Health care in Colombia
Encyclopedia
Nursing
Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death....
, and allied health professions in the Republic of Colombia.
Health issues
Tropical diseases are important issues in Colombia, and major causes of death. MalariaMalaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
affects near 85% of the national territory, mainly the Pacific ocean
Pacific Ocean
The Pacific Ocean is the largest of the Earth's oceanic divisions. It extends from the Arctic in the north to the Southern Ocean in the south, bounded by Asia and Australia in the west, and the Americas in the east.At 165.2 million square kilometres in area, this largest division of the World...
coast, the Amazon jungle
Amazon Rainforest
The Amazon Rainforest , also known in English as Amazonia or the Amazon Jungle, is a moist broadleaf forest that covers most of the Amazon Basin of South America...
and eastern savanna
Savanna
A savanna, or savannah, is a grassland ecosystem characterized by the trees being sufficiently small or widely spaced so that the canopy does not close. The open canopy allows sufficient light to reach the ground to support an unbroken herbaceous layer consisting primarily of C4 grasses.Some...
s, with an estimated of 250,000 cases/year and a mortality rate
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...
of 3/100,000.
The main agent is Plasmodium vivax
Plasmodium vivax
Plasmodium vivax is a protozoal parasite and a human pathogen. The most frequent and widely distributed cause of recurring malaria, P. vivax is one of the four species of malarial parasite that commonly infect humans. It is less virulent than Plasmodium falciparum, which is the deadliest of the...
with 66% of the cases, except on the Pacific coast, where Plasmodium falciparum
Plasmodium falciparum
Plasmodium falciparum is a protozoan parasite, one of the species of Plasmodium that cause malaria in humans. It is transmitted by the female Anopheles mosquito. Malaria caused by this species is the most dangerous form of malaria, with the highest rates of complications and mortality...
causes 75% of the cases.
Yellow fever
Yellow fever
Yellow fever is an acute viral hemorrhagic disease. The virus is a 40 to 50 nm enveloped RNA virus with positive sense of the Flaviviridae family....
and Dengue fever
Dengue fever
Dengue fever , also known as breakbone fever, is an infectious tropical disease caused by the dengue virus. Symptoms include fever, headache, muscle and joint pains, and a characteristic skin rash that is similar to measles...
are major public health concerns, due to their high epidemic
Epidemic
In epidemiology, an epidemic , occurs when new cases of a certain disease, in a given human population, and during a given period, substantially exceed what is expected based on recent experience...
potential, high mortality rate and wide distribution of Aedes aegypti
Aedes aegypti
The yellow fever mosquito, Aedes aegypti is a mosquito that can spread the dengue fever, Chikungunya and yellow fever viruses, and other diseases. The mosquito can be recognized by white markings on legs and a marking in the form of a lyre on the thorax...
. The Colombian government develops vaccination
Vaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...
campaigns against yellow fever on a regular basis.
Chagas disease
Chagas disease is a tropical parasitic disease caused by the flagellate protozoan Trypanosoma cruzi. T. cruzi is commonly transmitted to humans and other mammals by an insect vector, the blood-sucking insects of the subfamily Triatominae most commonly species belonging to the Triatoma, Rhodnius,...
is endemic
Endemic (epidemiology)
In epidemiology, an infection is said to be endemic in a population when that infection is maintained in the population without the need for external inputs. For example, chickenpox is endemic in the UK, but malaria is not...
to the Santander Department
Santander Department
Santander is a department of Colombia. Santander inherited the name of one of the nine original states of the United States of Colombia. It is located in the central northern part of the country, east of the Magdalena River, bordered to the south and southeast by Boyacá, to the northeast by Norte...
and nearby areas. Other diseases such as Leishmania
Leishmania
Leishmania is a genus of Trypanosomatid protozoa, and is the parasite responsible for the disease leishmaniasis. It is spread through sandflies of the genus Phlebotomus in the Old World, and of the genus Lutzomyia in the New World. Their primary hosts are vertebrates; Leishmania commonly infects...
, rabies
Rabies
Rabies is a viral disease that causes acute encephalitis in warm-blooded animals. It is zoonotic , most commonly by a bite from an infected animal. For a human, rabies is almost invariably fatal if post-exposure prophylaxis is not administered prior to the onset of severe symptoms...
