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Washington, D.C., 20 May 2019 (PAHO)- The Pan American Health Organization (PAHO) presented a report with the results of the ten-year evaluation of the Health System reform implemented in El Salvador. The report was presented in a event convened by the PAHO Office in El Salvador, on 17 May, 2019, with Violeta Menjíva (Minister of Health), María Isabel Rodríguez (former Minister of Health and current presidential adviser in health and education), and the Deputy Ministers of Health Services and Health Policies of El Salvador present.

In 2009, El Salvador began a long-term reform process to achieve a unified National Health System (NHS), based on the Strategy of Primary Health Care. The essence of the NHS reform reaffirmed that health is a social right, and introduced changes in the organization of the system intending to universalize access to quality health services, and improving people´s health.

Since then, El Salvador has achieved significant improvements in health outcomes: infant mortality reduced by 28.2%, maternal mortality reduced by 45.6%, and life expectancy increased by 3.5%. The increased use of maternal health services, and the implementation of the Family and Community Health Care Model, which prioritized the poorest departments of the country, contributed to these health outcomes improvements.

Health authorities in El Salvador created Community and Family Health Teams to implement the Family and Community Care Model, which changed the patterns of health services use in the country. The use of preventive services rate grew 135%, and the percentage of families reporting barriers to access health services for economic reasons, and poor quality of care decreased.

Also, the report reveals that El Salvador made significant progress towards achieving the goal of universal access to health. However, it recognizes the challenges that persist in the NHS. For example, there are still households that reported access barriers related to lack of care, human resources, and medicines. Also, although the resolutive capacity of the first level of care has improved, quality remains a worrying aspect.

The health reform in El Salvador was based on PAHO´s Strategy for universal access to health and universal health coverage (2014). Likewise, the universal health monitoring framework was implemented to guide the evaluation analysis.

Researchers used qualitative and quantitative methods, including interviews and focus groups with representatives of the Ministry of Health in El Salvador, social organizations, academy, the private sector, and international organizations. The goal was to research the political and socioeconomic context that influenced the process of reform and the objectives set by the country. The quantitative analysis was based on a set of immediate, intermediate, and impact indicators results. The study includes a bibliographic and documentary review.

The evaluation recognizes that the health reform was implemented gradually and that one of the most significant challenges related to limitations in the expansion of the National Health Policy to the entire national territory. Therefore, beyond concrete advances, the document proposes recommendations for the expansion and sustainability of the reform process. These recommendations, include: sustaining the improvements in the expansion of access to comprehensive and quality health services; consolidating the leading role of the Ministry of Health and to define roles in the NHS; improving and increase health financing, strengthening multisectoral coordination with strategic stakeholders; and improving research and monitoring of the health system.

From this evaluation, the country will continue working to move towards universal access to health and universal health coverage, and guarantee the application of the National Integrated Health System law, recently approved in El Salvador.

Some conclusions from the ten-year health reform:

  • Since the reform, improvements in health outcomes were reported, especially in reduced maternal and infant mortality, and increased life expectancy.
  • These improvements have been significantly higher in departments with greater coverage of Community and Family Health Teams, and lower socioeconomic status.
  • Challenges persist regarding the growing importance of non-communicable diseases, violence, and mental health.
  • Expansion of the Community and Family Health Teams for the implementation of the Family and Community Care Model positively impacted, the use of health services.
  • There are still barriers related to lack of services, human resources, and medicines, due to limitations in the capacity of the public offer of quality health services, and a shortage of Community and Family Health Teams.
  • The progress made was supported by financing policies, with a substantial reduction in out-of-pocket spending and an increase in public spending on health.
  • Straightening of stewardship capacity for planning and regulation, and the introduction of changes in the organization and financing of the NHS have been very relevant.
  • Intersectoral action, addressing social determinants of health and including social participation, has represented an important innovation.
  • The implementation of the National Integrated Health System Law, approved in May 2019, has been a critical factor in the success of this reform process.


Report available at OPS El Salvador Webpage "Presentación del Informe en el Camino a la Salud Universal 2019"  [ only in Spanish]