by Roxanne Oroxom and Amanda Glassman
Health outcomes in Venezuela are approaching emergency-like levels as services, medicines, and food become increasingly inaccessible. Venezuela’s under-5 mortality rate in 2016 already rivaled Syria’s, a Grade 3 emergency according to the World Health Organization (WHO). Since then, Caritas has estimatedthat 11.4 percent of children under 5 in Venezuela suffer from moderate or severe acute malnutrition. (The United Nations High Commissioner for Refugees considers a global acute malnutrition rate of more than 10 percent a “high public health concern.”) The consequences of Venezuela’s crisis have even spilled beyond its borders as more than 1.6 million people have fled the country since 2015, an exodus “on the scale of Syria,” according to UNHCR.
Despite the gravity of the situation, the Venezuelan government has repeatedly rejected offers of humanitarian assistance. NGOs trying to fill the service gap in the meantime have had their materials confiscated or blocked from entering the country. The inadequate and inconsistent treatment available in Venezuela violates the globally recognized right to healthcare, and the international community should respond accordingly.
How bad is the situation?
Shortages and high prices restrict access to even the most critical supplies. NGOs warned in December that Venezuela’s already-insufficient stock of antiretroviral medications risked total depletion if the government did not act quickly. The Pharmaceutical Federation of Venezuela estimates a national medicine shortage of around 80–85 percent. Even when medicines are available, they are often too expensive for many Venezuelans to afford. People are turning to measures of last resort, including spacing out doses and consuming pet medicines. Venezuela’s Medical Federation estimates that roughly one-third of the country’s physicians have left.
The lack of access to quality healthcare is driving up disease rates. The number of reported cases of malaria grew from 136,402 in 2015 to 240,613 in 2016 (and 406,000 in 2017). This increase occurred amidst a massive decline in the number of people protected by indoor residual spraying: 2.7 million people in 2015 compared to roughly 30,000 in 2016. WHO declared the Americas measles-free in 2016, but Venezuela has confirmed 3,545 cases in 2018 alone. Imported cases of measles and diphtheria (both highly infectious diseases) have been increasingly documented throughout Latin America following the mass exodus from Venezuela.
With the deterioration of Venezuela's health system, mortality rates are skyrocketing. Venezuela documented a 30 and 65 percent increase in infant and maternal mortality, respectively, in 2016. More recent accounts paint a similarly somber picture: “In 2012, there were 2,100 HIV-related deaths nationwide in Venezuela. So far [in 2018], at least 1,600 patients have died in Carababo alone, a state that accounts for around 7 percent of the total population of Venezuela.”
How has the international community responded—and what more can be done?
Some funders have approved new financing for Venezuela. China has agreed to extend Venezuela a $5 billion credit line, and the European Union pledged €5 million for health assistance, food and nutrition, water, and protection in Venezuela. The Global Fund’s Secretariat also recently requested draft investment cases for a new channel of support for noneligible countries with ongoing health emergencies, like Venezuela.
Other organizations, including UNICEF and PAHO, work directly with Venezuela’s health ministry. PAHO, for example, facilitates access to medicines through its Revolving Fund and Strategic Fund. However, there is little in the way of publicly available information on the actual distribution of purchased supplies by the government, or on the government strategy that informs that process.
Brazil’s health minister recently criticized the lack of openness around Venezuela’s immunization efforts, saying, “all we have is preliminary data from 2017. They are not updating the information and we can’t see the magnitude of the problem.” The Inter-American Commission on Human Rights has also flagged reports alleging that free access to the National Vaccination Plan requires an ID typically held by people who agree with the ruling government party.
- WHO/PAHO should consider declaring Venezuela at least a Grade 2 emergency. The situation in Venezuela is grave. One way the Global Fund will identify potential cases for its new channel of support is whether WHO classifies the country as a Grade 2 or 3 emergency.
- Donors should support data collection efforts at the national and civil society level— and make access to future funds contingent on increased transparency around health outcomes. A survey conducted by the opposition-led National Assembly and Médicos Por la Salud of 137 hospitals successfully identified 94 facilities in which patients buy all or most of their own medications. The survey also found that 96 facilities did not have water at all or only intermittently in the week prior to the survey.
- Countries supporting the Global Fund should consider the benefits and costs of a limited Emergency Fund and explore whether it should be expanded for the 2020–2022 period. The Global Fund mentioned in its approval document that its Emergency Fund for 2017–2019 had an allocation of $20 million for a three-year period, while the estimated cost of funding essential TB, HIV/AIDS, and malaria drugs for Venezuela amounted to roughly $30 million per year.
- Donors with strict income-status thresholds (e.g., Gavi) could considering introducing eligibility exceptions like the Global Fund’s. Venezuela’s status as an upper-middle income country restricts its access to several financing mechanisms.
Accounts of persistent medicine stockouts, rampant disease spread, and rising mortality rates have poured out of Venezuela for years, and the situation has only deteriorated since then. It’s time to give Venezuela’s crisis its rightful designation: a public health emergency.