j a n u a r y . 2 017
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TA B L E O F C O N T E N T S ANALYSIS AND INTERPRETATION OF AGGREGATE RESULTS OF MEDICINE SHORTAGE INDEX MEASUREMENTS FOR JANUARY 2017
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INDICATOR BEHAVIOR AND EVOLUTION
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AGGREGATE RESULTS NATIONWIDE: JANUARY 2018
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GRAPHIC DEPICTION OF RESULTS BY CITY AND MORBIDITY
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DIABETES
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HIGH BLOOD PRESSURE
ACUTE INFECTIONS OF THE RESPIRATORY TRACT (AIRS)
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DIARRHEA
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CONVITE STRONGLY DENOUNCES 2018: THE WORST START OF THE YEAR FOR VENEZUELANS’ RIGHT TO HEALTH
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MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018
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ANALYSIS AND INTERPRETATION OF AGGREGATE RESULTS OF MEDICINE SHORTAGE INDEX, MEASUREMENTS FOR
JA N UA RY 2 017
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Within the framework of the Monitoring the Right to
It is with great concern that we must state that
Health on Venezuela: An Approximation Based on Medicine Shortages, Preventable Deaths and Hospital Infrastructure project, Convite, A.C. has conducted a
the alarming trend towards
total of ten measurements (September I and II; October I
100 percent shortage
and II; November I and II; December I and II; and January
remains unchanged
I and II) of the basic basket of active ingredients for the four major causes of morbidity affecting the Venezuelan population: high blood pressure, diabetes, diarrhea, and acute infections of the respiratory tract (AIRs).
INDICATOR BEHAVIOR AND EVOLUTION The aggregate results of the ten measurements conducted over the last four-month period of 2017 and in January 2018 are broken down below:
MORBIDITY
P E R I O D 1st Week, September 2017
2nd Week, September 2017
1st Week, October 2017
2nd Week, October 2017
1st Week, November 2017
2nd Week, November 2017
1st Week, December 2017
2nd Week, December 2017
1st Week, January 2018
2nd Week, January 2018
HIGH BLOOD PRESSURE
AIRS DIARRHEA
GENERAL SI Table Nยบ 1: Fluctuation of the Medicine Shortage Indicator over each Measured Period, by Morbidi1.Period and Frequency of Data Collection: The survey consisted of two measurements made in January 2018 between the 15th and 17th and between the 29th and the 31st, which dates fall on the second and fourth weeks of the month, respectively, in order to detect variations that could be measured and circulated regarding medicine supply protocols in pharmaceutical establishments. For further information on the technical data sheet of the survey and other methodological details, please refer to Newsletter Nยบ 1, September, 2017, available at https://goo.gl/Vrh1EJ.
MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018
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Upon an analysis of the behavior of the Medicine Shortage Index based on the results obtained from each measurement to date, the following may be observed:
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Diabetes: The MSI indicator for diabetes medication was 90.7 percent in the first measurement, which
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General Shortage Index (GSI): The GSI exceeded 90 percent in more than 5 of the 10 measurements
was made on the second week of the month of
conducted to date, and was never below 87 percent
September of 2017, and showed marginal reductions
in the 5 remaining measurements.
of between 1 percent and 4 percent. The trend over
that attention be drawn to the threat that an almost
the course of the survey is that of a MSI indicator of
total shortage of medicines to treat the four major
between 86 percent and 90 percent.
causes of morbidity represents for the life of the
It is imperative
Venezuelan people.
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High Blood Pressure: The MSI indicator for high blood pressure medication has remained between 80 percent and 90 percent, and was 92.8 percent at the beginning of the survey. The trend is that it will remain over 90 percent (although it may not reach 100 percent).
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Diarrhea: Diarrhea medication is the second group
These results are an indicator of the terrible
of drugs that are most difficult to find in the five
complex humanitarian emergency that is
cities under study, and has shown a sustained trend
hitting the country.
of between 86 percent and 95 percent shortage, terrifyingly close to 100 percent.
