Honduran Healthcare System:

United States vs Honduras

United States Honduras

Approximately 329 million people Approximately 10.1 million people

Average income $56,310 Average income $2,200

Life expectancy = 76 (make) and 81 Life expectancy = 70.7 (male) and 73.2
(female) (female)

Where does Honduras Place?

 Do not rank anymore but in 2000 the WHO ranking of health systems places Honduras
at 131 out of 190 rankings
 2021 Global Health Security (GHS) index gave Honduras an overall rank of 163 out of
195 countries
o 6 categories (prevent, detect, respond, health, norms, risk)
o 37 indicators 
 Various indicators fall under each of the categories (i.e., antimicrobial
resistance and zoonotic disease fall under the prevent category)
 They had a health index score of 68.7 in 2021 (health status and health access)
o Countries are ranked by their health index score 

Leading Causes of Death in Honduras:

1. Coronary heart disease
2. Stroke
3. Violence
4. Kidney disease
5. Lung disease
6. Live disease
7. Alzheimer’s and dementia
8. Road traffic accidents
9. Influenza and pneumonia 
10. Diabetes 
 Surprised that violence is on this list and super high 

Beginning of Honduras’s Healthcare System:

 The Honduran Social Security Institute which runs the national public health system was
established in 1959
 Typically, people would travel to Tegucigalpa (capital) to receive services but in the
1970s a hospital was opened in San Pedro Sula (Second biggest city)
 In El Progreso, only 50 kilometers away and the third largest city in the country, IHSS
services were not available until 1992
 Starting in 2005, decentralization was introduced to the health system as a solution to
address major public health challenges facing the country - decision making
responsibilities given to local governing bodies

Honduran Healthcare System:

 Public
 o Ministry of Health
 Open to all but only about half of the population use it regularly
o Honduran Social Security Institute
 Covers about 40% of individuals who are employed accounting for 18% of
the population
 Private
o For those who have private insurers accounting for about 10% of the population

What is Healthcare Like?

 Care varies greatly from quality and availability
 Outside of tegucigalpa (capital city) and San Pedro Sula, medical care is inadequate
 Ambulance services are limited in major cities and almost non-existent elsewhere
 Support staff facilities and equipment are not up to US standards 
 Interview with Carmen Madrid of People's Health Movement in Honduras 
o Talks about how the healthcare system was wrecked by the 12 year rule of the
National Party and how it can be reviewed 
  Low investment in infrastructure, personnel, and medicine
 Little attention to primary care and prevention
 Lack of training for healthcare workers
 Travel long distances and long wait times 

Barriers:
 Lack of access to physicians
o The CDC reports there are 0.37 physicians per 1,000 people in Honduras 
 Poor management
 Poverty
 Rurality 
o Access to care is based on socioeconomic status and if you live in rural vs urban 

Political Corruption:
 Political corruption has plagued the countries government
 Health was not a priority of the last government 
 Corruption of the Honduran Social Security Institute
 49% of the public health budget diverted to other purposes (Anti-corruption task force)
 COVID-19 has further weakened the fragile state of their health system
 Libre Party
o Xiomara Castro was sworn in this year
 Previously the government was run by National Party for 12 years 

Outcomes of Political Corruption:

 Interview with Carmen Madrid of People's Health Movement in Honduras 
o Talks about how the healthcare system was wrecked by the 12 year rule of the
National Party and how it can be reviewed
 Corruption and mismanaged system leaves individuals paying for their own medical
supplies
 Women are often denied proper care (violence against women is a problem and
heightened with pandemic = did not seek help because there was no productive
outcomes)
 No attention paid to primary care and prevention (i.e, very few specialized dialysis
treatment centers making it more difficult for people who need that kind of care)
Solutions:
 National Health Model
o Services to rural and impoverished areas 
o Preventive care
o Some improvements with this model but not consistent enough for large impact
 Millennium Challenge Corporation (MCC)
o Working to improve government efficiency and transparency
o Social audits 
 Médecins Sans Frontières
o Outpatient consultations
o Mental health consultations
o Victims of sexual violence
 Central American Medical Outreach
o Women's health
o Disabilities
o Surgery
o General needs
 The Association for a More Just Society
o Advocating for transparency in the health system and reporting corruption

Spanish Healthcare System

Spain:
 Made of autonomous communities 
o 17 regions

Demographic and Socioeconomic Factors:

 Population: 47.3 million
 Over 65: 19.2%
 Fertility rate (2019): 1.2
 Poverty rate (2019): 20.7%
 Unemployment rate: 15.5%

United States vs. Spain:

 United States
o Approximately 329 million people
o $56,301 (average income)
o Life expectancy: 76 (male) and 81 (female)
 Spain:
o Approximately 47.3 million people
o $27,155 (average income)
o Life expectancy: 80.7 (male) and 85.7 (female)

Leading Causes of Death in Spain (2020):

1. Diseases of the circulatory system
2. Certain infectious and parasitic diseases
3. Neoplasms
4. Diseases of respiratory system
 5. Diseases of nervous system
6. Mental and behavioral system
7. Diseases of digestive system
8. Endocrine, nutritional, and metabolic diseases
9. Diseases of the genitourinary system
10. External causes of morbidity and mortality

Health in Spain:
 COVID-19 had a major impact on life expectancy
 Ischemic heart disease, stroke and lung cancer were the main causes of death in recent
years
 Most Spanish people reported being in good health before the COVID-19 pandemic
 The burden of cancer is higher for men than for women in Spain

Beginning of Spanish Healthcare System:

 Founded on Spain’s General Healthcare Act of 1986
 Universal healthcare coverage and free access to healthcare
 A guaranteed healthcare benefits package is stipulated by the Cohesion and Quality Act
of 2003

Spanish Healthcare System:

 Spain has a decentralized health system with national coordination and has been since
2002
 The national health system of Spain is: Sistema Nacional de Salud (SNS)
 The system consists of 3 organizational levels:
o Central (Organizacion de la Administracion Central)
o Autonomous community (Organizacion Autonomica)
o Local (Areas de Salud)
Funding:
 The spanish healthcare system is mainly funded through taxes
 As a result of this healthcare in Spain is either free or low cost for residents (and their
dependants) paying social security 

Coverage:
 The SNS covers 99.7% of the population with the remaining 0.3% utilizing access to
private medical care
 The common core package includes healthcare prevention, diagnosis, and treatment,
rehabilitation services, and emergency medical transport
 Includes a comprehensive package of primary healthcare benefits
 Does not cover dental treatment and some prescription drugs 

Challenges:
 Limited coordination between the autonomous communities
 Different approach to rehabilitation, convalescent and terminal illness
 Regional differences (i.e., bed distribution)