12% of the total population.
Economy:
The economy was characterized by a GDP depending on exports of goods and services,
with low development of domestic consumption. In 1999, the GDP fell 1.9% from
1998. In 1999, hurricane Mitch had a negative effect on the economy, although
the impact was partially diminished by international collaboration.
Literacy: In
2000 , the school coverage was 96% for the primary level, but 52.6 % of the
elderly population was illiterate.
Mortality: According to estimates of the Secretariat
of Planning, the crude death rate in 1996 was 5.8 deaths per 1,000 population,
(32,666 deaths; 18,510 male); 15% of deaths were reported through hospital discharges.
According to the General Bureau of Statistics and Censuses, the estimated underregistration
of mortality was 47% in 1999.
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years): According
to the National Survey of Epidemiology and Family Health of 1996, the infant
mortality rate was estimated at 36 per 1,000 live births (53 % neonatal), between
1991 and 1995. Acute respiratory infections and acute diarrhea with dehydration
were the leading causes of death in children under 5.
Schoolchildren (5 to 9 years): In
1994, among children 5-9 years of age there were 375 deaths, 2.3% of the total
deaths.
Adolescents (10 -14 and 15-19 years):In 1999, 17% of hospital discharges were adolescents:
47.8% due to the female reproductive process and care related to pregnancy,
childbirth and puerperium . Violence (mainly injury and poisoning) accounted
for 27% of hospitalizations. Survey data in this period indicated that the fertility
rate of females 15-19 years of age was 136 births per 1,000 women. The survey
also showed that the first sexual experience occurred before 15 years of age
among 20% of women. The maternal mortality rate among those 12-14 years of age
(391 per 100,000 live births) was almost four times that of the total maternal
mortality rate (108).
Adults (20-59 years): Normal
delivery and the reproductive process accounted for 43% of hospital discharges
in this population group. This age group of women represented 66% of the total
female hospitalizations. The use of contraceptive methods among women 20-24
years was 39% and among those 35-39 years it was 58%. The group 15-59 years
of age comprised 90% of AIDS cases, of which 61% were males.
The elderly (60 years and older):
In 1999, 59% of this population lived in rural areas. Elderly adults generated
10.2% of all public health outpatient consultations.
The disabled: It
is estimated that more than half a million inhabitants of the country display
some degree of physical or mental disability.
Indigenous groups:More
than half a million Hondurans are indigenous and/or of Afro descent; they are
distributed among 9 culturally distinct groups: Lencas , Chortis , Tolupanes
, Tawahkas , Garífunas , Afro English-speaking, Pech , Nahualt , and Miskitos
. Their health status reflects their marginalized situation, including lack
of access to basic health services and limited social participation.
Analysis by type of health problem Natural disasters: In
1998, the country was affected by Hurricane Mitch in 1998 and in 2000, a great
drought affected more than 85,000 people of the southern region of the country.
Hurricane Mitch brought torrential rains, and floods that affected 11 of 18
departments of the country, resulting in 1.5 million victims; 5,657 dead; 8,058
missing; and 12,272 injured. Losses due to Hurricane Mitch were estimated by
the Economic Commission for Latin-America and the Caribbean (ECLAC) at almost
3.8 billion dollars (70% of GDP) and nearly 100% of foreign debt.
Vector-borne diseases:Malaria has been endemic
since the 1950s. The Northern coastal area of the country (Department of Colón
) recorded the greatest number of cases, reporting 36% of cases in 1999. At
the end of 2000 there were 35,122 registered cases of malaria. Dengue has been
endemic in Honduras since 1998, when 28,064 cases were reported and 77 cases
of dengue hemorrhagic fever were confirmed. In 2000, the country reported an
epidemic concentrated in Tegucigalpa , with 13,795 cases. In 1999 dengue hemorrhagic
fever caused 8 deaths with a case-fatality rate of 20 % and in 2000, 10 deaths
with a case-fatality rate of 3%.