, Venezuelan equine encephalitis virus
Venezuelan equine encephalitis virus
Venezuelan equine encephalitis virus is a mosquito-borne viral pathogen that causes Venezuelan equine encephalitis or encephalomyelitis . VEE can affect all equine species, such as horses, donkeys, and zebras. After infection, equines may suddenly die or show progressive central nervous system...
and West nile virus
West Nile virus
West Nile virus is a virus of the family Flaviviridae. Part of the Japanese encephalitis antigenic complex of viruses, it is found in both tropical and temperate regions. It mainly infects birds, but is known to infect humans, horses, dogs, cats, bats, chipmunks, skunks, squirrels, domestic...
are also present in Colombia. Snakebite
Snakebite
A snakebite is an injury caused by a bite from a snake, often resulting in puncture wounds inflicted by the animal's fangs and sometimes resulting in envenomation. Although the majority of snake species are non-venomous and typically kill their prey with constriction rather than venom, venomous...
s are a big concern, because of the shortage in antivenom supplies countrywide.
Different forms of malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
severely affect the population, especially children under five years, with moderate to severe rates of malnutrition of 21% and iron deficiency anemia
Iron deficiency anemia
Iron-deficiency anemia is a common anemia that occurs when iron loss occurs, and/or the dietary intake or absorption of iron is insufficient...
of 23%. (see aguapanela
Aguapanela
Aguapanela or agua de panela is a drink native to southern Central America and northern South America. It literally means "panela water" as it is an infusion made from panela which is a hardened, concentrated syrup from the cane...
).
History
The first graduated medical doctor, Alvaro de Aunón came to New Granada from Sevilla SpainSpain
Spain , officially the Kingdom of Spain languages]] under the European Charter for Regional or Minority Languages. In each of these, Spain's official name is as follows:;;;;;;), is a country and member state of the European Union located in southwestern Europe on the Iberian Peninsula...
, in 1597 and stayed for a short time. The first drugstore
Pharmacy
Pharmacy is the health profession that links the health sciences with the chemical sciences and it is charged with ensuring the safe and effective use of pharmaceutical drugs...
in Colombia was opened at the same time, in the main square of Bogotá by Pedro Lopez Buiza.
In 1740, don Vicente Tomás Cansino started the medical teaching in the Rosario College (Colegio Mayor de Nuestra Señora del Rosario). The medical care at the time was made almost exclusively in the particular homes of the sick people due lo the lack of health institutions. The first hospital in Colombia was the San Pedro Hospital, in the capital city Bogotá
Bogotá
Bogotá, Distrito Capital , from 1991 to 2000 called Santa Fé de Bogotá, is the capital, and largest city, of Colombia. It is also designated by the national constitution as the capital of the department of Cundinamarca, even though the city of Bogotá now comprises an independent Capital district...
. The hospital started its functioning in 1564, built by bishop fray Juan de los Barrios. In 1739 was opened the Hospital San Juan de Dios
Hospital San Juan de Dios
Hospital San Juan de Dios is the name of several hospitals in the Republic of Colombia. The most important are located in Bogotá, Cúcuta and Pamplona.The one of Cúcuta is now a library....
, built by fray Pedro Pablo Villamor.
Health standards in Colombia have improved greatly since the 1980s. A 1993 reform transformed the structure of public health-care funding by shifting the burden of subsidy from providers to users. As a result, employees have been obligated to pay into health plans to which employers also contribute. Although this new system has widened population coverage by the social and health security system from 21% (pre-1993) to 56% in 2004 and 66% in 2005, health disparities persist, with the poor continuing to suffer relatively high mortality rates.
The refractive surgery
Refractive surgery
Refractive eye surgery is any eye surgery used to improve the refractive state of the eye and decrease or eliminate dependency on glasses or contact lenses. This can include various methods of surgical remodeling of the cornea or cataract surgery. The most common methods today use excimer lasers to...
keratomileusis
Keratomileusis
Keratomileusis is the surgical improvement of the refractive state of the cornea performed by lifting up the front surface of the eye by forming a thin hinged flap under which the shape of the cornea is changed by using an excimer laser or other surgical device, and was developed by José Ignacio...
was developed by Ignacio Barraquer
Ignacio Barraquer
Ignacio Barraquer was a Spanish ophthalmologist known for his contributions to the advancement of cataract surgery. Barraquer was born in Barcelona, Catalonia, Spain...
in 1964 in Bogotá. On January 10, 1985, Dr. Elkin Lucena performed the fist successful In vitro fertilization, that allowed the birth of the first Latin American test tube baby Carolina Mendez. On December 14, 1985 the Dr. Alberto Villegas performed the first heart transplant in Latin America to Antonio Yepes.
