Country Report: Paraguay
Paraguay is located in central South America and borders Argentina, Bolivia, and Brazil. It is administratively divided into 17 departments plus a capital district, Asunción.
In 2015, the population numbered 6,755,756, 1.8% of it indigenous.
The population grew by 59.5% between 1990 and 2015. Its structure has become less expansionary, and is stationary in the under-20 age groups. In 2015, the life expectancy at birth was 70.1 years.
The Paraguayan economy is growing. The country is the largest exporter of electricity in the Americas and the fourth largest exporter of soybeans and sixth largest exporter of beef in the world.
During the past decade, the Paraguayan economy grew at an annual average rate of 5%. Its per capita gross domestic product (GDP) was US$ 8,911 in 2014, while per capita gross national income was US$ 8,470 that year.
- The right to health is enshrined in the National Constitution of the Paraguayan Republic in terms of the right to life, to physical and mental integrity, and to quality of life. The constitution also establishes the State’s responsibility to protect and promote health.
- In Paraguay, the Indigenous Health Act, prepared in consultation with indigenous populations, was passed in September 2015.
- Despite the progress in health services coverage, broader access and coverage, especially in the most vulnerable groups, are still needed. One of the necessary efforts is to continue creating family health units (USFs).
- USFs are physical structures in which many of the activities included in the primary health care strategy are carried out in a coordinated, comprehensive, and ongoing manner.
- By creating a basic family health team responsible for the health of the assigned population, these units offer consultations, home care, reentry into the community, disease prevention and health promotion activities, medical care, and habilitation, rehabilitation, and social inclusion.
- Moreover, each USF conducts activities related to sanitation, education, research, and social organization.
Figure 1. Distribution of the population by age and sex, Paraguay, 1990 and 2015
Proportional Mortality (% of all deaths, all ages, both sexes), 2014
Source: Pan American Health Organization and PAHO Health Information Platform (PHIP).
SELECT BASIC INDICATORS
Note: Population data for 2015 has been derived from national estimates by the General Directorate of Statistics and Census of Paraguay.
Source: UN Population and Statistics Divisions, 1990; PAHO Health Information Platform (PHIP), 2013, 2014, and 2015.
SOCIAL DETERMINANTS OF HEALTH
- In the period 2010-2015, the employment rate ranged from 90% to 92%. Self-employed workers constituted the predominant group (33.5%) in the workforce.
- Between 2009 and 2014, the population living below the poverty line (less than US$ 4/day) fell from 32.5% to 18.8%.
- In 2015, 98% of households had access to clean drinking water.
- Some 52% of households have refuse collection services (76% in urban areas and 16.3% in rural areas); 15% of urban municipalities have an authorized dump.
- In the past 50 years, Paraguay has lost nearly 90% of its original forest cover. The worst natural disasters have been related to floods and droughts, especially due to El Niño, in some areas of the Paraguayan Chaco.
- Paraguay currently has areas that are free of foot-and-mouth disease as a result of vaccination.
HEALTH SITUATION AND THE HEALTH SYSTEM
- The maternal mortality ratio was 81.8 per 100,000 live births in 2015; the leading causes of death were preeclampsia, hemorrhage, and complications of abortion.
- In 2013, 80.6% of pregnant women had at least four prenatal checkups, and 96.2% of deliveries took place in health facilities. In all, 18.3% of births were to adolescent mothers.
- Mortality in children under 1 and children under 5 was 14.2 and 16.8 deaths per 1,000 live births, respectively. The leading causes of death were pneumonia, influenza, and diarrheal diseases.
- In 2015, vaccination coverage reached 89% for the pentavalent vaccine (DPT-3) and 66% for the measles vaccine. Six new vaccines were added to the national
vaccination schedule to prevent chickenpox, influenza, hepatitis A, whooping cough, and human papillomavirus and pneumococcal infections.
- In 2014, 25% of deaths were caused by circulatory system diseases, 15% by neoplasms, and 11% by ill-defined symptoms and signs not elsewhere classified. The leading specific causes of death were ischemic heart disease and cerebrovascular disease.
- The leading causes of death in the indigenous population were respiratory system diseases, accidents, tuberculosis, nutritional disorders and anemia, and homicides.
