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CIS
Colonia Libertad,
Avenida Bolívar # 103
San Salvador, El Salvador
Centroamérica
Teléfonos:
(503) 2226-5362
(503) 2235-1330
e-mail: cis_elsalvador@yahoo.com
July 2001
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The Plan Puebla-Panamá (PPP): Interests, Perspectives, and Viability
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The Attorney General, Institutional Incapacity, and the Case of FINSEPRO-INSEPRO
The Plan Puebla-Panamá (PPP): Interests, Perspectives, and Viability
On June 15, 2001, in El Salvador, the presidents of Mexico and Central America signed the Plan Puebla-Panama with the hopes of immediate execution in order to (officially) "generate economic development and better the living conditions of the mesoamerican population." The PPP officially consists of the following initiatives, which on paper look very attractive: (1) sustainable development orientated to preserve the environment, cultural identity and the natural resources of the region; (2) prevention and mitigation of natural disaster with the goal of generating a culture of prevention, hydrometer information and the development of safety measures; (3) revision of existing tourism projects and designing new projects; (4) facilitating commercial interchange with the objectives of making business more viable, modernizing customs homogenizing trade agreements, and promoting small and medium business; (5) integration vial, with the triple aim of installing a Pacific corridor, an Atlantic corridor, and other corridors in the southeast of Mexico that will inter- connect the region; (6) energy interconnection that looks to take advantage of the area; (7) integration of telecommunication services with the goal of incorporating technological innovations and configuring a fiber optic network; and (8) human development that involves educational, health and indigenous development projects as well as migratory issues.
However, that is the official statement. What are the real interests pushing the PPP? What is the viability and what can we expect from this plan?
Mexico has expanded its presence in the Central American isthmus since 1995 when the free trade agreement with Costa Rica took affect. Later came a free trade agreement with Nicaragua and then the free trade agreement with Northern Triangle of Central America (Guatemala, Honduras, and El Salvador).11 The free trade agreement between Mexico and Guatemala and El Salvador took affect on March 15. With Honduras it officially began on June 1st and only 4 Honduran companies are interested in the free trade agreement with Mexico. It implies a clear disadvantage, between industrialized Mexico and non-industrialized Honduras. La Prensa Grafica, 6/13/01. These distinct free trade agreements between the Central American states and Mexico present a bilateral benefit. Mexico, following the thought of the United States, recognizes that these free trade agreements in and of themselves will not be enough to enter the global market unless a judicial-economic infrastructure with regional characteristics is formed (Plan Puebla Panama). In this way, the PPP means the establishment of a strategic alliance of globalized neoliberalism. The PPP is different from other regional groupings (European Union, MERCOSUR, Andino Group etc.) in that it represents a prolongation of NAFTA and a preparation for the FTAA. The PPP is based on a poor Central America and a industrialized Mexico. There is yet to take into account the interests of the United States.
Taking a historical look, we would say that Central America always has been a poor region with a oligarchy in control and whose economy was based for decades on agriculture. During the 1950s and the 1970s, Central America experienced notable economic growth due to the price raise of international agricultural products that the region exported (coffee, cotton, sugar and bananas) and also due to the creation of the MERCOMUN (Central American Common Market). The MERCOMUN was made possible under the Industrialization for the Substitution of Imports program (ISI in Spanish). The logic of the program was to locally produce manufactured goods that the region would otherwise have to import at a much more expensive price. However, this industrialization process failed because it did not include a profound agricultural transformation (agrarian reforms, etc.) and also because it excluded small and medium business. During the 1980s - the decade of war in El Salvador, Guatemala, and Nicaragua - Central America endured a grave economic crisis due to various reasons: 1) the fall in international prices in the few goods that the region exported; 2) the interruption of the inter- American market; 3) the loss of the institutional power of the MERCOMUN; 4) the rise in international oil prices ; and 5) the crises provoked by the external debt. Since the 1990s neoliberalism has taken hold. Such system promotes the development of monopolies and oligopolies, modifying the existing state according to its own desires or making use of those fortunes built by illegal activity (corruption, narco- trafficking, money laundering, etc.). The implementation of three generations of Structural Adjustment Programs (SAPs) have not stabilized the national economies and on the contrary, they have produced greater debt as well as the "new poor" - the growing army of unemployed. Currently, the Central American economic activity rests on the following pillars: the informal sector; family remittances from the exterior; the maquila sector; agricultural exports; and tourism. Central America has a fragile and unsustainable economy (to say the least) with a growing poverty rate (60% of Central Americans are poor), a rising unemployment rate, and greater economic inequality within each country and between countries. Reality has clearly demonstrated that the ruling Central American governments and their predecessors have not wanted to define proper policies to structure the national productive forces into a sustainable economy but rather have dedicated themselves to implementing the neoliberal proposals of the International Monetary Fund (IMF), the World Bank, and the Inter-American Development Bank (IADB).
