El Salvador Assessment

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El Salvador Assessment



Jose Francisco Lopez Beltran
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El Salvador
UNDP 1998, World Bank 1999
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Health Care Delivery System

• Major Health Care Providers
• Public
• MSPAS (MOH) 42
• ISSS 12
• Private
• NGOs 9
• For Profit 37

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Pharmaceutical Sector

• Total value of market US 190.5 million
• Private expenditure 77
• MSPAS (MOH) 10
• ISSS 13
• More than 25,000 products registered
• 60 manufacturers
• 30 distributors
• 1,500 pharmacies

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Geographic Accessibility
Average number of facility operating hours per day
Hours
7
Availability
Percent
Set of un-expired tracer items in stock
Time out of stock
Percent dispensed
8
Affordability
Number of days worked to treat key conditions

• Population covered by risk sharing scheme
• ISSS 15
• Private insurance 2

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Affordability (2)

• MOH central level purchase price is 82 above
  median International Tender Price
  
• Hospital purchase prices are 23 higher than
  central level purchase price
  

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Quality of Products and Services
Drug samples that failed quality testing
Samples found substandard by MOH lab
44.1
Percent
26.3
26.5
4.5
0.6
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Quality of Products and Services (2)
Patient Exit Survey
Simulated Client Survey
Percent
Encounters with antibiotic prescription
Encounters with vitamin prescription
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Access Gaps

• Affordability
• 28 of population earns less than minimum wage
• Availability
• Inefficient procurement compounds budget
  limitations and affects availability in MSPAS and
  NGO sectors
  
• Quality
• Product and service quality need to be improved

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Potential Strategy
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Viability

• Facilitators
• Current legislation and reform policy
• MSPAS decentralization is under way
• NGOs interested in participating with MSPAS
• Private sector firms have the interest and
  capacity to provide services
  
• Barriers
• Payment mechanisms need to be modified
• Some political opposition to current reforms