Barrio Adentro and the Reduction of Health Inequalities in Venezuela: An Appraisal of the First Years

Abstract

This article presents an update on the characteristics and performance of Venezuela's Bolivarian health care system, Barrio Adentro (Inside the Neighborhood). During its first five years of existence, Barrio Adentro has improved access and utilization of health services by reaching approximately 17 million impoverished and middle-class citizens all over Venezuela. This was achieved in approximately two years and provides an example of an immense "South-South" cooperation and participatory democracy in health care. Popular participation was achieved with the Comités de Salud (health committees) and more recently with the Consejos Comunales (community councils), while mostly Cuban physicians provided medical care. Examination of a few epidemiological indicators for the years 2004 and 2005 of Barrio Adentro reveals the positive impact of this health care program, in particular its primary care component, Barrio Adentro I. Continued political commitment and realistic evaluations are needed to sustain and improve Barrio Adentro, especially its primary care services.

‘We do not do any activity until there is an outbreak’: barriers to disease prevention and health promotion at the community level in Kongwa District, Tanzania

“…On the other hand, in Venezuela, the reforms were a reaction against the poor health conditions of the poor under neoliberal policies. Armada et al (7) report that by the late 1990s, class-based health disparities were vast. Hence, when Hugo Chavez became president, he spent his first term, between 1998 and 2002, implementing a variety of strategies to eliminate barriers to health care.…”

“…The magnitude of the challenge notwithstanding, there is hope for turning the tide if prevention and health promotion at the community level are made a priority (4–7), as advocated in the PHC approach. According to WHO, PHC refers to ‘essential health care based on practical, scientifically sound, and socially acceptable method and technology; universally accessible to all in the community through their full participation; at an affordable cost; and geared toward self-reliance and self-determination’ (8).…”

A new typology of policies to tackle health inequalities and scenarios of impact based on Rose's population approach

“…In the USA, there has been a focus on implementing and establishing effectiveness of targeted interventions for high-risk social groups on early childhood health and development, such as the Nurse-Family Partnership and other home-visiting programmes,19 or out-of-home daycare 20. Other examples of interventions to improve environment and expand services in poor neighbourhoods, include urban renewal programmes,19 21 and Barrio Adentro in Venezuela with expanded access to universal healthcare 22…”

Social policy and health policy in Latin America: a field of political struggle

“…Meanwhile, clean slate attempts have led to the parallel development of another health subsystem built as a further obstacle to construction of the SUS. The most well-known case is Misión Barrio Adentro in Venezuela 9 .…”

“…For example, the SUS provided access to health services for tens of millions of previously excluded citizens 10 . In Venezuela, the Chavista government likewise expanded services to 17 million previously excluded Venezuelans 9 . There is also a sustained effort at building a public system focused on comprehensive, integrated primary care.…”