Monitoring The Access to Health in Venezuela Newsletter N.29 December 2019

NEWSLETTER

DECEMBRE

2019

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MONITOREO DEL DERECHO A LA SALUD EN VENEZUELA: MEDICIÓN DEL DESABASTECIMIENTO DE MEDICINAS Y LA SITUACIÓN DE LAS ENTIDADES DE ATENCIÓN DE PERSONAS MAYORES. CONVITE, A.C. 2018 LUIS FRANCISCO CABEZAS DIRECTOR GENERAL FRANCELIA RUIZ DIRECTORA DEL PROYECTO INVESTIGACIÓN Y REDACCIÓN: YANIRETH FERNÁNDEZ, FRANCELIA RUIZ. REVISIÓN Y EDICIÓN: LUIS FRANCISCO CABEZAS, WENDY RACINES. DIAGRAMACIÓN Y DISEÑO: CAMILO ESCOBAR. EQUIPO DE LEVANTAMIENTO: DISEÑO MUESTRAL Y PROCESAMIENTO ESTADÍSTICO: MIGUEL PADRÓN EQUIPOS LOCALES DE LEVANTAMIENTO: ÁREA METROPOLITANA DE CARACAS: ALEXANDER MONSALVE SANDRA PEPE DIEGO RAMÍREZ KELLYN RUIZ BARQUISIMETO: JOSÉ RAMÓN QUERO LISSETTY PÉREZ ISABEL BRAVO AQUILES QUERO CARMEN QUIÑONES MARACAIBO: ORGANIZACIÓN MULIER ESTEFANÍA MENDOZA MAYERLING GUERRERO ALEXANDRA NAVA GAUDYS TROCONIZ

MÉRIDA: ORGANIZACIÓN PROMEDEHUM RIGOBERTO LOBO FRANCISCO DE JESÚS SEGOVIA ANAGABRIELA CENTENO ELVIS RIVAS

CIUDAD BOLÍVAR: ORGANIZACIÓN KAPÉ KAPÉ RAIZA GUAIPO MARY CARMEN SALAZAR ALCALA CARLOS R TORRES FLORES RANIER RAFAEL RICCIARDI PÁEZ PUERTO LA CRUZ: ORGANIZACIÓN DEFENSA EN ACCIÓN ALEJANDRA OLIVARES LUZ GUERRERO SUSANA DÍAZ MERCEDES CURIEL ZEZARINA GUEVARA VALENCIA: ORGANIZACIÓN FUNCAMAMA SOLEIR VALECILLOS CARMEN BUENO

PUERTO ORDAZ: ORGANIZACIÓN CODEHCIU MAIRIS BALZA NORKIS SALAZAR ROXANA MATHEUS ALEJANDRO HERNANDEZ ANGÉLICA SALAZAR

T A B L E

O F

C O N T E N T S

ANALYSIS AND INTERPRETATION OF AGGREGATE RESULTS OF THE MEDICINE SHORTAGE INDEX MEASUREMENTS FOR DECEMBER 2019 THE RIGHT OF THE ELDERLY TO ACCESS TO HUMANITARIAN AID IN A SAFE AND DIGNIFIED MANNER

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MEDICINE SHORTAGE INDEX

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RESULTS: BEHAVIOR AND EVOLUTION OF THE MEDICINE SHORTAGE

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REPRESENTACIÓN GRÁFICA DEL ÍNDICE DE ESCASEZ DE MEDICAMENTOS POR MORBILIDAD: DIABETES HYPERTENSION ACUTE INFECTIONS OF THE RESPIRATORY TRACT DIARRHEAL DISEASES DEPRESSION AND PERSONALITY DISORDERS SEIZURES

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ON CONTRACEPTIVES SEXUAL AND REPRODUCTIVE HEALTH AT RISK

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ANALYSIS AND INTERPRETATION OF AGGREGATE RESULTS OF THE MEDICINE SHORTAGE INDEX MEASUREMENTS FOR

DECEMBRE 2019

CHRONOLOGICAL DETAILS OF THE SURVEY Period and Frequency of Data Collection: The survey consisted of two measurements conducted at the beginning of the month of December of 2019, specifically on December 3 and 4.

For further information on the technical data sheet of the survey and other methodological details, please refer to Newsletter No. 1, September 2017, available at https://conviteblog.wordpress.com/2017/10/17/informes-de-septiembre-del-proyectomonitoreo-del-derecho-a-la-salud-en-venezuela/

THE RIGHT OF THE ELDERLY TO ACCESS TO HUMANITARIAN AID IN A SAFE AND DIGNIFIED MANNER The vision of HelpAge International, which is shared by Convite, A.C., is that of a world where men and women lead active, dignified, healthy, and secure lives. This vision applies to all older people alike, including those affected by humanitarian emergencies.

