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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 The form of government of the Eastern Republic of
Uruguay is a representative democracy. Uruguay is divided into 19 departments,
governed by Departmental Councils.
Demography: The country has a total population
of 3,322,141 (year 2000 estimate). Some 91% of the population lives in urban
centers, ranging from a minimum of 80% in the department of Tacuarembó to a
maximum of 97% in Montevideo . Forty-two percent of the total population resides
in the department of Montevideo , where the capital of the same name is located.
The remaining 58 % lives in the other 18 departments, of which Canelones is
the most populated (14% of the total) and Flores the least populated (less than
1% of the total); the other departments each account for between 2% and 4% of
the country's population. Life expectancy at birth in 2000 was 74.5 years for
both sexes, with a sex difference of 8 years: 70.4 for males and 78.4 for females.
At least one person 60 years of age or older lives in almost half of urban households
in the country (49%). Over half (54%) of the elderly live in households consisting
exclusively of individuals 60 years of age and older. The crude birth rate is
16.3 live births per 1,000 population , and the crude death rate is 9.5 per
1,000 population. The average annual population growth rate is 0.6%, while the
total fertility rate is 2.3 children per woman. The age distribution in the
country shows an aging population with a bell-shaped population curve. However,
there are differences among departments.
Economy: In 2000, for the second straight
year, the Uruguayan economy was in recession. In 1999-2000, national income
fell significantly more (6%) than GDP (4%). In addition to these developments,
the impact of bad weather on several agricultural sectors is noteworthy. The
economically active population represents 61% (some 2 million people) of the
population. The urban unemployment rate in 2000 was 13.6%, one of the highest
in decades. Annual inflation (as measured by the consumer price index) in March
2001 was 4.7%.
Education: The illiteracy rate among the population
10 years of age and older is 3.1% (3.6 % among males and 2.6% among females,
and 2.8% in urban areas and 6.2% in rural areas).
Mortality: There were 32,430 deaths in 1999.
The leading causes of death among the population were diseases of the circulatory
system (36%), malignant neoplasms (23.1%), and accidents and adverse effects
(5.2%). Next in importance were chronic obstructive pulmonary disease (3.1%),
respiratory infections and pneumonia (3%), diabetes mellitus (2%), infectious
diseases (1.8%), suicide and self-inflicted injuries (1.3%), disorders in the
neonatal period (1.3%), and other causes (9.6%).
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years): In
1999, there were 56,006 births in Uruguay , the infant mortality rate was 14.4
per 1,000 live births, with a neonatal mortality rate of 8.5 per 1,000 and a
postneonatal mortality rate of 5.9 per 1,000. In 2000, the infant mortality
rate was 14.1 per 1,000 live births in the country, 14.6 in Montevideo and 13.7
in the rest of the country. The leading cause of death in 1999 among children
under 1 year of age was congenital malformations. The three leading causes of
death in the population aged 1-4 years were accidents and adverse effects (17.6
per 100,000), congenital anomalies (7.9 per 100,000), and acute respiratory
infections and pneumonia (7.1 per 100,000).
Schoolchildren (5-9 years):In
1999, accidents (with a mortality rate of 11.7 per 100,000), malignant neoplasms
(4.7 per 100,000), and certain infectious and parasitic diseases (1.8 per 100,000)
accounted for 68.4% of the deaths among children in this age group.
Adolescents (10-14 years): In
1999, accidents were the leading cause of death in the 10-14 years age group
(12.2 per 100,000), accounting for 45.2% of all deaths in this group. The second
leading cause was malignant neoplasms (4.1 per 100,000), followed by suicide
and self-inflicted injuries (1.5 per 100,000).
Adults (15-64 years): Of
the 32,430 deaths in 1999, 22.9% were in the group aged 15-64 years. The leading
causes of death among those aged 15-34 were accidents and adverse effects (39.2
per 100,000). Between 35 and 64 years of age, malignant neoplasms (196.6 per
100,000) were the leading cause of death, followed by diseases of the circulatory
system (140.26 per 100,000). There were six maternal deaths in Uruguay in 1999.
It is believed that there is underreporting, but its exact extent is unknown.
The Elderly (65 years and older):The
leading causes of death in this age group were diseases of the circulatory system
(2,139 per 100,000 population of 65 years and more), neoplasms (1,174 per 100,000),
and chronic diseases of the lower respiratory tract, acute respiratory infections,
and pneumonia (491 per 100,000). These same causes accounted for 69 % of all
diseases in this age group.
Analysis by type of health problem Vector-borne diseases: Uruguay
to a large extent has controlled Chagas ' disease. Successive international
evaluations in 1998, 1999, and 2000 have certified Uruguay 's accomplishment;
it is the first endemic country to interrupt transmission. Surveillance and
controls continue at present in an effort to completely eradicate T. infestans
. One potential problem for the country is the reintroduction of the Aedes aegypti
mosquito with possible cases of dengue. There is no autochthonous transmission
of dengue in Uruguay .
