Primary Health Care in Venezuela: Old Strategy and New Practice

Since 2003, Venezuela has sent a contingent of Cuban doctors, within a bilateral cooperation, to the shanty towns (barrios) in order to provide Primary Health Care (PHC) for the poor. This health care intervention, called Barrio Adentro (into the quarter), has been the subject of highly controversial and politicised debates. In 2006, the Pan American Health Organization (PAHO/WHO) convoked an international team of experts in order to compile a report providing objective data about Barrio Adentro within a time frame of three months. Barrio Adentro was delineated and its impact on health during the first two years of implementation was assessed in the form of a retrospective, rapid health impact appraisal under resource-constrained conditions. Access to health care, participation, equity, sustainable development and ethical use of evidence was emphasised. Results were in brief: Access: Through the creation of 8,613 new consultation points, Barrio Adentro achieved free access to PHC for a population that was previously excluded from it. This included dental and basic ophthalmological care. Equity: In areas with lower human development index (HDI) the average number of inhabitants per physician improved more than in states with higher HDI. Sustainability and participation: Approximately 17,000 medical students enrolled in the study programme of comprehensive community medicine. Health promotion strategies included the training of about 140,000 health promoters. Health committees established patient and health education groups all over the country. Child mortality: Since 1996, infant mortality rate has decreased, falling from 18.5 per 1,000 live births in 2003 to 15.5 in 2005. It could be shown that a model for PHC based on demand rather than on free market fundamentalism is feasible. In the beginning of 2009, an update of the data will be carried out. Development and impact of Barrio Adentro will be discussed.