During his weekly television show "Hello President" on Sunday, Venezuelan President Hugo Chavez inaugurated three new Integral Diagnostic Centres (CDI’s) in Mérida, Miranda, and Bolívar states as part of a plan to relaunch the government’s flagship healthcare program Mission Barrio Adentro (Inside the Barrio).
On September 20 Chavez declared an "emergency situation" in the health sector saying that Mission Barrio Adentro, which provides free health care to all Venezuelans, had deteriorated with some 2,000 of the total 6,700 local medical clinics being abandoned.
However, despite ongoing structural challenges and opposition claims that Mission Barrio Adentro, staffed largely by Cuban doctors, has failed, Chavez pointed out the significant achievements and importance of the health care program.
According to the government, Mission Barrio Adentro has saved 226,334 lives and, among other services, the diagnostic centres have carried out 237 million blood tests and 100 million electrocardiograms, the latter with a unit cost of 300 Bolivars (US$139) in the private health system, Chavez said.
"Ten years ago there were no doctors for the poor, now everything here is free," he added.
It is estimated that approximately 15 million Venezuelans regularly access the program, which together with other social missions in the areas of education, welfare and training, has been one of the Chavez government’s most popular policies.
Mission Barrio Adentro, which was launched in 2003, is divided into various stages, all of which are free.
Barrio Adentro I consists of 6,711 primary healthcare clinics throughout the entire country serviced by 7,964 doctors (1,641 of which are Venezuelan).
Barrio Adentro II, which involves 4,477 doctors, is composed of 499 Integral Diagnostic Centres (CDI’s), 445 rehabilitation centres and 27 High Technology Centres (CAT’s). The first of the CDI’s were opened in June 2005 in Maturin, Monagas State, with the goal of constructing 600 around the country.
Barrio Adentro III involves the renovation of Venezuela’s existing public hospital system and Barrio Adentro IV includes the construction of new comprehensive and specialized hospitals.
As part of the re-launch plan, last week Chavez announced the approval of 750.7 million Bolivars (US$349 million) for all stages of the program, which includes free distribution of medicines. Of the total, 400 million Bolivars ($ 186 million) was allocated to Barrio Adentro IV.
The head of state also emphasised the humanitarian social work performed by Cuban doctors in the different centres.
"The care and medicine here in the health centres is free, and specialists serve the people without distinction. We stand for free medical attention, and not, as under capitalism, for private clinics and private medicine," he said.
At present there are around 28,000 Cuban healthcare professionals, including doctors, nurses, specialists and sports teachers, working in Venezuela. The government aims to increase this figure to 32,000 with another 4,000 Cuban doctors expected to arrive by the end of October in order to revamp the health sector.
Five hundred Cuban medical students will also arrive in Venezuela by the end of October to start their medical internships together with 3,000 Venezuelan students. In January next year a further 9,000 fifth and sixth year Venezuelan medical students will also begin internships in Venezuelan hospitals through the Barrio Adentro Program.
Adolfo Delgado, president of the Bolivarian Society of General Comprehensive Medicine blamed former Health Minister Jesus Mantilla for the deterioration of the healthcare program.
Many staff had been left in "limbo" due to Mantilla’s inefficient administration, but are now resuming their posts in the clinics Delgado said.
One of the first decisions of the new Health Minister, Carlos Rotondaro, who replaced Mantilla in August, was to do an analysis of the real situation of Barrio Adentro, specifically in relation to staffing and equipment.
Rotondaro said that the fact that President Hugo Chávez declared health "emergency" was a recognition of the situation and showed a commitment to take the necessary steps to improve it. "Operationally Barrio Adentro declined, it’s not the mission it once was," he admitted.
Asked why the government was incorporating more Cuban doctors into the program, Rotondaro stressed the important social role the Cuban doctors are playing in the communities.
However, Dianela Parra, vice-president of the opposition-aligned Venezuelan Medical Federation (FVM) opposed the arrival of more Cuban doctors arguing they were not properly qualified.
Since the Barrio Adentro Program was first launched many Venezuelan doctors have refused to participate in the provision of free healthcare to the poor, preferring instead to operate more lucrative private clinics.
For his part, Delgado welcomed the arrival of the additional 4,000 Cuban doctors in the country as a "positive step" but contended it is necessary to involve more Venezuelan doctors in the program to ensure its long-term sustainability.
Currently a total of 2,500 Venezuelan doctors are working in the program, although the government has massively expanded placements for studying medicine through the Bolivarian university system to train more Venezuelan doctors.
Delgado also argued, "It is necessary to change the face of the administration" to improve the functioning of the program.
Regional committees of the Barrio Adentro Foundation should be either eliminated or reorganised, he said, because, in his view, in 90% of cases they have been ineffective in responding to the problems of staffing, equipment and pay among others.
Aware of structural problems in the administration and funding of the various social missions, President Chavez announced on September 19 the integration of all the social missions into a single system that will have a single fund to avoid the lack of coordination.
According to Delgado, the community should also participate actively in social oversight to ensure that the programs succeed.
Aristóbulo Istúriz, a leader of Chavez’s United Socialist Party of Venezuela (PSUV) also called on party activists to participate, together with local health committees, in voluntary work to recuperate the social mission.
During the month of September Istúriz said PSUV members carried out voluntary work to renovate schools around the country. "Now we should raise our hands with enthusiasm, everyone, to help in the recovery process and maintenance of the various health centres," he added.