GENEVA (ILO News) - In Latin America and the Caribbean, "more than 140 million people, that is a third of the total population, do not have access to health services", ILO Executive Director Mary Chinery-Hesse told delegates assembled today in Mexico at the opening of an international conference on health care in Latin America and the Caribbean. ¹ This means that one out of three persons in the region has no permanent access to health care services.

Though all countries in the region legally recognize the right to health care, almost one out of two inhabitants - around 218 million people - is excluded from social security systems according to a report submitted to the meeting. ² Even if some of them are partly covered by other public or private systems, a large number is still excluded for financial, geographical or cultural reasons. An estimated 121 million persons are too poor to afford any kind of health care and another 107 million have no access to any kind of health service simply because they live in remote areas.

Together with demographic growth which shows an increase of 7.5 million people per year "these facts call into question the capacity of the systems to deal with new social protection scenarios, in particular with regard to the health sector", Ms. Chinery-Hesse told the meeting.

The three-day meeting will analyse regional policies to extend social protection in the health sector, review innovative experiences and propose alternative mechanisms for extending health services to excluded groups in Latin America and the Carribean.

The situation of the poor is of particular concern. Out of the 200 million poor in Latin America, an estimated 70% has no access to basic health services.

Informal sector workers which represented 52% of all workers in 1990 and 58% in 1997 rarely, if ever benefit from any form of coverage.

Exclusion from health services affects countries in the region to different degrees. While in countries like Mexico, Chile or Cuba, less than 10% of the population is denied adequate access to health services, 60 % of the population in El Salvador has only inadequate access simply because they live in remote areas.

Childbirth without specialized medical assistance, which is virtually unknown in the Caribbean, is a common feature in countries like Bolivia (72%), Paraguay (64%) and Haiti (54%). The average rate of unassisted childbirth on the subcontinent is 17%.

While social security coverage is universal in the Caribbean, less than 30% of the population is covered in Andean and Central American countries.

Strategies to improve health coverage

In view of this situation, the International Labour Office (ILO) and the Panamerican Health Organization (PAHO), have decided to carry out a joint initiative to seek innovative ways to reach the excluded population and provide them with health care. The meeting will produce guidelines for a five-year action plan. This "Action Plan for the Americas" will be a powerful instrument to mobilize national and international efforts in order to allow all men and women to have access to health services.

The use of "micro-insurance", a community insurance system controlled by the community itself in terms of levels of contribution and benefits, has been proposed to reduce social exclusion. A report on Micro-insurance experiences ³ presented to the meeting shows that Micro-insurance systems have contributed to improved health equity.

The experiences of Colombia, the Dominican Republic, Ecuador, Nicaragua and Peru show that members of Micro-insurance systems have better access to health care, while the quality of care improved significantly.

"It is obvious that the micro-insurance approach is not the only one and that it has to be complementary to national social protection schemes and must allow for the participation of the public, private and social sectors", stressed Ms. Chinery-Hesse in her address to the meeting.

The Meeting will also help to forge alliances and cooperation among the different actors interested in receiving support in their efforts to reform the national health sector through international technical cooperation. The list of participants includes representatives from governments, employers' and workers' organizations, ILO, PAHO and other international organizations, national institutions in the health sector as well as from civil society.

The ILO is the specialized agency of the United Nations with a mandate for setting international labour standards and enhancing the scope of social protection for all.

PAHO is the specialized agency of the Inter-American system responsible for health issues. It is also the Regional Office of the World Health Organization. One of its main tasks is to seek "health for All" and to support member countries in their efforts to reform their health systems.

1 ILO/PAHO Latin American and Caribbean Regional Tripartite Meeting on the Extension of Health Care to Excluded Groups, Mexico, 29 November - 1 December 1999.

2 Overview of the exclusion of social protection in health in Latin America and the Caribbean, ILO/PAHO report to the ILO Tripartite meeting on the extension of social protection in health to excluded groups in Latin America and the Caribbean, Mexico, 29 November - 1 December 1999.

3 Synthesis of Case Studies of Micro-insurance Experiences and Other Forms of Extending Social Protection in Health in Latin America and the Caribbean, report to the ILO Tripartite meeting on the extension of social protection in health to excluded groups in Latin America and the Caribbean, Mexico, 29 November - 1 December 1999.

Table: Percentage of the population covered by social security in health (1995)

Subregion	Percentage of population covered by social security	Population without social security coverage
Latin America
Argentina	59	14,255,000
Belize	no data	-
Bolivia	19	6,005,000
Brazil	80	31,922,000
Chile	87	1,847,000
Colombia	11	34,302,000
Costa Rica	85	533,000
Ecuador	19	9,283,000
El Salvador	14	4,875,000
Guatemala	16	8,380,000
Honduras	14	4,862,000
Mexico	49	46,484,000
Nicaragua	18	3,629,000
Panama	61	1,026,000
Paraguay	19	3,911,000
Peru	30	16,472,000
Venezuela	36	13,980,000
Uruguay	63	1,191,000
Caribbean
Antigua and Barbuda	100	0
Bahamas	100	0
Barbados	100	0
Cuba	100	0
Dominica	100	0
Dominican Republic	7	7,275,000
Grenada	100	0
Guyana	100	0
Haiti	1	7,546,000
Jamaica	100	0
Saint Kitts and Nevis	100	0
Saint Lucia	100	0
Saint Vincent and the Grenadines	100	0
Suriname	no data	-
Trinidad and Tobago	100	0
Total		217,779,000

Source: Overview of the exclusion of social protection in health in Latin America and the Caribbean, ILO/PAHO report to the ILO Tripartite meeting on the extension of social protection in health to excluded groups in Latin America and the Caribbean, Mexico, 29 November - 1 December 1999.