Country Report: Venezuela (Bolivarian Republic of)
Venezuela is a federal republic located in the northern part of South America, consisting of a capital district, 23 states, 335 municipalities, and 1,091 parishes. It also includes federal dependencies that comprise 311 islands, islets, and keys. It has a land area of 912,446 km2, with great climate diversity due to its geography.
The estimated population in 2015 was 30.6 million, 88.8% of which was concentrated in urban areas; 2.7% of Venezuelans belonged to indigenous groups. In 2016, the life expectancy at birth was 74.6 years (78.8 years in women and 70.6 years in men).
Since the 1990s, the population pyramid has shifted from an expansive structure to a more stationary structure (especially in relation to the population under 25), as a result of the decline in fertility and mortality over the past 25 years. Annual population growth was 1.7%, with a birth rate of 19.7 per 1,000 population.
The country’s principal source of income is oil exports, which represent more than 85% of total revenues.
- By 2012, progress had been made in the social determinants of health, including a 7.7% reduction in the population living in extreme poverty and a 2.7% reduction in global malnutrition in children under 5, as well as increases in the coverage of drinking water (95%) and wastewater collection (84%).
- Between 2011 and 2015, one million homes were built as part of the Misión Vivienda housing initiative, meeting 26.7% of the housing needs of families enrolled in the National Housing Registry.
- As of May 2014, 2.6 million Venezuelans had benefited from Misión Robinson, a social literacy initiative that helps the illiterate population learn to read and write, using innovative educational materials.
- The SPNS, by strengthening and integrating the health network through the strategy known as 100% Barrio Adentro, is working to achieve full access to quality universal health coverage for the country’s population.
- The country has a “Plan of action to improve vital and health statistics,” which helps improve basic data collection for issuing birth certificates at birthing centers and death certificates at the place of death, ensuring broad coverage, as well as the quality and timeliness of data.
Figure 1. Distribution of the population by age and sex, Venezuela, 1990 and 2015
Proportional mortality (% of all deaths, all ages, both sexes), 2014
Source: Pan American Health Organization. Health Information Platform (PHIP).
SELECT BASIC INDICATORS
Note: Population data for 2015 has been derived from national estimates of the National Statistics Institute of Venezuela.
Source: UN Population and Statistics Divisions, 1990; PAHO Health Information Platform (PHIP), 2013, 2014, and 2015.
SOCIAL DETERMINANTS OF HEALTH
- Between 1998 and 2011, the percentage of households in poverty declined from 49.0% to 27.4%, while the rate of extreme poverty fell from 21.0% to 7.3%. However, in 2013 poverty increased to 32.1%, and extreme poverty to 9.8%.
- The employment rate between 2010 and 2014 remained above 90%, with no significant differences between men and women.
- According to the Central Bank of Venezuela, the cumulative inflation rate from 2015 to February 2016 was 180.9%.
- Since 2012, there has been a steady decline in international oil prices that has impacted the country’s economic activity, particularly imports of basic goods such as food and medicines, some of which have regulated prices and are subsidized by the government.
- Nearly 70% of energy production in the country is hydroelectric. This is adversely affected in periods of drought, having both a financial and social impact.
- Between 2010 and 2013, school enrollment increased by 4.16% at the primary level and 2.73% at the secondary level. Mean years of schooling stood at 9.4 in 2014.
- In 1999-2014, amid growing access to new technologies, Internet access increased from 680,000 to 12.56 million users.
- In 2015, 93% of the population had access to clean drinking water, and 94% used improved sanitation facilities. About 80% of trash is sent to sanitary landfills, while just 2.3% is recycled.
- Caracas had a homicide rate of 63.5 deaths per 100,000 population in 2015.
- The country is highly vulnerable to the effects of climate change and natural hazards, including major floods, droughts, wildfires, explosions, spills, and earth movements.
- The country has great natural wealth, with many different species of flora and fauna. In the past two decades, deforestation has been reduced by 43.2%.
HEALTH SITUATION AND THE HEALTH SYSTEM
- Between 1990 and 2009, maternal mortality held stable at 60 deaths per 100,000 live births. It subsequently increased, however, to 70 deaths per 100,000 live births in 2015.
- The leading causes of maternal death in 2016 were hemorrhage and hypertensive disorders. Indigenous mothers accounted for 3.17% of total maternal deaths, while those of African descent accounted for 1.85%.
- Nearly all births (98%) take place in health facilities; one in five pregnancies are in women under the age of 20.
- In 2013, the infant mortality rate was 14.7 per 1,000 live births, according to PAHO data on basic indicators. Perinatal disorders and congenital malformations are the leading causes of infant death.
- Chronic malnutrition in children under 5 decreased from 13.4% in 2009 to 3.37% in 2013.
- In the five-year period from 2011 to 2015, immunization program coverage remained below 95% in children up to 1 year of age. In 2016, in 1-year-olds, coverage against measles, mumps, and rubella (MMR) was 88.3%, with 84.0% coverage for yellow fever and 6.7% for the third dose of PCV1. At the state and municipality level, varying levels of coverage have been observed.
- The country has remained free of polio, rubella, congenital rubella syndrome, yellow fever, and diphtheria, with no reported cases of these diseases since 2011. However, 7 cases of neonatal tetanus and 68 cases of tetanus in other age groups have been reported, along with 18 cases of whooping cough, 3,000 cases of mumps, and 8 cases of meningitis caused by Haemophilus influenzae type b.