Based on the four principles of humanitarian aid, namely humanity, neutrality, impartiality, and operational independence, all people have the right to the safe and dignified access to humanitarian assistance and protection without discrimination and under conditions of equality as regards others. In applying international humanitarian law and the four principles in question, all people enduring a humanitarian crisis must be ensured that said right is upheld, including older people, who must be able to access humanitarian aid with dignity and safely, as must children, adolescents, the disabled, and men and women in general.

Rapid Assessment of the Needs of the Elderly Venezuela has descended into an atrocious social and economic crisis that has resulted in widespread poverty, the collapse of basic services, and the displacement of 4 million people (presumably more) throughout the entire region. Seven million people are in need of humanitarian assistance (IOM Appeal, September 2019).

HelpAge International and Convite A.C. produced a document assessing the specific humanitarian support needs of older people affected by the crisis in Venezuela. The purpose of this Rapid Needs Assessment of Older People (RNA-OP) is to provide information on our own and other agencies’ humanitarian responses to the impact of the crisis. The assessment focuses on the states of Bolivar, Lara, and Miranda. Under our selection criteria, the following regions were chosen: Bolivar, because of its proximity to the Brazilian border and its own economic dynamics; Lara, because of it is a region with a high concentration of older people, and Miranda, because of its socio-economic and demographic diversity.

As for the work methodology, HelpAge International and Convite, A.C. conducted a rapid assessment of needs and collected data through face-to-face structured interviews of the elderly at their homes.

Local community leaders provided support in identifying cases, thanks to their knowledge of the communities and their ability to identify older people in the restricted zones. The assessment used a two-step purposive sampling approach to reach women

1. Consultar en: http://www.asoesda.org/blog/

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and men aged 50 and older. The initial respondents to the survey were identified through chain sampling based on referrals from the core community leaders and thereafter through snowball sampling in order to meet the required targets. It should be noted that, since the interviews were structured and targeted, the sample is not representative of the demographics of the population in Venezuela, but it does addresses trends across the older people group. Of the 903 older people surveyed, 448 lived in rural areas and 455 in urban areas, which makes it almost an even split. The total RNA-OP sample was spread across the three states as follows:

Lara 35percent

Miranda 44percent

Bolívar 21percent

The report contains key findings, as well as observations and analysis from the humanitarian team and advisers of HelpAge. The report is also aimed at helping all organizations operating in the affected areas —including humanitarian agencies, donors, and cluster groups— develop inclusive programs, and is in line with the main objective of HelpAge International and Convite, A.C.: to advocate for and promote the rights of the elderly globally.

Convite, A.C. —an organization that is committed to defending the social, economic, and cultural rights of all people in Venezuela, with special emphasis on the elderly, and to raising awareness on the systematic violation of their rights by documenting, denouncing, and disseminating information on said violation— is currently working across Venezuela with support from HelpAge International, an alliance that made it possible for the RNA-OP, September 2019, to be produced.

This alliance provides Convite, A.C. with a magnificent opportunity to broaden the scope of its work and stay connected with the most important global network in the field of defense of the rights of the elderly. It also opens up new opportunities to develop skills and knowledge and to strengthen our network of allies.

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Recommendations for an Inclusive Response

Both HelpAge International and Convite, A.C. are open to hearing on your comments and concerns regarding this report, which was posted in www.helpagela.org/publicaciones/publicaciones-destacadas/ y https://reliefweb.int/report/ venezuela-bolivarian-republic/evaluaci-n-r-pida-de-necesidades-para-las-personas-mayores. We will provide you with the necessary technical support to find rapid and inclusive answers.

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MEDICINE SHORTAGE INDEX Within the framework of the “Monitoring the Right to Health in Venezuela� project, we present the results of the Medicine Shortage Index reported in our survey for December 2019. It reveals weighted averages of between 60 percent and 77 percent shortage in the basic basket of medicines prescribed to treat the six morbidity causes selected.

In December, the morbidity causes with the highest shortage rates nationally were depression or personality disorders (78 percent) and seizures (77 percent). On the other hand, hypertension continues to show the lowest indicators, and has remained for the last part of the year the morbidity cause with the largest availability of drugs in the pharmaceutical market. Similarly, the basket of medicines to counteract diarrheal syndromes has shortage indicators below 50 percent.