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Acute Infections of the Respiratory Tract (AIRs): The supply of medication to treat acute infections
The
existence
of
this
humanitarian
emergency is still being denied by the State agencies and institutions responsible
of the respiratory tract is the scarcest over the
for guaranteeing Venezuelan citizens their
measured period. The MSI indicator for the nine
full enjoyment of the right to health and
active ingredients monitored was dangerously close
the right to life.
to 100 percent in all measurements conducted. It is usually over 94 percent, as per our records.
MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018
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AGGREGATE RESULTS NATIONWIDE: J A N U A R Y 2 0 1 8 .
CITY
AIRS
HIGH BLOOD PRESSURE
DIARRHEA
METROPOLITAN AREA OF CARACAS
Table Nº 2: Aggregate Medicine Shortage Index Nationwide over the Entire Period.
The Metropolitan Area of Caracas was the most hit
various municipalities of the former Metropolitan District
by medicine shortages, which is not an encouraging
of Caracas in crowded transportation conditions.
prediction if we take into account that it is the first measurement of the new year . There is an aggravating
Another important element to be taken into account when
factor: the Metropolitan Area of Caracas is the region with
it comes to analyzing MSI indicators in the Metropolitan
the largest population concentration, with approximately
Area of Caracas is that there is a sustained shortage of
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2,904,376 inhabitants .
medicine to treat diarrhea in a city where interruptions of water supply services are frequent or where the quality
Alarmingly, acute infections of the respiratory tract (AIRs)
thereof is poor, with devastating effects on the population
are the second highest cause of morbidity in the MAC. The
because they both increase the risk of developing diarrheal
mode of transmission of ARIs involves physical proximity
diseases. For the one part, food sanitation and hygiene
between people. This is an area of approximately 3,585
cannot be guaranteed because of water shortages; for
inhabitants per square kilometer, which increases the
the other part, the transmission of food contaminating
chances for the spread of ARIs.
microorganisms and bacteria escalates.
Additionally, the Metropolitan Area of Caracas is
In Barquisimeto, a city located in the central-western
experiencing a collapse in transportation, which means
region of the country, the trend is the same, and
that people go from one place to another across the
the
problems
affecting
Caracas
are
replicated.
2 .According to data available on the National Institute of Statistics website for the municipalities of Libertador, Baruta, Chacao, El Hatillo and Sucre, in the “Registered Population by Sex, Federal Entity, Municipality and Parish. 2011 Census” at: http://www. ine.gov.ve/index.php?option=com_content&view=category&id=95&Itemid=26
MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018
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Barquisimeto’s population is 3,519 inhabitants per square
Nevertheless, the figures are still alarming for the four causes
kilometer, and the regional authorities have admitted
of morbidity being surveyed. For instance, medication to
serious deficiencies in the supply of safe drinking water,
treat respiratory infections is the scarcest in both Mérida
stating that they are due to “six of the engines (...) needed
and Maracaibo, followed by antidiarrheal drugs in Mérida
for water distribution across the state (...) burned out for
and high blood pressure drugs in Maracaibo.
various reasons...”, and to the lack of proper maintenance for more than twenty years 3.
In Nueva Esparta, the shortage of medication to treat respiratory infections is also the most alarming, followed by
As for Mérida and Maracaibo, aggregate indexes are
the shortage of drugs to treat diabetes and diarrhea.
smaller than those for the Metropolitan Area of Caracas and Barquisimeto, whose location closer to the border may allow them to be better supplied through independent local pharmacy chains that have logistic communication with suppliers across the border.
General SI
Graphic Nº 1: Behavior and Evolution of the Medicine Shortage Index by Morbidity 3. February 7, 2018. Hidrolara Admitts to Deficiencies in the Supply of Safe Drinking Water, in Noticias Barquisimeto, available at: http://www.noticiasbarquisimeto.com/2018/02/07/hidrolara-admite-deficiencia-en-el-servicio-de-agua-potable/. Also available at:
http://www.noticiasbarquisimeto.com/2018/02/02/no-somos-camellos-barquisimetanos-exigen-a-hidrolara-que-se-le-de-
respuestas-por-falta-de-agua.
MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018
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Graphic NÂş 1 depicts the behavior of the MSI indicator by
The evolution of the indicator for the four causes
morbidity in all measurements conducted so far.
of morbidity under study is then clear. This piece of research allows us to verify how Venezuelans who suffer
Drugs with the worst supply along these 10 measurements
from any of these pathologies have endured an increase
are those prescribed to treat diarrheal diseases (92.4
in the shortage of essential drugs over this first month of
percent) and those prescribed to treat acute infections of
the year.
the respiratory tract (96.7 percent), which clearly shows that the complex humanitarian crisis hitting Venezuela is
Most people are unable to treat their diseases on a timely
only worsening. For instance, the State of MĂŠrida, whose
basis or to early and timely recover from infections and
capital is one of the five cities being surveyed, is being
viruses, and/or guaranteeing a quality of life consistent
stricken by an outbreak of diarrhea and vomit affecting at
with their chronic ailments. These Venezuelans are in
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least 1,500 persons in the Andean region . The quality of
dire danger.
water for human consumption is poor, and the availability of medication to threat diarrhea is widely reduced. Again, the MSI for drugs to treat acute infections of the respiratory tract is even higher than the Global SI, while that associated with drugs to treat diarrhea has fluctuated around the General MSI along with those to
All in all, shortages increase in size, seriousness
treat diabetes. The MSI for drugs to treat high blood
and impact over time. This is not only the
pressure has remained the lowest; however, shortage thereof is still a cause of deep concern.
case of chronic illnesses such as high blood pressure and diabetes, but also of common
One of the most distressing findings is that there has
ailments such as infections of the respiratory
been a 9 percent increase in the MSI for the group of
tract and diarrhea.
medicines to treat high blood pressure in the second January measurement, as compared against the second measurement of the month of December. Between the second measurement of the month of September and the second measurement of the month of December,
In Venezuela, falling with a common illness is increasingly easy, but recovering therefrom can be a real luxury.
the basket of drugs to treat this cause of morbidity was relatively the best supplied at the aggregate level across the country. Over the measured period, the MSI remained between 79.6 percent and 82.8 percent, the latter being the highest ever recorded for this morbidity cause.
4. Diario de Los Andes (2018). Viral Agent Likely Culprit for Gastrointestinal Disease Outbreak in MĂŠrida, available at: https:// diariodelosanndes-com/site/agente-viral-seria-responsale-del-brote-gastrointestinal-merida. html.
MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018
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GRAPHIC DEPICTION OF RESULTS
BY C I T Y A N D M O R B I D I T Y 5 DIABETES
General SI
Graphic Nº 2: Behavior and Evolution of the Medicine Shortage Index for Diabetes, by City. September 2017 – January 2018.
A glance at the historical behavior of the Medicine
It should be noted that in the second week of the
Shortage Index for diabetes medication shows a
month of October, which is the second week measured
reduction of 2.9 percent, which doesn’t necessarily mean
and the fourth chronologically in the period, diabetic
that supply has improved, for the availability levels are
Barquisimetans were unable to obtain the medication
extremely low. Minor fluctuations of the aggregate index
they needed to treat the disease, since the shortage of
for this cause of morbidity are revealed, which peaked in
drugs for diabetes was TOTAL, with a MSI of 100 percent.
September of 2017. Under a geographical strata perspective, the cities of Barquisimeto, Caracas and Nueva Esparta are the least stocked with drugs to treat diabetes, whereas Maracaibo, comparatively, had the best supply of hypoglycemic drugs.
5.This is a graphic depiction of the behavior and evolution of the MSI indicator by morbidity and city for every measurement conducted between September 2017 and January 2018.
MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018
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HIGH BLOOD PRESSURE
General SI
Graphic Nº 3: Behavior and Evolution of the Medicine Shortage Index for High Blood Pressure, by City. September 2017 – January 2018.
A marginal reduction of just 3.3 percent was recorded
smaller shortage of HBP drugs, although the last indexes
over the last period of the statistical survey, with slightly
recorded are the highest for the city.
dynamic reductions in the case of diabetes medication. However, this is in no way good news in a complex
It is important to note that none of these percentages
humanitarian crisis.
mean that availability and supply have improved, or that the inventory of drugs in the country has normalized.
