Vulnerability and violence, reflections of poverty

Social Watch El Salvador
Jeannette Alvarado    
Scarlett Cortez  
Mario Paniagua

El Salvador, which elected its first leftwing Government last year, is committed to achieving the MDGs. To do so, the new Government must prioritize reducing poverty and extreme poverty, reforming the health system in order to make it accessible to the entire population, developing prevention policies for natural disasters, and advancing towards gender equality. If El Salvador wishes to attain the MDGs by 2015, it is imperative to make efforts to combat the vulnerability of a large part of its population, without neglecting violence and criminality.

The course of 2009 was marked by events that changed the political, economic and social direction of the country. The presidential election of March 2009 has become one of the country’s main historic events since for the first time a candidate of the left – journalist Mauricio Funes, of the Frente Farabundo Martí de Liberación Nacional – became President for a term of five years.

The most serious concerns when President Funes took office were the economic crisis, resulting in up to 50% of the population being unemployed or underemployed, and widespread social insecurity; according to UN figures only 2 out of 10 workers had a formal employment contract, with social security and a liveable wage. According to survey data published in various news media, the three major problems affecting Salvadorans in 2009 were high crime rates, the lack of jobs and the high prices of basic consumer products.

The need for tax reform

No Excuses. Reaching the Millennium Development Goals by 2015, the 2009 UNDP Human Development Report, states that extreme poverty in El Salvador has fallen by over 50% – from 28.8% of households in 1991, to 10.8% in 2007.[1]

However, these figures should not imply that the country has overcome the problem of poverty, which remains one of the Government’s principal challenges. There are still over 800,000 people living in conditions of extreme poverty, which means that the issue must be given comprehensive attention, including the investment of greater resources.

According to analyst W. Marroquín, countries in the region vary with regard to the fight against extreme poverty, which is somewhat more manageable for El Salvador than for its neighbours. It is reckoned that if El Salvador were to allocate 6% of the country’s income to this purpose, extreme poverty could be eradicated, but for Honduras and Nicaragua, 8% of national income would be needed, a figure difficult for them to attain on their own.[2]

Reducing income inequality requires both fiscal reform and an equitable redistribution of wealth. In his inaugural speech in June 2009, President Funes pledged to tackle poverty and unemployment by means of a global economic recovery plan which includes measures to stabilize the economy, invest in infrastructure projects, including the expansion of electricity to rural areas, and compensate workers and their families for the loss of jobs. Among the most groundbreaking measures was the extension of the Social Security system to cover domestic workers, of which some 90% are women. The Ministry of Labour undertook a campaign to eliminate child labour and strengthen labour protection through the legalization of 75 new trade unions.

Changes in the health system

The new Government also took steps to halt the dismantling and neglect of public health and social security. Among the most serious problems are: the chronic and deliberate shortage of drugs, the establishment of so-called voluntary health care quotas,[3] budget cuts for hospitals and conflicts of interest between ministers and private services which supply the public and social security system. [4]

In May 2009 a new health policy was presented under the name of Construyendo la Esperanza (“Building Hope”), which reflects the intentions of various social organizations as well as the new Government’s public commitment to the issue of health.[5] Thus for the first time the State acknowledges health as a right and by regarding it as a public asset,[6] explicitly rejects the commercialization of health.  

In the early months of the new Ministry of Public Health and Social Welfare (MSPAS), medicine to supply hospitals and health units was purchased, amounting to SVC 17,9 billion (just over USD 2 million), with the intention of reinforcing the budget for 2010, extending public contracts for 2009, and supplying hospitals with essential drugs.[7] During the second half of 2009, MSPAS invested some USD 150,000 to combat the H1N1 influenza epidemic and thus was able to keep mortality rates low in comparison with other countries in the region.

Drugs in El Salvador – both brand-name and generic – are the most expensive in Central America. There is no price or quality regulation policy in place. In February 2010, the MSPAS submitted a draft bill on medicines which will guarantee price and quality regulation, unleashing a flurry of attacks from the media, led by the largest national pharmaceutical company and supported by parties of the right. This has stalled debate on the bill in Congress.