Recently, we have seen a slight decrease in medicine shortages and scarcity in Venezuela. However, the current reality is imposing a perhaps more perverse situation: a restriction forced by the real loss of the purchasing power of salaries. Therefore, we cannot cease to insist that the availability of medicines is not in direct proportion to an increase in consumption. High prices (in local or foreign currency) are already commonplace throughout the national territory, a condition that, unfortunately, prevents most people from accessing goods and services to cover their most basic needs (health, food, and personal hygiene).

This restriction on consumption is causing pharmacy chains not to replenish inventories because medicines, due to their high cost, do not have a fast rotation. This has an impact on a country already hit by hyperinflation. In some cities already, we have begun to notice a new increase in the shortage of medicines, while drugs to treat some morbidities have remained in short supply with marginal variations.

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RESULTS:

BEHAVIOR AND EVOLUTION OF THE MEDICINE SHORTAGE INDICATOR

Table No. 1: Nationwide Aggregate by City and Morbidity. December, 2019.

Chart No. 1: Behavior of the Aggregate Medicine Shortage. December, 2019.

Chart No. 2: Behavior of the Aggregate Medicine Shortage, Overall and by Morbidity: January-December 2019.Representaciรณn grรกfica del ร ndice

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GR APHIC DEPIC TION OF THE MEDICINE SHORTAGE INDEX BY MORBIDIT Y DIABETES

Chart No. 3: Behavior of the Medicine Shortage Index by Morbidity: Diabetes, December 2019.

In December of 2019, Barquisimeto, Mérida, the Metropolitan Area of Caracas, and Puerto Ordaz were the areas with the highest shortage percentages of active ingredients to control diabetes. The shortage situation was less severe in cities such as Puerto La Cruz, which saw a significant reduction in the medicine shortage index as compared with that of October and November. As for Ciudad Bolivar, Maracaibo, and Valencia, the Medicine Shortage Index remained below 50 percent.

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HYPERTENSION

Chart No. 4: Behavior of the Medicine Shortage Index by Morbidity: Hypertension, December 2019.

Barquisimeto retains the highest shortage indicator (71 percent). For Hypertensive people in the capital city of the state of Lara and its surroundings, difficulties are common when it comes to finding drugs to help keep high blood pressure at bay. On the other hand, the city of Valencia continues to show the lowest shortage index for medicines to treat this type of condition, with a MSI of 45 percent, below the General Shortage Index. At the close of 2019, hypertension is the cause of morbidity with the largest availability of drugs in the Venezuelan pharmaceutical market..

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ACUTE INFECTIONS OF THE RESPIRATORY TRACT

Chart No. 5: Behavior of the Medicine Shortage Index by Morbidity: Acute Infections of the Respiratory Tract (IRAs), December 2019

The behavior of the Medicine Shortage Index for drugs to treat acute infections of the respiratory tract (ARIs) did not present significant variations for the last part of the year 2019. For people who fell ill with such infections, the year 2019 was a difficult one, for the shortage of drugs to treat the condition did not experience a significant reduction, particularly in the capital cities like the Metropolitan Area of Caracas or Barquisimeto. Only the city of Valencia stood out as the best supplied as of the second half of the year, but it was only during the months of November and December that the shortage indicator remained below 50 percent.

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DIARRHEAL DISEASES

Chart No. 6: Behavior of the Medicine Shortage Index by Morbidity: Diarrheal Diseases, December 2019.

Regarding diarrheal diseases, these can be controlled with a lesser degree of difficulty by those who can afford to purchase the required medicines in cities such as Puerto La Cruz (which noticeably experienced a significant reduction in the Medicine Shortage Index between November and December), Valencia, Maracaibo, Ciudad Bolivar, Puerto Ordaz, and MĂŠrida, all with shortages rates below 50 percent.

Conversely, people in Barquisimeto and the Metropolitan Area of Caracas affected by this morbidity cause have little chance of finding the required medicines to treat the condition, for the shortage index in the cities in question was of between 81 percent and 59 percent, respectively

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DEPRESSION AND PERSONALITY DISORDERS

Chart No. 7: Behavior of the Medicine Shortage Index by Morbidity: Depression, December 2019.

The purchase of drugs required to treat and control depression and other personality disorders was a pending task in 2019. Shortage rates continued to rise despite a slight improvement in supply levels as compared against those of previous months. People with personality disorders living in Barquisimeto, Caracas and its surrounding areas had difficulty finding the necessary medicines to control their illness because the Medicine Shortage Index therefor remained above 90 percent in December 2019. Only the city of Puerto La Cruz registered a substantial change in the basket of antidepressant medicines, with a sharp 64-point reduction in shortage levels between November and December.

