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Dominican Republic Health and Social Security
Programs offered through the Secretariat of State for
Public
Health and Social Welfare (Secretaria de Estado de Salud
Pública
y Asistencia Social--SESPAS) covered 70 to 80 percent of
the
population in the late 1980s. The Dominican Social
Security
Institute (Instituto Dominicano de Seguro Social) covered
another
5 percent (or 13 percent of the economically active
population),
and the medical facilities of the armed forces reached an
additional 3 to 4 percent. SESPAS had a regionally based,
fivetiered health care system designed to bring primary care
to the
whole population. The services ranged from specialized
hospitals
in the National District to rural clinics scattered
throughout
the countryside.
Both personnel and facilities were concentrated in the
two
largest cities (see
table 4, Appendix A). There were
roughly
3,700 inhabitants per physician nationally, for example,
but this
figure ranged from about 1,650 in the National District to
roughly 5,000 in some southeast provinces and in the
southcentral provinces. Similarly, more than half of all
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 early 1980s, the government had set
up more
than 5,000 rural health clinics, health subcenters, and
satellite
clinics. Doctors, performing their required year of social
services, as well as a variety of locally hired and
trained
auxiliary personnel staffed the facilities. Critics
charged that
lack of coordination and inadequate management hampered
the
program's effectiveness, however. Preventive services
offered
through local health workers (who were often poorly
trained in
disease prevention and in basic sanitation) were not
coordinated
with curative services. In addition, absenteeism was high,
and
supplies were lacking. In 1982 there were approximately
2,500
physicians in the country (a ratio of one physician to
2,600
inhabitants) and 516 dentists.
Life expectancy at birth was 62.6 years for the 1980-84
period, 60.9 years for males and 63.4 for females. The
crude
mortality rate was 4.7 per 1,000 population in 1981. The
infant
mortality rate was 31.7 per 1,000 live births in
1982--down from
43.5 per 1,000 in 1975. Early childhood mortality declined
from
5.9 per 1,000 in 1970 to 3.2 in 1980. The main causes of
death in
the population as a whole were pulmonary circulatory
diseases and
intestinal diseases (see
table 5, Appendix A). Enteritis,
diarrheal diseases, and protein energy malnutrition were
the
major causes of death in those under four. Maternal
mortality in
1980 was 1.66 deaths per 1,000 live births. The main
causes were
toxemia, hemorrhages, and sepsis associated with birth or
abortion. Roughly 60 percent of births were attended by
medical
personnel. As of late 1988, the Dominican Republic had
reported
701 cases of Acquired Immune Deficiency Syndrome (AIDS);
of
these, 65 had died. Studies of the human immunodeficiency
virus
conducted in 1986 among sample groups of Dominican
homosexual and
bisexual males indicated an infection rate of 8.3 percent,
much
lower than the 70 percent rate detected in some similar
sample
groups in the United States.
Social security coverage included old-age pensions,
disability pensions, survivors' and maternity benefits,
and
compensation for work injuries. General tax revenues
supplemented
employer and employee contributions. Wage earners,
government
employees (under special provisions), and domestic and
agricultural workers were eligible, although the benefits
that
most domestic and farm workers received were quite
limited.
Permanent workers whose salaries exceeded 122 Dominican
Republic
pesos
(RD$--for value of the peso, see Glossary) per week
and the
self-employed were excluded. In the early 1980s, more than
200,000 workers were enrolled. They represented only about
13
percent of the economically active population, or
approximately
22 percent of wage earners. Most of those enrolled were in
manufacturing, commerce, and construction.
Although the level of government services exceeded that
of
the republic's impoverished neighbor, Haiti, limited
resources,
inefficiency, and a lagging economy circumscribed the
overall
impact of these programs. In 1985 some 8.8 percent of the
national budget supported health services and an
additional 6.9
percent funded social security and welfare programs. From
the
perspective of the late 1980s, there appeared little
prospect for
major improvement in the quality of life for most
Dominicans by
the end of the twentieth century.
* * *
There is a wealth of information on rural life and the
changing rural-urban context in the Dominican Republic.
Kenneth
Sharpe's Peasant Politics, Glenn Hendricks's The
Dominican Diaspora, Patricia R. Pessar's works, and
Malcolm
T. Walker's Politics and the Power Structure, all
give a
sense of the constraints most Dominicans must deal with.
Jan
Knippers Black's The Dominican Republic: Politics and
Development in an Unsovereign State and H. Hoetink's
The
Dominican People are both valuable background reading.
Sherri
Grasmuck's "Migration within the Periphery: Haitian Labor
in the
Dominican Sugar and Coffee Industries" details the
contemporary
situation of Haitians in the Dominican Republic. José del
Castillo and Martin F. Murphy describe the broad outlines
of
emigration and immigration in "Migration, National
Identity, and
Cultural Policy in the Dominican Republic." "Agricultural
Development, the Economic Crisis, and Rural Women in the
Dominican Republic," by Belkis Mones and Lydia Grant,
describes
the ways in which rural women earn a living. (For further
information and complete citations,
see Dominican Republic -
Bibliography.)
Data as of December 1989
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