Monitoring The Right To Health in Venezuela Newsletter Nro 6

j a n u a r y . 2 017

XLaSalud

TA B L E O F C O N T E N T S ANALYSIS AND INTERPRETATION OF AGGREGATE RESULTS OF MEDICINE SHORTAGE INDEX MEASUREMENTS FOR JANUARY 2017

3

INDICATOR BEHAVIOR AND EVOLUTION

3

AGGREGATE RESULTS NATIONWIDE: JANUARY 2018

5

GRAPHIC DEPICTION OF RESULTS BY CITY AND MORBIDITY

8

DIABETES

9

HIGH BLOOD PRESSURE

ACUTE INFECTIONS OF THE RESPIRATORY TRACT (AIRS)

10

DIARRHEA

11

CONVITE STRONGLY DENOUNCES 2018: THE WORST START OF THE YEAR FOR VENEZUELANS’ RIGHT TO HEALTH

12

MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018

2

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

JA N UA RY 2 017

1

Within the framework of the Monitoring the Right to

It is with great concern that we must state that

Health on Venezuela: An Approximation Based on Medicine Shortages, Preventable Deaths and Hospital Infrastructure project, Convite, A.C. has conducted a

the alarming trend towards

total of ten measurements (September I and II; October I

100 percent shortage

and II; November I and II; December I and II; and January

remains unchanged

I and II) of the basic basket of active ingredients for the four major causes of morbidity affecting the Venezuelan population: high blood pressure, diabetes, diarrhea, and acute infections of the respiratory tract (AIRs).

INDICATOR BEHAVIOR AND EVOLUTION The aggregate results of the ten measurements conducted over the last four-month period of 2017 and in January 2018 are broken down below:

MORBIDITY

P E R I O D 1st Week, September 2017

2nd Week, September 2017

1st Week, October 2017

2nd Week, October 2017

1st Week, November 2017

2nd Week, November 2017

1st Week, December 2017

2nd Week, December 2017

1st Week, January 2018

2nd Week, January 2018

HIGH BLOOD PRESSURE

AIRS DIARRHEA

GENERAL SI Table Nยบ 1: Fluctuation of the Medicine Shortage Indicator over each Measured Period, by Morbidi1.Period and Frequency of Data Collection: The survey consisted of two measurements made in January 2018 between the 15th and 17th and between the 29th and the 31st, which dates fall on the second and fourth weeks of the month, respectively, in order to detect variations that could be measured and circulated regarding medicine supply protocols in pharmaceutical establishments. For further information on the technical data sheet of the survey and other methodological details, please refer to Newsletter Nยบ 1, September, 2017, available at https://goo.gl/Vrh1EJ.

MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018

3

Upon an analysis of the behavior of the Medicine Shortage Index based on the results obtained from each measurement to date, the following may be observed:

1

Diabetes: The MSI indicator for diabetes medication was 90.7 percent in the first measurement, which

5

General Shortage Index (GSI): The GSI exceeded 90 percent in more than 5 of the 10 measurements

was made on the second week of the month of

conducted to date, and was never below 87 percent

September of 2017, and showed marginal reductions

in the 5 remaining measurements.

of between 1 percent and 4 percent. The trend over

that attention be drawn to the threat that an almost

the course of the survey is that of a MSI indicator of

total shortage of medicines to treat the four major

between 86 percent and 90 percent.

causes of morbidity represents for the life of the

It is imperative

Venezuelan people.

2

High Blood Pressure: The MSI indicator for high blood pressure medication has remained between 80 percent and 90 percent, and was 92.8 percent at the beginning of the survey. The trend is that it will remain over 90 percent (although it may not reach 100 percent).

3

Diarrhea: Diarrhea medication is the second group

These results are an indicator of the terrible

of drugs that are most difficult to find in the five

complex humanitarian emergency that is

cities under study, and has shown a sustained trend

hitting the country.

of between 86 percent and 95 percent shortage, terrifyingly close to 100 percent.

