Mission ''Barrio Adentro'' (English: Mission ''Into the Neighborhood'') is a Venezuelan

social welfare Welfare, or commonly social welfare, is a type of government support intended to ensure that members of a society can meet basic human needs such as food and shelter. Social security may either be synonymous with welfare, or refer specifical ...

program established by the President Hugo Chávez. Initially billed as an attempt to deliver a ''de facto'' form of

universal healthcare Universal health care (also called universal health coverage, universal coverage, or universal care) is a health care system in which all residents of a particular country or region are assured access to health care. It is generally organized ar ...

, ''Barrio Adentro'' later became a way to grant access to medical care to Venezuelan citizens whose political stance the Bolivarian government deemed acceptable. Of a planned 8,500 ''Barrio Adentro'' I centers, 2,708 had been built by May 2007, using an investment of around US$126 million, with a further 3,284 under construction.Jones, Rachel (2008), ''

The Lancet ''The Lancet'' is a weekly peer-reviewed general medical journal and one of the oldest of its kind. It is also the world's highest-impact academic journal. It was founded in England in 1823. The journal publishes original research articles, ...

'', "Hugo Chávez's health-care programme misses its goals", Volume 371, Issue 9629, 14–20 June 2008, p. 1988 In Caracas, Mission ''Barrio Adentro'' I and II centers in 32 parishes were the subject of constant complaints regarding performance even after receiving 1.492 million bolívares from the government. As of December 2014, it was estimated that 80% of ''Barrio Adentro'' establishments were abandoned in Venezuela, with the majority of Cuban medical personnel leaving the country. By the end of 2015, the Bolivarian government reported that one in three of Venezuelan patients admitted to public health facilities that year died. In October 2016, the ''Miami Herald'' reported that hundreds of doctors were being recalled by the Cuban government, allegedly due to a lack of payments by Venezuela.

History

Of a planned 8,500 ''Barrio Adentro'' I centers, 2,708 had been built by May 2007, using an investment of around US$126 million, with a further 3,284 under construction. In Caracas, Mission ''Barrio Adentro'' I and II centers in 32 parishes were the subject of constant complaints regarding performance even after receiving 1.492 million bolívares from the government. Councilman Alejandro Vivas stated that "instead of having positive results, what is observed is the discontent of the citizens for a performance that leaves much to be desired".

Analysis

Jorge Díaz-Polanco, a sociologist of the Center for Development Studies (CENDES), stated that despite an increase of investment, the maternal mortality rate increased and in 2009, the rate was 70 deaths per 100,000 live births, the highest since the 1990s. In Caracas, Mission ''Barrio Adentro'' I and II centers in 32 parishes were the subject of constant complaints about performance even after being funded 1.492 million Bolivares by the government. Councilman Alejandro Vivas stated that "instead of having positive results, what is observed is the discontent of the citizens for a performance that leaves much to be desired". One academic study noted that the successes of the ''Barrio Adentro'' program in 2003 and 2004 may have "crucially influenced" Chávez's 59% to 41% victory in the

2004 Venezuelan recall referendum The Venezuelan recall referendum of 15 August 2004 was a referendum to determine whether Hugo Chávez, then President of Venezuela, should be recalled from office. The recall referendum was announced on 8 June 2004 by the National Electoral ...

.Briggs, Charles, and Mantini-Briggs, Clara (2009), ''

American Journal of Public Health The ''American Journal of Public Health'' is a monthly peer-reviewed public health journal published by the American Public Health Association that covers health policy and public health. The journal was established in 1911 and its stated miss ...

'', "Confronting Health Disparities: Latin American Social Medicine in Venezuela", I(3) The functioning of the programme has been hampered by opposition from the media and Chávez' political opponents. However, this opposition has also made the programme more visible to the populace. Arachu Castro, Assistant Professor of Social Medicine at

Harvard Medical School Harvard Medical School (HMS) is the graduate medical school of Harvard University and is located in the Longwood Medical Area of Boston, Massachusetts. Founded in 1782, HMS is one of the oldest medical schools in the United States and is consi ...

, wrote that the programme has achieved "the materialization of the right to health care for millions of Venezuelans". Due to its reliance on community organisation, the programme has "created a new space for political participation and activism that has forcefully extended throughout Venezuela". By 2017, it was reported by ''

Abandonment

In July 2007, Douglas León Natera, chairman of The Venezuelan Medical Federation, reported that up to 70% of the ''Barrio Adentro'' modules had been either abandoned or were left unfinished. In some cases the Venezuelan government accused elected opposition officials of trying to impede or close existing Missions. In 2006 Chávez accused the governor of Zulia State of impeding ''Barrio Adentro'' there.''El Universal'' (11 Aug 2006
Acusó a Gobernación del Zulia de "sabotear" Barrio Adentro
Retrieved 9 September 2006 According to investigative journalist Patricia Marcano, in 2010 the Venezuelan government promised to start 357 clinics of which 148 were completed. In 2012, 298 clinics were promised and 175 were completed, and in 2013, 62 were promised with 35 completed. In December 2014, it was estimated that 80% of ''Barrio Adentro'' establishments were abandoned with reports of some structures being filled with trash or becoming unintentional shelters for the homeless. The majority of Cuban medical personnel had left Venezuela as of 2016.

