The humanitarian health crisis in Venezuela is a widespread media topic.
But what is really going on in the country? Accounts of this drama are based on limited reports mainly from people leaving the country and international players potentially holding their own political agenda.
On the other side, objective accounts are also challenged by the difficulties in getting true responses in a context of citizens fearful of sharing their opinions to an interviewer by using any traditional fielding approach.
To overcome these limitations, Toluna and Fine Research joined efforts putting together their HCPs and general population panels in a pro bono initiative to provide Save The Children with unbiased information that will help them improve the delivery of their projects at the country's borders.
The results will be presented during the ESOMAR 2020 Latam Conference in Lima - Peru, April 22-24.
Online panels provide the benefit of minimizing the risk of biased opinions, by providing an anonymous platform, with no interviewer that could be linked to any specific political affiliation.
We used a Patient Journeys approach, which is a widely used market research tool. To provide an adequate context for the research, we also interviewed regular citizens and health professionals not only in Venezuela but also in other regional markets (Brazil, Mexico, Colombia, Argentina and also physicians in the US).
Final sample included 1320 doctors (of which 120 are Venezuelans), and 1130 regular citizens (including 311 residents from Venezuela).
Final Output will include not only a formal research report, but also a video that may be used by Save The Children to expose the health situation in the country for raise funding purposes.
As a side benefit of this initiative, a donation was associated to each participation for Save The Children, thus collecting 15,000 USD to the mission this organization has devoted to support health and other needs of Venezuelan children leaving the countries across the Colombian border.
In summary, this pro bono project shows how technologies originally created for Market research, can be used to generate independent evidence in spite of serious political challenges.
In this case provides an account of the health situation in Venezuela and at the same time support Save The Children's mission at the border
There is a very negative view of Venezuelan doctors about their own health system which 8 out of 10 define as poor, the lowest possible value.
Venezuelans doctors identify critical problems in terms of limited access to basic tests, lack of materials, lack of approvals of new treatments and high cost of medicines.
While all these are problems shared by all Latin American countries (and some of them also affect the United States), these are dramatically exacerbated in the country.
In the evaluation of their work, the main difference of Venezuelan HCPs with their regional peers is the sharp lack of access to materials and drugs in their workplaces stated by 9 out of 10 HCPs, doubling the regional average, followed by their low remuneration and insecurity in their workplaces (7 out of 10).
In fact, being forced to choose a challenge more than half of health professionals in Venezuela, indicates the lack of materials and drugs in the workplace, tripling the regional average.
The same results are consistently seen when analyzing the data from the patient point of view.
Over half of Venezuelans state that have not seen a doctor or did just once in the past year. This proportion doubles the data for the other countries. Cost seem to explain to a large extent this comparative low visit rate, since Venezuelans (as do Mexicans) show a very high levels of self-coverage, while in the other countries citizens either go to an accessible public system or have some kind of insurance.
The second driver for a lower use of the healthcare systems is its perceived quality. Consistent to the doctor`s view Venezuelan citizens have a significantly much lower evaluation of the overall system specially of the public hospitals, which contrasts to their much more positive view of the doctors and the private (but not accessible) clinics.
"Currently the health system became a practice of war medicine"
"The system is chaos, there are no medications, no supplies, poorly equipped hospitals, poorly trained doctors"
"…The public health system is precarious, insufficient and poorly prepared….patients and their families… must provide practically all the medical surgical supplies necessary for the care of their ailments"
As a consequence in no other country seems to be so hard form the perspective of the ordinary citizens to adhere to a treatment and again the main obstacles, while relevant everywhere, do get in these country extreme values with 9 every 10 Venezuelans agreeing that treatments are too expensive and institutions lack basic equipment.
They agree with HCPs that main challenge for doctors is not as much their lack of qualifications or the time they spent with patients but scarcity of basic materials and drugs at their workplace.
In spite of this scenario, both Venezuelan physicians and citizens are the most optimistic in the region, and a significant majority believe that in 10 years they will be much better. They imagine improvements especially in working conditions, remunerations for physicians and general improvement of the public system.