Diseases preventable by immunization: No
cases of poliomyelitis have been reported since 1989, and vaccination in children
under 2 years of age had a coverage over 90% in 1998-2000. The last case of
measles was reported in 1996; vaccination coverage of children under two was
98% from 1998-2000. The coverage with DTP vaccine in the population under 2
has been 94 % or higher since 1997. The country has not reported cases of diphtheria
since 1981. Several whooping cough outbreaks have occurred in recent years,
with more than 648 cases and 28 deaths in 1996-2000. In 2000, no case of neonatal
tetanus had been reported. The coverage with BCG vaccine has been higher than
97%. In 2000, only 4 cases of tuberculosis meningitis were reported in children
under 5. Rubella has been controlled with the pentavalent vaccine (MMR, plus
anti Haemophilus influenzae and anti Hepatitis B) since 2000. Intestinal infectious
diseases: In 1997, 90 cases of cholera were reported. In 1998 there was an outbreak
in Mosquitia (Department of Gracias a Dios ) with 289 cases and a 3.9% case-fatality
rate. In 1999, 57 cases and 3 deaths were reported. In 2000, 15 cases of cholera
were reported and 3 died. The annual average number of cases of diarrhea for
this period fluctuated around 200,000, 85% in children under 15.
Communicable chronic diseases:There
was an average of 4,700 cases of TB reported between 1997 and 1999. The association
between TB and HIV/AIDS increased in the period 1996-2000. In 1998, the National
Program of Leprosy was reinitiated after being discontinued for almost two years
(1996-1998). At the end of 1998, the program had followed up on 78 cases, of
which 13% remained on multiple drug therapy. In 1999, cases declined to 72.
Acute respiratory infections (ARI):The general trend of ARI in the country has been increasing
constantly, with an annual average rate of 5%. In 1996, about 90,000 infections
were reported; in 1998, reported cases reached 98,790.
Zoonoses:In
1998 and 1999, there were 7 and 5 cases of canine rabies and no case of human
rabies reported. In 2000, 1 case of human rabies and 15 cases of canine rabies
were reported.
HIV/AIDS:In
the Department of Cortés , the metropolitan areas of San Pedro Sula and Francisco
Morazán ( Tegucigalpa ) accounted for 60 % of the 11,789 confirmed cases of
HIV in 2000. The pattern of predominant transmission was sexual ( 85% heterosexual,
3% homosexual and 5 % bisexual), blood transfusions (1%) and vertical transmission
(6.1%). In 2000 the Male-Female ratio was 1.2.
Nutritional and metabolic diseases: In
1996, The Micronutrient Survey found that 26% of non-pregnant women and 32 %
of pregnant women were anemic. The prevalence of malnutrition in 1997 was 40.6%,
26% moderate and 14% severe.
Malignant neoplasms: In
1998, 456 cases of malignant neoplasms were reported, of which 67.8% were females.
The most frequent sites of primary cancer in women were cervix (34%) and breast
(17%). In men the most frequent site was the eye, brain and central nervous
system (16%), followed by the hematopoietic and reticuloendothelial system (15%)
and genitalia (4%).
Emerging and re-emerging diseases: Between
1998 and 1999, a laboratory diagnostic capability was developed for leptospirosis
, and in 1998, the first diagnosis was made 4 days after the occurrence of Hurricane
Mitch. In 1999, 39 cases of leptospirosis were diagnosed.
RESPONSE OF THE HEALTH SYSTEM National health policies and plans: The
reform process has undergone several stages: modernization of the State (1990),
National Initiative Emphasizing Access to health Services (1996), New Agenda
in Health (1998) and Transformation of the Health Sector (2000). In 1996-98,
the Ministry of Public Health established access to health services as the central
policy for reform of health services. In 1998, after the worst disaster in the
history of the country, Hurricane Mitch, the Ministry of Public Health issued
policy guidelines for 1999-2001 that considered the need to promote health sector
reform in the national reconstruction process. The objective was to strengthen
the health care network and expand coverage.
Health sector reform: The
Strategy of Health Sector Reform was based on the principles of universality,
solidarity, equity, efficiency, participation, quality, and transparency (guidelines
of policy 1999-2001). For the achievement of its objectives, four basic lines
of action were designed: institutional development of the Ministry of Public
Health; decentralization and local development; health promotion and reorganization
of the health care model and strengthening of management. One of the pillars
of sectoral reform is strengthening of the steering role of the Ministry of
Public Health. To improve the institutional management at different levels,
the Coordinating Council of the Ministry and the Technical Council for Institutional
Management were integrated. To improve and strengthen the information system,
a Management and Financial Information System was introduced in 1999, and a
Management Information System was introduced in 2001, both of which were designed
to serve as managerial support tools for the information system as a whole.
