David Vargas
ASUNCION, Oct 4 2007 (IPS) – In spite of official claims to the contrary, it is becoming less and less likely that Paraguay will meet the health goals the United Nations member countries committed themselves to achieve by 2015, experts say.
A study published by Dr. Antonio Arbo, head of paediatrics at the Institute of Tropical Medicine in Asunción, indicates that far from showing progress, health indices have worsened in recent years.
The report places Paraguay among the five countries with the highest child mortality rates in the Americas. In Paraguay, for every 1,000 live births, 25 children die before reaching their fifth birthday.
This figure has not varied much in the past 12 years, Arbo said. In 1995 it was 30 children per 1,000, and now it remains at between 25 and 30 children per 1,000, he told IPS.
Other countries in the region with high child mortality rates are Haiti, with 60 deaths of children under five per 1,000 live births, Bolivia with 55 per 1,000, and Guyana and Guatemala.
The U.N. member countries committed themselves to reduce by two-thirds the mortality rate for children under five by 2015, with respect to 1990 indices, something which at the present rate of change seems unlikely. They also promised to cut the maternal mortality rate by three-quarters.
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Chile has a child mortality rate of eight per 1,000, and Uruguay s is just over 12 per 1,000. If our baseline was a mortality rate of 30 per 1,000 for children under five, the target is to reach the level of Chile or Uruguay by 2015. But judging by our record in the last five years, we aren t going to meet that goal, Arbo said.
The first of the Millennium Development Goals (MDGs) adopted in 2000 by the United Nations General Assembly is to halve the proportion of people living in extreme poverty and hunger, from 1990 levels.
In addition to the goals on poverty and health, the MDGs include achieving universal primary education, promoting gender equity, combating the spread of HIV/AIDS, malaria and other diseases, ensuring environmental sustainability and building a global partnership for development.
The recent death of a teenage boy from lack of timely medical treatment has become a symbol of the lack of infrastructure and the shortcomings of Paraguay s health system.
Alcides Osorio, 14, died of pneumonia complications after being taken by his family from one clinic or hospital to another for more than six hours, in search of one that would admit him.
Before he received any medical treatment, he suffered two cardiac arrests, which caused severe brain damage. He eventually died.
We had to contact the press in order to get the health authorities to listen to us. But by the time we got him a bed, he was very unwell, complained Gladys Osorio, the boy s sister.
The lack of infrastructure is only one of the health system s failings, the head of the Paraguayan Medical Association, Desiree Masi, told IPS.
The low level of spending on health per capita is another. Masi said that Paraguay comes in third for spending the least amount on health in the Americas. Haiti spends 12 dollars a head on health, followed by Nicaragua with 29 dollars a head and Honduras and Paraguay which both spend an average 31 dollars per person per year.
This in turn has a direct effect on human resources. Masi said that Paraguay has barely four doctors and two nurses for every 10,000 people.
We are the fourth country from the bottom in terms of the proportion of doctors, and for nurses we are only better off than Haiti, which has 1.1 nurses for every 10,000 people, while we have 2.2. We have a serious deficit of health personnel, she said.
Arbo, meanwhile, pointed out that The Pan-American Health Organisation (PAHO) recommends eight to 10 hospital beds for every 1,000 people. In Paraguay, we have one bed per 1,000 people, and they re badly distributed, because in Asunción there are six beds per 1,000 people while in Caaguazú, 150 kilometres away from the capital, there are 0.4 beds per 1,000 people.
According to Arbo s study, little or no progress has been made in Paraguay to reduce extreme poverty and hunger, to achieve universal primary education, or to promote gender equality and empower women.
If these goals were achieved, health would improve, because the less malnutrition and poverty people suffer, the better their health becomes, Arbo said. When mothers are better educated, and gender equality and the autonomy of women are promoted, they have access to better incomes and that improves the health of the population at large.
Low vaccination coverage and increasing cases of child malnutrition are also signs of a worsening health situation, according to Masi and Arbo.
Our vaccination coverage is between 75 and 85 percent, compared to more than 94 percent in Uruguay, Arbo noted.
Malnutrition raises mortality among children. The prevalence of chronic malnutrition in children under five in Paraguay is between 10 and 15 percent, with higher figures in the rural areas, and it has not changed much, he said.
Maternal mortality is another issue that gives rise to concern. Arbo s study places Paraguay among the six countries with the highest maternal mortality rates in the region.
The highest rate is in Haiti, where 500 women die for every 100,000 live births, followed by Bolivia with a maternal mortality rate of 295 per 100,000 live births, and Peru with 190 per 100,000 live births. Paraguay, Guatemala and Suriname have similar maternal mortality rates, of 170 per 100,000 live births.
By comparison, the maternal mortality rate in Chile is only 10 per 100,000 live births, while Uruguay s rate is 12 per 100,000.
The Paraguayan health authorities, however, do not appear to be unduly concerned by this scenario.
Deputy Health Minister Norma Duré admitted that the consensus opinion is that Paraguay will not be able to fulfil the MDGs by 2015, but said that the country is not alone in this predicament.
At the World Health Assembly (WHA) held in Geneva in May, it became clear that Paraguay will not be the only country to fail to meet the MDGs, as many other countries worldwide are in the same situation. Only a handful of countries will fulfil the goals, she told IPS.
Since nobody is going to meet the Millennium Goals, it was proposed that at least efforts should continue to bring down the overall indices of poverty, mortality and ill-health, Duré said.
