Assessment of the public health sector in Honduras, 1975-1985

This health sector assessment concentrates on human resources, management, logistics, and financing in three priority areas -- communicable disease control, environmental sanitation, and personal health care. Diarrhea is a principal cause of general morbidity and high infant mortality in this nation. Despite efforts to vaccinate against immunopreventable diseases, outbreaks continue. In 1979, a polio epidemic occurred, with 226 paralytic cases and nine reported deaths. In addition, almost 5,000 cases of measles and 5,252 cases of whooping cough were reported (with 280 and 184 deaths, respectively). Many elements in the Government"s malaria eradication effort were discarded due to political and program changes. As a result, a marked increase in reported cases occurred -- 7,503 in 1974 and 34,606 in 1978. Other common health problems include tuberculosis, malnutrition, and pregnancy and birth complications. Since 1974, high priority has been placed on water and waste disposal and basic health care coverage for all people. However, a reorientation within the Ministry of Health (MOH) toward integrated, regional-level preventive health care did not eliminate a long-standing predisposition toward nationwide programs and hospital-based care. The sheer growth of the MOH in recent years has produced a critical need for reorganization. Its major weaknesses relate to weak lines of authority, poor communications, poor use of volunteer workers, inadequate financing, and the politics of hospital construction. Authors recommend the establishment of clear lines of responsibility, creation of position descriptions for all MOH personnel, and promulgation of policy guidelines. In addition, regular performance inspections of regional sanitation programs should be carried out; logistical support should be provided to community-level health workers on a priority basis; and continuing education should be provided to volunteer workers. Basic medical education should be oriented toward nonclinical public health services and preventive medicine.