Panama Health Profile 2012

According to CEPAL statistics, 28.6% of the population lives in poverty and 11.7% in extreme poverty. Welfare institutions exist but do not cover all risks for all segments of the population. The most important institution is the Caja de Seguridad Social (CSS), a public corporation administered by the state and charged with managing various social services and entitlement programs such as health care, medical insurance and pensions. The scope and effectiveness of the social security system varies according to territory, social stratum and economic sector. The CSS mainly benefits workers in the formal sector of the economy and covers only a part of the rural population. Nearly a third of the 3.3 million Panamanians are not included in the CSS scheme. The Torríjos government carried out a major reform of the CSS to overcome the serious under-funding of the institution. In December 2005, the legislature approved a new law that gradually increases the monthly contribution rate (applied on salary) by employees and employers from a combined 18% to 21.5% by 2013. Torríjos had originally wanted to raise the age of retirement and augment monthly payments further, but after violent protests he compromised and submitted the new reform. Currently, the system covers about 170,000 retirees, 72% of whom receive monthly pensions below $500.
A number of institutions work to compensate for gross social inequalities, though their efforts remain insufficient. Blacks and most notably members of the indigenous communities have limited access to (higher) education, better paid jobs and public office. According to national surveys, nearly 90% of the 300,000 people belonging to the seven different indigenous groups live in extreme poverty. Poverty and extreme poverty are concentrated in the countryside. A strong correlation exists between poverty and child malnutrition in Panama. Approximately 12% of all children under five suffer from some form of malnutrition. 10% of the population does not use an improved water source. Disparities in education are key causes of poverty, malnutrition and inequality. Close to 80% of the poor work in the informal sector. Social data indicate that women are disadvantaged in general, but women from higher social strata have significantly easier access to higher education, better jobs and public office. With its Red de Oportunidades (Network of Opportunities) program, the Torríjos government established a conditioned cash transfer to some 75,000 of the country’s poorest households. This initiative provides cash grants to poor families for keeping their children in school and for meeting mother and infant health controls, child growth monitoring and vaccination schedules, among other requirements.

HEALTH & DEVELOPMENT
Panama is considered a mid-high income country whose economy shows sustainable growth based on a service sector highly involved in international trade. However, nearly 40% of its population is in poverty and the public debt amounts to 70% of the GDP. The indicators of economic and social development show that the indigenous population (respectively 19% and 35% of the poor and extremely poor of the nation) is most deprived of its rights. The estimated total population for 2006 is 3 283 959 people, with a slight predominance of men (51%). Children under 15 and adults 65 and older represent 30% and 6% of the population respectively. It is a predominantly urban population (64%), which is currently experiencing a rapid process of demographic transition expressed in the downward trend of its population growth rate (1.7%), total fertility rate (2.7%), birth rate (19.8 per 1000 people) and the crude death rate (4.3 per 1000 people). The demographic dynamics of the different provinces are associated with urban growth, the migratory phenomena, and other patterns of economic and social development, which have modeled differentiated demographic scenarios.
The morbidity and mortality profiles show disease and death to be associated with lifestyles and unhealthy behaviour, including accidents and violence that are prevalent in urban populations. This profile is also influenced by the lack of access and the declining response capacity of the health services that for the most part is concentrated on urban areas, leaving large populations from rural and indigenous areas almost completely without health services. Health care is provided by the Ministry of Health (MOH) and the Social Security Fund (SSF or CSS as in Spanish). Currently, 67% of the Panamanian population benefits from social security through the CSS. Unfortunately, these institutions remain separated causing unnecessary spending, and although a law for Social Security reform was proposed, it concentrated only on the alteration of retirement and pensions. The current government is implementing interventions for the reduction of poverty and the improvement of health, but these changes have yet to be instated. Panama’s public spending on healthcare is among the highest in the Region, and yet no significant advances have been made in fighting the drastic disparities in health.
 

OPPORTUNITIES

• Programme of opportunities network
• Leadership at regional and subregional level of the Government
• Reforms of the health care system

CHALLENGES
• Health system reform
• Inequities
• Aging population
• Epidemiological polarization