Colombia - Economic growth : problems and prospects (Vol. 11 of 12) : Public health

RETURN TO RESTRICTED PO|RS DESK FILE COPY Report No. WH-200a WITHIN 1N E WEEK This report was prepared for use within the Bank and its affiliated organizations. They do not accept responsibility for its accuracy or completeness. The report may not be published nor may it be quoted as representing their views. INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT INTERNATIONAL DEVELOPMENT ASSOCIATION ECONOMIC GROWTH OF COLOMBIA: PROBLEMS AND PROSPECTS (in XII Volumes) VOLUME XI PUBLIC HEALTH November 1, 1970 South America Department  CURRENCY EQUIVALENTS (Certificate Market Selling Rate of Exchange) End 1968 1 US$ = 16.91 Pesos 1 Peso US$0.05913 End 1969 1 US$ = 17.90 Pesos 1 Peso US$o.o5586 End-March 1970 1 US$ = 18.20 Pesos 1 Peso = us$0.05494 End-June 1970 1 US$ = 18.h8 Pesos 1 Peso US$0.05411 End-September 1970 1 US$ = 18.80 Pesos 1 Peso = US$0.05319  TABLE OF COPJ TEi'CTS Page No. SUiM4ARY AND WNCLUSIONS 1. HEALTH AND M*EDICAL CAW4, AS Cktl'1ICAL ASPECTS OF ECONOMIC AND SOCIAL DEVELOPAENT 1T4 CO4LOMBIA . . . . . 1 . . A. Definitions and Orientations . . . . . . . . . . . . . 1 B. The Health Care System . . . . . . . . . . . . . . . . 4 1. Governmental Programs . . . . . . . . . . . . . . . 4 2. hne Private Sector . . . . . . . . . . . . . . . . 5 C. Sources of Funds arid Major Outlays for Health and Medical Care . . . . . . . . . . . . . . . . . . . o II. AS'SESSI1ENT OF THE PRESENT HEALLTH SITUATION . . . . . . . . 13 A. Significant Demographic Variables Associated with Health and Medical Care in Colombia . . . . . . . 13 1. Population Characteristics . . . . . . . . . . . . 13 2. Socio-Economic Characteristics . . . . . . . . . . 19 B. Morbidity Indices and 'Their Socio-Economic Relationships . . . . . . . . . . . . . . . . . . 25 1. Illness and Restricted Activity . . . . . . . . . . 25 2. Utilization of Health Services . . . . . . . . . . 26 3. Socio-Economic Correlates of Morbidity and the Utilization of Health Care Resources . . . . . 23 C. Major Categories of Health Problemus in Colombia . . . . 31 1. Di.arrheal Diseases and Blelated. Conditions . . . . . 31 2. 'The Common Acute In.f.ectious Diseases (of childhood) 31 3. Malnutrition . . . . . . . . . . . . . . . . . . . 32 4. Tuberculosis and Other Chronic Infectious iLiseases 32 5. High ithrtility aid Abortions . . . . . . . . . . . 35 6. Accidernts . . . . . . . . . . . . . . . . . . . . . 37 7. Dental D)isease . . . . . . . . . . . . . . . . . . l4o d. Mental IlUless . . . . . . . . . . . . . . . . . . 40 D. lnstitutional Resources for Health . . . . . . . . . . 41 E. Health Personnel-Supply and Dis tribution . . . . . . . 45 1. Physicians . . . . . . . . . . . . . . . . . . . . 45 2. DenLLtists . . . . . . . . . . . . . . . . . . . . . 47 3. Professional Nurses . . . . . . . . . . . . . . . . 47 14. Auxiliary Nurses . . . . . . . . . . . . . . . . . 4 5. Other Healti Manpower . . . . . . . . . . . . . . . .149  Page No. F. Education and Training for the Health Occupations . . .49 1. Medical Biucation . . . . . . . . . . . . . . . . . 49 2. Nursing Education ................ . 51 3. Auxiliary Nurse Education . . . . . . . . . . . . . 51 4. Dental and Other Health Professions and Occupations Education . . . . . . . . . . . . . . . 52 III. THE NATIONAL TEN YEAR HEALTH PLAN FOR COLOMBIA (1968-1977) 53 A. Origins and Evolution of the Plan . . . . . . . . . . . 53 B. Major Elements of the Plan . . . . . . . . . . . . . . 55 C. The Ten-Year Health Plan - Analysis and Comments . . . 56 1. National Support for the Plan . . . . . . . . . . . 57 2. Support Within the Health Sector . . . . . . . . . 58 3. Financing of the Health Plan . . . . . . . . . . . 59 4. Manpower Requirements . . . . . . . . . . . . . . . 62 5. Suggested Areas for Further Development of the Ten Year Health Plan ............... . 64 IV. RECOMMENDED PROJECT PROPOSALS . . . . . . . . . . . . . . . 71 A. Health Project Proposal Colombia - I . . . . . . . . . 72 B. Health Project Proposal Colombia - II . . . . . . . . . 73 C. Health Project Proposal Colombia - III . . . . . . . .7 D. Health Project Proposal Colombia - IV . . . . . . . . . 75 E. Health Project Proposal Colombia - V . . . . . . . . . 76 V. INVENTORY OF DEVELOPMENT STUDIES IN PROGRESS . . . . . . . 77, A. Human Resources for Health - Phase II . . . . . . . . . 77 B. Experimental Study of Health Services in Colombia - Phase II . . . . . . . . . . . . . . . . . . . . . . . 78 C. Development of a Comprehensive Health Planning System at the Local Level - Phase I . . . . . . . . . . 78 D. Integrated Nutrition Program of Applied Nutrition - Phase II . . . . . . . . . . . . . . . . . 79 E. Family Planning Programs in Colombia . . . . . . . . . 