Public spending on health, which had been falling in recent years, has remained unchanged at 3.6% of GDP. The present government’s undertaking is to reach 5% within this five-year period. If this figure is achieved, improvements in access, availability and the quality of care provided by the MSPAS should become apparent. Even though improvements of official indicators related to health services coverage are reported for 2009, there is no guarantee of the continuity of many of these strategies, due to their dependence on external financing.

The final report of the National Family Health Survey 2008 (FESAL, in Spanish) highlights a reduction of 9 points in the child mortality ratio (for children under the age of one year). Meanwhile, among the under-five population the reduction was 12 points at national level.[8] However, there is a considerable gap between the levels of progress for the urban and more highly favoured population, and the rural population whose remain socially and economically vulnerable. Most of the under-five children who die uses to lived far away from the large cities, in conditions of poverty and with difficult access to health services.

Maternal mortality continues to be a priority, although the most recent available data indicate a continuation of the alarming figures of recent years, making it unlikely that the country will meet the MDG target of reducing the maternal mortality ratio by 75% by 2015.  In 2006, there were 82 deaths per 100,000 births, a figure which remained the same in 2009. Improvements in 2007 and 2008 (to 64 deaths in 2007 and 62 in 2008), were mainly due to under-registration.[9]

In November 2009 it was determined that a total of 23,731 persons were affected by HIV/AIDS, of whom over 15,000 had been diagnosed with HIV and the rest were suffering from AIDS.[10] UNAIDS has suggested that there may be an under-registration of up to 25,000 cases. Thus it would be hard to claim that the target for MDG5, halting the spread of HIV has been met. At present, the national HIV/AIDS program is only funded through the Global Fund[11], which places its continuity at risk.

In June 2009, the issue of participation and social regulation was addressed in the paper Construyendo la esperanza. At present, steps are being taken to constitute a National Health Forum, programmed for 2010; a body which will provide follow-up to all of these matters and will be coordinated by social organizations.

Environmental vulnerability intensifies

The damage from tropical storm IDA in November 2009 once again laid bare the country’s precarious environmental situation. In four hours 355mm of rain fell all over the country – a tremendous amount, bearing in mind that during Hurricane Mitch recorded rainfall was 400mm over five days.[12] Hardest hit were the high and coastal areas of the departments of San Salvador, San Vicente, La Libertad, La Paz and Cuscatlán. Nationwide there were 198 people registered as dead, 77 missing and 7,428 families who suffered the effects of the storm. Some 14,300 evacuees were given refuge in the 117 shelters installed for the purpose. Landslides and floods caused bridges to collapse and roads to be cut, which led to the isolation of several of the country’s municipalities. Heavy losses in bean, maize, sugar cane and coffee crops were also reported.

The impact of tropical storm Ida was foreseeable, given the country’s serious social and environmental vulnerability, as well as the failure of previous administrations to address the environmental crisis which the neo-liberal economic model has exacerbated. Social organizations brought together in the Permanent Risk Management Board of El Salvador have denounced the lack of public policies on the subject of risk management and territorial legislation, as well as the need to amend the current Civil Protection Act for Disaster Prevention and Mitigation.[13]

Violence: an obstacle to education

In 2009 the National Civil Police recorded 4,365 murders – 1,186 more than in 2008 – that is, an average of between 12 and 13 murders a day. According to the Central America Human Development Report for 2009-2010, in 2008 the country was second only to Honduras in this regard, with 52 murders for every 100,000 inhabitants, compared to 58 in Honduras.[14] This makes it urgent to control the activities of gangs, which continue to operate with impunity.  

The violence and criminality of recent years have seriously affected the country’s education sector. In June 2009 alone, the Ministry of Education reported that 742 schools were at risk from crime, even more than in 2008, when 500 schools were in this situation. This reflects the serious problem of juvenile violence, which makes access to education difficult for thousands of young people, most of whom are attending Basic Plan and Middle Education levels.

