SEAM: Country Programs: El Salvador

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El Salvador - Country Assessment



	View El Salvador's Assessment Report (PDF, 415KB)

Key Findings from El Salvador Assessment

The Salvadoran Ministry of Health and Social Welfare (MSPAS)
has a network of 30 public hospitals (including outpatient care)
and primary care facilities grouped administratively under 18 regions and 27 basic health care systems. The public-sector network covers almost 50 percent of El Salvador's six million people. These public-sector facilities, particularly hospitals, have difficulty maintaining a sufficient stock of essential medicines.

SEAM found that, of a list of critically needed medicines, just 84 percent were available at the MSPAS primary care facilities and 70 percent were available at public hospitals. (Private pharmacies and the NGO/mission sector also faced stock-outs, with availability of tracer items just 74 percent and 52 percent, respectively.) Although the Government has increased its health care budget in recent years, availability of essential medicines continues to be a problem at public facilities.

Map of El Salvador The SEAM assessment found that inefficient, decentralized procurement and poor management of drug supplies are major contributors to the problem. Recent steps to reorganize MSPAS decentralized the procurement function for public hospitals without ensuring sufficient local management capacity, with the result that public hospitals are unable to maintain adequate stock or obtain favorable prices.

Pricing and affordability issues are a major concern throughout the public health system. At the central level, which still handles procurement for MSPAS primary care facilities, El Salvador routinely purchases pharmaceutical products at prices above the international median; the SEAM assessment found that, for a list of tracer items, MSPAS central-level purchase prices for pharmaceuticals was 82 percent above median international purchase prices. Decentralized hospital purchase prices were another 23 percent higher overall than the prices paid by central-level purchasers, placing a great financial burden on patients and hindering hospitals' ability to maintain adequate stock.

When MSPAS facilities run out of medicines, patients turn to private pharmacies to fill their prescriptions, paying even higher prices. This creates an even heavier economic burden for workers and their families, particularly for the 28 percent of the Salvadoran population living on less than minimum wage.

The private not-for-profit (NGO and mission) sector is another alternative for patients, though the sector is small, serving just 7.5 percent of the population, mostly in rural areas not served by MSPAS. Because of their small purchase volumes, NGOs and mission facilities are unable to negotiate favorable prices for medicines, which in turn restricts their buying power and adversely affects the availability of essential medicines in the sector.

In addition to cost and availability issues, the quality of pharmaceuticals on the market remains a problem. The SEAM assessment found products of substandard quality in 50 percent of samples collected from public facilities, 27 percent of samples from NGO and mission hospitals, and 29 percent of samples from private pharmacies.

Related Information

» View the Assessment Report (PDF, 415KB)

» World Bank Country Data Profile