HEALTH SPENDING IN EL SALVADOR - euroresources.org

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HEALTH SPENDING IN EL SALVADOR
OWNERSHIP AND PARTICIPATION OF CIVIL SOCIETY AND THE PARLIAMENT
The Intersectoral Committee (CISALUD), formed
by government representatives, civil society and
other main stakeholders, was established as a
consultative entity for the elaboration of policies,
with the participation of civil society and private
actors. CISALUD played a key role in the early and
successful control of A H1N1 (2009) and the
dengue emergency (2010), among other
achievements.
Moreover, as mentioned above, one of the key
priorities of the Ministry of Health during its first 100
days in office has also been the establishment of a
national health forum, aimed at uniting the existing
diversity of non-state actors around the issue of
health. It seeks to overcome two of the major
challenges characterizing civil society and
community movements until recently, namely a
high degree of fragmentation and polarization
around party affiliation: While many CSOs under
the previous government were associated with the
opposition and often excluded, on that basis, from
decision-making processes, the right-wing ARENA
is now in the process of establishing its own
counter-movement, which is equally experiencing
some degree of stigmatization under the new
government 22 :
The National Health Forum, which was launched
on 28 May 2010, will seek to unify and strengthen
the civil society movement by acting as an open
platform for all non-state actors working on health.
In that sense, it is to be distinguished from the
existing CISALUD which involves government
officials. In order to achieve it its objectives, the
Forum, headed by the so-called “Organising
Committee”, will be in charge of organising regional
conferences, thematic roundtables as well as
establishing joint planning and monitoring systems
for health sector policies, by prioritising community
leadership. To name just some of the topics
selected for the thematic roundtables in 2010:
■ Sexual and reproductive health
■ Social violence and violence against women
■ Prevention and Mitigation of natural disasters.
■ Medicines and health
■ Water and sanitation.
The representative of the Ministry of Health
interviewed during the fact-finding visit stated that
he would like to see the consultation of this entity
become a mandatory precondition for establishing
new policies in the health sector, thus ensuring that
non-state actors can effectively carry out their
policy watchdog role. However, clear Terms of
Reference, membership adherence rules, as well
as working procedures and consultation rules need
to be established in order for the forum to function
properly.
Some civil society organisations interviewed during
the mission claimed they had neither been invited
to contribute to the process of establishing the
Forum nor to any events organised by the Forum.
They suspect that a certain favouritism based on
party affiliation is still common practice in their
country. This picture was confirmed by some of the
donors interviewed, claiming that social
participation is still very polarized and faith-based
as well as the feeling that opposition party CSOs
are still being excluded from the process.
In general, those CSOs interviewed claim that
there is still a lack of recognition on the
government’s side of the added value that CSOs
and CBOs can bring to policy-making processes:
With regard to those few consultation processes in
which the interviewed CSOs participated, there
was also hardly any follow-up to the
recommendations given by CSOs.
Only two of the six interviewed CSOs had so far
been involved in the government’s health services
coverage expansion programme and in the
consultation process about the new health reform.
There is also a perceived lack of transparency on
the government side about their consultation
processes and the possibilities for Civil Society to
get involved in budgetary scrutiny of public
expenditures.
On the other hand, those CSOs interviewed which
were affiliated with the governing party were able to
name a number of occasions in which they had
been invited to participate in policy-making
processes. This divergence in opinions about Civil
Society participation reflects the impact that party
polisarisation has in every sphere in El Salvador.
One positive example of CSO participation
mentioned by some of the interviewed was the socalled
DAIA (Disponibilidad Asegurada de Insumos
Anticonceptivos) initiative, launched in several
Latin American countries by Civil society in
conjunction with government officials and the
support of USAID, in order to jointly advocate for
the allocation of public resources to the purchase
of Family Planning supplies.
22 These statements are based on the opinions expressed by Civil Society representatives interviewed during the mission. They do not necessarily reflect
AfGH positions.
DSW – German Foundation for World Population
www.dsw-brussels.org