80 F. Nutrition and Development - Phase II . . . . . . . . . 81  Page No. VI. RECOMMENDED PREINVESTMENT PROGRAM PROPOSALS . . . . . . . 83 VII. EXTERNAL ASSISTANCE IN THE COLOMBIAN HEALTH SECTOR . . . 84 VIII. BIBLIOGRAPHY AND REFERENCES . . . . . . . . . . . . . . . 85- ANNEX 1 - -to Chapter VI. APPENDIX A - to Chapter VII.   STJIfrD1A rr AND CONCLITJSIQNcl 1. This is the first time, in recent years, that the World Bank has incluided a total survey of the health sector of a country as part of a gene:ral appraisal of development problems, policies and prospects. The information assembled in this general appraisal is to be utilized as the basis for fur-ther discussion by the Bank, other international instituitions, goverrnmen-ets and inter-governmental agencies with the country concerned (Colombia) on its development policies and plans including those affecting the health sector. Among the major objectives set for the survey and applied in this report on the health sector are: (1) The assessment of the domestic and external financing requirements and of the possibilities that those requirements can be met; (2) an analysis of the principal pre- invest;rnent surveys and studies required to carry out the development pro- gram; and (3) an analysis of the problems of investment and resource mobilization within the health sector. 2. For this survey the hea-ilth sector has been Lroadly defined to incluide all planned and orginize7d publi a endeavor directed at the national level toward the promotion of health, the prevention of illness and dis- abilli.ty, the care of the sick and the restoration to useful work or activit.- of all. those whose health statuis has been impaired. Part A of this renort, Chanters J-ITTT describes the (olombian health care system, assesses the mna lor health problems of the country and provides a detailed analysis of the l'ational Ten Year Heal th Plan (.1.)A-19i77). Part FB, Chapters JV- _, cc.nsiders selected proposals and projects that could accelerate the pa-e of achievement or consolidate the sound obJectives of the Ten Year Health Plzan. Separate reports consider the special health related problems o.f water supply and sewage disposal ari( of housing and community development. 'S fiAs in many develc.ping oclin-tries thle health care system of Colon- i)J. is prelominantly a functioln of government. The Ministry of Health, th.( ugh at. the apex of this system, is only one of miultiple governmental aghencies directly concerned wit.h the pro'vision of health and medical services. rn recent rears the 2cl.ombzia n or.i tute of 2oci.al Cccii vi ty :nri t-.h.he NLlJonal Caia',an (we:Lfare funr.l-s have ga31ined prcmi nence in the hea-llth sector. I?ecrn t Jlegi s.].ali on has )dded tlo the oper:O iin;4l responnSi- TJi l ti ca of t.he Mr:ir s try o lIe Ith bJy an:ifJ grti.ng t.o . t .lle.rly ic f:i ned ,in thri ti re for na; iJ ona,l healthh p1. nun ni a nd cl:o (li.na. t i 1n and for the c.ontinnirnv evaluation and supervision of all healt.h services at. regional --nd ic alcl levels. IJiLthin the last two ye:.rs, and For the first. t.ire, r(sl.mhi;in possesses an integrate(i network of heal Li programs and LJi. vi Li ef wi lii hiifh potential for the e.rly dievel.orment of a comprehensive. and e.fi - -i7ant heal lh ciJre systcem.  - ij - heal t,h e, x end :i t.ires hi re r:isell t'] VEa-'P0l(d :iJ.- the rril , period, i)1-1 , f'ro in T rvI Ii Jlion pesos a,nr .a; u J, to ? Y r"iiI I i pesos wittl a si.,eable furl'li(t,- increa.se budrge t.eX for CI ( h Il, pun i*, or goreTnrnnentally coat;ro' le ezipenldi Llres for he:eIlth fo ny r 'f i r'y constantly at the level pI ercent are now t , ' r.ii ( in GNP. Lip,nificant.Lly, e voen w:itr subsattarhLiai nro sin a,; ini3 i r to the TYirnistry of THeall,Ji its share oft thre ijncrea :fer- 1pu .Ihlr. exrlrendi! for health has faillen Iron 30 to 20 percent anc ie* c -i t_a e"ren ':i tu-E:s for health services for t,ULe gener I.] poult Li o.;cr, are ric;i a t, the s:rie Level! they were 1(0 years ear:!ier, namineiy ;2 pesos per capitra. lin can O expendliitures for hospi4t-S an( mcdi r'a care .for the f'.ive ,.-cfeo f po'pula ti.i n covered by 11 se ri t, or the we:l.fare F'u :nds of i. ] ini-L stries have risen hijr I ir, tle sarmF :i. tlrvnl tram i2r Lu 7"' -,; . peI caT)ita and the a,ggr'i t, c rt .a Lhese ser-vice-s now reupreserni. over' h;lf (p53 percent ) oIL' a11 publAic expendi !,reg -f'or hP.i-L v , a.e exnen(iiLtures t'or he;a I h, thou''h s ubLiar Lia]l . 1 a nra. L re.L ii' y Uc 3d Ca aJ ta-l invews, Lftfri ts made in t'he Tpas;l, 4'or he;al Lii th Li ,; equilpment have rint ber., si.ije.]t e:ither tLa aria.lyJs3s or p1la ever v t,h!an h-h tfhere is abundant. evidenc- that .al:l evel.s of'' govermer,ent aind rnr-ny aIlbliu spiri ted in,dividuals ar-, groups !rave m.