The health system:The
health system is made up of public and private subsectors ; the public sector
consists of the Ministry of Public Health and the Honduran Social Security Institute
(IHSS), the National Water Supply and Sewerage Service and the National Institute
for the Prevention of Alcoholism, Drug Addiction, and Drug Dependence. In the
review period, the estimated coverage for the Ministry of Public Health was
60%; Social security covered between 10-12% and the private services covered
10 % of the population. The Ministry of Public Health is organized into 9 Health
Regions and 42 Areas.
Organization of regulatory actions: The
Ministry of Health's Department of Pharmacy is responsible for the regulation
of medical drugs and concentrated efforts on the Public Health Registry, with
8.725 drugs, 83.4% proprietary and the rest generic. Water and sewerage services
and sanitation in general have shown limited progress in the last five years.
Investment over the last two years in this sector has focused on repairing infrastructure
damaged by Hurricane Mitch. In 1999, access to potable water at the national
level was 80.9%; 71.1% of the population was served with some form of excreta
disposal. Since 1995, regular monitoring of air quality has been carried out
in Tegucigalpa and intermittently in the cities of San Pedro Sula and La Ceiba
. The results of monitoring indicate that concentrations of suspended particulates
are continuously outside standard limits.
Organization of public health care services:
The Ministry of Education coordinates activities
related to sports and for the improvement and promotion of healthy lifestyles.
The National Congress has worked on a new code for protection of children as
well as various laws to combat alcoholism and drug addiction; a new penal code;
a law creating the Children and Family Institute; and a special law on family
violence. The Office of the National Commissioner for the Protection of Human
Rights has also been strengthened with special attention given to minor offenders,
battered women and abused minors. The Ministry of Public Health's Bureau on
Population Risks carried out normative functions for health programs. Up until
2000, epidemiological surveillance was based on a network comprised of 1,190
reporting units that constituted an "Action Alert" system. Technical and financial
resources obtained following Hurricane Mitch strengthened the network of public
health laboratories.
Organization of individual health care services:
In 1996, Ministry of Public Health care facilities
provided 5.8 million outpatient consultations and 372,000 hospital discharges.
There is a National Blood Reference Center , 26 blood banks and 29 blood collection
centers. Mental health care was mainly concentrated in hospital services, including
2 psychiatric hospitals.
Health supplies : Total
spending on drugs amounted to 1.9% of the GDP in 1997 and 1.7% in 1998. There
are no programs to control the price of drugs. The Ministry of Public Health
has a Basic List of Drugs including 271 active ingredients. Public spending
on health allocated to drugs was 13.8% in 1996, 14.6% in 1997, 12% in 1998 and
8.3% in 1999.
Human resources:In 2000, there were 5,287
registered physicians, 37.8% working in the public subsector (8.8 physicians
per 10,000 population). There were 1,957 registered professional nurses (3 per
10,000), 45.3% of them working in the public subsector .
Health Research and Technology: The
Honduran Science and Technology Council is responsible for coordinating the
sector's science and technology. In 2000, the Ibero -American Program of Science
and Technology for Development was launched to train human resources in areas
of scientific and technological research, to help solve specific problems and
implement projects of social interest.
Health Sector Expenditure and Financing: The
sources of health sector financing in 1999 were: families (53.7% of national
spending on health); Government (32.9%); IHSS (7.8%); and non profit organizations
and private insurers (4.3% and 1.3%, respectively). Between 1993 and 1999, the
financing of the Ministry of Public Health increased by 91.6%, mainly due to
external financing that reached 117%. The financing of the IHSS, sustained through
member contributions, was insufficient to cover expenses. Public spending on
health in relation to public spending as a whole decreased from 7.2% to 6.7
% between 1993 and 1998. The total per capita health expenditure showed a decline
of 24.1% between 1995 and 1999.
External technical cooperation and financing:After
Hurricane Mitch, the flow of technical and financial cooperation increased considerably.
Bilateral international cooperation for all sectors amounted to US$ 1,113.2
million; increasing non-reimbursable funds to US$ 945.8 million. Multilateral
Cooperation amounted to US$ 1,099.3 million; the non-reimbursable funds reached
US$ 298.8 million. The total of non-reimbursable funds was US$ 1,244.6 million
and the total of the reimbursable funds was US$ 967.9 million.
