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Panama HEALTH AND WELFARE
The Ministry of Health bore primary responsibility for public
health programs in the late 1980s. At the district and regional
levels, medical directors were responsible for maintaining healthcare services at health-care centers and hospitals and monitoring
outreach programs for the communities surrounding these facilities.
The Social Security Institute also maintained a medical fund for
its members and ran a number of health-care facilities, which
members could use for free and others for a nominal fee. In
practice there was a history of conflict between Social Security
Institute and Ministry of Health personnel at the district and
regional levels. Since 1973 the Social Security Institute and the
Ministry of Health had attempted--with limited success--to
coordinate what were in essence two public health-care systems, in
an effort to eliminate redundancy.
Despite the bureaucratic conflicts, a number of health
indicators showed significant improvement. Life expectancy at birth
in 1985 was seventy-one years--an increase of nearly ten years
since 1965 (see
table 10, Appendix A). Infant mortality rates in
1984 were less than one-third their 1960 levels, and the childhood
death rate stood at less than 20 percent of the 1960 level. The
number of physicians per capita had nearly tripled.
The Department of Environmental Health was charged with
administering rural health programs and maintaining a safe water
supply for communities of fewer than 500 inhabitants--roughly onethird of the total population. The National Water and Sewage
Institute and the Ministry of Public Works shared responsibility
for urban water supplies.
By 1980 approximately 85 percent of the population had access
to potable water and 89 percent to sanitation facilities. In rural
Panama in the early 1980s, roughly 70 percent of the population had
potable water and approximately 80 percent had sanitation
facilities. The quality of water and sewage disposal varied
considerably, however. Water transmission was less than reliable on
the fringes of urban centers. In rural areas, much depended on the
community's dedication to maintaining sanitation facilities and an
operating water system. Many water treatment facilities were poorly
maintained and overloaded, because of the intense urban growth the
country had experienced since the end of World War II. In rural
Panama, latrines and septic tanks tended to be over-used and undermaintained . The system as a whole stood in need of substantial
renovation and repair in the late 1980s.
Public health, especially for rural Panamanians, was a high
priority. Under the slogan "Health for All by the Year 2000," in
the early 1970s the government embarked on an ambitious program to
improve the delivery of health services and sanitation in rural
areas. The program aimed at changing the emphasis from curative,
hospital-based medical care to community-based preventive medicine.
The 1970s and early 1980s saw substantial improvements in a wide
variety of areas. Village health committees attempted to
communicate the perceived needs of the villagers to health-care
officials. The program enjoyed its most notable successes in the
early 1970s with the construction of water delivery systems and
latrines in a number of previously unserved rural areas. Village
health committees also organized community health-education
courses, immunization campaigns, and medical team visits to
isolated villages. They were assisted by associations or
federations of these village health committees at the district or
regional level. These federations were able to lend money to
villages for the construction of sanitation facilities, assist them
in contacting Ministry of Health personnel for specific projects,
and help with the financing for medical visits to villages.
Village health committees were most successful in regions where
land and income were relatively equitably distributed. The regional
medical director was pivotal; where he or she assigned a high
priority to preventive health care, the village communities
continued to receive adequate support. However, many committees
were inoperative by the mid-1980s. In general, rural health-care
funding had been adversely affected by government cutbacks.
Facilities tended to be heavily used and poorly maintained.
In the early 1980s, there continued to be marked disparities in
health care between urban and rural regions. Medical facilities,
including nearly all laboratory and special-care facilities, were
concentrated in the capital city. In 1983 roughly 87 percent of the
hospital beds were in publicly owned and operated institutions,
mostly located in Panama City; one-quarter of all hospitals were in
the capital (see
table 11, Appendix A). Medical facilities and
personnel were concentrated beyond what might reasonably be
expected, even given the capital city's share of total population.
Panama City had roughly 2.5 times the national average of hospital
beds and doctors per capita and nearly 3 times the number of nurses
per capita (see
table 12, Appendix A). The effect of this
distribution was seen in continued regional disparities in health
indicators. Rural Panama registered disproportionately high infant
and maternal mortality rates. Rural babies were roughly 20 percent
more likely to die than their urban counterparts; childbearing was
5 times more likely to be fatal in rural Panama than in cities (see
table 13, Appendix A). In the early 1980s, the infant-mortality
rate of Panamá Province was one-third that of Bocas del Toro and
one-fourth that of Darién.
Panama's social security system covered most permanent
employees. Its principal disbursements were for retirement and
health care. Permanent employees paid taxes to the Social Security
Institute; the self-employed contributed on the basis of income as
reported on income-tax returns. Agricultural workers were generally
exempted. Changes in 1975 lowered the age at which workers could
retire and altered the basis on which benefits were calculated. The
general effect of the changes was to encourage the retirement of
those best paid and best covered. It did little to benefit the most
disadvantaged workers.
* * *
There are a number of useful works on Panamanian society. John
and Mavis Biesanz's The People of Panama, although dated,
remains the most complete treatment of Panamanian society in its
entirety. Stephen Gudeman's The Demise of a Rural Economy
looks at the changing situation of small farmers and describes
mestizo life in the countryside. There is an extensive literature
on Panama's principal Indian tribes. Of particular use to the
general reader are Ngawbe by Philip D. Young (on the
Guaymí), as well as his article co-authored with John R. Bort,
"Politicization of the Guaymí," and The Kuna Gathering
(about the Cuna) by James Howe. Statistical information on a wide
variety of topics is available from the Panamanian government's
Panamá en Cifras. (For further information and complete
citations,
see
Bibliography.)
Data as of December 1987
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