4

Acute Infections of the Respiratory Tract (AIRs): The supply of medication to treat acute infections

The

existence

of

this

humanitarian

emergency is still being denied by the State agencies and institutions responsible

of the respiratory tract is the scarcest over the

for guaranteeing Venezuelan citizens their

measured period. The MSI indicator for the nine

full enjoyment of the right to health and

active ingredients monitored was dangerously close

the right to life.

to 100 percent in all measurements conducted. It is usually over 94 percent, as per our records.

MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018

4

AGGREGATE RESULTS NATIONWIDE: J A N U A R Y 2 0 1 8 .

CITY

AIRS

HIGH BLOOD PRESSURE

DIARRHEA

METROPOLITAN AREA OF CARACAS

Table Nº 2: Aggregate Medicine Shortage Index Nationwide over the Entire Period.

The Metropolitan Area of Caracas was the most hit

various municipalities of the former Metropolitan District

by medicine shortages, which is not an encouraging

of Caracas in crowded transportation conditions.

prediction if we take into account that it is the first measurement of the new year . There is an aggravating

Another important element to be taken into account when

factor: the Metropolitan Area of Caracas is the region with

it comes to analyzing MSI indicators in the Metropolitan

the largest population concentration, with approximately

Area of Caracas is that there is a sustained shortage of

2

2,904,376 inhabitants .

medicine to treat diarrhea in a city where interruptions of water supply services are frequent or where the quality

Alarmingly, acute infections of the respiratory tract (AIRs)

thereof is poor, with devastating effects on the population

are the second highest cause of morbidity in the MAC. The

because they both increase the risk of developing diarrheal

mode of transmission of ARIs involves physical proximity

diseases. For the one part, food sanitation and hygiene

between people. This is an area of approximately 3,585

cannot be guaranteed because of water shortages; for

inhabitants per square kilometer, which increases the

the other part, the transmission of food contaminating

chances for the spread of ARIs.

microorganisms and bacteria escalates.

Additionally, the Metropolitan Area of Caracas is

In Barquisimeto, a city located in the central-western

experiencing a collapse in transportation, which means

region of the country, the trend is the same, and

that people go from one place to another across the

the

problems

affecting

Caracas

are

replicated.

2 .According to data available on the National Institute of Statistics website for the municipalities of Libertador, Baruta, Chacao, El Hatillo and Sucre, in the “Registered Population by Sex, Federal Entity, Municipality and Parish. 2011 Census” at: http://www. ine.gov.ve/index.php?option=com_content&view=category&id=95&Itemid=26

MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018

5

Barquisimeto’s population is 3,519 inhabitants per square

Nevertheless, the figures are still alarming for the four causes

kilometer, and the regional authorities have admitted

of morbidity being surveyed. For instance, medication to

serious deficiencies in the supply of safe drinking water,

treat respiratory infections is the scarcest in both Mérida

stating that they are due to “six of the engines (...) needed

and Maracaibo, followed by antidiarrheal drugs in Mérida

for water distribution across the state (...) burned out for

and high blood pressure drugs in Maracaibo.

various reasons...”, and to the lack of proper maintenance for more than twenty years 3.

In Nueva Esparta, the shortage of medication to treat respiratory infections is also the most alarming, followed by

As for Mérida and Maracaibo, aggregate indexes are

the shortage of drugs to treat diabetes and diarrhea.

smaller than those for the Metropolitan Area of Caracas and Barquisimeto, whose location closer to the border may allow them to be better supplied through independent local pharmacy chains that have logistic communication with suppliers across the border.

General SI

Graphic Nº 1: Behavior and Evolution of the Medicine Shortage Index by Morbidity 3. February 7, 2018. Hidrolara Admitts to Deficiencies in the Supply of Safe Drinking Water, in Noticias Barquisimeto, available at: http://www.noticiasbarquisimeto.com/2018/02/07/hidrolara-admite-deficiencia-en-el-servicio-de-agua-potable/. Also available at:

http://www.noticiasbarquisimeto.com/2018/02/02/no-somos-camellos-barquisimetanos-exigen-a-hidrolara-que-se-le-de-

respuestas-por-falta-de-agua.

MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018

6

Graphic NÂş 1 depicts the behavior of the MSI indicator by

The evolution of the indicator for the four causes

morbidity in all measurements conducted so far.

of morbidity under study is then clear. This piece of research allows us to verify how Venezuelans who suffer

Drugs with the worst supply along these 10 measurements

from any of these pathologies have endured an increase

are those prescribed to treat diarrheal diseases (92.4

in the shortage of essential drugs over this first month of

percent) and those prescribed to treat acute infections of

the year.

the respiratory tract (96.7 percent), which clearly shows that the complex humanitarian crisis hitting Venezuela is

Most people are unable to treat their diseases on a timely

only worsening. For instance, the State of MĂŠrida, whose

basis or to early and timely recover from infections and

capital is one of the five cities being surveyed, is being

viruses, and/or guaranteeing a quality of life consistent

stricken by an outbreak of diarrhea and vomit affecting at

with their chronic ailments. These Venezuelans are in

4

least 1,500 persons in the Andean region . The quality of

dire danger.

water for human consumption is poor, and the availability of medication to threat diarrhea is widely reduced.

Again, the MSI for drugs to treat acute infections of the respiratory tract is even higher than the Global SI, while that associated with drugs to treat diarrhea has fluctuated around the General MSI along with those to

All in all, shortages increase in size, seriousness

treat diabetes. The MSI for drugs to treat high blood

and impact over time. This is not only the

pressure has remained the lowest; however, shortage thereof is still a cause of deep concern.

case of chronic illnesses such as high blood pressure and diabetes, but also of common

One of the most distressing findings is that there has

ailments such as infections of the respiratory

been a 9 percent increase in the MSI for the group of

tract and diarrhea.

medicines to treat high blood pressure in the second January measurement, as compared against the second measurement of the month of December. Between the second measurement of the month of September and the second measurement of the month of December,

In Venezuela, falling with a common illness is increasingly easy, but recovering therefrom can be a real luxury.

the basket of drugs to treat this cause of morbidity was relatively the best supplied at the aggregate level across the country. Over the measured period, the MSI remained between 79.6 percent and 82.8 percent, the latter being the highest ever recorded for this morbidity cause.

4. Diario de Los Andes (2018). Viral Agent Likely Culprit for Gastrointestinal Disease Outbreak in MĂŠrida, available at: https:// diariodelosanndes-com/site/agente-viral-seria-responsale-del-brote-gastrointestinal-merida. html.

MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018

7

GRAPHIC DEPICTION OF RESULTS

BY C I T Y A N D M O R B I D I T Y 5 DIABETES

General SI

Graphic Nº 2: Behavior and Evolution of the Medicine Shortage Index for Diabetes, by City. September 2017 – January 2018.

A glance at the historical behavior of the Medicine

It should be noted that in the second week of the

Shortage Index for diabetes medication shows a

month of October, which is the second week measured

reduction of 2.9 percent, which doesn’t necessarily mean

and the fourth chronologically in the period, diabetic

that supply has improved, for the availability levels are

Barquisimetans were unable to obtain the medication

extremely low. Minor fluctuations of the aggregate index

they needed to treat the disease, since the shortage of

for this cause of morbidity are revealed, which peaked in

drugs for diabetes was TOTAL, with a MSI of 100 percent.

September of 2017.

Under a geographical strata perspective, the cities of Barquisimeto, Caracas and Nueva Esparta are the least stocked with drugs to treat diabetes, whereas Maracaibo, comparatively, had the best supply of hypoglycemic drugs.

5.This is a graphic depiction of the behavior and evolution of the MSI indicator by morbidity and city for every measurement conducted between September 2017 and January 2018.

MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018

8

HIGH BLOOD PRESSURE

General SI

Graphic Nº 3: Behavior and Evolution of the Medicine Shortage Index for High Blood Pressure, by City. September 2017 – January 2018.

A marginal reduction of just 3.3 percent was recorded

smaller shortage of HBP drugs, although the last indexes

over the last period of the statistical survey, with slightly

recorded are the highest for the city.

dynamic reductions in the case of diabetes medication.

However, this is in no way good news in a complex

It is important to note that none of these percentages

humanitarian crisis.

mean that availability and supply have improved, or that the inventory of drugs in the country has normalized.

