Dominican Republic and Haiti: Country Studies

Dominican Republic: The Society and Its Environment
effectiveness, however. Preventive services offered through
local health workers (who are often poorly trained in disease
prevention and basic sanitation) are not coordinated with curative
services. In addition, absenteeism is high, and supplies are
lacking.
SESPAS responded to these criticisms and problems in 1997
when it announced as its highest priority the reversal of the
long-standing shortfall in health and social spending. SESPAS
declared that its primary goal would be the reduction of infant
and maternal mortality, mainly by strengthening health services
at the provincial level.
In 1990 SESPAS employed 3,598 physicians and 6,868
nurses; by 1994 those numbers had increased to 5,626 and
8,600, respectively. Reflecting a 47 percent increase since 1986,
the Secretariat in 1992 operated 723 health care establishments—81
percent were rural clinics and dispensaries and 11
percent were health centers and local hospitals. In 1992 IDSS
operated one maternity hospital, twenty polyclinics, and 161
outpatient clinics, mostly rural. The private sector operated
420 health care establishments in 1990. By 1996 the number of
health care facilities in the country had risen to 1,334, with 730
of them coming under SESPAS, 184 under IDSS, and 417
under the private sector. In 1997 the government opened the
Health Plaza in Santo Domingo, a modern, high-tech health
complex. It has 430 beds, a diagnostic center, and hospitals for
child and maternal care, geriatrics, and trauma treatment. The
proper place of the health complex in the national health system
is being debated.
The Roman Catholic Church plays an important role in the
health and welfare field. In 1993 (the latest year for which figures
are available) it operated twenty-nine hospitals, 155 dispensaries,
twenty-three orphanages, twenty-five homes for the
aged, twenty-one nurseries, and scores of other welfare facilities.
In terms of overall national health statistics, life expectancy
at birth was seventy-one years for the 1990-95 period, sixty-nine
years for males and seventy-three for females. The general mortality
rate has gradually declined, falling to 5.5 percent per
1,000 population for the 1990-95 period. It is expected to
decline to 5.2 percent per 1,000 population for 1995-2000.
The infant mortality rate has steadily declined since 1985. The
rate for the 1990-95 period was forty-two per 1,000 live births.
The main causes of death in the population as a whole con-
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