Diseases preventable by immunization: Cases
of poliomyelitis, neonatal tetanus, or diphtheria have not been reported since
the early 1980s. Thirty-four cases of measles, 2 of acute flaccid paralysis,
3 of pertussis , 3 of rubella, 24 of mumps, and none of non-neonatal tetanus
were reported in 1999. In 2000, vaccination coverage in the population under
1 year of age was 99% for BCG, 88% for DPT3, 88% for OPV3, and 90% for the measles
vaccine.
Chronic communicable diseases:
There were 708 cases of tuberculosis reported in 1997, 668 in 1998, and 627
in 1999. The rate of HIV infection among tuberculosis patients was 1.3% in 1999.
Acute respiratory infections:Pneumonia
ranked seventh as a cause of infant mortality, the second leading cause of postneonatal
mortality, and the third leading cause of death among children aged 1-4 years.
Between 1998 and 2000, acute infections of the lower respiratory system were
the leading cause of hospitalization in the Pediatric Hospital of the Pereira
Rossell Hospital Center , accounting for 25% of discharge diagnoses. This facility
is the only pediatric referral center in the country and is under the Ministry
of Public Health.
Zoonoses: Autochthonous
transmission of urban rabies has not been reported since 1966. No cases of bovine
tuberculosis or brucellosis have been reported either. In 2000, there were no
reported cases of swine brucellosis, a disease that was reintroduced in the
country in the mid-1990s. Leptospirosis is an endemic occupational disease and
an epizootic in areas of the country in which dairy cattle are raised and rice
or sugar cane is grown. In 2000, 23 cases of leptospirosis were reported (5
deaths).
HIV/AIDS:Since
1983, when the first case was reported to the Ministry of Public Health's AIDS
Program, to 31 December 2000, 1,583 cases of AIDS were reported (a cumulative
rate of 50 per 100,000 population). About 80% of the cases were in Montevideo
. Of the total number of cases, 67.5 % infections were sexually transmitted,
28.6% were bloodborne, and 3.9% were mother-to-child.
Diseases of the circulatory system:For 45 years, diseases of the circulatory system have
been the leading cause of death, accounting for 34% of all deaths in 1999. The
rate of mortality from these diseases was 357 per 100,000 in 1995 and 330 per
100,000 in 1999; these numbers indicate a mild but steady decline over the past
10 years.
Malignant neoplasms:In 1996 and 1997, there
were 13,506 deaths from neoplasms among males, with an age-standardized rate
of 325 per 100,000. Among females, deaths due to neoplasms numbered 12,482,
with an age-standardized rate of 251 per 100,000 women.
Accidents and violence:Between March 2000
and March 2001, 322 persons died as result of traffic accidents. The number
is appreciably lower than that registered between March 1999 and March 2000
(521 persons). The decline seems to be due to the widespread use of seat belts.
Emerging and re-emerging diseases : The
country has a few cases of hantavirus pulmonary syndrome each year, mainly among
the rural population engaged in farm work.
RESPONSE OF THE HEALTH SYSTEM National health plans and policies: The
following six main health-related objectives have been established for the 2000-2005
period: strengthen the management of public and private health care institutions;
adapt the supply available services to the epidemiological characteristics and
needs of the population; make health care coverage universal by facilitating
access and care at the four levels of complexity; enhance the quality of services
at the four levels of complexity; rationalize the use of services at the Institutes
of Highly Specialized Medicine; and promote the participation of service users
and health care institutions in order to solve problems in a climate of trust
and respect for the rights of citizens. The Ministry of Public Health has established
a program, under an agreement with the principal health care institutions, to
overcome the crisis affecting the Collective Health Care Institutions (CHCI)
and to maintain job opportunities. Reducing the prices that the public pays
for drugs is one of the priorities established by the Ministry of Public Health.
Prices could drop significantly, as much as 40%, if an agreement were reached
between the Ministry and the chambers representing domestic and foreign laboratories.
Health sector reform: The
Government's main concern is the coverage and maintenance of the mutual assistance
system, which means reorganizing the management of the mutual assistance associations
and their health care models. To this end, the Minister of Public Health convened
the Intersectoral Commission for the Strengthening of the Mutual Assistance
System. In 2000 and early 2001, the Ministry conducted a number of CHCI management
audits to analyze the financial status of the institutions. The audits reflected
the debt situation of the CHCIs .
The health system: The
public health system in Uruguay consists of two sectors: public and private.
The public sector is made up of the institutions under the Ministry of Public
Health, through the State Health Services Administration (ASSE); the University
of the Republic ( University Hospital ); the Armed Forces Health Service; the
Police Health Service; the Social Welfare Bank; the health services of autonomous
and decentralized agencies; and the services delivered by the 19 departments.