Risk of Epidemics
In the regional average, a majority of the physicians believe that our countries are little or not at all prepared for the risk of epidemics, though Argentina and Colombia have a relative majority of those who feel they are very or quite prepared
The negative value is more extreme in Venezuela where almost half say they have no preparation at all, tripling the regional average, being the main problems the organization of the health system, the lack of policies for attention to the most vulnerable, lack of protocols, alert systems and training, as well as access to international humanitarian solidarity networks. It does however show more positive values and in line to the rest of the region in terms of internal citizen solidarity organization.
Checking on HCPs patient loads we see that:
A. Dengue is the main problem in the region in terms of incidence, reported by HCP as representing an average of 2% of their workload. This is specially worrying in Brazil and Venezuela whose 4% double the regional average, and values somewhat higher than the average also for Mexico and Colombia. Practically no cases were reported in Argentina and the USA.
B. Chicungunya appears as the second problem, based on incidence, although strongly focused on Brazil with some minor incidence in Colombia and Venezuela
C. And thirdly, the Zika reported in Brazil, Colombia and Venezuela
D. Although with a relative incidence of less than 1% again it is Brazil where more relative numbers of cases of Chagas and Leishmaniosis are reported
E. Malaria cases are more marginal although the few reported cases were concentrated in Venezuela (0.6% of the average patient load)
Ordinary Venezuelans tend to share the professional view, with half of them rating as high, their country epidemic risk, while most of them at the same time agree that Venezuela is little or not at all prepared to face this hazard. These figures are much higher than in the rest of the region.
"I work in the capital and we see dengue frequently, but in other cities there is malaria, chagas and chicunguya"
"We see every day with more pathologies such as Hepatitis, Malaria, Dengue, TB, among others, with fewer resources to perform complementary tests, medications for acute and chronic pathologies"
The country comparative vulnerabilities stated by ordinary citizens are similar to the ones pointed out by the professionals: lack of adequate public policies, early alert systems and protocols, crisis training, and also limited access to international humanitarian support.
Regarding nutritional issues, in all the region there are significantly high levels of obesity and diabetes reported by doctors, although this does not prevent malnutrition and anemia, with relatively lower values reported in Argentina, the United States and Brazil.
In Venezuela, however, the lowest obesity values are reported by the HCPs , but this country more than doubles the regional malnutrition values in doctor`s patient loads (41% against 18%) and also a higher prevalence of anemia is reported (42% against 25%).
As a confirmation of the professional view, ordinary Venezuelan again diverge from the average values, showing the lowest perceived obesity values in a family member (23% compared to 33-53% in other countries) and again higher levels of perceived malnutrition in themselves or any family relative (27% compared to 5-12% in the rest of the LatAm countries).
Nutritional problems are explained by both doctors and regular citizens by a stressful daily routines, lack of access to healthy meals and specially in Latin American countries, problems related to the living conditions of the population and the lack of governmental policies (in both cases with significantly higher values for Venezuela).
In the opinion of health professionals and the general population, Venezuela's health system faces serious shortcomings with significantly more negative metrics than the rest of the region in terms of:
Poor functioning in general of the health system
Limits on access to medicines and basic materials in care facilities
Problems of Malnutrition and Anemia associated to poor living conditions of the population
The levels of epidemic diseases investigated and reported in the country are generally high but for the diseases with more prevalence not higher than Brazil. Specifically, both countries share a significant presence of Dengue.
Though having a lower prevalence, it is in Venezuela where most cases of Malaria were reported.
In any case, based on the opinion of both professionals and regular citizens, Venezuela is the country facing the greatest vulnerabilities in terms of possible epidemic risks due to the poor organization of the healthcare system, the lack of proper policies, protocols and alert systems.
This research confirms the dramatic situation of the Venezuelan population, in the context of the region, providing a strong support to the relevance of Save The Children Mission call and focus on facilitating access to basic healthcare, improved nutrition, and prevention of epidemic risks.
The results will be presented during the ESOMAR 2020
Latam Conference in Lima - Peru, April 22-24.