Health System Performance in Venezuela: A Triumph of the Bolivarian Revolution

The Bolivarian Revolution has been under attack in the mainstream media on a daily basis over the last few years. In April 2002 a CIA-led military coup tried to oust Chavez from office, but was overthrown after 48 hours by a massive popular uprising. Since then every attempt of the oligarchy to reconquer its grip on the Venezuelan state has been rejected by the mass struggle of the Venezuelan people, culminating in the landslide victory of Chavez in the Presidential election last December. The main reason for this hostility from the rich and the powerful is the programme of social reforms developed by the Bolivarian government empowered by the mass support of the Venezuelan people. This is well reflected in the remarkable achievements in the Health system.

Before Chavez was elected in 1998, the access to healthcare for Venezuelan population was deteriorating, as there was an increasing trend towards the privatisation of public health services. The health system and its medical staff distribution was similar to those of the colonial age - urbanised and exclusive for the oligarchy - leaving 17 million Venezuelan people without access to health care. In 2000, the Bolivarian Republic of Venezuela was proclaimed and article 83 of the new Constitution states that health is a fundamental right, and a new decentralised, intersectoral, participative Public Health System emerged with the responsibility of providing free and universal health care. As was the case with the Cuban government in the 1960s, the priority is the development of primary healthcare facilities to alleviate the workload in the hospitals and ambulatories.

Consequently, in April 2003 Chavez launched the primary healthcare programme called Misión Barrio-Adentro I that began with the community-based work of 58 Cuban doctors which provide Libertador, one of the poorest municipalities of Caracas, with healthcare. This mission is an integral programme interrelated with health education, sport, and social security activities. One year later Cuban doctors were allocated in all the poorest and remote areas of Venezuela and in the period 2004-07 the number of outpatient visits through Barrio-Adentro was more than 1.5 million with 30,000 Cuban doctors and nurses operating in the new health service network.

Meanwhile, Barrio-Adentro patients that need more specialised care are sent to La Havana. The Venezuelan government pays for their transportation, food, and hospital care. In the Barrio-Adentro facilities the Cuban doctors adopt their preventive, diagnostic, and treatment module which allowed the curing of 95% of the most common diseases free of charge for the users. Ophthalmology and dentistry care are also provided at these centres.

The secondary level of care is implemented through Barrio-Adentro II which includes the Diagnostic Integrated Centres (DICs) (offering more specialised services such as electrocardiography, endoscopies, rehabilitation and emergency units, physiotherapy, intensive therapy, etc.).

Following the Cuban example of health promotion strategies, both Barrio-Adentro I and II promote healthy life-style practices among the population such as a basic gymnasium, and Cuba offers specialised sport personnel which work in teams with the Barrio-Adentro doctors and Venezuelan sport teachers helping in rehabilitation work and exercise for pregnant women and the elderly.

Barrio-Adentro III is a network of high-tech hospitals providing the people with new services such as tomography, and intensive therapy.

In 2004 Chavez launched Operación Milagro, an additional health-care mission which has been extended to 11 other Latin American and Caribbean countries such as Guatemala, Panama, and Haiti. At the end of 2005, Cuban doctors from the BA performed more than 400,000 different ophthalmology surgeries (optometric, retinitis pigmentaria and cataracts mainly) and the government declared its desire to expand the programme to serve 600,000 patients annually.

The real social spending per capita has been increased by 314% in the last 8 years, up to 20.9% of the Gross Domestic Product. The Bolivarian Revolution started with the people and for the people... Health is a human right which is not marketable. This is the first step towards social justice.

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