- The last yellow fever outbreak in Paraguay was reported in 2008, with a total of 28 reported cases. Later, in 2013, Paraguay endured one of the worst dengue epidemics in its history, which resulted in 133,718 cases and 251 deaths. Introduction of the chikungunya virus was reported in June 2014 and the Zika virus, in 2015. The country has successfully eliminated indigenous transmission of malaria and has succeeded in eliminating vector-borne transmission of Chagas disease in 17 of the country’s 18 departments.
- During the five-year period studied, Paraguay had no indigenous cases of measles, rubella, or congenital rubella syndrome. In 2014, it was formally declared free of the endemic transmission of these diseases. Planning for the final phase of polio eradication began in 2015 with the introduction of the inactivated polio vaccine.
- An estimated 17,564 people were living with the human immunodeficiency virus (HIV) in 2015; more than half of them were between the ages of 20 and 34.
- There are 4 cases of congenital syphilis per 1,000 live births.
- The incidence of tuberculosis is 55 cases per 100,000 population, with a mortality rate of 2.9 deaths per 100,000 population.
- An estimated 10.7% of the population is living with a disability. The most frequent forms are multibody system disorders (28%), body system disorders (28%), physical disability (19%) and vision disorders (18%).
- Some 32.3% of the population reported having been diagnosed with hypertension and 9.7% with diabetes mellitus. Obesity is present in 23.2% of the population.
- In 2011, the prevalence of acute malnutrition in children under 5 was 5.2%, and chronic malnutrition, 12.9%; 26% of schoolchildren and adolescents were overweight or obese. In people over 20, the figure was 57%.
- In 2011, 14.5% of adults reported smoking. Some 50.9% had consumed alcohol in the past month; it was striking that 75.2% of them reported excessive consumption in the past year. Some 4.7% reported regular marijuana use, and 2.0% reported that they had used cocaine at some point in their lives.
- From 2009 to 2013, there was a 2.1 percentage point increase in deaths from traffic accidents, with the percentage of deaths from motorcycle accidents increasing from 44.4% to 55.8%.
- The National Health System is made up of the public, private, and mixed sectors. It operates with diverse financing, regulatory, enrollment, and service delivery modalities. The Ministry of Public Health and Social Welfare serves as the health sector authority.
- The public sector consists of the Ministry of Public Health and Social Welfare; the Military, Police, and Navy Health Services; the Institute of Social Welfare (IPS); the Clinics Hospital; and the Maternal and Child Health Center. The private sector includes nonprofit and for-profit organizations. The Ministry and IPS cover 95% of the population.
- Total health expenditure in 2014 was 7.7% of GDP (54.3% financed by the public sector and 45.7% by the private sector).
- Health service delivery has been concentrated in urban areas, with more than 90% of health facilities located in the Eastern Region, where more than 95% of the country’s population lives. Nationally, there are 34.4 health workers per 10,000 population (ranging from 69.3 in the capital to 7.9 in Alto Paraná); 8.2% of the health workforce is employed in primary health care.
- Primary health care is particularly important, but that system currently covers less than 30% of the population. As part of the effort to improve primary care and increase access to health services, in December 2008, the Ministry of Health began creating family health units (USFs). By the end of 2015, there were 754 USFs and by the end of 2016, 796.
- The National Health Information System (SINAIS) has developed the epidemiological information system, the economic, financial, and administrative information system, the sociodemographic information system, and the clinical information system.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- The country has made significant progress toward guaranteeing the full right to health for all Paraguayans. Between 2011 and 2015, health care coverage for the population in the poorest quintile increased, reaching 66% in 2015.
- That achievement was facilitated by free access to services and progress in the coordination and decision-making capacity of the Integrated Health Services Network.
- Progress was made in the elimination of malaria, measles, and congenital rubella syndrome, with the potential elimination of rabies and Chagas disease. There was also progress in the development and introduction of information and communication technologies.
- Although by law, the health authority is the Ministry of Public Health and Social Welfare, leadership is weak and in actual practice, National Health System operations are uncoordinated and fragmented, with different financing, regulatory, enrollment, and service delivery modalities.
- The rise in direct out-of-pocket payments (60%) for health care is being addressed in the strategies of the National Health Policy 2015–2030, which should be extended to the entire country, until substantial changes are achieved that guarantee all citizens the right to health.
- The growing prevalence of noncommunicable diseases (NCDs) and their risk factors poses a challenge. Policies, legal instruments, and strategic plans have been created to prevent risk factors and treat the leading NCDs. This effort should emphasize and guarantee an intersectoral and integrated national response with strong citizen participation.
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