Healthcare in El Salvador 2025
The healthcare delivery system in El Salvador has three tiers, depending on how care is paid for. At the bottom of the tier is the public hospital system. This system, administered by the Ministry of Health provides free or very low cost healthcare to Salvadorans of limited means who do not have employment in the formal economy. The next system is the social security hospital system (ISSS) which is a system of care for persons who work in the formal economy and who pay into the system along with their employers to receive healthcare and pension benefits from the government. The third tier is the private healthcare system. This is healthcare provided by private hospitals or doctors in private clinics whose charges are paid by the wealthy who can afford private health insurance.
The country’s national healthcare plan is deemed
a national secret and is not available to the public. So we can only look at where the government
is operating openly.
Hospital Rosales in San Salvador is the nation's tertiary care public hospital for those
who cannot afford a private hospital and do not participate in the social
security hospital system. Old and suffering from years of neglect, there has long been a need for a new hospital. Despite the fact that financing for a new public
hospital was approved in 2018 before Nayib Bukele took office, work on a new
hospital, or even selection of a contractor to build the hospital, only began
in 2023.
It may soon be finished. According to an interview
given last week by the Minister of Health:
The hospital is almost complete, or its infrastructure is finished, its equipment is already in place, it's already tested, and the medication is entering the delivery sites because the medication is already in the country.
He did not offer a specific date for its opening.
According to independent journalism site VozPublica,
some 40 specialists have quit the Hospital Rosales staff in the leadup to the
new hospital opening. Issues cited
included doctors' transfer to other hospitals during the transition to the new
facility and a fear of not being allowed to transfer back, as well as working conditions
and compensation.
The process of closing the old Hospital Rosales down as the
new hospital nears completion caused chaos outside the hospital last week according
to La Prensa Grafica, which described hundreds of persons arriving for
outpatient visits being told that their caregivers and hospital equipment had
been transferred to other locations. The
government was transporting some patients to other locations in its vehicles or
giving people phone numbers to call to reschedule appointments at other
locations.
President Nayib Bukele has been holding up the new Hospital
Rosales as a symbol of promises to modernize and improve healthcare delivery in
the country.
A related promise in 2019 by the president was construction
of a new public hospital to the north of San Salvador in Nejapa. He did not lay
the first stone at the site until June 2023.
That hospital is still not open and a report
from VozPublica details the significant cost overruns and delays in
building of that facility.
According to the Minister of Health, the country now has 500 Intensive Care
Unit beds, the vast majority in Hospital El Salvador, the former COVID-19
specialty hospital. That’s half of the
1000 ICU beds which Nayib Bukele claimed Hospital El Salvador would have in a June 2020 tweet. And because the press and independent sources are not allowed into Hospital El Salvador, the claim of 500 ICU beds or the staff for those beds cannot be verified.
The Legislative Assembly recently passed a new National
Hospital Network Law. In the name
of efficiency and modernization, the law creates a new agency to oversee the
operation of hospitals in the country.
No longer will hospitals fall under the Ministry of Health, instead the
executive board of the Network will report directly to the Office of the President
who will appoint its members. Assembly
leaders denied any plan to combine the social security and public healthcare
systems or to privatize healthcare in the country.
One of the ongoing challenges of the two government run healthcare
systems, both public and ISSS, has been a shortage of specialists. There are
estimates that between 250-300
medical professionals have quit the ISSS since 2023. The shortage of specialists in the ISSS
system is leading to long
delays in getting appointments for care. There have also been reports of widescale departures of specialists from
the public healthcare system.
The government has closed down 50 Family "ECO" clinics across
the country. These small primary care
clinics were located in rural areas outside of the urban centers and were
designed to bring basic primary care to underserved areas of the country. ECOs were an initiative started
under the Mauricio Funes administration in 2010 to take a holistic approach
to rural healthcare.
These cuts and other pressures in the system seem directly
linked to government cutbacks in funding for the healthcare systems. The budget proposed by the Bukele government
for 2025 included a $91 million reduction in funding for healthcare. The budget
put in place salary freezes, not permitting health system workers to advance
on the salary ladder known as the "escalafón." The budget
included a hiring freeze and actually cut 3727 positions within government
healthcare institutions. According to an analysis
of the budget by La Prensa Grafica, the greatest number of cuts
involve doctors and nurses.
In addition the healthcare budget slashed the funding for
the public hospitals in the country. The 31 public hospitals in the
country saw a budget
cut of $54 million, with the country's tertiary care public hospital,
Hospital Rosales in San Salvador, saw a cut of 10% in its funding.
Comments