Health politics from below

The “Grassroots Health Reform” in El Salvador supported by medico international

El Salvador faces the challenge of reducing the country’s extreme social disparities. One of the most important changes is taking place in the healthcare system, which was previously characterized by privatization. Now ideas are coming to bear that were already being practiced by the liberation movement during the civil war, when health promoters were looking after the people. The core element in the health reforms is the introduction of “Equipos Comunitarios de Salud Familiar” (ECOS), which address the population’s health problems at village and urban district level and operate in a nationwide network.

As a rule, these healthcare teams consist of a physician, two nurses, and two health promoters who, in addition to providing concrete healthcare, perform preventive activities as well. They are making a crucial contribution to healthcare also becoming available to people in poor and remote districts who previously had no access to it. Since the beginning of the reforms in 2009, 380 of these ECOS have started working in the 141 poorest communities in El Salvador. In addition, there are 28 “ECOS Especializados” with personnel specializing in areas such as dental medicine, midwifery or dietetics who ensure that special treatment is available at local level.

Large numbers of promoters who were trained and employed by civil society organizations such as “Asociación de Promotores Salvadoreños” (APROCSAL), which is supported by medico international, over the last few years to provide primary healthcare services have been integrated in the new ECOS. Furthermore, the national rescue system has been improved through the introduction of 170 ambulances whose area of operation also includes remote villages. In addition, social determinants of health have been addressed in the context of the reform process, for example by tackling the causes of diseases such as contaminated drinking water and poor housing conditions and discussing sustainable solutions in cross-sector round-table debates.

Ninety percent of El Salvador’s total area is regarded as a risk zone for extreme natural events such as hurricanes and volcanic eruptions, causing this small Central American country- with its 21,000 square kilometers the size of Germany’s Federal State of Hesse to regularly feature among the ten countries with the highest disaster risk. When floods developed throughout the country following several days of continuous rainfall in late 2011, via the network of community health committees, medico international were able to provide immediate emergency relief for the people affected by distributing food, hygiene kits, medicine and plastic tarps.

In 2014, elections will be held in El Salvador. The “Grassroots Health Reform” supported by medico international for more than twenty years has been successfully and sustainably integrated in government policy. Above all, the level of democracy achieved in health policy thanks to the people’s ownership gives rise to hopes that this far-reaching concept will also be continued after the elections.


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