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Immigrant and Refugee Health

Healthcare Access and Conditions in Guatemala, Honduras, and El Salvador

Central American Refugee Health Profile

Even though minors from El Salvador, Guatemala, and Honduras may be designated as refugees, they have not been living in refugee camps, and usually come from their hometown or village.

Primary Care

Compared to the United States and other high-income nations, physician density in El Salvador, Guatemala, and Honduras is quite low. According to recent data, there are approximately 1.6 physicians per 1,000 population in El Salvador. Physician population density is markedly lower in both Guatemala and Honduras, with 0.93 and 0.37 physicians per 1,000 population, respectively14. The World Health Organization estimates that countries with fewer than 23 healthcare workers (including physicians, nurses, and midwives) per 10,000 population will likely fail to achieve adequate coverage rates for primary healthcare, as defined by the Millennium Development goals15. Therefore, the number of doctors in El Salvador, Guatemala, and Honduras is likely insufficient to achieve adequate coverage for primary healthcare needs.

Access to basic healthcare in Central America largely depends on socioeconomic status and environment (urban or rural). El Salvador, Guatemala, and Honduras have worked to improve access and quality of care, particularly in rural settings. Despite improvements to health services and systems, rural populations still have difficulty accessing basic health services. In Guatemala, it is estimated that basic health and nutrition services meet only 54% of the needs of the rural population16. Similarly, in Honduras, 88.3% of the total population receives care from the Ministry of Health. However, the majority of health services are located in the most developed cities, not easily accessible for rural and indigenous populations17. Minors from rural and often underserved regions may also seek care from traditional healers, such as curanderos or folk healers18. Curanderismo exists throughout Latin America, and practitioners treat a wide range of ailments including illnesses recognized by modern medicine as well as “folk illness” specific to the local population18.

Immunizations

Despite challenges in accessing basic primary care services in El Salvador, Guatemala, and Honduras, each country reports high immunization coverage among children. Vaccination coverage in El Salvador varies from 90% to 93%, depending on the vaccine, while vaccination coverage ranges from 93% to 98% and 88% to 93% in Guatemala and Honduras, respectively19. El Salvador, Guatemala, and Honduras administer vaccines in accordance with the World Health Organization’s (WHO) Expanded Program on Immunization.

Women’s Health Issues

Select reproductive health indicators for El Salvador, Guatemala, and Honduras are presented in Table 1. In many cases, access to reproductive healthcare is likely limited for indigenous populations throughout Central America.

Table 1. Reproductive Health Indicators for El Salvador, Guatemala, and Honduras

Country Prevalence of contraceptive use (%) Fertility rate# Adolescent fertility rate† Infant mortality rate‡ Maternal mortality ratio§ Prevalence of pregnant women receiving prenatal care (%)ǁ Births attended by skilled birthing attendant (%)
El Salvador 72 1.9 66 14 54 96 98
Guatemala 54* 3.2 81 24 88 93* 63
Honduras 73 2.4 66 17 129 97 83

#Total fertility rate represents the average number of children born to a woman during her childbearing years
†Number of births per 1,000 women ages 15-19
‡Number of infant deaths per 1,000 live births
§Number of maternal deaths per 100,000 live births
ǁPercentage of all pregnant women receiving prenatal care at least once during pregnancy by skilled health personnel

Source: World Bank HealthStats Databank20, unless otherwise cited.
*UNICEF21

Sexual- and Gender-Based Violence

Sexual- and gender-based violence has been increasing throughout Central America and Mexico. El Salvador, Guatemala, and Honduras report extremely high rates of femicide, with rates up to five times higher than overall homicide rates in the majority of Northern, Western, and Southern European countries22. Gangs and other armed criminal groups often perpetrate violence against women, and domestic violence throughout Central America is widespread23. In Honduras, 16,000 allegations of violence against women were registered in 2012, with 74% relating to domestic or interfamily violence, and 20% relating to sex crimes24.

References

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