From the ground: Chocó. Health and Wellness. SDG3
Lina Marcela Muñoz
Sociologist. Policies for equality
Director PROCLADE COLVEN
ODS3- Health and Wellness: Ensuring healthy living and promoting well-being for all at all ages
To talk about health in Chocó is to touch the tip of an iceberg that is deeply related to issues such as corruption, armed conflict, inequality and the exploitation of natural resources. To talk about health in Chocó is to highlight unfortunate figures for a country that talks about peace in the great scenarios of the world.
Although today the department has a high percentage of population affiliated to the social security system in health 84.4%, Chocó is lagging behind when the rate of affiliation in health in the rest of the country is 95%, an aspect that would not be entirely scandalous if the health promoting entities - EPS (third operators) in which are affiliated the 40,000 people who are within the percentage of members attended in the department, being a virtual coverage more than real, because these EPS operate in other parts of Colombia.
The situation worsens when one looks at the conformation of the health system in the department, there are 5 public hospitals, of which 3 are in the south zone, the other 2 hospitals are located in the capital Quibdó in the center of the department, leaving the municipalities of the middle atrium, low atrium and north pacific coast without hospital attention, In sub-regions such as the Low Atrato, health coverage is around 48%, while in the Medium Atrato sub-region it is 20%. For the municipalities on the North Pacific coast (Bahía Solando, Acandí, Juradó), there is no coverage.
The department has the second highest maternal mortality rate in the country (285.7 per 100,000 live births), the highest under-five mortality rate in Colombia at 50.4% (per 1000 live births), a tuberculosis incidence of 51.4% (per 100,000 inhabitants) and the highest malaria incidence rate in Colombia at 62.2% (per 1,000 inhabitants).
Other diseases that have a high incidence in Chocó are diseases related to poverty and war, in the first case diseases such as fever, malnutrition, parasitosis, skin infections, malaria, dengue fever and gastrointestinal diseases, since the majority of the population does not have sewage or access to drinking water conditioning their access to two main sources: The consumption of rainwater is dependent on the winter season and the consumption of water from the rivers in times of drought; on the other hand, although mental health is neglected within the Colombian health system, the consequences of the armed conflict on the mental health of the communities is an aspect of great importance and is part of the compensation for damages, however there are traumas, mourning and illnesses such as depression and anxiety that have not been addressed in a professional manner.
Challenges for the SDG3 crash
The national government whose agenda goes from 2018-2022 through the National Development Plan - PND mentions three strategies to comply with the ODS3 in the country, the first one called Health Finance proposes the cleaning up of the debt for recoveries of the contributive regime (which includes the workers) with a cut-off date of 31 December 2019; The second strategy is the so-called End Point Agreement, which guarantees the financing of the General Social Security System-SGSSS and the third strategy is the Comprehensive Action Programme in Hospitals "Ai Hospital", which seeks to better monitor actions in prevention and health promotion in the territories and insurance companies.
The first two strategies refer to the management of payments to mitigate the indebtedness of the health system and guarantee that the system functions and provides its services to the population, while the third strategy only monitors the provision of services.
In these three strategies, other dimensions required to guarantee the fulfillment of the ODS2 in terms of quality, infrastructure, prevention work, and the expansion of coverage, among many others, are also obviated. In addition, by 2020, the national budget for health has been cut by 2.7 billion pesos, which raises questions about the intentions outlined in the PND, the intention to improve and the scope of the three strategies for the scope of the ODS3.
The communities urgently express the most pressing needs in the area of health that are not reflected in the national agenda. These needs respond to the most basic needs for access to health, such as construction, adaptation and provision of health posts and centers, strengthening of the transportation network for emergency water and land (inter-municipal) hospitals, appointment of nursing professionals, and accompaniment of community health promoters, creation of special attention centres for the youth population, but also the strengthening of important figures at the cultural and community level for health care, especially Jaibanás (traditional indigenous doctors), Yerbateros (Afro-healers) and midwives who have played a very important role in promoting self-care practices and who have had to respond to the absence and difficulties of access to health care in this region.
Lina Marcela Muñoz
Specialist in public policies for equality
Director PROCLADE COLVEN