Mexico recognizes our regional poverty. In fact, the Mexican government's web page shows a F-O-D-A (acronym in Spanish for Strengths, Opportunities, Weaknesses and Threats analysis) of the region - from the southeast of Mexico through Central America to Panama. As strengths, the report recognizes the abundance of natural resources (which is not the case in El Salvador, Honduras and Nicaragua) and the potential for tourism. The weaknesses detected relate to economic and developmental backwardness22 That is how the recent Report on Human Development in El Salvador reports it: 51.2% poverty (does not cover basic needs: education, health, food, housing); 23.4% extreme poor (does not cover basic food needs, starving); a step backwards of three years in human development due to the past earthquakes that left 225,000 new poor and dropped El Salvdor 5 points in the world ranking on human development. Héctor Dada Hirezi, economic analyst, pointed out that the earthquakes exacerbated the the problems but did not create them. La Prensa Grafica, 7/6/01, high levels of marginalization, emigration, low levels of education, all of which limits the development of technological industries and infrastructure. The most notable "opportunities" are the free trade agreements, the cultural and ecological tourism market and the betterment of transportation infrastructure which reduces connecting costs and engulfs new markets. For "threat" the report signals low productivity and higher labor costs which in turn leads other large industries to go to China, Vietnam, Malaysia and Thailand. However, El Salvador is very competitive in the "race to the bottom" as virtually tied with the PPP are a series of laws that will "flexibilize labor" - including the elimination of minimum wage.
In summary, the PPP region symbolizes a market of 65 million consumers and a potential pool for even cheaper labor (the PPP is a perfect example of the two contradictory forces that characterizes global neoliberalism: the "consolidation of a cheap- labour economy on the one hand and the search for new consumer markets on the other"33 Michel Chossudovsky, "The Globalization of Poverty", 1998.) that under the new conditions of the PPP (flexibilization of labor laws, creation of highways, strategic ports hegemony of commercial laws, etc.) could attract foreign investment and open new jobs. Once again, the immediate guarantee of the IADB to "generously" finance $4 billion dollars and their hoisting the banner of "economic and human development" through the PPP is quite worrisome. Despite so many beautiful official phrases, neither the free trade agreements, nor the PPP will benefit the population if there is no economic paradigm change that is an alternative to the privatization and the transnationalization of the territory between Puebla and Panama. The weekly journal "Proceso" from El Salvador points out that the PPP is more Puebla than Panama: "the Mexicans have developed a careful plan of what they want to do with the southeast of their country, a zone extremely rich in natural resources but not very developed and for that reason poor as well as having grave problems of national identity and rebellion. As for the rest that corresponds to Central America and Panama it does not say anything. Maybe the seven governments of the south do not have any ideas or perhaps it is because they are waiting for the others, which is to say the Mexicans and the IADB functionaries, to tell them what they have to do”44 Proceso 956, June, 20, Pg. 2.
One of the principal interests of the Mexican government is the
"resolution" of the "problem" that the southeast
part of the country poses. The north is "integrated" and
"consolidated" with NAFTA. The southeast however needs other
exits and Central America and Panama (38 million habitants) would
conform the ideal area for its potentials. In this way, Mexico, who
already feels the affects of NAFTA, globalization, and has seen some of
its businesses break by not being able to compete with the Chinese or
Taiwanese products, should engulf Central America before other world
economic forces. Central America has to accept. In this way, the Central
American countries would become the backyard of Mexico. The PPP despite
using beautiful phrases such as "multidimensional
development", "territorial ordering", "sector and
environmental policies", "state policies and long term",
"integrated rural development", "more civil society
participation", "new forms of generating consensus"
"elevate human and social development of the zone",
"fortify cultural traditions of the region", "respect for
indigenous rights", "fortify local authority",
"coordination between local and national levels", "create
a conservationist culture", etc. is based on poor and weak
economies whose equilibrium is maintained by family remittances from the
exterior and the informal sector.
The other underlying interest is that the United States, due to
difficulties signing rapid free trade agreements with different Central
American states (due to some members of Congress, union pressure, and
other organizing efforts that stopped "fast track") is looking
to Mexico to open up Central America and lay the ground work for the
FTAA. Therefore, Mexico will not become the "big brother"
exactly, but rather the butler that cleans up and "corrects"
the little ones of the south, underdeveloped and incapable of governing
by themselves. The PPP would in this manner put into place the
infrastructure in order to carry out the FTAA. The visionary project of
the FTAA needs a different reality than what the region currently is.
