The state of CentAm healthcare investments

Health systems in Central America have not improved structurally even during the pandemic but are increasingly relying on multilateral loans, BNamericas was told.

Loans were also crucial to gain access to vaccines.

“It’s chronic, structural and even though they try and increase the amounts, they don’t compensate for the deficit due to inflation and the lack of investment for the past 30-40 years. That’s why these loans become key and they still misspend them,” Karin Slowing, consultant and former head of Guatemala’s planning department (Segeplan), told BNamericas.

Guatemala and Honduras must rely on loan-funded ad hoc hospitals for at least another year because of the slow vaccination process, Slowing said. 

The slow roll-out in Guatemala is related to citizens having to register online to get a jab, although few households have internet access, especially in rural areas, according to Slowing.

BNamericas presents an overview of the status of hospital projects in Central America.

Guatemala

Last year, a hospital was opened in Villa Nueva. While it serves as an exclusive COVID-19 treatment facility, it wasn’t purpose-built and was a delayed project from previous administrations.

President Alejandro Giammattei aims to decentralize the healthcare system, announcing at least four new regional hospitals and 50 health centers outside Guatemala City.

Giammattei also mulls partially privatizing the social security system (IGSS), which is owed up to 40bn quetzales (US$5.19bn) by the state, municipalities and businesses.

El Salvador 

The US$82mn San Miguel regional hospital began operations in April 2020.

Rosales’ hospital complex is still in the early design phase. A US$170mn Inter-American Development Bank (IDB) loan which included US$80mn for Rosales has been stuck in the legislative assembly since 2016. Updates have not been provided since.

To combat the pandemic, the first two phases of Hospital El Salvador were opened, but staff shortages present problems. According to President Nayib Bukele, four hospitals were built and several ad hoc facilities bought.

Honduras

Most hospitals in the country are older than 40 years. 

BNamericas’ projects database tracks three hospitals in the country, representing total capex of US$131mn. They include a trauma hospital in Tegucigalpa, an oncological facility and a general hospital in Choluteca.

A Unicef plan for the health system said, “the hospital and health center infrastructure is deficient, services are not of the required quality and coverage, and in recent surveys, users' perception of the quality of care has not been good.”

The seven ad hoc hospitals investment promotion agency Invest-Honduras bought for US$47mn have become linked to a corruption investigation.

Nicaragua 

Using multilateral resources most effectively, Nicaragua is building four hospitals, and BNamericas’ database tracks five hospital projects in total.

Among others, these include the Oscar Danilo Rosales Arguello school hospital and the Chinandega department hospital, partially funded by the Kuwait fund for Arab Economic Development.

Costa Rica

The only Central American country with a detailed healthcare plan, Costa Rica has also spent most on the public health system in recent years.

But pandemic-related lockdowns are still being enforced regularly to avoid straining the system.

The BNamericas database includes five hospitals, two of which are under construction: the Turrialba hospital due to open in 2022, and the Mexico hospital in San José. 

Panama

According to BNamericas’ projects database, three of Panama’s 10 health facilities involving combined capex of US$1.56bn are under construction: the Aquilino Tejeira hospital, the Manuel Amador Guerrero facility in Colón, and Puerto Armuelles in Chiriquí. 

But works were delayed because of pandemic restrictions.

The largest project is a US$614mn children and maternity hospital in Panama City.

“It’s a huge business and since people like hospitals [authorities] prioritize them; they’re politically attractive, they generate business etc., but they’re not the most recommended investment for our health system or the region’s,” Slowing said.

Governments should prioritize emergency care instead. 

“To make big investments in hospitals makes very little sense if you’re not going to create a base of a local [health] network first.”

Photo credit: Panama government