El Salvador's battle against privatization

The Report: August 2003 vol.24 num.4


n El Salvador, health care workers, including doctors, have been on strike for nine months to protest government efforts to privatize the countrys health system. Salvadoran President Francisco Flores and the ruling National Republican Alliance (ARENA) party claim privatizing the health system will bring health care -to each according to the ability to pay." Union members call it, -Pay or die."

Two doctors from El Salvador were recently in BC to share information about this strike and the issues surrounding it. Speaking in Victoria, Dr. Armando Lucha Cornejo explained, -The policy of the government of El Salvador is to bring the public health service to a collapse by firing all the support staff in the hospitals. The number of people working in the laundry and catering facilities is being reduced by the government - a story that, I think, is very familiar to you here."

Dr. Cornejo is a grievance officer with the National Medical Association (SIMETRISS) which represents doctors. Also on the tour was Dr. Luz Estrella Rodriguez, who is the newly elected mayor of Apopa, a city of 400,000 near San Salvador, and a member of the Health Workers Union (STISS) which includes nurses and other health workers.

Repeated staffing cutbacks have undermined the efficacy of the system, Dr. Cornejo said. The government is now arguing the current system is -non-functional" and a private health system is needed. Health workers unions recognize the need for improvements but reject privatization as a solution.

El Salvador has a three-tier health system. There is a private system for the wealthy; and a public system that runs charity hospitals to take care of the very poor, and in he middle is the Social Security Institute, similar to Canadas medicare plan. This program is financed by contributions from employers, workers and government and provides health care to workers in most large companies, unionized labour and public employees. This is the program the government is trying to privatize.

In El Salvador, 48 per cent of the countrys 6.3 million people live below the poverty line. -The minimum wage is US$200 per month and must support a family of four to five people," Dr. Cornejo said.

The child mortality rate is six times higher than in Canada, he added, -and we wonder, with these kinds of conditions, how can a private health care system bring any good to the country?"

The Share Foundation, an American developmental agency, says the Salvadoran government is not interested in improving the health system but is motivated by profit. It claims ARENA members from some of the countrys wealthiest families are in position to benefit financially through purchasing health care facilities and providing insurance in a for-profit system.

-If the government is permitted to continue on its path to increase the scope of privatization, the low and middle income groups will be forced to pay higher rates for education, water and health care," she warned. -We can not allow this to happen."

The present strike - which has shut down El Salvadors social security hospitals and clinics - began last September when workers went on a one-day strike to oppose privatization and the illegal firing of 10 STISS members. In response, the government fired 30 more workers. The union then declared an indefinite strike. When striking union members were forcibly evicted by police from one hospital and held captive at gunpoint, SIMETRISS members joined the strike. Since then, many members have been jailed and some have received telephone death threats.

The striking workers are demanding the government enter into negotiations with their unions. They also want the government to guarantee there will be no reprisals against workers when they return to work, and want the Flores Administration to open up plans for health care reform to public debate.

The governments privatization scheme is also being influenced by the Inter-American Development Bank (IDB) and the World Bank. According to the Share Foundation, following the countrys earthquakes in 2001, the IDB and World Bank agreed to finance the reconstruction of damaged hospitals with the understanding the government would promote an agenda of privatization.

-Right now, we are in the middle of a situation where the government was seeking approval for a loan of US$140 million for hospital reconstruction which was negotiated with the World Bank and IDB," Dr. Rodriguez said. -The wording was almost ready for approval but was thankfully voted down [in the National Assembly] by the opposition parties." While the health care unions agree the system needs resources, they dont support taking a loan that forces the government to hand the sytem over to the private sector.

When elections were held two months ago to select the countrys mayors and deputies to the National Assembly, the National Liberation Front (FMLN) elected 31 deputies along with 27 for ARENA and 26 for the smaller opposition parties. Dr. Rodriguez was elected under the FMLN banner.

Protest marches have attracted up to 250,000 people showing their solidarity with the health workers against privatization of the health system. A survey by Central American University reports 89 per cent of Salvadorans oppose privatization of their health system, and 70 per cent support the strike.

-As you can see, this struggle has been very complicated and very difficult," Dr. Rodriguez said. -But the most important point is, at this time, there has been no progress in privatization of the health system in El Salvador."

Breaking news: Striking health care workers signed a settlement June 13, ending the strike and all government efforts to privatize health. Watch for continued coverage in the next issue of The Report.

This speaking tour was organized by CoDevelopment Canada and the Christian Task Force for Central America. HSA supports these solidarity efforts with donations through the HSA Solidarity Fund.