The PPP is, following the strategic logic of the US, the ideal project
for the future FTAA, an extension of North American dominance and the
expropriation of Central America. For example, a new mechanism for
expropriating wealth is "biopiracy" which consists of
appropriating the natural resources of the region through the process of
genetic modification. Such mechanisms will rob mesoamerica of its
natural resources. Accordingly, the playing countries will have to
modify their legislation, "liberate" their economies,
eliminate restrictions, and permit the "free" circulation of
goods (however, the agreement does not allow unrestricted migration
because the US wants to stop the flux of immigration coming from the
south). All in all, talking about the "regionalization" of
development in this case is too risky, it is more appropriate to talk of
the consolidation of the neoliberal model whose affects are more
underdevelopment, more poverty, more emigration and more social
violence.
The Attorney General, Institutional Incapacity, and the Case of FINSEPRO-INSEPRO
One of the most important institutions that investigates crime is the Attorney General's Office. From the kidnappings and citizen security to the unresolved cases of corruption, drug trafficking, and money laundering, all have to do with deficiency of the Attorney General, Belisario Artiga. This month there has been at least two cases that have called attention to his operating mode and his inefficiency: absolving of Roberto Mathies Hill, accused of million dollar fraud, (the case of FINSEPRO- INSEPRO), and the case of the theft and sale of fertilizer donated from Japan. These two cases are added to a long list of injustices that have been notably unresolved: the rape and murder of the minor Katya Miranda; telephone espionage relating to political and commercial affairs; the hundreds of deaths due to alcohol poisoning; the lack of procedure regarding the demand placed to investigate the intellectual authors of the assassination of the six Jesuit priests of the UCA (an investigation that would involve ex-president Cristiani himself); corruption in the FEDEFUT; false professional titles; in addition to other cases of assassination and crimes that occur without investigation. It is sad to acknowledge that in El Salvador a de facto power exists that uses the state apparatus for private economic interests. Despite tough words the attorney general has not responded to the Salvadoran population and has allowed operational impunity.
One example of the attorney general's inefficiency has been the FINSEPRO-INSEPRO case. Four years ago, in the middle of 1997, the bankruptcy of the financial institutions managed by Roberto Mathies Hill became public. Almost a billion colones pertaining to hundreds of individuals who had accounts in the institutions was not accounted for. Hill was accused of not controlling finances and not avoiding bankruptcy. Since the beginning there were anomalies and dark intentions. The government auditors, by way of the Superintendent of the Financial System (SSF in Spanish), were inconsistent and inflated the missing sum to ¢1.3 billion colones. This was done with two objectives: 1) so that the state institutions recuperate 100% of the lost capital; and 2) to fraudually benefit people who had not been affected by the fraud (the list of victims presented by the SSF differed substantially than the list presented by the victim's committee). In 1998, the Legislative Assembly approved a ¢785 million colon trusteeship, fixed on the assets of the financial institutions, in order to pay the victims but that meant that according to the "official" list of the SSF there was still ¢600 million left to pay. After four years, a tribunal absolved Hill without ever investigating where the missing money was. The victims of the scandal now have no idea how they will recuperate their money.
During the investigation the participation of Mario Galdámez came to public light. Galdámez had received at least 529 million colones from FINSEPRO-INSEPRO in name of three businesses of his: Automotriz y Arrendadora Sabater (439 millions), Caribe Motor (72 millions) y Autosal (18 millions). These businesses presented other anomalies: Sabater for example in a matter of five years lost 48 million colones, 18 of which ($2 million US dollars) were lost in two years. Mario Galdámez used the lost money to buy the franchises of Precision Tune San Antonio Texas for 75 million dollars, create a company called FLOSEP in Florida, and to acquire 6,600 actions in WE JAC Corporation for a value of $8 dollars each action ($52,800 dollars). Furthermore he paid important sums to economists, politicians, and deputies. Inside the FRACTASA building, which he bought with the $10 million colones that INSEPRO gave him, Galdámez constructed hidden passage ways, double doors, undeclared rooms and safes where he archived files on public figures whom he considered to be enemies. Documents were also found that demonstrated his intention to start an economic journal and a newspaper. The investigation established the following connections between Mathies Hill and Mario Galdámez: (1) The father of Mathies Hill was vice-president of Autosal and president of Caribe Motor at the same time when Galdámez managed them. Roberto Mathies Hill Jr. also worked in Caribe Motor while Galdámez was manager. (2) High ranking FINSEPRO personnel assured that at the end of each year Galdámez revised the financial situation of each financial institution that Hill ran. (3) Mario Galdámez received a salary as consultant of INSEPRO. (4) Galdámez assured that he acquired Sabater with loans from five national banks. Roberto Mathies Hill proved him wrong by stating that he received the money from FINSPRO - INSEPRO. (5) The ¢529,000 that he received from FINSEPRO - INSEPRO qualifies Mario Galdámez as a privileged client of these institutions. (6) The Sabater building that Galdámez bought for ¢10 million colones was financed by INSEPRO. In spite of all the evidence Galdámez was also absolved by the tribunal, however he still remains in prison waiting trial for other cases of fraud.
