Countries of the World/COUNTRYS.BIN/dp/0383/03835.txt

Text File | 1991-06-25 | 38KB | 606 lines

$Unique_ID{COW03835}
$Pretitle{297}
$Title{Uruguay
Chapter 7B.   Health}
$Subtitle{}
$Author{The Director Foreign Area Studies}
$Affiliation{HQ, Department of the Army}
$Subject{percent
rural
health
montevideo
retirement
fund
public
system
population
water}
$Date{1971}
$Log{}
Country:     Uruguay
Book:        Area Handbook for Uruguay
Author:      The Director Foreign Area Studies
Affiliation: HQ, Department of the Army
Date:        1971

Chapter 7B.   Health

Public Health Administration and Finance

     Under an appointive minister, the Ministry of Public Health maintains an
extensive system for administration of the country's health program.
Administration in the past has been heavily concentrated in Montevideo, but
during the late 1960s some decentralization was accomplished. In this
respect, the Constitution of 1967 assigned to the governors (intendentes) of
the departments immediate supervisory responsibility for public health matters
within their areas of jurisdiction.

     During the late 1960s the General Health Office of the Ministry
administered hospitals containing more than 77 percent of the hospital beds in
the country, and the ministry was directly responsible for construction,
repair, and remodeling of the public hospitals. Other state and
state-associated entities supervised hospitals with 6 percent of the beds, and
the remainder were in private or mutual care (mutualista) establishments.

     Through the departmental governments, the ministry supervised the
numerous departmental health centers, auxiliary centers, and polyclinics.
Among its principal administrative elements, centered in Montevideo, were the
Planning and Budget Office and departments of environmental hygiene, maternal
and child protection, family planning, mental health, and nursing. Other
operative units included those for pharmaceutical and technical matters. Among
its other responsibilities were coordination and general supervision of the
activities of related institutions, such as the National Medical School, the
National Institute of Hygiene, the National Institute of Endocrinology, the
Institute for Premature Children, and a colony for tuberculosis research.

     The ministry regulated standards for the practice of medicine and
paramedicine in all its branches; set conditions to be met by producers of
food, beverages, and drugs; and maintained control of narcotics laws.

     The Constitutions of 1934 and subsequent constitutional documents,
including the Constitution of 1967, have stipulated that the government
provide gratis the means of making available preventive care and treatment to
those who are indigent or lacking in sufficient funds to provide for their
adequate medical care. In addition, partial systems for insurance covering
illness and medical care for personnel in a dozen sectors of employment have
come into existence through separate legislative acts in the 1960s. Various
union groups have obtained medical coverage through collective bargaining.
Most of the medical protection, however, is provided by commercial insurance
or by some forty small mutual protective associations that receive various
forms of subsidies and loans from the government. In 1963 over half of the
population of Montevideo participated in some kind of mutual association.

     These mutual societies are supervised by the Coordinating Committee for
Collective Medical Assistance, which is headed by the subsecretary for public
health. Under a 1969 decree the committee was to ensure that the various
collective health groups provide adequate and standardized services as
prescribed by it. This was seen as a first step toward the establishment of a
nationwide program of health insurance (seguro del salud).

Medical Personnel and Facilities

     Because of the limited number of the surviving indigenous population,
the widespread high level of education, and the general availability of
medical services, traditional attitudes toward health have had little effect
on medical practices. Nevertheless, in the mid-1960s midwives practiced
extensively; and woodland herbs, such as chamomile, sarsaparilla, and
quinine, were used frequently as rural home remedies.

     It has become a cliche that Montevideo has a monopoly on the country's
medical facilities and services, but in 1970 more than half the population
lived in the capital city, communication systems in the small and compact
country were good, and a rural health program had been emphasized during
recent years. In 1966, however, the number of physicians in Montevideo per
10,000 population had been 11.4; the ratio outside the capital and the other
larger cities (the remaining 45 percent of the population) had an average of
4.3 per 10,000.

     The number of practicing physicians increased from 2,600 in 1960 to 3,300
in 1968 and to a preliminary report of 3,500 in 1969. This 34.6-percent growth
during the nine-year period more than tripled the overall rate of growth of
the population and resulted in a substantial emigration of young physicians
who had completed their university training only to find no openings in their
profession at home. Enrollment in the medical faculty at the University of the
Republic, however, continued to increase at a fast pace during the 1960s.
Moreover, the traditional concern in Uruguay over the excellence of its
medical personnel is underlined by the fact that in 1968 some 51 out of a
total of about 1,000 Pan American Health Organization (PAHO) and World Health
Organization (WHO) fellowships awarded to Western Hemisphere countries for
advanced training in medical and related studies went to Uruguayan students,
an impressive number for the size of the country (see ch. 8, Education).

     The superabundance of physicians has been offset by a shortage of nurses.
Between 1960 and 1969 the number of graduate nurses more than doubled, but the
increase in actual numbers was only from 300 to 610. In 1969 practicing
physicians outnumbered graduate nurses by a ratio of almost six to one. It was
therefore necessary to supplement the small corps of trained nursing personnel
with auxiliaries, of whom there were about 3,800 in 1964-14 per 10,000 of the
population. The rapid growth in the size of the small corps of graduate nurses
during the 1960s was both encouraging and indicative of a change in attitude
toward the nursing profession. In Latin America as a whole, nursing has never
been a popular calling. The nurse, even at the graduate level, has not been
well paid and has not enjoyed the prestige and social position accorded her in
many other parts of the world.

     The 1,250 dentists practicing in 1962 (the most recent date quoted in
1969 and 1970 publications) were generally well trained and their number in
proportion to the population as a whole (4.8 per 10,000) compared very
favorably with that in most other Latin American countries. A 1962 survey in
Montevideo and in other parts of the country, however, found dental health to
be far less satisfactory than health in general. Cavities were few in the
teeth of people of all ages examined, but there had been many extractions,
there was extensive evidence of peridontal (gum-related) disease, and oral
hygiene seemed to have been largely ignored. The country's need appeared to be
for more and better education in the care of teeth and gums than for more and
better dentists.

     The law requires that all pharmacies be operated personally by graduate
pharmacists, with degrees issued or validated by the University of the
Republic. The Medicaments Control Commission under the Ministry of Public
Health has for many years controlled prices of medicines and monitored
publication of advertisements concerning them.

     The number of hospital beds increased from 12,135 in 1960 to 17,200 in
1968. In 1963 the ratio had been a very satisfactory average of 65 beds per
10,000 population, with 76 in urban and 54 in rural localities. Also in 1963
there had been seventy-eight hospitals, including seventy-two general
institut