According to the latest MDG report for El Salvador, issued in March 2009, among the most difficult goals is universal primary education, since child labour and poverty play a leading role in preventing children from completing primary education. With regard to eliminating the gender gap in education, while it is true as UNDP report notes that this has been achieved, it reflects only the population enrolled in the formal educational system, excluding the segment of the population which has not yet been able to obtain access to this basic human right.[15]

To address these problems the Government introduced several proposals during 2009, including the reduction of illiteracy, which is expected to drop from 16% to 3.2% in five years,[16] the school lunch program, the delivery of school packs and free uniforms to the student population and the strengthening of educational programs in order to improve the quality of education all over the country.


Gender equality a distant goal

Despite the fact that in legal terms El Salvador supports gender equity and encourages the empowerment of women, and has endorsed numerous global conventions and agreements, Salvadoran women have made scant progress in the 15 years since the Beijing Conference. The achievements that have been made are primarily due to the struggles of the women’s movement and the will of some of the political parties.[17]

With regard to the commitment undertaken in Beijing to promote gender balance in its institutions, it can be seen that the State has made no effort to close the gender gap and that men still outnumber women in management positions. The share of women in Congress is at present only 9%.[18]

It is important for Social Watch El Salvador to repeat the statements made in 2004 by Ms Yakin Ertürk, Special Rapporteur on Violence against Women to the Secretary-General of the United Nations. Ertürk stated that the lack of investigation, trial and punishment of those who commit acts of violence against women gives rise to a climate of impunity and a lack of confidence in the judicial system. The result is a society in which women are subjected to ongoing sexual, economic and psychological violence, in a situation of economic disparity and a macho culture which limits their possibilities of achieving a decent standard of living.


If El Salvador wishes to attain the MDGs by 2015, it is imperative to make efforts to combat the vulnerability of a large part of its population, as well as violence and criminality in society. Vulnerability is apparent in poverty and extreme poverty rates which are still high, in the health problems caused, among other factors, by the cost of coverage and medicines, in the lack of a more effective policy for the prevention of natural disasters and in the lack of implementation of gender policies to put an end to inequity. Also, it is necessary to put an end to the activities of gangs, which behave with far too much impunity.

[1] UNDP, El Salvador 2009 Annual UNDP Report. Available from: <>.

[2] W. Marroquín, El Salvador pobreza extrema y reforma fiscal (San Salvador: Ajá! Museum, 2009). Available from: <>.

[3] A public health funding system set up during the previous Government in which hospital officials ask patients for money before providing full care. These resources are used to cover administrative expenses and salaries.

[4] Alianza Ciudadana Contra la Privatización de la Salud, Balance de salud 2009, December, 2009.

[5] Ibid.

[6] M. Rodríguez, Construyendo la Esperanza, Estrategias y Recomendaciones en Salud (San Salvador: Ministry of Public Health and Social Welfare, 2009).

[7] Alianza Ciudadana Contra la Privatización de la Salud, op.cit.

[8] Asociación Demográfica Salvadoreña, Encuesta Nacional de Salud Familiar 2008. Informe final. Available from: <>.

[9] MSPAS, Mortalidad Materna en El Salvador, años 2006 al 2009, San Salvador, 2010.

[10] Ibid.

[11] The Global Fund was set up in 2002 in order to attract and administer resources for control and prevention of HIV/AIDS, tuberculosis and malaria, within the framework of the MDGs.

[12] Maquilishuatl Foundation, Informe de la emergencia IDA, November 2009.

[13] Available from: <>.

[14] UNDP, Central America Human Development Report for 2009-2010. Available from: <>.

[15] See: <>.

[16] Inter-Sectoral Association for Economic Development and Social Progress (CIDEP, in Spanish), Balance educativo 2008-2009.

[17] Dina Sales, Informe Beijing + 15 El Salvador, CIDEP, December 2009.

[18] Prudencia Ayala Feminist Pact; Las Mélidas; Las Dignas; Salvadoran Women’s Organization, statement on La Violencia contra la Mujer siempre es una Emergencia Nacional, November 2009.