- In 2013, the total death rate was 4.9 per 1,000 population (6.1 in men and 3.8 in women). The leading groups of causes were circulatory system diseases (30%) and external causes (19%), which together accounted for half of all deaths in the country.
- The most important specific causes of death include chronic noncommunicable diseases, including heart disease (20.7%), cancer (15.4%), diabetes (7.6%), and cerebrovascular disease (7.5%).
- The five leading malignant neoplasms were prostate, breast, cervical, lung, and colorectal cancers, which together represented 54% of all cases.
- In 2013, there were 9,720 deaths from accidents, which accounted for 6.51% of all deaths. Of that total, 72.31% were due to road traffic accidents.
- In 2015, the first autochthonous vector-borne case of Zika virus was reported. In 2016, there were 2,200 laboratory-confirmed cases of Zika, with an incidence rate of 192.9 per 100,000 population, without notification of associated Guillain-Barré cases.
- The first cases of chikungunya virus infection were reported in 2014. In 2015, the cumulative incidence rate was 54 cases per 100,000 population, declining to 11.2 cases per 100,000 in 2016.
- Between 2011 and 2015, there were 285,960 reported cases of dengue, with evidence showing that the four serotypes were circulating. There were 90 deaths from dengue in 2015 and 30 in 2016.
- The malaria incidence rate tripled between 2011 and 2015 (from 1.58 to 4.45 per 1,000 population), with a total of eight deaths in 2015, making it a priority on the domestic health agenda.
- There were 76 reported cases of Chagas disease by oral transmission in 2011-2015.
- Visceral leishmaniasis is endemic, with an incidence rate of 0.12 cases per 100,000 population in 2013. Between 2013 and 2015, the incidence rate of cutaneous leishmaniasis remained close to 7 per 100,000 population.
- In January 2011, there were 99 confirmed cases of imported cholera. No new cases have been reported.
- Between 2011 and 2016, only one case of human rabies was reported, with two cases in cats and 35 cases in dogs.
- A total of 303 new cases of leprosy were reported in 2016, 87 of which were in women and eight in children under the age of 15.
- Onchocerciasis transmission continues in the Yanomami indigenous area. However, transmission declined by 75% from 2014 to 2015.
- In 2015, tuberculosis incidence was 22.19 cases per 100,000 population; 83.6% of cases were pulmonary and 16.4% extrapulmonary. The 15-34-year age group accounted for 38.9% of total cases.
- An estimated 108,575 people are living with human immunodeficiency virus (HIV), 64.7% of them men. More than 60,000 people with HIV receive antiretroviral therapy. The prevalence rate is 0.56% in the general population and above 5% in the most vulnerable groups.
- In 2014, the prevalence of overweight in adults over age 20 was 62.3%.
- The prevalence of smoking was 17.0% in adults and 5.6% in adolescents 13-15 years of age.
- In 2011, a total of 37,531 patients were seen in psychiatric hospitals, 53% of whom were women and 7% children or adolescents. One percent of patients received inpatient treatment in psychiatric hospitals lasting 5 to 10 years.
- The National Public Health System (SPNS) is based on principles enshrined in the National Constitution of 1999, which stipulates that health is a fundamental social right guaranteed by the State through the provision of free health services in a single health care system that is universal, decentralized, and participatory.
- The National Health System (SNS) is made up of the public and private subsectors. The Ministry of Health is the government’s regulatory agency and has the following vice-ministries: Comprehensive Health; Public Health Networks; Hospitals; Resources, Technology, and Regulation; and Outpatient Healthcare Networks.
- The public sector consists of the Venezuelan Social Security Institute (IVSS), the Institute for Social Welfare of the Ministry of Education (IPASME), the Institute of Social Welfare of the Armed Forces (IPSFA), the Corporación Venezolana de Guayana (CVG), and Petróleos de Venezuela S.A. (PDVSA).
- In 2016 there were 16,908 facilities in the Community Care Network and 293 hospitals in the public sector.
- Between 2010 and 2014, total health expenditure as a share of gross domestic product (GDP) increased by 49%, from 4.75% to 7.09%.
- Since 2011, “comprehensive community physicians” have been authorized to practice medicine. Between 2010 and 2015, the Ministry of Health granted 5,873 scholarships for undergraduate studies and 8,959 for graduate studies in the health sciences.
- The Ministry has a Health Information System that includes an electronic medical records system, which is a very useful tool for the epidemiological surveillance of health programs.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- The National Health Plan 2014-2019 establishes objectives, policies, projects, and strategies to guide the government’s management of the system, aimed at ensuring health as a universal right; health care as a public good and a State responsibility; and comprehensive public health care, including promotion, prevention, treatment, and rehabilitation.
- Based on efforts made and the trends observed, it is expected that neglected diseases such as leprosy and rabies can be eliminated by building consensus on common objectives with all sectors involved in addressing the social determinants of health.
- Maternal mortality and malaria control have become priority issues on the domestic health agenda.
- The objective of preventing and controlling chronic noncommunicable diseases has led to the development of intersectoral policies that cover the promotion of healthy practices, quality of care, regulation, and legislation.
- Given the rapid increase in older adults, preserving the functional capacity of the elderly has become a priority. This requires specialized services for this group, including sustainable long-term care.
- The National Agreement for the Universalization of Health Services reflects the political will to improve access for the entire population.
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