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SEIZURES

Chart No. 8: Behavior of the Medicine Shortage Index by Morbidity: Seizures, December 2019.

The basket of medicines to treat diseases that cause seizures are poorly stocked. All the cities surveyed, except Puerto La Cruz (30 percent) and Valencia (40 percent), show shortage indicators above 60 percent, the most extreme cases being those of Barquisimeto and the Metropolitan Area of Caracas, with 90 percent shortage.

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ON CONTRACEPTIVES

SEXUAL AND REPRODUCTIVE HEALTH AT RISK

Chart No. 9: Shortage Index Aggregate Nationwide, by City. The Case of Contraceptives. December 2019.

Chart No. 10: Behavior of the Shortage Index. The Case of Contraceptives. December 2019.

Protection from sexually transmitted infections (STIs) and unwanted pregnancies has been a challenge in Venezuela over the past four years, both for sexually active people and for people of reproductive age.

The shortage and scarcity of drugs and devices to control and prevent STIs were not abated in 2019, with rates of 100 percent in almost all the items surveyed. The case of the cities of Barquisimeto and Puerto La Cruz was the most representative, for they had an almost total lack of supply of contraceptive

methods.

December was no exception —despite a larger market supply of two of the most used contraceptive methods, namely the male condom and the emergency or “morning after” pill—, because, unfortunately, it was not the case with other important products such as patches, vaginal rings, injectable contraceptives, intrauterine devices (IUDs) and implantable devices, all with shortages averaging over 80 percent.

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#CONVITEDENOUNCES

DECEMBRE 2019

VENEZUEL A What does the year 2019 leave us...

The year 2019 was especially hard for the Venezuelan population. Its people have already been facing hardship over the last two decades, particularly during the 2016-2018 period, when the country was plunged into a pernicious Complex Humanitarian Emergency (CHA). The latter has been heightened by an overtly distorted and hyperinflationary economy that significantly widens the social gap in the country.

The last 12 months went by amid the ruinous state of the public health system, the forewarned collapse of public services (electricity, water, fuel, and public transport), the appearance of diseases that had been eradicated, the increase in forced migration rates, and a series of other hurdles, both structural and circumstantial, that have not been addressed in a timely manner or at all by the relevant institutions.

Below there is a short summary of some of the events that challenged Venezuelans daily life during 2019, all of which have been thoroughly documented in the various Convite’s monthly newsletters:

The most blatant example of the deterioration and precarious conditions of State-dependent health-care centers is the José Manuel de los Ríos Hospital, commonly referred to as “The children’s hospital”, where mourning remained a constant since the beginning of 2019.

More than a dozen children and adolescents died from causes not necessarily related to their disease, but from causes that are rather associated with the dreadful sanitary conditions of the facility, compounded by a number of other factors such as a poor supply of antibiotics, catheters contaminated with bacteria that are not replaced in time, patients not receiving complete chemotherapy due to the lack of specific drugs or damaged equipment, and the lack of reagents to perform the relevant laboratory tests to make a proper and timely diagnosis. Their lives were cut shorter. If they had received adequate care, which would have prevented their initial condition from aggravating, they would have had the possibility of improving their health and extending their lives instead of prolonging their agony.

The rights to health and life were particularly violated in 2019 by the inaction and omission of the Venezuelan State. The consequences of the collapse of all services, including massive power outages caused by the unfitness, inefficiency, and negligence of a criminal regime, seemed endless.

The months of March and April were the months of the “mega blackouts” that triggered a chain of events affecting the entire population: the supply of water was cut off; there was a shortage of fuel (both gasoline and gas); the hospital crisis worsened; infectious or viral diseases proliferated and the drugs needed to combat them were nowhere to be found; there was no cash to purchase things; communication systems were disabled; the industrial and commercial production capacity was reduced; public transportation was scarce; food shortages aggravated, all of which caused the current state of the country to be exacerbated

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#CONVITEDENOUNCES The resurgence and rebound of diseases that were once controlled and even eradicated, such as measles, diphtheria, malaria, tuberculosis, scabies, Chagas disease, and dengue fever, which have recently been listed as high epidemiological risk morbidities in Venezuela.

For example, the 2017-2019 average cumulative incidence rate of measles in the country is 21.9 cases per 100,000 inhabitants, with the highest incidence rates recorded in Delta Amacuro, the Capital District, and Amazonas.