On May 20, 1994 Dr. Manuel Elkin Patarroyo
Manuel Elkin Patarroyo
Manuel Elkin Patarroyo is a Colombian pathologist who made the world's first attempt of synthetic vaccine for malaria, a disease transmitted by mosquitoes that affects millions of people in tropical and subtropical regions, including parts of the Americas, Asia, and Africa...
received the Prince of Asturias Awards
Prince of Asturias Awards
The Prince of Asturias Awards are a series of annual prizes awarded in Spain by the Prince of Asturias Foundation to individuals, entities or organizations from around the world who make notable achievements in the sciences, humanities, and public affairs....
by his technical and scientific research in the development of synthetic malaria vaccine
Malaria vaccine
Malaria vaccines are an area of intensive research. However, there is no effective vaccine that has been introduced into clinical practice.The global burden of P. falciparum malaria increased through the 1990s due to drug-resistant parasites and insecticide-resistant mosquitoes; this is illustrated...
.
In 2002 Colombia had 58,761 physicians, 23,950 nurses, and 33,951 dentists; these numbers equated to 1.35 physicians, 0.55 nurses, and 0.78 dentists per 1,000 people, respectively. In 2005 Colombia was reported to have only 1.1 physicians per 1,000 people, as compared with a Latin American average of 1.5.
Status of public health
General government spending on health accounted for 20.5% of total government expenditures and for 84.1% of total health expenditures (private expenditures made up the balance) in 2003. Total expenditures on health constituted 5.6 percent of gross domestic product in 2005. The per capita expenditure on health care in 2005 at an average exchange rate was US$150.Urban and rural residents experienced significant differences in access to health care. The coverage in the three largest cities -- Bogotá, Medellín, and Cali -- was almost 95 percent. At the rural level, the best services were delivered by the departments in the coffee-growing areas. At the bottom of the scale -- in terms of quality and coverage -- were the rural areas in the non-Andean regions as well as the marginal neighborhoods in medium-sized and small cities.
Since 2001–2 Colombia has halved its homicide rate, which was more than 60 per 100,000 inhabitants, or 28,837, in 2002, one of the world’s highest homicide rates. In 2006 a total of 17,206 violent deaths were recorded, the lowest figure since 1987. Other than homicide, heart disease is the main cause of premature death, followed by strokes, respiratory diseases, road accidents, and diabetes. Waterborne diseases such as cerebral malaria and leishmaniasis are prevalent in lowland and coastal areas. Child immunization for measles in 2004 as a percentage of children under 12 months of age was 92 percent.
Acquired immune deficiency syndrome (AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
) is the fifth-leading cause of death in the working-age population. According to Colombia’s National Health Institute data reported in 2003, nearly 240,000 people — mostly women and young people — or 0.6 percent of the population had been infected with the virus since AIDS arrived in Colombia in October 1983. Estimates of the number of people living with human immunodeficiency virus (HIV), adults and children (0–49 years of age), in 2005 ranged from 160,000 to 310,000. The comparable figure for women (15–49 years of age) was 62,000. The number of AIDS and hepatitis B cases has been rising. In 2005 the estimated HIV adult prevalence rate (15–49 years of age) was 0.6 percent. As of 2006, between 5,200 and 12,000 people had died from AIDS. Services provided by the new Multisectoral National Plan, launched in July 2004, include integrated care for people living with HIV and provision of antiretroviral drugs. Under the plan, about 12,000 people have been receiving combined antiretroviral therapy (approximately 54% of those requiring it).
