Extension of health services coverage in El Salvador: The RHESSA project experience

For a variety of reasons, the governments of Central America have struggled to provide basic healthcare services to their rural and impoverished populations. The lack of incentives for healthcare personnel to reside in or even to travel to remote areas, along with the deep rural-urban and rich-poor divides have resulted in poor coverage and poor health indicators. Further, language and cultural barriers and the lack of a budget for transportation in the rural departments have added to the complications in meeting the needs of the poor. In an effort to address the poor health indicators and the clients' complaints, to achieve equitable access to healthcare, and to reach the goals established by the Millennium Development Goals, the Salvadoran Government sought to extend essential healthcare services to disadvantaged populations, especially mothers and children, the poor, and rural and indigenous populations. With the help of a World Bank loan, the Ministry focused on: (1) solidifying the provision of health services to remote and poor areas; (2) expanding coverage; and (3) institutionalizing the program to assure its sustainability and governance for improved health results. Given the emerging financial crisis, which could affect the size and effectiveness of social budgets, the challenge is to maintain this program and consolidate the improvements of the health indicators.