El Salvador: Who Will Have the Hospitals?
Schuld, Leslie
In El Salvador, efforts to put the public health system into private hands have provoked a wave of opposition: Last September 18, unionized doctors and workers at the Social Security Hospital...
...more, the government's Ministry of Health has only re 71 percent of the pop- spent 5.8 percent of its $2 million pharmaceutical line, the majority of budget in the first part of 2002, creating artificial Vol X)(XVI, No 4 JANUARY/FEBRUARY 2003 43 0 a 5 0 0 04 o: 5 Vol XXXVI, No 4 JANUARY/FEBRUARY 2003 43PRIVATIZATION IN THE AMERICAS October 2002 White March in San Salvador shortages of medicine so people will become fed-up with the system...
...The reason is simple: The system receives a steady monthly income from formally employed Salvadorans and system accounts contain $250 million dollars in reserves...
...The government invested millions of dollars to attack the antiprivatization decree from all angles, including publicity, court challenges, calls to the legislative assembly to reverse the decree, and most outlandish, suspension of telephone, electric and garbage services to hospitals with the argument that private Police stand guard during anti...
...But the issue has highlighted the continuing differences of the main opponents of the Salvadoran war years: ARENA-tied to death squad activity during the civil war era and El Salvador's ruling party for the last thirteen years-has promoted privatization...
...It will also remain a focal point of grassroots mobilization and protest...
...Private investors are viewing this pot with a greedy eye...
...The U.S...
...a poll taken by the prestigious Jesuit University polling institution IUDOP showed that eight out of 10 Salvadorans are against privatization of the public health care system...
...Hospital Rosales now contracts state employees at $400 a month, all of which goes directly to the worker...
...Though Flores denied that his proposal was actually intended to privatize the system, members of the private business association ANEP were the main spokespeople for the plan...
...The FMLN and a broad center left coalition have not been able to come up with a candidate with as widespread support as Silva had, though at the moment, the FMLN is still ahead of ARENA in the polls...
...contracts for such services were prohibited under the anti-privatization decree...
...Notably absent was any consultation with the medical profession...
...Then, on October 31, in an attempt to thwart the mobilizations, Flores announced in a nationally televised address that he would not veto the bill, but using a play on words he also did not say he would sign it into law...
...On November 14th the Legislative Assembly passed the bill again, this time with a two-thirds majority, obligating the President to sign the bill into law...
...According to legislative assembly member Shafik Handal of the FMLN, President Flores' plan includes giving $50 million to the private insurance companies to pay for start-up costs...
...Last year's White Marches were the culmination of a series of actions against health care privatization that dates back to 1992, when workers affiliated with the General Union of Hospital Workers (SIGESAL) at the main national hospital, Hospital Rosales, began protesting World Bank and International Monetary Fund calls to privatize health care as part of an overall structural adjustment plan...
...e strike.The Salvadoran Privatization has important supporters among the riulti-million dollar pro- Salvadoran elites whose economic interests are at he strike, offered work- stake...
...The Farabundo Marti National Liberation Front (FMLN), the former guerrilla front, is now a legal political party that won 31 of 84 seats in the last assembly election, the largest number of 42NM2IA REPORT ON THE AMERICAS Leslie Schuld is the director and co-founder of the Center for Exchange and Solidarity (CIS), <http://wwwcis-elsalvadororg> in El Salvador...
...One month into the health care workers' anti-privatization strike, President Flores presented a proposal to "modernize" and "democratize" the health care system...
...In the end, Silva has been left in an embarrassing situation, rejected by the medical profession and his own party, which has steadfastly opposed health care privatization...
...Privatization opponents have been successful in stopping or overturning some of these initiatives, such as the privatization of Hospital Rosales' ophthalmology department...
...Another $10 million will go to a propaganda campaign to sell the Salvadoran population on private insurance...
...If private insurance companies and private medical practices took over the provision of and payment for health care, these services would not be covered or would escalate users' costs way beyond their income...
...The Ministry of Public Health covers 74 percent of hospitalization, covering people with no or ofessionals continue the informal employment, generally those earning less than er...
...State Department was reportedly grooming Silva as a presidential candidate to provide an alternative to the ARENA government, but required that he distance himself from the FMLN so that neoliberal economic measures could go forward as planned...
...This was a major victory for the anti-privatization movement, but it was short lived as on December 19 the decree was overturned in yet another assembly vote when the right-wing Party for National Conciliation (PCN), which had initially voted for the decree, joined the governing Nationalist Republican Alliance (ARENA) in opposing it...
...On October 23, community and social organizations joined the health care workers as an estimated 200,000 people dressed in white marched to the president's house-the biggest protest in El Salvador since the civil war days of the early 1980s...
...owns one of the largest The government has tried to sell the privatization iscatlmn...
...As the anti-privatization White Marches built up steam late last year, President Flores looked for a NACIA REPORT ON THE AMERICAS 44PRIVATIZATION IN THE AMERICAS way to demobilize the movement before November 23, the start date for the Central American and Caribbean Olympic Games, which El Salvador was hosting in the international media's eye...
...Only nine percent of be privatized, the strik- surgeries are currently done in private hospitals, accordle government will take ing to a report by the Salvadoran doctors' professional ack wages and reinstate association...
...1 nesses were privatized first...
...Anti-privatization sentiment is widespread...
...Silva, a doctor by profession, accepted, perhaps envisioning a resolution of the health care crisis as his ticket to the 2004 Presidency...
...Instead of alleviating the crisis, President Flores' plan deepened it by generating insecurity about the future of health care in the country...
...he government's strategy was to begin privatization of the health sector by privatizing individual hospital services like security and food, or individual medical sections such as ophthalmology...