From a geographical comparative analysis perspective,
On the contrary, it is clear evidence that the full-fledged
the most affected cities, that is, the cities with a MSI above
humanitarian and public health crisis that we are
average for high blood pressure medication, are Caracas,
experiencing has not changed.
Barquisimeto and Nueva Esparta. In Mérida, the shortage of high blood pressure medication is comparatively lower. Maracaibo remains “the most benefited city” due to a
MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018
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ACU TE INFEC TIONS OF THE RESPIR ATORY TR AC T
(AIRS)
General SI
Graphic Nº 4: Behavior and Evolution of the Medicine Shortage Index for Acute Infections of the Respiratory Tract, by City. September 2017 – January 2018 .
The health problem that is most worsened by medicine
Another alarming MSI increase was that recorded for the
shortages in all measurements and cities is the one
city of Nueva Esparta, which began the lowest vis-à-vis
pertaining to acute infections of the respiratory tract. The
the other cities under study but which eventually leveled
shortage of drugs to treat AIRs is between 90 percent and
with the dramatic global trend.
100 percent, peaking in the survey for the second week of November (sixth chronological week in the period).
Once again, Maracaibo had the lowest index, but still dangerously close to the General SI, which is not good
This is more than horrifying because, due to the low
news for Marabinos.
temperatures recorded in December, the spread of infections of the respiratory tract increased. In January, the MSI for acute infections of the respiratory tract in the Metropolitan Area of Caracas was 98.9 percent, the highest ever recorded nationwide.
MONITORING THE RIGHT TO HEALTH ON VENEZUELA JANUARY. 2018
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DIARRHEA
General SI
Graphic Nº 5: Behavior and Evolution of the Medicine Shortage Index for Diarrhea, by City. September 2017 – January 2018.
Fluctuations in the historical behavior of the MSI for
Geographically, Caracas and Barquisimeto are above
drugs to treat diarrhea are the most dynamic. The global
the global index, whereas Nueva Esparta and Mérida are
trend for this ailment, as with the aforementioned causes
about average. Once again, Maracaibo is the city with the
of morbidity, was towards a reduction, with a MSI of 3.2
largest availability of drugs to treat diarrhea.
percent, which peaked in the survey for the first week of September. This is in no way an improvement in the shortage situation but a slight increase, albeit marginal, in the availability of some antidiarrheal medication.
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CONVITE STRONGLY DENOUNCES 2018: T H E W O R S T S TA R T O F T H E Y E A R F O R V E N E Z U E L A N S ’ R I G H T TO H E A LT H The Article 83 of the Constitution of the Bolivarian Republic of Venezuela mandates that health is “a fundamental social right” and establishes that it is “the obligation of the State” to guarantee it. International health indicators show an unprecedented decline of health in Venezuela. Although ours is an advanced legislation in terms of its treatment of the right to health, our badly named “Health System” is not, and its multiple deficiencies are at the core of the awful deterioration of Venezuelans health that we are regrettably witnessing. This start of the year has been marked as the worst for health in Venezuela in all our republican history. We received 2018 with a backwards leap of at least 30 years in health. In our effort to document that what #TheStateDoesn’tCare about, we take this opportunity to denounce that in the month of January, us, Venezuelans suffered the perverse effects of the following phenomena:
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The shortage of drugs to treat the four most recurrent causes of morbidity in the country was above 90 percent. During the first 30 days of the year, Venezuelans didn’t have access to common medication (basic basket of drugs) prescribed to treat the four diseases that hit the population the most.
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of serology reagents, which is a serious alert for Caraqueños, for it is an emblematic trauma center that receives a large number of trauma patients in need of multiple transfusions; in some cases, patients relatives must sign a consent form for risky transfusions.