On June 8th, when the tribunal absolved Mathies Hill, the attorney general railed against the institution (that, independent of his judgments is an example of concrete participation of citizen participation in the legal system) and was extremely accusatory. He used an unprofessional tone when referring to the members of the jury. He transmitted a certain grade of degradation because of sex and social condition. Instead of accepting his own responsibility in regards to the verdict he handled himself in a defensive and unprofessional manner. He named two public prosecutors shortly before the trial knowing that it was a case that would require a profound study of the more than 130 pieces that make up the file. One of the two prosecutors, the youngest, was involved with the FEDEFUT investigation that just a few weeks earlier had demanded much time and effort. The other prosecutor was presented as a "star" prosecutor due to his more than thirty years experience in the Attorney Generals Office and his effective use of words. In practice, his performance contained nothing that you could consider as meriting a star status. Furthermore, he was only named to the case two weeks before trial. This makes Belisario Artiga responsible for the irregularities of justice, public distrust in the Attorney General's Office, and the operating impunity.
In the future it is the responsibility of the Attorney General's Office to follow the whereabouts of the missing money. An anonymous informant reported to the Co-Latino that the Attorney General should investigate a series of banks and other financial institutions in Colombia, Chile, Brazil, Argentina, Miami, Honduras, Paraguay, Ecuador, and Guatemala55 Colatino, 07/21/01. Recently, in the Prensa Grafica, it has been revealed that the directors of FINSEPRO have activities in the Caribbean: in 1990 Michael Laenec, Roberto Annicchiarico y Roberto Mathies Hill incorporated Secure Investments Corporation in the Virgin Islands where between 1993 and 1996 they moved five million dollars. In 1993, also in the Virgin Islands, INSEPRO Investment Corporation was registered by the same directors. In the Caiman Islands a ghost company called Orange Groves Limited was founded and in 1999 declared bankruptcy. The beneficiaries of these businesses are being investigated in the United States in Europe66 LPG, 07/11/2001.
The Kidnapping of Gerardo Villeda Kattán and Penal Reform
On Thursday June 21 the Salvadoran society was shook up by the brutal assassination of the 9 year old Gerardo Villeda Kattán. The minor had been kidnapped at 7:10 in the morning. Minutes after the kidnapers demanded ¢400,000 colones for the ransom. After the demand the father informed the National Civilian Police (PCN) of the kidnapping. Since 4:00 A.M. an anonymous informant had advised 911 of a kidnapping and gave stated it would take place in Mejicanos. The Rapid Reaction Police Group (GRP) followed the kidnappers and entered the property to trap the kidnappers. An hour and a half later all was finished. The result: the death of the child; the death of two GRP agents; the death of two kidnappers; and the detention of 5 individuals. Immediately the authorities attribute the death of the minor to Eduardo Henríquez, alias 'Gigio'. The following days were filled with pain and confusion. Many question the rushed action and the lack of negotiation on part of the GRP especially knowing that they had received the information ahead of time (the address of description of the vehicle used in the crime). Many believe the child was killed in cross fire due to the irresponsibility of the police chief. Once again Maricio Sandoval, Police Chief of the National Civilian Police, who while running a radio during the 1989 offensive, asked on open microphone for the death of the Jesuit priests only one week before the crime. Since then, Mauricio Sandoval has been characterized by his war-like mentality and irrational use of force. Events such as the kidnapping have been tried to be manipulated and used a flag to show the "effectiveness" and "heroism" of the police so as to change the image of corruption - police have been involved in kidnappings and other crimes.
Forensic and Ballistic Medicine of the Attorney General's Office have supposedly not been able to establish who killed the child. The evidence shows that the child was not shot closer than 60 centimeters - initially the police stated the child was killed by the kidnappers at close range, execution style, out of frustration. Furthermore, the evidence shows five frontal impacts by high caliber arms (similar to what the police use) and two on the back side. Six days after the supposed assassin, who declared he did not kill the child, Eduardo Henríquez, 'Gigio', and the others were transferred to the San Francisco Gotra Penal Center in Morazan. Only twelve hours later the authorities inform that "Gigio" had been killed, supposedly by other kidnappers with whom the victim had pending accounts to settle. Others believe that it was done in order to cover up the truth so that "Gigio" would never speak again. So not surprisingly, authorities have not been able to establish the exact killer of Eduardo Henriquez, "Gigio" or the child. The Villeda Kattán family, being advised by a lawyer offered by ANEP (the National Association of Private Business) and backed by the right and even President Flores, wave the banner of penal reform and especially demanding the start of the death penalty.