Law 100 of 1993
The national constitution was reformed in 1991, and with this purpose the general system of social security was reformed with the implementation of Law 100, that extended widely the health coverage to the population, but the economic resources to finance this reform were insufficient, causing collapse of many public health institutions and affecting the income of the medical staff.The law 100 of 1993 is divided into four books:
- First book: About PensionPensionIn general, a pension is an arrangement to provide people with an income when they are no longer earning a regular income from employment. Pensions should not be confused with severance pay; the former is paid in regular installments, while the latter is paid in one lump sum.The terms retirement...
regulations. - Second book: About the general system of healthcare
- Third book: About Occupational safety and healthOccupational safety and healthOccupational safety and health is a cross-disciplinary area concerned with protecting the safety, health and welfare of people engaged in work or employment. The goal of all occupational safety and health programs is to foster a safe work environment...
- Fourth book: About Complementary social services
The reform of the Colombian healthcare had three main goals:
- The achievement of an antitrustAntitrustThe United States antitrust law is a body of laws that prohibits anti-competitive behavior and unfair business practices. Antitrust laws are intended to encourage competition in the marketplace. These competition laws make illegal certain practices deemed to hurt businesses or consumers or both,...
policy, to avoid the statal health monopolyMonopolyA monopoly exists when a specific person or enterprise is the only supplier of a particular commodity...
. - The incorporation of private health providers to the healthcare market
- The creation of a subsidiatedSubsidyA subsidy is an assistance paid to a business or economic sector. Most subsidies are made by the government to producers or distributors in an industry to prevent the decline of that industry or an increase in the prices of its products or simply to encourage it to hire more labor A subsidy (also...
healthcare sector, covering the poorest population.
The general principles of the law determine that the healthcare is a public service, which must be granted in conditions of proficiency, universality, social solidarity and participation. The article 153 of the law determines that the health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
must be compulsory, the health providers must have administrative autonomy, and the health users must have free choice of health provider.
Glossary of Acronyms
- SISBEN: Sistema de Identificación de Beneficiarios de Subsidios Sociales (system of identification for social subsidies beneficiaries).
- EPS: Entidades Promotoras de Salud. (Health promoting entities)
- EPS-S: Entidades Promotoras de Salud Subsidiadas. (Subsidized Health promoting entities).
- IPS: Instituciones Prestadoras de Servicios de Salud. (Health providing institutions)
- ESE: Empresas Sociales del Estado. (Statal social organizations)
- ESS: Empresas Solidarias de Salud. (Health solidarity organizations)
- CCF: Cajas de Compensación Familiar. (Family welfare financial institutions)
- POS: Plan Obligatorio de Salud. (Compulsory plan of health)
- Fondo SYGA or FOSYGA: Fondo de Solidaridad y Garantía. (Fund of Solidarity and guarantees)
- MAPIPOS: Manual de Procedimientos y Actividades del POS. (POS-related procedures and activities handbook)
- SOAT: Seguro Obligatorio de Accidentes de Tránsito (Compulsory Auto insurance
SISBEN
The System for the Selection of Beneficiaries of Social Programs (El Sistema de Seleccion de Beneficiarios para Programas Sociales), the national system of identification of beneficiaries for social subsidy, classifies the people according to their socio-economic level into 6 strata, being stratum 1 homeless people and extreme poverty and stratum 6 the highest level of affluence.Most of the social subsidies and public health programs are focused in the 1 and 2 strata. So, the fraudulent expedition of low level SISBEN carnets is a major problem in the healthcare system, since the regional politicians are often accused of providing these carnets to not really poor people in exchange for votes. This wrong identification of beneficiaries prevents the real poor people from receiving the subsidies designed for them.
EPS
The National Health Superintendent (Superintendencia de Salud) defines which organizations may qualify as EPS according to a number or requirements, including infrastructure, capital, number of users, functionality and covering. The function of the EPS is to sell health service packages to the public, and contract such services with the healthcare-providing institution.Health professionals and the healthcare system
The health professionals had little or no participation in the development of the reform to the healthcare system. So, basic principles such as cost-benefit, healthcare quality, and implications in the professional health practice were misjudged. The reform of the health system restricted severely the opportunity of the health professionals to hire their services privately, phenomenon that caused a heavy loss of income for the average health practice.See also
- Health care systems
- List of hospitals in Colombia
- Water supply and sanitation in ColombiaWater supply and sanitation in ColombiaWater supply and sanitation in Colombia has been improved in many ways over the past decades. Between 1990 and 2004, access to sanitation increased from 82% to 86%, but access to water increased only slightly from 92% to 93%.. In particular, coverage in rural areas lags behind. Furthermore, despite...