The private health sector consists mainly of the collective health care institutions,
which are private nonprofit organizations that are formed and operate under
the provisions of Law 15,181 and its regulatory decrees. There are some 48 CHCIs
that provide medical care to almost half of the population through prepaid comprehensive
health insurance. There are also several private sanatoriums, which provide
private medical care to high-income groups; most of them lease their services
to the CHCIs and offer partial insurance coverage. In terms of coverage, the
ASSE serves 33.7% of the population, the CHCIs 46.6%, the Armed Forces Health
Service 4.2%, the Police Health Service 1.8%, and other institutions 1.2%. Some
11.7% of the population does not have formal coverage, and there are no data
for 0.9%. Partial medical insurance has been expanding rapidly since the early
1980s.
Organization of public health care services:
In the area of maternal and child health, the
Ministry of Public Health has promoted activities aimed at newborns weighing
less than 1,500 g and at sudden infant death, especially at home. It was anticipated
that starting in 2001, professional assistance would be provided free of charge
to all women receiving care in the public sector.
Potable water, excreta disposal, and sewerage
services: The coverage of potable water services
is high in Uruguay (98% of the total population). Sewerage service coverage
is 80% in the urban area of Montevideo . In urban areas in the provinces, such
services are provided to half of the population, and the State Sanitarian Works
Administration (OSE) has set in motion plans for the treatment of effluents
in large cities and has proposed other solutions appropriate for small towns.
Forty-six percent of the country's population is connected to the sanitation
system, and 48% eliminates wastewater "in situ."
Food safety: Uruguay
has traditionally had a high level of food hygiene. The year 1994 saw the start
of intersectoral coordination and structuring of institutional and technical
resources for food safety. The National Advisory Commission for Foodstuffs was
formed; it operates within the orbit of the Ministry of Public Health and consists
of representatives of the national and municipal public sector, chambers of
industry and the food trade, and consumer organizations. The System for the
Epidemiological Surveillance of Foodborne Diseases, which is coordinated by
the Ministry of Public Health, provides nationwide coverage.
Organization of individual health care services:
There are 76 blood collection centers in Uruguay
, and 51 of them process blood. Transfusions are regulated by a number of laws
and decrees.
Health supplies:A broad legal framework regulates
the importation, production, distribution, sale, and advertising of drugs. The
Ministry of Public Health controls the requirements and demands for registering
drugs that are regarded as necessary, effective, safe, and produced under conditions
that ensure their quality. It also monitors the standards for the inspection
of production laboratories, points of distribution and sale, and production
processes. To perform this task, the Ministry has units for evaluation and registration,
inspection (of manufacturers, importers, distributors, and sale and disbursement
sites), and laboratory analysis for drug quality control. The basic inspection
activities focus on production laboratories or marketing and on products, including
labeling and advertising. Several factors impede the Ministry of Public Health's
performance of these functions to varying degrees, among them shortages of human
resources, delays in administrative processes, and the interests at work around
the pharmaceutical industry.
Human resources: As
of 31 December 1999 , there were 12,486 physicians (39.5 per 10,000 population),
2,613 professional nurses (8.2 per 10,000 population), and 4,050 dentists (12.8
per 10,000 population) in Uruguay . The training of human resources for health
is not planned. In addition to the University of the Republic, private universities
and institutes for the training of physicians, professional nurses, dentists,
and nursing auxiliaries have been established in recent years. In general, there
is a surplus of physicians and a shortage of professional nurses.
Health research and technology:
Very little research in health technology is conducted in Uruguay , and it is
done outside the Ministry of Public Health. Records are not available to estimate
the number of clinical trials for evaluating the efficacy and safety of new
procedures.
Health sector expenditure and financing: Per
capita health expenditure in 1998 was US$ 697, and total spending on health
was equivalent to 10% of GDP. Public spending (46%) and private spending (54%)
were relatively proportional. Public spending on health accounted for 14% of
overall government outlays. The public sector accounts for all spending on health
promotion, disease prevention, and epidemiological surveillance. In 1998, the
private sector spent around four times more on drugs (US$ 266 million) than
the public sector (US$ 70 million). In addition, the private sector spent US$
975 million on personnel costs, while the public sector spent US$ 223 million.
External technical cooperation and financing: Both
the World Bank and the IDB cooperate with the Ministry of Public Health and
other institutions in the area of social services. Cooperation focuses on such
areas as the decentralization of the Ministry's health care services, improvements
in the identification of beneficiaries, and the training of human resources
to manage the services. The Ministry of Public Health, in coordination with
PAHO, continues the activities indicated in the Agreement between Uruguay and
the Province of Emilia-Romagna, Italy, in the area of mental health. On several
occasions in the 1998-1999 period , the PAHO/WHO Country Office in Uruguay provided
advisory services in the area of health services management with a view towards
strengthening the Dr. Manuel Quintela University Hospital.