This case is not the only case. Two other children had been kidnapped day before. Carlos Ernesto Vega, 4 years old, disappeared on June 12 and his body was found four days later. There has been no results from the investigation. Sara Eugenia Lagos, 9 years old, was kidnapped June 19 in Ahuachapán and liberated the 29th of the same month after her parents paid an unspecified ransom. Days before family friends and school mates had protested in the streets demanding the healthy return of Sara.
The kidnapping and death of Gerardo Villeda has been used to try push through reforms: constitutional reforms; penal code reforms; penal processing code reforms; and penitentiary reforms. The proposals include: the death penalty (supported by ARENA, ANEP and by President Flores); raising maximum sentence to 75 years; reforms on secret agents; telephone tapping; and penitentiary reforms. Until the moment the commission has 15 proposals to reform the Penal Processing Code and the Penitentiary Law. One the other hand the Assembly has still not established a starting date for the law against window polarization since they are looking for exceptions. The Polarized Law, which could help stop some criminal activity in the country, has been stagnated since last May. However, such reforms are all in vein in face of a police and justice system that does not guarantee justice but rather deepens the violation of human rights77 The last work report from the Human Rights Procurator's Office, June 2000 to May 2001, revealed that 70% of the denouncements were related to violations committed by the PNC. EDH, 07/26/2001.. In reality such reforms are part of a larger process of militarization as control and the use of brute force.88 Since the writing of this bulletin the Assembly voted against the death penalty but approved the maximum sentence of 75. The FMLN voted againt the death penalty and voted for a shorter maximum prision term agrguing that 75 years is really a disguised life term given that the life expectancy in El Salvador is only until around 60.
Ex- Rural Patrollers Deceived
On May 31 the Legislative Assembly approved an indemnity for the sum of $1,000 for each of the 37,000 that are part of either the Farm Workers Association of Ex-Patrollers and Homeless (ASOCEPD) or the Salvadoran Union of Ex-Patrollers and Campesinos (USEPOC). Shortly after President Flores, vetoed the law saying it was unconstitutional because the Assembly did not specify where the money was going to come from and thus accused the opposition parties of being "irresponsible" for approving the decree. But the struggle of the ex-patrollers is a long one which goes back to them being ignored in the Peace Accords99 CIS Bulletin, November 1998-January 1999... Their demands correspond to the benefits received by the ex- combatants of the FMLN. They came from various different points of the country in 1994 but they didn't not achieve anything. In October of 1998 Calderon Sol approved a pension for 300 colones for three thousand ex-patrollers (those that completed 20 years of service or were over 45 years old). With hurricane Mitch and with the next elections the demand of the ex- patrollers were added to those of the disaster victims but in reality the government has negated time after time their demands. Last year the Assembly approved a Guarantee Fund for the ex- patrollers that consisted seed capital of ¢50 million colons but was vetoed by the president. This year once again, the Assembly approved the indemnity of $1,000 dollars and again it was vetoed by the president.
One day before President Fox came to visit El Salvador in order to sign the PPP agreement, the ex-patrollers hit the streets protesting the president's decision. Human rights organisms had to intervene and the ex-patrollers agreed to an eight day truce. The government promised to study other ways to achieve "something" for the ex-patrollers. On June 20th, Flores, during a press conference, recognized only 20,000 ex-patrollers and not 37,000 as stated in the decree. Eight days later the government offers land, housing and credits for agriculture to 10,000 ex-patrollers. President Flores is looking to lands held by ex-cooperatives that they would give up in order to pay outstanding debts. This strategy caused divisions within the ex- patrollers between those who would be benefited and those who would not be. Once again, promise and veto, protest and initial indifference and posterior weakening. The struggle of the ex-patrollers moves towards a slow disappearance caused by the dividing crumbs thrown at only a few. On July 27, the ARENA and PCN had enough votes to file the case for at least six months.
The Privatization of Health in El Salvador1
"Health Reforms" in Latin America
In the first place one must point out that almost all governments, when referring health reforms, are using the same terms (equality, quality, efficiency, efficiency, recuperation, contracts, decentralization, basic packets etc.) and in countries with low and medium income, such reforms are being defined by foreign "experts" in macroeconomy and debt collection. Such experts are strongly influenced by ideology and profits.
