- Deep and unequal access gaps to the public health system in Paraguay, caused by the lack of sufficient investment and inefficient use of resources, not only put people’s lives and health at risk, but also severely affect their economic income, he said. Amnesty International today in a new report.
“The health debt” analyzes the guarantee of the right to health in Paraguay based on the situation of the public health system. In line with international standards, the report studies the gaps in access to health services, focusing on the dimensions of availability, accessibility, acceptability, and quality, with special emphasis on primary health care (PHC). The APS constitutes a basic and obligatory element for all States party to the International Covenant on Economic, Social and Cultural Rights, of which Paraguay is a part.
“The public health system is failing everyone in the country, and is particularly hard on groups that are routinely discriminated against, such as trans women and indigenous people, who face multiple barriers when trying to access it. The Paraguayan authorities must urgently strengthen and humanize it, through more and better investment. The well-being of more than 5 million people depends on it,” said Ana Piquer, director for the Americas of Amnesty International.
The public health system is failing everyone
people in the country, and it is particularly hard
with groups usually discriminated against, such as trans women and indigenous people, who
face multiple barriers
when trying to access it. The Paraguayan authorities must urgently strengthen and humanize it, through more and better investment. The well-being of more than 5 million people depends on it.Ana Piquer, director for the Americas of Amnesty International
The report’s methodology combines quantitative and qualitative tools. On the one hand, statistics and records from the State itself are used, as well as international indicators on health and economic development. This was complemented with 18 focus groups in which 200 people participated; in addition to four in-depth interviews with people impacted by the precariousness of the health system.
In summary, Paraguay does not invest the minimum recommended by the Pan American Health Organization (PAHO) to ensure access to health for all people: 6% of the Gross Domestic Product (GDP). In fact, at the regional level the country occupies the last places in investment in health. This lack of financing is serious in a country where seven out of 10 people do not have any health insurance, who, most of the time, depend on the Ministry of Public Health and Social Welfare to avoid expenses due to illness that compromise their life project.
Deep and unequal gaps in access to health in Paraguay
The right to health is a human right recognized by international law and must be guaranteed without discrimination. This implies that the Paraguayan State must adopt all the necessary measures to gradually ensure access to health services for all people.
On the contrary, the State’s debt to the health of the Paraguayan people produces inequalities that are expressed in different ways. In territorial terms, the capital and urban areas concentrate the majority of the infrastructure and resources compared to the rest of the country. In population terms, the institution that serves the most people, the Ministry of Public Health and Social Welfare (MSPBS), receives less money per person served than other public institutions.
These gaps worsen considering other related rights. The report identified that food insecurity is greater in households with children under five years of age; and that people without health insurance are more likely to have less access to water and sanitation, which exposes them differentially to diseases. Additionally, there is a direct relationship between employment status and access to health insurance. People who are in a situation of informal employment tend to be more vulnerable to medical emergencies. Informal work is usually feminized – that is, a higher percentage of women choose this situation than men – and the majority of people in this situation are in the poorest income strata.
“I didn’t treat my cancer because I had to feed my children and I couldn’t stop working. If now I have to choose between my treatment and feeding them, I will stop the treatment,” said Felipa, whose name we changed for her protection. She is a resident of a peripheral neighborhood of Asunción and her income depends on the sale of farm animals and with which she faces advanced cervical cancer.
I didn’t treat my cancer because I had to feed it
my children and I couldn’t stop working. If I now have to choose between my treatment and feeding them, I will stop the treatmentFelipe*
These gaps in access to health are accentuated by the discrimination that women and indigenous people frequently experience. The inadequate or lack of prenatal care and obstetric events is violence that directly affects pregnant women. Likewise, trans women reported to Amnesty International that they suffer transphobic violence in health centers due to the lack of recognition of their gender identity; so much so that some of them prefer not to go to public institutions, even with degenerative diseases.
On the other hand, figures from the National Institute of Statistics indicate that a good part of indigenous people also give up on medical care due to lack of infrastructure in their territories or due to the costs associated with care, either due to the physical distance from health centers or due to frequent shortages of medicines or supplies. Amnesty International also heard stories of people who were given inadequate care for speaking a language other than Spanish.
“It is always about making the indigenous people suffer and then taking care of them, we only ask that they take care of us correctly,” said Silvio, a member of the Enxet People and whose name we changed for their protection. The life and income of Silvio and his family were paralyzed for months by the negligent and untimely care of a fracture in the leg of Lilia, his partner.
It is always making the indigenous people suffer and then serving them, we only ask that they serve us correctly
Silvio*
Inefficient, insufficient and unfair financing
According to international law, the Paraguayan State must maximize public resources to guarantee human rights, highlighting the right to health, with sufficient investment in programs and budgets for this. The design of these interventions must comply with criteria of equity and non-discrimination in access to this human right.
In contrast, Paraguay is one of the most expensive places in the world to get sick. Almost four out of every 10 dollars of annual health spending comes directly from people’s pockets due to lack of supply of medicines, supplies or lack of care in general. This is frequently supported by personal indebtedness and solidarity contributions from family or community networks. At the same time and for several consecutive years, the authorities have not used the entire budget allocated for the purchase of medicines despite the fact that 40% of people report not having received free medication as established in Paraguayan law.
According to PAHO, at least a third of the annual investment in health should be allocated to primary care, which is key for the early detection of diseases and consequently for the well-being of the population and desaturation of higher levels of attention. However, Paraguay invests less than half of what is recommended by international organizations; while -paradoxically- it does ensure 4% of the public budget to cover private medical insurance for civil servants.
Finally, the financing trends of Paraguay’s public system are unsustainable. During recent years, a third of investment in health was made with public debt. According to Amnesty International’s analysis, the urgent strengthening of the public health system involves, to a large extent, implementing progressive fiscal policies that allow for greater and fairer collection of public funds. Among these, consideration could be given to raising the corporate income tax rate and strengthening the fight against tax evasion. The report highlights that, today, goods with direct impacts on people’s health, such as tobacco, alcohol, foods with low nutritional content or sugary drinks, are a marginal source of income for the public budget. In addition to increased revenue, taxes on these goods could well lead to a reduction in consumption and bring improvements in people’s health.
Keys to strengthening the public system in Paraguay
Amnesty International urges the Paraguayan State to guide its health policy around five axes of action:
- Strengthen primary care and the hospital network at all levels.
- Guarantee medicines, supplies and free transportation in health services.
- Reduce discrimination and promote equity in the health system.
- Better finance the public health system through fair tax reforms, instead of increasing public debt.
- Improve efficiency in the spending of current public resources.
Amnesty International sent this analysis to the Paraguayan authorities to find out their position regarding the organization’s findings. In this regard, the Ministry of Public Health and Social Welfare shared the report presented in November 2023 on the first 100 days of government, where seven areas are reported where various actions have been carried out: 1) less waiting for consultations and appointments, 2) health mental, 3) health information system, 4) optimization of financial resources and reduction of administrative steps, 5) cardio-protected institutions and cardio-protected city, 6) cardiovascular telediagnosis, and 7) launch of clinical practical guide for cardio-cerebrovascular diseases . Amnesty International takes note of these contributions, and supports the findings of its analysis, maintaining the importance of the Paraguayan State taking action in a structural manner to improve access to the right to health in line with what was concluded in its report.
*Name changed for your protection.
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