Dominican Republic and Haiti: Country Studies

Dominican Republic and Haiti: Country Studies
State for Health and Social Welfare (Secretaria de Estado de
Salud Publica y Asistencia Social—SESPAS) is in charge of
health services and is responsible for applying the Code. SES-
PAS has a regionally based, three-tiered organization for providing
health care, health promotion, and preventive health
services to the whole population. The three tiers are central,
regional, and provincial, with the Secretariat's programs organized
at and directed from the central and regional levels.
There are eight regional offices that direct the services and
oversee the health areas at the provincial level. The health
areas have rural clinics while most provincial capitals have a
hospital. Health services offered by SESPAS in theory cover
about 80 percent of the population; in reality, in the late 1990s
barely 40 percent were covered. The Dominican Social Security
Institute (Instituto Dominicano de Seguro Social—IDSS) covers
another 6.5 percent (or 15 percent of the economically
active population), and the medical facilities of the Social Security
Institute of the Armed Forces and National Police reach
another 3 to 4 percent. The responsibility for workers' health,
particularly workplace accidents and occupational diseases, is
also shared with the secretariats for labor, education, agriculture,
and public works. In the late 1990s, however, 22 percent
of the population received no health care.
Both personnel and facilities, in the public as well as in the
private sector, are concentrated in the National District and
urban areas. This situation has continued since the 1970s when
there were roughly 3,700 inhabitants per physician nationally.
However, the figure ranged from about 1,650 inhabitants per
physician in the National District to roughly 5,000 per physician
in the southeast and the south-central provinces. By 1997
the number of health personnel included 17,460 physicians
and 1,898 dentists; there are no details on the geographic distribution
of these personnel (see table 4, Appendix). However,
it was also the case that in 1997 more than half of the national
total of 15,236 hospital beds were in the National District and
the central Cibao.
SESPAS began a major effort to improve rural health care in
the mid-1970s. By the mid-1980s, the government had set up
more than 5,000 rural health clinics, health subcenters, and
satellite clinics. Doctors doing their required year of social service
as well as a variety of locally hired and trained auxiliary
personnel staff the facilities. Critics charge that lack of coordination
and inadequate management hamper the program's
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