Of all the regions of the World Health Organization, the American region is the most active in implementing the reforms. The reasons for implementing such reforms -objectives and characteristics - are rarely discussed in the documents of the agencies that prescribe the reforms: Inter-American Development Bank (IADB), the World Bank, the Economic Commission for Latin America, the Organization of American States (OAS), the Pan-American Health Organization/World Health Organization, United Nations Population Fund (UNPF), UNICEF, USAID, Latin American Economic System, International Monetary Fund (IMF) and other personal authors who identify with them.
In general the following measures are imposed: reducing public spending and increasing private participation; a basic health packet (the so called basic health coverage which in practice never reaches the citizens); focusing public health spending on the extremely poor (again, in reality just the opposite occurs as a number of case studies suggest); eliminating the governmental apparatus through privatization; exploring new ways of contracting service contracting.
The roots of such reforms are found in the application of the Structural Adjustment Programs (SAPs) that the Latin American countries were first subjected to during the recession in the 70s2. The imposition of the SAPs hit the poor the hardest. In many places SAPs meant the sale of hospitals and health centers to the private sector who then raised prices out of reach for the poor. The fall in real wages, scarcity of food, the growing number of unemployed/subemployed also contributed to the "pauperization" of families with middle and low incomes.
Since the beginning, privatization was understood as the transferring of responsibility, functions, and property of the state to private companies, particularly to those with lucrative goals. However, sometimes responsibility was given to NGOs as "soft way" to privatization. The sale of state businesses has been the most common form of privatization in the "underdeveloped" countries however there is also the form of "concession contracts".
In "sensitive areas", like health care, privatization in one swoop is not the most recommended strategy. On the contrary, the privatization of the health sector has been coming slowly and strategically in short steps for the last number of years. The strategy is based on an increasing disinterest in public health and the game of rhetoric and praxis that provokes disgust and skepticism. The "experts" and "theories" of the World Bank are restricting and tying paradigms of transformation of health: from the paradigm of the Primary Health Attention (PHA) to the paradigm of the Compressed PHA and then to the Selective PHA. We'll take a closer look. From the proposal of the PHA in 1978, which took place in the middle of a precarious health situation and whose proposal for transformation included at its base a "reorganization and reorientation of the systems of production and distribution of goods and services" (which in reality was systematically negated in the practice) the paradigm passed to Compressed PHA. The Compressed PHA conserved all its proclaimed revolutionary character that consisted of: health education; disease control; expanded immunization program; prenatal attention; availability of basic medicines; nutritional promotion; etc. However, these beautiful words were never converted into reality but rather the plan was reduced to "good intentions" and partial actions. When this proposal was just starting to see some light the theorists and "experts" redefined the theory in the 80s to create the Selective PHA which is obviously exclusive. Their argument was that due to the world recession and the cut in health budgets the Compressed PHA was too expensive and therefore only those groups of greatest risk should receive a few "cost effective" measures. To be clear, the "efficiency" referred to immediate resolution and low cost depreciating the fact that health is an inversion whose efficiency you cannot measure in the short term. The paradigm of the Selective PHA laid the ground work for the privatization, denying the universalization of health ("all of the right to health", proclaims the constitution) and placed the base to start new money recovering procedures, acquisition of private services, and a proclaimed emphasis on extreme populations which in reality has proved not to be true.
The SAPs did give the results that the international financial institutions promised. On the contrary, the results were more debt and economic dependency. In addition, privatization of "sensitive areas" and "non-sensitive areas" continued without taking into account the lessons form the first experience with the SAPs. Even the president of the World Bank admitted that the social damage done could frustrate the economic objectives of the World Bank policies. The policies adopted continued to be carried out unhindered by the results of the multiple evaluations of the health systems in Latin America which pointed out the failure of Latin American counties of not having reached a universal and equitable health coverage system. They avoided a vindictive reform not only of a biomedical focus (view of health as absence of illness that treats isolated cases and whose principal strategy is the converting the system into a system of medicines) but also of socio-natural -structural nature (also called "people oriented", such vision views health as a fundamental human necessity for development and the exercising of one's own capacities in order to resolve vital human necessities - work, study, etc. - and also plans according to the processes of health-sickness taking into account the genesis and development of health-sickness). This vision would imply passing from a health system based on drugs that focuses on eliminating individual sickness to a more profound system that can give universal and quality coverage for "free". It is possible. In Latin America, there are sufficient resources to organize health services based on solidarity and equity. Such is the case in Costa Rica and Cuba where they reach high levels ("virtually universal") of coverage with undeniable quality and with less money (or a little more) spent per capita in health than what El Salvador spends.
