Country Report: Panama
Panama is located in Central America, between the Pacific and Atlantic Oceans and the Caribbean Sea, and bordering Colombia and Costa Rica. It is politically and administratively divided into 10 provinces, 77 districts or municipalities, 5 indigenous regions, and 655 corregimientos.
Between 1990 and 2015, the population grew by 60%, reaching 4,037,043 in 2016. The population pyramid has become less expansive, reflecting greater aging. The indigenous population is 12.3% of the total.
In 2015, life expectancy at birth was 78.0 years nationwide (80.6 in women and 73.4 in men), and 70 years in indigenous regions.
Economic conditions are determined largely by airport activity and trade through the Panama Canal and the Colón Free Trade Zone.
Estimated gross domestic product (GDP) growth in 2016 was 6.2%, the highest in the Region of the Americas.
- The country has addressed the issue of tobacco use, considering that unless vigorous action is taken (especially through the promotion of effective smoking prevention measures among young people), a continued rise in tobacco use is very likely.
- Panama has achieved full implementation of the measures and recommendations established in the WHO Framework Convention on Tobacco Control and has ratified the Protocol to Eliminate Illicit Trade in Tobacco Products.
- This involved passing legislation that guarantees smokefree environments; making graphic health warnings larger; banning all tobacco advertising, promotion, and sponsorship, including the display of tobacco products at points of sale; and increasing taxes on tobacco (with some of the proceeds going to public health and customs).
- This has reduced the prevalence of tobacco use in the adult population to 6.4%, the lowest in the Region of the Americas and one of the lowest in the world. Finally, the country has been able to provide technical and financial cooperation to strengthen tobacco control elsewhere in the Region.
Figure 1. Distribution of the population by age and sex, Panama, 1990 and 2015
Proportional mortality (% of all deaths, all ages, both sexes), 2014
Source: Pan-American Health Organization, World Health Organization, and PAHO Health Information Platform (PHIP).
SELECT BASIC INDICATORS
Source: UN Population and Statistics Divisions, 1990; PAHO Health Information Platform (PHIP), 2013, 2014, and 2015.
SOCIAL DETERMINANTS OF HEALTH
- In 2014, the overall poverty rate was 21.4% (11.9% in urban areas and 41.0% in rural ones), while 11.5% of the population lived in extreme poverty (3.3% in urban and 28.0% in rural areas).
- In 2016, unemployment among the working-age population was 5.2%. Overall, 79.5% of men and 51.2% of women are in the labor market.
- The Panama Canal accounts for 2% of the country’s GDP; revenue from the Colón Free Trade Zone, which once represented 8% of the country’s GDP, fell by 12% between 2013 and 2014.
- In 2015, improved-water coverage in the country was 95% (98% in urban areas and less than 50% in rural and indigenous communities), while 75% of the population (84% in urban areas and 58% in rural ones) was covered by improved sanitation services.
- The health impact of growing deforestation is unknown, as is that of energy development initiatives such as thermoelectric and hydroelectric power plants, some of which directly affect indigenous populations, since these plants are located partially within indigenous regions.
- In 2016, 2,119 investigations of drug-related crimes were conducted, more than half (53.6%) of which involved possession, with 11.8% involving trafficking.
- There are major socioeconomic and health inequalities between the country’s urban and rural populations. The indigenous population lives in more disadvantaged conditions and experiences greater vulnerability in health. The population living in more marginalized areas has less service coverage and less access to health care.
HEALTH SITUATION AND THE HEALTH SYSTEM
- The maternal mortality ratio in 2014 was 58.5 deaths per 100,000 live births (30.6 in urban areas and 110.8 in rural ones). That same year, the infant mortality rate was 13.8 deaths per 1,000 births, with wide geographical variation (ranging from 21.0 in the Guna Yala region to 6.6 in Los Santos).
- The overall national mortality rate was 4.6 deaths per 1,000 population in 2014.
- Diseases of the circulatory system caused 28% of deaths and neoplasms 17%.
- In recent years, the incidence of malaria has remained stable, with no deaths. More than 90% of total cases were reported in indigenous regions. In the case of dengue, the case-fatality rate between 2011 and 2015 was 0.17%, and serotypes 1, 2, and 3 were in circulation.