...The continuing privatization struggle is sure to be a defining issue for both the 2003 mayoral and legislative assembly elections and the March 2004 presidential elections...
...Workers went on a week long hunger strike in 1993 and were able to derail privatization administrative services...
...have been partially privatized...
...impact of contributing to a reformed national health care system and stopping a neoliberal economic measure that would hurt the poor majority will have a far-reaching impact...
...After the same hospital began replacing its security guards with a private contractor, SIGESAL, the hospital workers union, convinced a new management to reverse the plan: According to SIGESAL Secretary General Mario Arevalo, the hospital was paying the private firm $628 monthly per security guard, yet the security guards only earned $143, El Salvador's minimum wage, leaving workers in a desperate situation which motivated some to carry out robberies...
...Net generation, education, water-a In El Salvador, a country where ulation lives below the poverty Salvadoran doctors demonstrate against health care privatization...
...Some were employed workers via payroll deductions and employer international charges that contributions...
...of ophthalmology and health care is covered by two national hospital systems: 100 workers, including The Social Security system accounts for 17 percent of me prominent doctors, hospitalizations and provides coverage for all formally .e protests...
...the entire union board and so were fired for their role in th rehired in 1997, in the wake of ii the firings were illegal...
...The FMLN has been the only party to consistently support the anti-privatization movement and its call for maintaining the public health system...
...Privatization began in El Sa election of the first ARE Christiani...
...The strike and marches were most immediately aimed at showing support for a legislative decree that would prohibit privatization of El Salvador's two national health care systems: the Social Security Institute and the Ministry of Public Health...
...Now, medical workers and pr strike they began last Septemb that the hospital system will not ers also want guarantees that th no reprisals against them, pay b workers fired in the wake of th Government has carried out a 1 paganda campaign to discredit t ers sums of money to break the s protestors and now refuses to co ating table...
...The ARENA government uses the artificially generated crisis to build its case for privatization...
...Since the sign- of health care to the public by citing corruption and that definitively ended inefficient management in the current Social Security electric distribution and System...
...What's ad health...
...The national assembly passed the bill on October 17 with a simple majority, but President Francisco Flores threatened to veto it...
...But even if the FMLN loses the San Salvador municipal elections, the political )rivatization protests in San Salvador...
...Though workers are getting almost triple the salary, budget costs went down, as did robberies around the hospital...
...The banking se privatized, and Christiani now banks in El Salvador, Banco Cu ing of the 1992 Peace Accords the armed conflict, telephone, pensions have been privatized...
...In 1995...
...Besides a guarantee the $143 monthly minimum wage...
...While the Salvadoran people may have been fatigued by 13 years of war, the threat of privatization of health care has touched a sensitive public nerve: Although the social security system does need to be reformed and modernized, most Salvadorans continue to support it because it pays for all users' emergency situations, surgeries, and pregnancies, as well as ongoing consultations and exams...
...On October 9, employees of the Ministry of Public Health hospital system joined in with their own work stoppages...
...The Poma family, one of the wealthy Salvadoran elite Ilvador in 1989 with the known as the "fourteen families," is planning on iNA president, Alfredo investing in the mega-insurance business that goes sector was the first to be along with privatization of health care...
...For instance, Legislative Deputy Roberto trike, used force against D'Aubuisson Jr.-son of the ARENA founder and mpromise at the negoti- death squad leader--owns a business that provides hospital food service and intravenous feeding...
...A week later, protestors blocked the country's main roadways, paralyzing 18 major arteries for most of the morning...
...The Social Security health care system is targeted to be next up for privatization...
...Electric rates have gone up five times since that system was privatized and telephone costs have more than doubled...
...But while Flores' plan made big promises-for instance, that maids and farmers, who generally earn between $60 and $90 a month, would be included in the new health system and that people could choose to go to a private doctor instead of waiting in line at the Social Security Hospital-he offered no explanation of how all this would be paid for, nor did he mention that the monthly fees that would be channeled to private insurance firms would bankrupt the social security system...
...For the past 13 years, however, all the hosThe ports and airport pital directors have been appointed by ARENA[he most lucrative busi- among them are some of the same people who hope xt on the list are electric to profit from private health businesses...
...NACILA REPORT ON THE AMERICAS 42PRIVATIZATION IN THE AMERICAS any single party...
...The public has also become aware that costs following privatizations generally go up, not down as supporters claim...
...Silva's move also leaves the FMLN, which controlled San Salvador's city government during the six years of Silva's mayoralty, in a weakened position just a few months before El Salvador's mayoral and legislative elections...
...In an audacious surprise move, Flores' October 31 address proposed that San Salvador's FMLN mayor, Hector Silva, head up a commission to study health care reform, by implication in a privatized framework...
...In El Salvador, efforts to put the public health system into private hands have provoked a wave of opposition: Last September 18, unionized doctors and workers at the Social Security Hospital in San Salvador, the capital, began an unprecedented joint strike in opposition to the privatization of the national system of which the hospital is a part...
...Two more large White Marches took place on November 14 and December 6. The authorities reacted by stopping buses coming into San Salvador: People wearing white were taken off the buses, searched, intimidated and threatened, in a style reminiscent of the violent era of the 1970s and 80s...
...Instead Silva sacrificed his 2003 mayoral candidacy-a Flores requirement for being named "negotiator"-and perhaps his political career for the long term...
...On October 16, thousands of doctors and medical workers protested in San Salvador against privatization in what has come to be called a White March, with participants dressed in white to show solidarity with the typically white-garbed medical profession and as a symbol of peace...
Vol. 36 • January 2003 • No. 4