Health Reforms in El Salvador
El Salvador was not the Latin American and Caribbean exception where privatization gained vigor during the 90s. >From the point of view of privatizing businesses, the privatization plan identified three types of ways: those that should be sold immediately (the most lucrative and such companies were sold to themselves transferring the public income into private hands); those that should be sold in one of two year terms; and then there were those companies whose form of privatization and the time needed to privatize depended in many circumstances given the political risk. This third group included public hospitals, the University of El Salvador, and the water and electricity companies.
By 1995, the governments of Cristiani and Calderón Sol had privatized the banking system, sold the Hotel Presidente, INCAFE, INAZUCAR, CORSAIN, ANTEL, and electric energy, Maya Cement and the Free Zone of San Bartolo. In 1994 the "The Health Reform: Towards Equity and Efficiency, the Final Report" was published by the Analysis of the Health Sector in El Salvador (ANSAL) which came about under the auspices of USAID, WHO, World Bank, and IADB. The proposal of ANSAL was to "transfer the management and administration of the hospitals from MSPAS and the ISSS to the private sector" under a "regimen of concession of the service" where the government would, prior to the transfer, have to renovate the physical structures, replace the equipment, raise the financing under the mode of per capita. In this way, the private administration would receive reconstructed hospitals, new equipment, more financing from the government, and the co-pay from the population. The Health Sector Reform Group (GRSS, commissioned by the government to execute the privatization) managed the reform project without the participation of the local actors, without the necessary transparency, and without having support from the active health sector, and under the pressure and influence of imported ideas whose real goals were tried to kept secret. The activity of the GRSS was focused towards the World Bank and IADB proposal but that is also where it was defeated. The IADB retired from the negotiations because they considered that the APS would have little impact on the health indicators. The World Bank reduced their health loan form $100 million to $20 million which was destined to the renovation of the hospitals and the implementation of the APS programs, which were not perfect but were better than what there is now.
Finally in April of 1999 the Official Daily gives authorization for the sale of services of Hospital Nacional Zacamil. In reality, the Zacamil Hospital is a private hospital with less costs, the services are sold, and those who can't pay are sent to Hospital Rosales3. Now in the administration of Flores a new publication has appeared: "Benjamin Bloom the National Children's Hospital and the New Alliance for Change - A Modern Hospital in Search of Excellence". Such publication contains clauses such as "recovering costs in a health market", "ask something of patient even if minimum", "quality is not important what is important is to have happy customers" - giving evidence of its exclusive nature and its market vision.
The health situation in El Salvador is deplorable. The most vulnerable sectors are the children and women. Post-natal illness occupies the first place as cause of death in children under one year old while infectious diseases such as intestinal disease and pneumonia are the second leading cause of death. The leading cause of death is due to the lack of public health and lack of prenatal care. The second leading causes of death are due to the lack of basic infrastructure - potable water, lack of clean drinking water and electricity - and also due to pollution, malnutrition and stress. Here are some statistics:
20% of the children under five suffer severe malnutrition. In the future that will affect their academics, and subsequently their ability to find an acceptable job. Malnutrition is related to the income level. It is the great structural problem, a historical process of health-sickness. In the last semester, of the 69 children that died of pneumonia, 48 were malnourished4.
One of the principal causes of death in women is pregnancy. According to the United Nations, 80% of the deaths in women in child bearing age is pregnancy5. Furthermore, 60% of the deaths were not under any pre or post-natal attention and 17% of the deaths were in young women between 15 and 19 years old. Tumor in the uterus, an infectious formation, caused 25.7% of the deaths in 1998. Such tumor is transmitted sexually and therefore it is avoidable. Such type of cancer affects Salvadoran women more than AIDS but the health authorities have done little to prevent it.
More than the half of the sick population seeks their cure outside the established systems. Only 20% of the sick go to the national health system (it is important to point out that the poor, when they have access, use the national health system because they don't have any other option - privatization would therefore mean taking away health attention from 20% of the population). Almost half of those that are ill self-prescribe cures.
In the last 10 years the HIV/AIDS rate increased by over 150%. This means that it went from 2.7% of the population to 7.2% in 2000. By 2010 it will pass 11%. The group most affected is between 15 and 39 years old. Despite an increase in the budget (from 1.2% from 1.9% of the GAP) the services are still deficient6. In Hospital Rosales, AIDS has converted in to he second most grave and special attention does not exist. AIDS patients are treated in the same room (where there can be up to a 100 people) as the rest of the ill7.