- Cutaneous leishmaniasis is endemic in Bocas del Toro, Coclé, Colón, and Panamá Oeste, although its incidence has declined. In 2015, 72 confirmed cases of Chagas disease were diagnosed, 35 of them in blood banks.
- The first 68 cases of chikungunya virus were confirmed in 2014, with no deaths. At the end of 2015, the first outbreak of Zika virus infection with autochthonous transmission was reported, with four cases of microcephaly and three of Guillain-Barré syndrome.
- In 2015, the estimated prevalence of HIV was 0.6% in the general population and 0.4% in pregnant women. The incidence of tuberculosis declined from 63.3 cases per 100,000 population in 2005 to 46.5 in 2014.
- As of 2010, hypertension and diabetes mellitus were the leading risk factors for cardiovascular disease in the adult population.
- In 2013, 15.9% of school-age children (first graders) suffered from chronic malnutrition, and 3.4% had serious stunting. Chronic malnutrition is more prevalent in areas with indigenous populations. Some 33.8% of children aged 6-59 months and 23.2% of pregnant women suffer from anemia.
- In 2008, an increase in overweight was observed at the national level, with a prevalence of 10% in preschoolers, 30% in schoolchildren, 25% in adolescents, and 57% in adults.
- In 2012, the prevalence of tobacco use in the population over the age of 15 was 6.4%, reaching 11.6% in young men (aged 13-15). Estimated alcohol consumption in the over-15 population was 5.5 liters of pure alcohol per year, with alcohol consumption beginning at the age of 12 on average.
- The Ministry of Health (MoH) has the responsibility of determining, regulating, and implementing Government health policy and the essential public health policies. The public health system is composed of the MoH, organized into 15 health regions, and the Social Security Fund (CSS), which is organized in a similar regional fashion and by levels of complexity.
- Health services delivery, financing, and insurance roles are shared by the Ministry and the CSS. The country allocates 7.6% of its GDP to public health expenditure, while private spending represents 23.2% of total health expenditure. Some 70% of the public health budget is allocated to the CSS and 30% to the MoH.
- The public health sector covers 100% of the population. In 2015, the MoH provided services to 47% of the population, under agreements between the two institutions that offer service in areas with no CSS facilities; 84.4% of the population had CSS coverage that year. There are 2.3 hospital beds per 1,000 population and 7.2 medical specialists per 10,000 population.
- The joint services network comprises 912 establishments, 836 of which belong to the MoH and 76 to the CSS (almost all CSS facilities are secondary and tertiary). Indigenous regions and remote rural areas are covered by Ministry-run outpatient primary care services.
- Private health services are available to those who pay out of pocket or have private health insurance. The health services are still not sufficiently organized into integrated networks, leading to duplication of efforts and gaps in care, and, consequently, fragmentation of the health care system. This hinders implementation of the Primary Health Care Strategy.
- This fragmentation is also the result of hospital management; hospitals have legal autonomy and employ mixed management models, which gives rise to long waits for medical-surgical care, among other services. For the 2016- 2025 period, priority has been given to transforming the health system, in accordance with the new National Health Policy, which was formulated on a sectoral basis and implemented by the MoH.
- The State has invested in improving the production of scientific information, which is still not sufficiently available. Information management tools for health care and epidemiological surveillance have been implemented, especially electronic medical records and the Epidemiological Surveillance System.
- During 2010-2015, the country saw an increase in the development and incorporation of technologies for managing and delivering health services. Five hospitals and 20 Innovative Primary Health Care Centers were built.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- At present, chronic noncommunicable diseases (especially those of the circulatory system) are the leading causes of death in both men and women. These diseases will become even more important in the future as the population continues to age.
- This scenario means that the country must address the risk factors for these determinants globally and beyond the health sector. The health system must also adapt so that it can respond appropriately.
- The country must address the marked inequalities between the urban and rural populations, in regard to both the social determinants of health and the health situation of the various population groups.
- The country must eliminate the existing differences in service coverage and access to comprehensive, high-quality health services. This will require greater availability and better distribution of human resources, health infrastructure of all types, health technology, drugs, and other medical supplies.
- Government plans provide for the modernization of State infrastructure through the transformation of the health system, the purpose of which is to strengthen the leadership role of the MoH, improve service efficiency, and ensure access to higher-quality services, with particular attention to the most vulnerable populations.
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