Defections

In August 2006, the

George W. Bush George Walker Bush (born July 6, 1946) is an American politician who served as the 43rd president of the United States from 2001 to 2009. A member of the Republican Party, Bush family, and son of the 41st president George H. W. Bush, he ...

administration of the United States created the ''Cuban Medical Professional Parole program'', specifically targeting Cuban medical personnel and encouraging them to defect when working in a country outside of Cuba.'' Monthly Review'', January 2009
The Cuban Revolutionary Doctor: The Ultimate Weapon of Solidarity
/ref> According to a 2007 paper published in

medical journal, "growing numbers of Cuban doctors sent overseas to work are defecting to the United States". Cuban doctors working abroad are reported to be monitored by "minders" and are subject to curfew. In February 2010, seven Cuban doctors who defected to the US introduced an indictment against the governments of Cuba and Venezuela and the oil company

PDVSA Petróleos de Venezuela, S.A. (PDVSA, ) (English: Petroleum of Venezuela) is the Venezuelan state-owned oil and natural gas company. It has activities in exploration, production, refining and exporting oil as well as exploration and production ...

for what they considered was a conspiracy to force them to work under conditions of "modern-day slaves" as payment for the Cuban government's debt. In 2014, it was reported by a Miami NGO, Solidarity Without Borders, that at least 700 Cuban medical personnel had left Venezuela in the past year and that hundreds of Cuban personnel had asked for advice on how to escape from Venezuela weekly. Solidarity Without Borders also stated that Cuban personnel cannot refuse to work, cannot express complaints, may be blackmailed, and suffer threats against their family in Cuba.

Controversy

Licensure

The Venezuelan Medical Federation, the largest association of medical doctors in Venezuela, opposed vigorously the use of Cuban doctors in Mission ''Barrio Adentro'' and was in a legal dispute with the Chávez administration over the legitimacy of the Cuban doctors' licensure and practice. In 2003, they obtained a court order preventing Cuban doctors from practicing in Venezuela, on the basis that they were not properly licensed according to the Venezuelan system. A compromise was reached enabling them to continue working in ''Barrio Adentro''.

Irregularities in funding

In 2014, the Comptroller General of the Republic "found serious irregularities in the ... repair, modernization, and extension of eight national referral hospitals". In 2006, the Venezuelan government funded companies without reason and without certain regulations. The Comptroller said that the project was "marked by weakness and improvisations" and that " is authorization does not imply commitment to the Foundation or the MPPS (Ministry of Health)".

Dumping of medicine and faking of reports

In 2017, ''

The Miami Herald The ''Miami Herald'' is an American daily newspaper owned by the McClatchy Company and headquartered in Doral, Florida, a city in western Miami-Dade County and the Miami metropolitan area, several miles west of Downtown Miami.2018 Venezuelan presidential election Presidential elections were held in Venezuela on 20 May 2018, with incumbent Nicolás Maduro being declared re-elected for a second six-year term. The original electoral date was scheduled for December 2018 but was subsequently pulled ahead t ...

s; all sixteen revealed that they were required to participate in voting fraud. Some of the Cubans said that "command centers" for elections were placed near clinics to facilitate "dispatching doctors to pressure residents". Some tactics reported by the Cubans were unrelated to their profession: they were given counterfeit cards to vote even though they were not eligible voters, they witnessed vote tampering with officials opening ballot boxes and destroyed ballots, and they were told to instruct easily manipulated elderly patients in how to vote. But they also "described a system of deliberate political manipulation"; their services as medical professionals "were wielded to secure votes for the governing Socialist Party, often through coercion," they told ''The New York Times''. Facing a shortage of supplies and medicine, they were instructed to withhold treatment – even for emergencies – so supplies and treatment could be "doled out closer to the election, part of a national strategy to compel patients to vote for the government". They reported that life-saving treatment was denied to patients who supported the opposition. As the election neared, they were sent door-to-door, on house visits with a political purpose: "to hand out medicine and enlist voters for Venezuela's Socialist Party". Patients were warned that they could lose their medical care if they did not vote for the Socialist Party, and that, if Maduro lost, ties would be broken with Cuba, and Venezuelans would lose all medical care. Patients with chronic conditions and those at risk of death if they couldn't get medicine, were a particular focus of these tactics. One said that government officials were posing as doctors to make these house calls before elections; "We, the doctors, were asked to give our extra robes to people. The fake doctors were even giving out medicines, without knowing what they were or how to use them," he said.

Notes

References

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External links

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Venezuela slum takes socialism beyond Chavez
by ''

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'' {{Authority control Bolivarian missions Healthcare in Venezuela 2003 establishments in Venezuela