The Minister of Public Health (MSPAS) in El Salvador contains 30 hospitals and 362 health units in addition to other rural nutrition centers and health houses. The Salvadoran Institute for Social Security (ISSS) in 1997 had 15 hospitals, 35 medical units, 27 communal clinics and 100 company clinics available. Even though the most demand comes from the health units they receive less than half of what the hospitals receive. In addition to being an insufficient service, it forces the population to self- prescribe/medicate without professional attention. People go to one of the 1,800 pharmacies in the country where the pharmaceuticals and sellers prescribe any kind of medicine in order to obtain earnings. In addition, there are abundant sales in plazas, markets, buses or stores where any type and any quantity of medication is freely commercialized without any type of control8.
The evolution of state spending in health passed from 1.92% of the GDP in 1979 to 1.24% in 1997. Even though it is proclaimed that, for example, in 1996 7.3% of the GDP was spent in health the majority of the money came directly from citizens pockets (4.2%) surpassing the MSPAS (1.7%) and the ISSS (1.2%). In addition, it is important to point out that the costs of the MSPAS and the ISSS also come from the pockets of the citizens whether in the form of taxes, insurance quotas, etc. 58.385 of the health costs is covered by citizens9.
With the past earthquakes the health situation has gotten worse. More than 1,000 health establishments with second or third levels were gravely damaged or destroyed10. Respiratory diseases have increased due to all the rubble, the overcrowding in the shelters, and the arrival of the rainy season. In addition, gastroenteritis has increased due to the lack of potable water in many regions. After the earthquakes, the hospitals in the central regions (principally Hospital Rosales, Benjamin Bloom and the Maternity) are overcrowded. In Hospital Benjamin Bloom, the only national pediatric hospital in the entire country, attends more than 600 extreme cases a day. With the increase in diarrhea and pneumonia, malnurishment, lack of potable water and electricity, etc. the number has increased. 80% of the cases of diarrhea and respiratory illness could have been attended to outside of Bloom in the health centers. In the same manner, 65% of the deliveries could have been delivered outside of Bloom11.
This situation will continue to get worse and will not get better without grassroots organizing and social participation. The problem is the little force that the grassroots health organizing has and the lack of organiztaion and demobilization of the civil society. It is a tough struggle that has lasted the last decade. Hospital Rosales is a clear example of this struggle against the privatization and in favor of the universilization of health. Since 1991, the labor conflicts between the domineering directive and the workers became more intense. The conflict rose to its climax in 1995 when the union board of directors, along with workers and doctors that opposed the neoliberal measures, were all fired. It was a direct attack against the health system and all those who resisted the change imposed by transnationals and international financial systems. Incapable directors were placed in order to mismanage the hospitals resources and then justify the need for privatization. It wasn't until 1997 that that the union members and doctors were reinstated. Since then the union has had to start from zero in their affiliation, education, organizational efforts. Once again in 1998, another important resistance mobilization was organized. The base took to the streets to demand health for all Salvadorans (and not only for those that can pay) and better working conditions, including a better salary. The civil population expanded their support and contributed to the temporary victory against privatization. Since then, the government has developed a new strategy and does not want to get worn out by non-strategic fighting with Rosales. They placed a director that knows how to handle internal conflicts. Other strategies are preferable to a direct attack. El Dr. Melvin Guardado Ramos points out that the governments since have signed two agreements that promised to set up commissions that would address and give answers to the health problems: "yes in theory but a round and systematic no in practice". He goes on to conclude that currently in El Salvador there is no national health system and that, on the contrary, it already collapsed: "it all points to a near privatization of the ISSS, and with that we will all follow." Along with it all neoliberalism accomplishes its three objectives: a poor, sick and ignorant people.
Notes
1. Consulted Bibliography: Ernesto Selva Sutter, On the Principal Health Problems in El Salvador, UCA 1995, revised in March 1999; Al Oidos de aquellos interesados en las reformas de salud, UCA July 1998; Prohibited Stories of Health Reforms in El Salvador, UCA March 2000; La salud de la pobreza y la pobreza de la salud, Editorial de ECA 623, September 2000; Colegio Médico de El Salvador, Propuesta Ciudadana por la Salud, July 1999.
2. Between 1972 and 1981 developing countries obtained loans that were meant to finance the deficit in their payment balance, and their debt was multiplied by six: $100 billion to $600 billion.
3. Dialogue with Melvin Guardado Ramos, Chair of the Department of Sirgury, Hospital Rosales and Director of Association of Doctors.
4. LPG, 07/17/20012
5. Cited in: La salud de la pobreza y la pobreza de la salud, Editorial ECA 623, September 2000, p. 809.3
6. EDH, 07/06/20014
7. Dialogue with Mario Arévalo, General Secretary of the Workers of Hospital Rosales
8. Colegio Médico de El Salvador, Propuesta Ciudadana por la Salud, 1999, pp. 43-456
9. Id., pp. 45-48
10. EDH, 07/06/20018
11. Id., pp. 45-467