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Health reform in El Salvador: a lost opportunity for reducing health inequity and social exclusion?
  1. Eduardo Espinoza1,
  2. Françoise Barten2
  1. 1
    Observatorio de Políticas Públicas y Salud- OPPS/CENSALUD, Universidad de El Salvador, San Salvador, El Salvador
  2. 2
    Radboud University Nijmegen, UMCN, Institute for International Health, Nijmegen, The Netherlands
  1. Dr Eduardo Espinoza, Final 25 Av Norte y Boulevard de Los Héroes, Ciudad Universitaria, Universidad de El Salvador, San Salvador, El Salvador; eduardo{at}

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Since the 1993 World Bank Report, health reforms based on market criteria and cost effectiveness studies have become popular.1 The models from Chile and Colombia, with their respective variations, were introduced as social experiments. Both failed and did not contribute to improved health or health equity.2 On the contrary, these neoliberal innovations appear to have widened existing health inequity according to critical reviews by institutions such as the Pan American Health Organization (PAHO).3

The human development reports (UNDP) have identified Guatemala, Brazil and El Salvador as the most inequitable countries within the planet’s most inequitable subcontinent (Latin America). In El Salvador, the post-conflict context is causing a high incidence of violence and homicides that mainly affects young people. A national health system (SNS) is one of the few mechanisms to be established in a state that has been greatly weakened by structural adjustment programmes.4 5 However, more than 10 reform proposals from different sectors have classified it as:

“…segmented, inadequately financed in spite of the existing resources, with scarce coverage, emphasis on curative actions and with large groups of the population unable to access health care”

Clearly, a healthcare system with such characteristics has been a constant source of conflict.6 In November 2006, a pressurised national steering committee for the integral health reform proposal (CNSPRIS), presented the latest version of a proposal for health reform (proposal by the Comisión Nacional de Seguimiento a la Reforma Integral de Salud. (CNSPRIS), Ministry of Public Health and Social Welfare, November 2006).

This has been received with scepticism and the feeling is that it will simply reinforce the status quo defined by …

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  • Competing interests: None declared.

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