From a geographical comparative analysis perspective,

On the contrary, it is clear evidence that the full-fledged

the most affected cities, that is, the cities with a MSI above

humanitarian and public health crisis that we are

average for high blood pressure medication, are Caracas,

experiencing has not changed.

Barquisimeto and Nueva Esparta. In Mérida, the shortage of high blood pressure medication is comparatively lower.

Maracaibo remains “the most benefited city” due to a

MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018

9

ACU TE INFEC TIONS OF THE RESPIR ATORY TR AC T

(AIRS)

General SI

Graphic Nº 4: Behavior and Evolution of the Medicine Shortage Index for Acute Infections of the Respiratory Tract, by City. September 2017 – January 2018 .

The health problem that is most worsened by medicine

Another alarming MSI increase was that recorded for the

shortages in all measurements and cities is the one

city of Nueva Esparta, which began the lowest vis-à-vis

pertaining to acute infections of the respiratory tract. The

the other cities under study but which eventually leveled

shortage of drugs to treat AIRs is between 90 percent and

with the dramatic global trend.

100 percent, peaking in the survey for the second week of November (sixth chronological week in the period).

Once again, Maracaibo had the lowest index, but still dangerously close to the General SI, which is not good

This is more than horrifying because, due to the low

news for Marabinos.

temperatures recorded in December, the spread of infections of the respiratory tract increased. In January, the MSI for acute infections of the respiratory tract in the Metropolitan Area of Caracas was 98.9 percent, the highest ever recorded nationwide.

MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018

10

DIARRHEA

General SI

Graphic Nº 5: Behavior and Evolution of the Medicine Shortage Index for Diarrhea, by City. September 2017 – January 2018.

Fluctuations in the historical behavior of the MSI for

Geographically, Caracas and Barquisimeto are above

drugs to treat diarrhea are the most dynamic. The global

the global index, whereas Nueva Esparta and Mérida are

trend for this ailment, as with the aforementioned causes

about average. Once again, Maracaibo is the city with the

of morbidity, was towards a reduction, with a MSI of 3.2

largest availability of drugs to treat diarrhea.

percent, which peaked in the survey for the first week of September. This is in no way an improvement in the shortage situation but a slight increase, albeit marginal, in the availability of some antidiarrheal medication.

MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018

11

CONVITE STRONGLY DENOUNCES 2018: T H E W O R S T S TA R T O F T H E Y E A R F O R V E N E Z U E L A N S ’ R I G H T TO H E A LT H The Article 83 of the Constitution of the Bolivarian Republic of Venezuela mandates that health is “a fundamental social right” and establishes that it is “the obligation of the State” to guarantee it. International health indicators show an unprecedented decline of health in Venezuela.

Although ours is an advanced legislation in terms of its treatment of the right to health, our badly named “Health System” is not, and its multiple deficiencies are at the core of the awful deterioration of Venezuelans health that we are regrettably witnessing. This start of the year has been marked as the worst for health in Venezuela in all our republican history. We received 2018 with a backwards leap of at least 30 years in health.

In our effort to document that what #TheStateDoesn’tCare about, we take this opportunity to denounce that in the month of January, us, Venezuelans suffered the perverse effects of the following phenomena:

1

The shortage of drugs to treat the four most recurrent causes of morbidity in the country was above 90 percent.

During the first 30 days of the year, Venezuelans didn’t have access to common medication (basic basket of drugs) prescribed to treat the four diseases that hit the population the most.

2

of serology reagents, which is a serious alert for Caraqueños, for it is an emblematic trauma center that receives a large number of trauma patients in need of multiple transfusions; in some cases, patients relatives must sign a consent form for risky transfusions.

70 percent of blood banks in the country lack bags and reagents for donations and serology 6. Of the country’s 334 blood banks, 236 in the public system cannot guarantee transfusions due to the lack of serology reagents. Miguel Pérez Carreño Hospital has had an irregular supply

6.Pineda, Juliett (2018). 70 Percent of Blood Banks in the Country are in Crisis for Lack of Reagents. Available at: http://efectococuyo.com/principales/ en-crisis-70-de-los-bancos-de-sangre-del-pais-por-falta-de-reactivos.

MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018

12

3 4

An 8-year-old boy from Caracas died from diphtheria after having been taken to at least nine health-care

10

Mérida saw an epidemiologic alert triggered due to an outbreak of diarrhea and vomit starting on January

centers and sent back home with a misdiagnosis of

14, which has affected at least 1,546 persons. The

tonsillitis.

situation worsens by the day in Mérida due to a 97.5 percent shortage of antidiarrheal drugs recorded in the

Only 3 of the 23 antiretroviral drugs required for a 77,000 population of HIV patients registered in the antiretroviral supply program nationwide are 7

available .

second survey of the month of January.

11

62

newborns died in January at the Luis Razetti

Hospital in Barcelona 12 .

In said cases, the most

recurrent death causes are associated with mother’s

5 6

80 percent of HIV patients in need of treatment are

malnutrition during pregnancy, mostly teenagers, as

8

receiving NONE .

well as with lack of prenatal care. Additionally, there is a shortage of pregnancy and postnatal medicines,

Due to a shortage of immunosuppressive drugs, 30

supplements and vitamins across the country.

organ transplant patients are in serious emergency, and 3,500 are at risk of losing donated organs and dying.

Convite, A.C. had already alerted of this 9

situation in our previous newsletter .

12

The health of Venezuelans has hours of operation: Convite, A.C. took on the task of calling the 0800-Salud telephone service set up by the national executive to distribute drugs. The service operates from 9:00 am

7

There is a total lack of medical supplies. For instance,

to 3:00 pm Mondays through Fridays. This means that

José María Vargas Hospital, one of the oldest in the

Venezuelans cannot fall sick before 9:00 am and after

country, located in the Capital District, recorded a

3:00 pm on weekdays, let alone on weekends; medical

10

deficit of medical supplies of 90 percent in January.

8

emergencies are not a possibility for said “service”.

32 of dialysis centers at the national level have closed for lack of supplies. At the same time, there are 15,000 Venezuelans whose lives depend on dialysis to survive and are having none due to said lack of supplies 11.

9

The growing trend in the number of confirmed cases of the four epidemics of hepatitis B, diphtheria, malaria and measles remains unchanged.

7.Source: Stop VIH. 8.Source: Stop VIH. 9.Source: Codevida

10.Barreto, Gabriel (2018). % (Vargas Hospital has already recorded a deficit of medical supplies of 90 percent). Available at http://contrapunto.com/noticia/el-hospital-vargas-ya-alcanzo-un-deficit-de-insumos-medicos-de-90-183667/ 11.Herrera, Isayen (2018). 32 Dialysis Units Closed due to Lack of Supplies). Available at http://www.el-nacional.com/noticias/ salud/unidades-dialisis-cerraron-por-falta-insumos_221256 12.Tal Cual (2018). 62 babies died at the Luis Razetti Hospital in Barcelona). Available at http://talcualdigital.com/index. php/2018/02/18/en-enero-murieron-62-bebes-en-hospital-luis-razetti-de-barcelona/

MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018

13

13

The

national

government

stubbornly

denies and ignores the terrible complex humanitarian emergency facing the country, one that has resulted in the death of a large number of Venezuelan citizens. As if that wasn’t enough, it decided to implement a new health plan of the “naturophatic” type: President Nicolás Maduro launched an “ancestral health plan” to treat diseases with herbs and natural products and agents amidst a serious shortage of drugs in the country, which has been estimated at 95 percent by the medical profession13.

Photograf: Agencia EFE

13.Panorama (2018). Maduro Launches “Ancestral Health” Plan Amidst a Serious Shortage of Drugs.

Availabe

at

http://www.panorama.com.ve/politicayeconomia/Maduro-lanza-plan-de-salud-ancestral-en-medio-de-grave-

escasez-de-farmacos-20180119-0099.html

MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018

14

Follow us on @conviteac

Convite Asociaciรณn

http://conviteblog.wordpress.com

@conviteac

XLaSalud