COLOMBIA: Most vulnerable fall through gaps in health system

[struggle4progress]

12 Jan 2009 15:40:28 GMT
Source: IRIN

BOGOTA, 12 January 2009 (IRIN) - When Martin Alonso Hernandez, an AIDS activist in Bogota, Colombia's capital, learned that his partner of six years was HIV positive, he waited another five years before getting himself tested for the virus.

"I was out of the social security system," he explained. "It was very expensive to test otherwise."

Hernandez's partner did have health insurance through his job, but was fired when his status was discovered. He lost his health benefits and fell into a deep depression, Hernandez told IRIN/PlusNews, eventually dying in 1999.

By the time Hernandez accessed Colombia's state-regulated health insurance system and tested for HIV in 2001, he had a number of AIDS-related symptoms and weighed just 32kg. "I was quite sure of the result," he said. "I just wanted the piece of paper so I could access treatment" ...

http://www.boston.com/news/world/latinamerica/articles/2009/01/12/group_urges_early_obama_easing_of_cuba_sanctions/

[Judi Lynn]

1. So Pastrana put this system in place, and they are using it selectively. Figures, doesn't it?

By the way, I've read accounts from citizens that the death squads kill gay people when they learn their identities. Testimony by former members.

Here's the link to your article:
http://www.irinnews.org/Report.aspx?ReportId=82318

Excerpt:

Colombia introduced its national health insurance system in 1997, with the goal of achieving universal coverage by 2000. But about 14 percent of the population remain uninsured and according to a 2008 grant proposal submitted by the Colombian government to the Global Fund to Fight AIDS, Tuberculosis and Malaria, a disproportionate number come from among the "vulnerable, excluded and impoverished".

In theory, those not covered by the health insurance system - mostly the very poor and those who lack identification documents - should be able to access health services directly from the state. But Dr Ricardo Luque, an advisor to the Public Health Directorate on sexual and reproductive health issues, noted that Colombia's decentralised system of government means that each of the country's 32 regional departments determines its own spending priorities. "There's competition for resources and they're spent based on demand," he said.

The Global Fund proposal confirms that some departments have not prioritised the health needs of their most impoverished populations who are most likely to be uninsured.

Treatment refused

The health insurance system functions by requiring those who are employed to pay into a state-administered fund which is used to pay private health companies to deliver services. An additional, smaller salary deduction helps pay for a social security fund that subsidises health services for the unemployed.

The private health companies are mandated to provide essential services, including all those related to HIV and AIDS treatment, care and prevention. But according to Ricardo Garcia, UNAIDS country coordinator, people living with HIV, especially those covered by the subsidised health system, have often been refused such services and had to resort to the courts to force the health companies to meet their obligations.

Garcia added that while access to ARV treatment had improved in recent years, with 80 percent of people in need of the drugs now getting them according to government figures, the quality and consistency of provision was still patchy. "We've had complaints of people receiving the ARVs for three or four months and then, because of a shortage of drugs resulting from bad supply management, they have to interrupt treatment."

UNAIDS estimates that 170,000 people are living with HIV in Colombia, of which 18,000 are currently accessing treatment according to Luque of the Public Health Directorate. He explained that the figure of 80 percent coverage for ARVs was based on reported cases rather than prevalence estimates - the basis for most countries' treatment coverage figures. "Only 25,000 people have tested positive and found to be in need of treatment," Luque said. "Access to treatment is one thing; the gap in diagnosis is another."

Vulnerable groups miss out on prevention

Critics of Colombia's health system argue that there is little incentive for the private health companies to promote HIV testing and that regional health authorities have also under spent on either promoting testing or training health personnel to provide it.

Thanks for the article. Plan to save this for future use.

[Texano78704]

2. This happens everywhere universal healthcare is not available

Even in Colombia, which has one of the most affordable health care systems in the world.