Deficit human resource Costs in the provision of health services El Salvador Shortfall in resources for health Needs unmet in rural areas, emerging Diseases and re-emerging health Guatemala Access to health services unmet Demand Lack of adequate food Honduras Diarrhoea, Pneumonia, Anemia, parasitism, malnutrition, Nicaragua Requirements unmet Deficit of resources, Efficiency, equity, quality in the provision of Health

Services Panama accessibility of services

equity of services cost increase health Paraguay inequitable access to health services inadequate infrastructure poor resolution capacity of emergency guard services. Peru under access to services, particularly related to pregnancy, the puerperium and the newborn Insufficient quality and efficiency in the services Deficit in human resources, Accumulation of epidemiological Dominican Republic Limited coverage in primary care Disarticulation budget insufficient Coverage Uruguay the Absence of a model of comprehensive health care between private agents and public Absence of programs of care of the disease mo-communicable Weakness in primary care and health its articulation with higher levels Bolivarian Republic of Venezuela Without information Without information Without information Source: Authored on the basis of country responses to the health

ECLAC survey on national health programmes, 2005. C. The causes associated with health care problems the authorities attributed the main health care problems to several sets of causes: the first of which relates to economic conditions (poverty, inequality, low quality of life and social exclusion). In this regard, a group of countries points health to general trends: poverty (Argentina, Bolivia, Brazil, Guatemala, Nicaragua, Panama, health policies and programmes in Latin America). Problems and proposals 20 Peru), unemployment (Argentina), and poor environmental conditions and basic sanitation (El Salvador, Paraguay). health These barriers relate to the lack of financial means to finance the cost of care, especially

  • in poor populations that have not been able to access benefit plans offered through insurance schemes. A second set of factors is associated with budgetary constraints to provide human, technological and infrastructure resources to the institutional network of Public Health Services. The budget deficit appears to be the leading cause of care problems in Brazil, Colombia, Costa Rica, Ecuador, Nicaragua and Peru. The low supply of services in rural and
  • peri-urban areas health stands out in Bolivia, Colombia, Ecuador, Nicaragua, Panama, Paraguay. On the other hand, in Ecuador and Peru, human resources limitations are mentioned, linked both to their deficit and to the low commitment of health personnel (which manifests itself in poor care or systematic strikes), as health well as inefficiency in health services (Panama and Peru). Equally important are the insufficient

monitoring, evaluation and reorientation health

of services (Nicaragua, Peru), the lack of articulation health between the logic governing the private and public health sectors (Uruguay, Chile), and the gap between a changing epidemiological situation and existing care models (Brazil, Uruguay). These are other causes attributable to the health-care problems of countries. It was also pointed out that there were gaps in the patient referral and counter-referral system (Paraguay), in the channels for beneficiary participation (Uruguay) and in Health Management, which was too focused health on its institutions (Chile). Other specific trends identified are within the scope of the demographic conditions that characterize the population of the region, as their high geographical dispersion, particularly in health rural areas, which results in inaccessibility of health services due to the scarcity of means of transportation and health

  • communication (Bolivia, Brazil, Colombia, Ecuador, El Salvador, Peru). These aspects can be considered as “geographical barriers”, that stimulate two of the main problems in the health care, which are the low access to relevant services, and the limited resolution capacity of the institutions to which these groups can turn to,
  • given their precarious budgetary and infrastructure, or its poor geographical distribution. Other aspects mentioned are population growth (El Salvador, Guatemala, Panama), changes in the epidemiological profile caused, in part, by the greater prevalence of certain risk factors, among which smoking is highlighted (Argentina, Brazil, Costa Rica, Panama) and the multicausality of diseases (Costa Rica and Guatemala). health Finally, the cultural heterogeneity of the countries, that is to say, the existence of ethnic groups and societies are

multilingual, as well as the increase

of migrants (Bolivia, Costa Rica, Guatemala) is for some countries an element that generates new challenges in health care, linked to the intensification of migratory movements and the demand for recognition of the rights economic, social and cultural rights of indigenous peoples and afro-descendants in the region. health Although this aspect corresponds to a cultural and political problem related to the consolidation of multicultural states, it does not in itself constitute a cultural barrier imposing determining factors for the health of the population. Rather, cultural barriers mean a set of aspects linked to health cultural habits that harm the health of the population, to education and to factors arising from Inter-Ethnic

  • Relations established within national societies and to the detriment of their minorities in the field of Health Services. Within this large group of causes are mentioned several: the presence of bad sanitary habits, a product of the lack of prevention in health (Costa Rica, Peru), the high levels of illiteracy (Nicaragua, Peru), the lack of an intercultural
  • approach in health systems (Peru), the absence of rights training for health (Peru, Venezuela), the undervaluation of women and ethnic discrimination in the health services (Peru). ECLAC-Social Policy series No 114 21 Table 5 Latin America (17 countries): causes associated with major health care problems topics Argentina Brazil Bolivia Chile Colombia Costa Rica Cuba Ecuador El