70 percent of blood banks in the country lack bags and reagents for donations and serology 6. Of the country’s 334 blood banks, 236 in the public system cannot guarantee transfusions due to the lack of serology reagents. Miguel Pérez Carreño Hospital has had an irregular supply
6.Pineda, Juliett (2018). 70 Percent of Blood Banks in the Country are in Crisis for Lack of Reagents. Available at: http://efectococuyo.com/principales/ en-crisis-70-de-los-bancos-de-sangre-del-pais-por-falta-de-reactivos.
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3 4
An 8-year-old boy from Caracas died from diphtheria after having been taken to at least nine health-care
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Mérida saw an epidemiologic alert triggered due to an outbreak of diarrhea and vomit starting on January
centers and sent back home with a misdiagnosis of
14, which has affected at least 1,546 persons. The
tonsillitis.
situation worsens by the day in Mérida due to a 97.5 percent shortage of antidiarrheal drugs recorded in the
Only 3 of the 23 antiretroviral drugs required for a 77,000 population of HIV patients registered in the antiretroviral supply program nationwide are 7
available .
second survey of the month of January.
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62
newborns died in January at the Luis Razetti
Hospital in Barcelona 12 .
In said cases, the most
recurrent death causes are associated with mother’s
5 6
80 percent of HIV patients in need of treatment are
malnutrition during pregnancy, mostly teenagers, as
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receiving NONE .
well as with lack of prenatal care. Additionally, there is a shortage of pregnancy and postnatal medicines,
Due to a shortage of immunosuppressive drugs, 30
supplements and vitamins across the country.
organ transplant patients are in serious emergency, and 3,500 are at risk of losing donated organs and dying.
Convite, A.C. had already alerted of this 9
situation in our previous newsletter .
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The health of Venezuelans has hours of operation: Convite, A.C. took on the task of calling the 0800-Salud telephone service set up by the national executive to distribute drugs. The service operates from 9:00 am
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There is a total lack of medical supplies. For instance,
to 3:00 pm Mondays through Fridays. This means that
José María Vargas Hospital, one of the oldest in the
Venezuelans cannot fall sick before 9:00 am and after
country, located in the Capital District, recorded a
3:00 pm on weekdays, let alone on weekends; medical
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deficit of medical supplies of 90 percent in January.
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emergencies are not a possibility for said “service”.
32 of dialysis centers at the national level have closed for lack of supplies. At the same time, there are 15,000 Venezuelans whose lives depend on dialysis to survive and are having none due to said lack of supplies 11.
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The growing trend in the number of confirmed cases of the four epidemics of hepatitis B, diphtheria, malaria and measles remains unchanged.
7.Source: Stop VIH. 8.Source: Stop VIH. 9.Source: Codevida
10.Barreto, Gabriel (2018). % (Vargas Hospital has already recorded a deficit of medical supplies of 90 percent). Available at http://contrapunto.com/noticia/el-hospital-vargas-ya-alcanzo-un-deficit-de-insumos-medicos-de-90-183667/ 11.Herrera, Isayen (2018). 32 Dialysis Units Closed due to Lack of Supplies). Available at http://www.el-nacional.com/noticias/ salud/unidades-dialisis-cerraron-por-falta-insumos_221256 12.Tal Cual (2018). 62 babies died at the Luis Razetti Hospital in Barcelona). Available at http://talcualdigital.com/index. php/2018/02/18/en-enero-murieron-62-bebes-en-hospital-luis-razetti-de-barcelona/
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The
national
government
stubbornly
denies and ignores the terrible complex humanitarian emergency facing the country, one that has resulted in the death of a large number of Venezuelan citizens. As if that wasn’t enough, it decided to implement a new health plan of the “naturophatic” type: President Nicolás Maduro launched an “ancestral health plan” to treat diseases with herbs and natural products and agents amidst a serious shortage of drugs in the country, which has been estimated at 95 percent by the medical profession13.
Photograf: Agencia EFE
13.Panorama (2018). Maduro Launches “Ancestral Health” Plan Amidst a Serious Shortage of Drugs. Availabe
at
http://www.panorama.com.ve/politicayeconomia/Maduro-lanza-plan-de-salud-ancestral-en-medio-de-grave-
escasez-de-farmacos-20180119-0099.html
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