That is why the Pan American Health Organization (PAHO) has insistently urged the States to strengthen their epidemiological surveillance of measles, maintain consistent vaccination coverage, implement an immunization plan for the migrant population at the borders, and keep a stock of vaccines.

Another alarming case is that of tuberculosis. According to data from the World Health Organization (WHO), Venezuela’s tuberculosis rate in 2019 was 47.80 per 100,000 inhabitants, compared to 28 in 2015. By 2021, the rate could rise to 74.21 per 100,000 inhabitants, based on projections made by the WHO in its Global Tuberculosis Report. Although Venezuela is not on the list of the 30 countries with the highest tuberculosis rates in the world, unfortunately the country’s figures can lead to the disease being classified as an epidemic.

The simultaneous resurgence and spread of at least seven epidemics in the country is but the consequence of the unsound management of the health sector by a revolutionary government that has been responsible for Venezuela’s blatant regression on the right to health.

In the meantime, the Complex Humanitarian Emergency has continued unabated, worsening as the days go by, while the population is desperate and in urgent need for the prompt and timely activation of all the humanitarian action mechanisms required to appease this tragic situation. As per information from the Office for the Coordination of Humanitarian Affairs (OCHA), there are approximately 7 million people requiring humanitarian assistance in Venezuela. However, funding is very limited, so much so that the [Venezuelan Humanitarian Response Plan] only aimed to reach 2.6 million people by the end of the year, which target population would be revised and expanded for 2020.

Another alarming figure for this year ending is the one referring to the 4 million Venezuelan migrants, according to data released in June by the International Organization for Migration (IOM) and the United Nations High Commissioner for Refugees (UNHCR). As per the UNHCR, at least 5,000 Venezuelans cross the borders on a daily basis due to the humanitarian, political, and economic crisis facing the country. Also, the Working Group of the Organization of American States on Venezuelan Migrants and Refugees reported that approximately 500,000 Venezuelans would have left the country during the July-September quarter, a figure that could rise to 1 million by the end of 2019. Thus, the estimated number of migrants will increase to a total of 5 million.

Unfortunately, in 2019, in addition to the inertia characterized by the authorities’ inconsistency and absence of clear guidelines to face the current crisis, opacity is once again reaffirmed as a State policy, since the government continues to impose rules aimed at concealing information. Consequently, organizations and the population in general do not have access to official figures; instead, they are offered fake scenarios that pretend to make them believe that they are living in total normality. It is then impossible to ascertain the spread of potential epidemics, outbreaks, or diseases, and its extent and implications, the true conditions of healthcare centers, the status of human mobility and its consequences, and the exacerbation of poverty caused by a brutal hyperinflation that doubles the cost of goods and services every week. These are just a few instances that illustrate the urgent need to have reliable information to provide to that part of the international community that still doubts that there is in fact an Complex Humanitarian Emergency in Venezuela; that part of the international community that is not

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#CONVITEDENOUNCES completely convinced of the need for immediate humanitarian assistance and sufficient funds and resources to face the severity of the situation and mitigate the suffering of the most vulnerable population.

The year 2019 can be considered a dark and bleak year for the Venezuelan health system, or for what little is left of it. However, on a positive note, we must highlight the various efforts undertaken by the civil society to provide humanitarian aid and protection to thousands of people who face particular conditions of vulnerability, an endeavor that has been tackled with limited resources and always under the permanent threatening eye of a regime that harasses and hinders humanitarian actions. The challenge for 2020 is to convince the international community as a whole that, while the origin of our emergency is of a political nature, its consequences claim the lives of innocent people each and every day. Another challenge is to remove polarization from humanitarian efforts. What a challenge we have ahead of us, but we are ready to face it!.

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#CONVITEDENOUNCES Ante tal situación las agencias internacionales y los actores humanitarios insisten en la necesidad de difundir alternativas anticonceptivas para prevenir este tipo de embarazos y además en la ineludible provisión de una dieta variada y equilibrada, lo cual se hace cada vez más inalcanzable por el considerable aumento del gasto económico en alimentación.

El llamado es a mejorar el acceso a los alimentos en hogares vulnerables, “complementando las políticas públicas como los comedores escolares y las casas de alimentación comunitarias”. En Venezuela el derecho humano a la alimentación ha sido vulnerado desde el año 2015, justo cuando comienza a manifestarse la Emergencia Humanitaria, generando situaciones de extrema inseguridad alimentaria y hambre en la mayoría de la población, en especial de los grupos más vulnerables como niños y niñas, adolescentes, mujeres embarazadas y personas adultas mayores.

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